Tuesday, February 20, 2007

The Top 10 Things I Don't Like About Being A Shrink

I'm doing this alone-- my co-bloggers are welcome to post their own-- because finding and then nagging Roy is a full-time job. Still waiting for the carpenter to come put things back after we dragged him out to say why he loves his job.

I love my job, as mentioned below in Who Wants To Be A Psychiatrist. But every thing, every job, every relationship, every new or old endeavor, has it's down side, and so this is to present a more balanced side of what I generally think of as my blessed life.

The Top Ten Things I don't like about being a Shrink:

10. Filling out HCFA forms for Medicare over and over and never knowing why they're rejected.

9. Chronic benzodiazepines. The ones that fell down the sink. Why don't zoloft prescriptions ever run out early?

8. The heating unit in my office is awful. It's loud and the room is always too hot or too cold -- this has persisted after it was replaced with a new and improved unit.

7. Arguing with ClinkShrink about who deserves care and what an illness is.

6. No place to lock my belongings in the clinic where I work so I carry my purse everywhere.

5. Wondering if I'll live through eight psychotherapy sessions in a row when I've forgotten to schedule myself a lunch. Or worse, remembering to schedule a lunch, then only having one patient after that, and the patient right before lunch cancels, leaving me two hours of dead space before the last session.

4. Nonsensical paperwork in the clinic.

3. The work of seeing patients who don't talk spontaneously and look to me to guide the entire session, then answer any questions I can think of in single sentences. These can be long sessions.
2. The chaos of patients who simply don't show up or who repeatedly cancel at the last minute. Especially if the reason is that it's the only time they could get an appointment with their hairdresser.

And the Number One thing I don't like about being a psychiatrist.....

1. Talking about unpaid bills, which I have on ocassion let go much longer than I should.



When I innocently (really!) mentioned Xanax to the first and only psychiatrist I've ever seen, I got an uncomfortably penetrating look followed by a ten-minute lecture on the inadvisibility (read: sinister evil) of taking benzodiazepines. It's obviously a sore spot for a lot of docs.

ClinkShrink said...

Wow, I made the top ten!

Hope your virus is better. I mean, I hope you are better and your virus is worse. I mean....

Oh heck, there we go arguing disease again.

Midwife with a Knife said...

I'm blogging when I should be working!

Its interesting to me that a lot of the top 10 things that you mentioned are the same that any doc in any specialty would hate. Things like unpaid bills, chronic narcotics (I don't prescribe a lot of benzos.. I send people to psychiatrists for that! ;) ), insurance/disability paperwork, any other paperwork, patients who don't or can't give a good history (even when they're fluent in English) or who seem to choose not to participate in their own care. Those things would all be on my list. I would add bad outcomes (maternal or fetal) to the list, but otherwise, I think it would be pretty similar.

Dinah said...

mwak: I tried to post a comment on your blog and it wouldn't go.

When's your homework due?

And see my rant on 10/16:

Patient Anonymous said...

Oh dear...#7 sounds erm...well, hopefully they are "spirited debates" and not really bad "arguments" ;)

As for the latter part of #5 (i.e the "dead space" you could try to do some "creative blogging" haha. Or maybe you get enough of that already?


Midwife with a Knife said...

Homework's due 2/27 :P Love those last minute "Can you talk to the residents about...." assignments. I didn't include the deadline, because I'm curious about and would appreciate the answer whether or not I get it in time for the lecture. But I don't want to pressure y'all.

Thanks for pointing me towards your rant. I agree 100% with what you said. I agree, I don't have anything terribly embarassing or interesting in my record, but I don't want my co-workers looking at my personal medical information What makes the situation even worse is that one of the offending people was one of my attendings (I feel more ... I don't know the word.. because it was someone who has power over me and my career), and the political ramifications to me would be huge if I reported it. (this is not a warm/fuzzy place) So, basically, I'm screwed.

Oh, and the blog comments should work now. I tried as an anon. and it seemed to be ok.

(I still should be working, and I'm still blogging.)

Anonymous said...

Re item #3: I tried going to talk to a psychologist when I was 19, a psychiatrist when I was 21 or so, and a different one a couple of years later. I knew there was something wrong with me, but I didn't know what to say about it. I couldn't spontaneously talk about myself for an hour. There was a lot of silence, so I didn't go back. Each time I'd convince myself I could be different, but I wasn't. I guess I was a difficult patient.

Lately I tried again, and I think it is working out better now, in that I'm more able to express what I think is wrong with me. But my life is quite a bit worse now than it was 10 years ago (actually, maybe it is closer to being exactly the same, and that is why I feel more desperate). I'm still not good at talking though - especially about myself.

