A 54-year-old woman with severe rheumatoid arthritis comes to the office for a routine follow-up examination. Rheumatoid arthritis was diagnosed at age 35 years, and the patient has been unable to work for the past 10 years. She has difficulty bathing and dressing, but she is able to stand and walk independently. Medical history is otherwise unremarkable. Medications include etanercept, methotrexate, prednisone, and tramadol. She tells you that her husband of 30 years left her 6 months ago. She appears depressed. Vital signs are normal. Physical examination discloses marked joint deformities in the hands, wrists, shoulders, and feet; the findings are unchanged from previous visits. The patient says, "I cannot continue to live as I am. I've had it." Which of the following is the most appropriate response?
(A) "Do you think you're depressed? I can help with that."
(B) "Have you considered moving to an assisted living facility where your quality of life could be much better?"
(C) "I know just how you feel."
(D) "I'd like to refer you to a counselor."
(E) "Would you like to tell me more about why you feel this way?"
(Answer: E)