Kevin

Kevin, 29, a delivery driver, comes in asking for a four-week sick note for finger pain from typing. He is talking quickly, jumping between topics, and seems energised and confident. He mentions, almost in passing, that he is not going back to his job anyway because he is working on a cryptocurrency project that is going to change everything. He is on no medications, rarely attends, and seems open and friendly, though slightly irritable if you seem unconvinced by his plans. As he talks, you notice he mentions barely sleeping and feeling the best he ever has. He wants the note signed so he can get back to his project. You have a limited-length appointment. Rank the following as an opening move, the option that best sets up a safe and useful consultation, given what you can see so far.

You have a limited-length appointment. Rank the following as an opening move, the option that best sets up a safe and useful consultation, given what you can see so far.

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1
Tell him he seems very energetic and ask directly whether he thinks he might be unwell, focusing the conversation immediately on possible mania
2
Decline the sick note and advise him to see occupational health through his employer instead
3
Sign the four-week sick note he has asked for, since finger pain from typing is plausible, and move on
4
Gently slow the consultation down and explore how he has been in himself lately, asking about his sleep, energy, mood, and any recent changes, before deciding about the sick note
5
Reassure him that his crypto plans sound exciting and encourage him to pursue them while he recovers