Mother Jones RN said...

My doctors hate getting beeped at 2 o'clock in the morning when they are on call. That would be in my top ten.


Jessica said...

# 3 is uncomfortable from the patient's perspective too. (I should know I tend to be one of those patients sometimes).

Dinah said...

Clink: I love you.

Seamonkey: Xanax is a sore spot for lots of docs.

Patient Anonymous: I don't have a computer in my office. I need somewhere safe to escape from myself.

Mother Jones: no one calls me at 2AM. I'm happy to keep it that way. Once every few years. I think it's that I don't see inpatients.

Dry Tears and Anony: I don't want to make anyone feel badly. Often the patients who don't talk are doing just fine and are just not real talkative folks, so if there's not a problem (and I do like when people come in saying they're better) they just don't talk. Others can talk about the events of their lives, who said what, how it relates to 1) their childhood 2)their spouse's childhood 3)why they have their current pet who is having his own difficulties 4)a movie they saw last night and 5) a book they're reading--- even if there's nothing problematic going on.

It's not that I don't like patients who don't fill the session with problems, it's just hard for me to sit in silence, so I ask questions, and after a while, this gets to be work.

Anonymous said...

I'm the same anonymous person from before. Maybe I should get an identity if I'm going to do this.

I don't have conversations in my real life - except that I talk about work things at work. So, without questions from someone, or guidance of some sort I honestly have no idea where to start. At the current clinic I go to, the first meeting I had was diagnostic where I was asked a million questions about a multitude of topics. That would have been useful in my youth.

I feel guilty sometimes, because I'm trying to get help for things that other people don't always consider to be a problem (for free too - because I live in Canada, and although mental health care isn't entirely free, it is in some settings). I've read journal articles where people debate whether certain problems are worthy of treatment, or if they're just normal personality traits. And I've listened to the podcast on the same topic. I hope people would think I'm worthy of help.

NeoNurseChic said...
This comment has been removed by the author.
Unknown said...

Hmmmm medcounts and Dr's dislike of xanax.

One thing I have noticed is the 25 size seroquel is NEVER 180 count, the high is around 185 and the low around 165: The 100 mg is always 180 count. I've long thought druggists should use a counting machine. There are several very good ones on the market for industrial use: I'm sure someone could modify one to be quiet enough for pharmacy use ... they do tend to be noisy.

I suppose xanax and such are easily misused, yet they are very useful and for some, real important. I wonder what the rules psychiatrists use in prescribing them???

Midwife with a Knife said...


Thank you so much for your interest in helping with my homework. I re-sent my question to mythreeshrinks. :)

Patient Anonymous said...

RE: the whole #3, not talking (drytears, anonymous, dinah)...and well everyone else?

Sometimes yes, this can be very difficult. It can be difficult if you are entering a new relationship or even if you've been in a longer relationship with your psych/therapist.

I have this problem too. Sometimes I can talk and other times I just can't get anything out. I have a terrible time accessing my emotions, feelings--sometimes even verbalizing my thoughts.

Take yesterday. The session got too heavy, I just completely went off into space!

At times, I've found it's okay to take a bit of a break from the "heavy stuff" and just talk about other things if you really can't dig deep down. There's always another session?

It doesn't mean that *you* are a difficult patient. The entire process is difficult! And it's not the sort of thing that just gets "solved" immediately (if "it" gets solved at all?) Not to sound too maudlin but really...? Some issues took years to build--it surely will take more than an hour to sort them out!

Just tossing a few more cents onto the comment board.

Anonymous said...

I, too am blogging when I should be working! In addition to all the biggies, like getting shafted by insurance companies, what I find annoying about being a shrink relates directly to the fact that I live in a tiny town. There are only four other psychiatrists in private practice, and one of them is my husband. There is a small local hospital which I would never in a million years use if a patient needed admission, the care is so abominable. 1. Lack of referral resources means I'm taking care of super sick people that should be referred to a more intensive setting, but there is no such place to send them. There are many patients in the practice that aren't going to get better as a result, when they might if the resources were available. It's extremely frustrating. 2. Firing patients for not paying, and then seeing them at the post office, the movies, a restaurant, at my kid's school, etc. and having them come over, to tell me how much they need my services (without mentioning the outstanding balance), while everyone around is listening with ears flapping. It would be a challenge for Emily Post. 2. Having local idiot GPs change my patient's psych meds. Either because a. the patient calls/sees him/her for psych symptoms instead of me (while extremely annoying and grounds for firing the patient, the patient is still the patient and can't be expected to be reasonable), or b. the GP is an arrogant idiot who has boundary problems and changes psych meds during an annual checkup or whatever. When the patient crumps, guess who has to deal with it?
3. Prescribing off label doses (standard practice since I get the sickest of the sick) of the one medicine the patient has responded to, which, even though I take the time to fill out the proper paperwork, the insurance refuses to pay for. 4.Being a doctor, even if only a shrink, in a small town makes me a celeb, and all my behaviors (my husband's and my kid's) are observed with great interest. It's taken me years to stop worrying about it, and simply to live. Early on, I had a patient tell me that the state of my husband's car was a disgrace (he's a slob, it was undoubtedly littered with take out bags, empty cardboard coffee containers, dirty snotrags, drifts of articles, sneakers and exercise equipment...). I had to laugh! I shrugged,and commented that when you're married, you have to pick your battles.(The patient didn't agree with me.). 4. Getting stuck with a patient that should be a clinic patient (i.e. doesn't pay reliably, is very needy, has constant drama in his/her life, calls and pages a lot) but the clinic is so overwhelmed it would take six months to get the patient there, and the patient isn't behaving in a way that's obvious enough to justify refusing to continue seeing them.... Sigh. I have to stop. There's more, but why go on?

Dinah said...

Because venting is helpful.
Can I use your comments as a guest blogger post?

Anonymous said...

Dear Dinah,
I have no idea what I'm doing, being a blog virgin. My last post was my first. To answer your question: sure you can use my comments as a guest blogger post. What is a guest blogger post? Isn't that my last (and first, or was it first and last?) comment to this site? Or, are you going to post those priceless pearls elsewhere? And if so, where? I await enlightenment breathlessly...P.S. Nice of you to encourage me to vent. You know no good deed goes unpunished.

Anonymous said...

Top thing shrinks hate about being shrinks is that they are supposed to be quiet and listen. It isn't all about them. So, they find clever ways around this such as posting rambling blogs, and then moving on to Podcasts to feed the addiction. "Oh my name is so unusual so there is the chance that people will know who I am". Hey, you up your chances when you display the cover of your flirtation with fiction on your very own website.
Another thing shrinks do not like is admitting how flawed they are. My goodness, it is very well known, and not just urban legend, that shrinks do commit suicide at a higher rate that average and that female shrinks do so more than males. Not just in Wales either. Denial??

Anonymous said...

i need help finding a name for a song i like to buy, can any one help me?

Anonymous said...

Hmm, top ten things I don't like about being a shrink:
1. other shrinks pestering me about prescribing Xanax to my panic disorder patients
2. other shrinks pestering me about prescribing Xanax to my panic disorder patients
3. other shrinks pestering me about prescribing Xanax to my panic disorder patients
4. other shrinks pestering me about prescribing Xanax to my panic disorder patients
5. other shrinks pestering me about prescribing Xanax to my panic disorder patients
6. other shrinks pestering me about prescribing Xanax to my panic disorder patients
7. other shrinks pestering me about prescribing Xanax to my panic disorder patients
8. other shrinks pestering me about prescribing Xanax to my panic disorder patients
9. other shrinks pestering me about prescribing Xanax to my panic disorder patients
10. other shrinks pestering me about prescribing Xanax to my panic disorder patients

Never mind, it's FDA-approved for that indication and is safe and effective. I see too many shrinks towing the big pharma line (lie) about their (mostly) useless SSRIs. They just simply cannot - or refuse - to think for themselves and go by clinical experience. I have yet to see a panic disorer patient who hasn't benefitted from Xanax even as monotherapy.

I also never prescribe a drug that hasn't been on the market for at least 10 years and never use an SSRI for panic disorder. My office isn't full of the flashy pens and other crap that drug reps attempt to bribe me with. I don't attend any of the fancy dinners.

What we need is not newer drugs but better use of existing drugs.

In fact, I would say to pour your heart and mind out to a psychiatrist is the most dangerous thing you could ever do.

I know I struck a nerve there. :-)

Anonymous said...

"Chronic benzodiazepines. The ones that fell down the sink. Why don't zoloft prescriptions ever run out early?"

Perhaps they did fall down the sink or maybe the pt needs a higher dose. Don't always assume the worst, which is abuse (and is quite rare). Patients are afraid to talk with their doctor about increasing their BZD dosage for fear of being treated like an addict. Zoloft prescriptions don't run out early because it isn't very good or effective. It doesn't work right away, so how could you just take a few extra here & there? You can't.That's a lack of knowledge right there about pharmacokinetics on your part. However, try going just one day without Zoloft and your whole world will come to an end and crashing down around you.. really.. try skipping just one dose after being on it for a few months. See what happens. I dare you. :-D