Tuesday, August 26, 2008

Places I'd Rather Be

Addendum: Here is an old post on "No Shows" which is a completely different phenomena than leaving early....

I've vowed never to put real patient stories on the blog. Tonight, I'm saying, "What the hell." The following is not confabulated.

Over the years, I've been stood up for oh so many reasons. Martial arts class sticks out among them. Forgotten meetings, forgotten dates, forgotten children...they've all been reasons to forget a therapy session. No one that I'm aware of has ever canceled an appointment at the last minute for a hair dresser's appointment, but maybe I just don't know. Today a patient left early. Why? Had to get those fantasy sports picks in. This was a first. Roy would have passed over the iPhone and been done with it. I'm not so accommodating and I don't have an iPhone, 2g, 3g or otherwise.

I hate it when patients simply don't show up and don't call-- when I spend an entire session pacing back and forth to the waiting room and can't use my time. If people opt out because life is busy and the choices are too many, I can't say I mind. It's their life, it's their right to define priorities, as long as my time isn't wasted or someone else isn't left wanting for that session, then hey, Fantasy Picks, what can I say? I'm not one for being judgmental or shoving down someone's throat that therapy needs to be their top priority: that's for them to decide, especially in a long-term therapy with a stable patient. Sorry, there's no pro-rating for judo class, fantasy sports, whatever. Life is busy and we all have to make choices.

Sometimes I think people should cancel their sessions. Get your hair permed at a different time, but for someone who's had trouble finding or maintaining employment, well...they should cancel therapy sessions (or schedule outside of work hours) for the first few weeks of a new job. "Gotta blow this crab feast for an hour" the first week on the new job just doesn't feel wise.

Well, I hope my patient got the good players.


Gerbil said...

Ooh, I can't stand no-shows either--whether they are therapy clients or violin students. I've even instituted a no-show policy for my students, where they get a grace of one no-show before being required to pay for missed lessons. Mrs. Gerbil, who has piano students who no-show a lot, thinks my policy is a bit excessive. But I think if I set time aside for someone, they should respect both my time and the importance of whatever we are going to do during that time--whether it's etudes or therapy.

Anonymous said...

I consider seeing my psychiatrist a priority and I actually take the day off, requesting it the required two weeks in advance at my job.
It is a stressful trip to downtown Dallas, and I have found that if I schedule the apt. in the afternoon and work in the morning, I can't concentrate on my work at all. I won't go in the morning because of fear of rush hour and fear of getting lost on the way back when I am expected to be back at work by a certain time. I got lost once, on the way home from my apt. for 2 hours.

Last time we had a miscommunication. He thought I was coming in one day, and I thought it was another day. His office staff situation right now is quite lacking. I try to call ahead and make sure we are on the same page. His secretary has been out on leave for quite some time.

I didn't show up once...and didn't call. I was at home depressed in bed, and couldn't imagine making the arduous trip to Dallas. I feel bad about that. I think I called the next day, though, and was secretly pleased when his secretary said he was worried about me ; )

These patients sound too well to come in, but they should cancel within a reasonable amount of time, or not say why they are leaving early! How rude!

I don't think anything but a serious family emergency or sudden illness could move me from that couch.


Anonymous said...

Thanks for rewarding my demandingness with such a great post, Dinah. :)

I agree with Lily that a no-show without calling is rude, especially if you're blowing off the appointment for something else and haven't really forgotten. It devalues the other person's time and feelings, imo.

I have only no-showed on my psychiatrist twice in 10 years (med management, no therapy, darn it): Once was truly by accident, because I remembered the appointment while standing in line at the grocery store and was not generous enough to let the ice cream melt in order to spare his feelings (Sorry for the selfish impulse, Dr. B). But in my defense, I did give him 5 minutes to fill the slot with someone else.

The other time, tho, was deliberate because I said/did something at the previous appointment that I was too embarrassed to face him about later. As it turned out, he had completely forgotten the incident and laughed at my confessed avoidance (or maybe at the fact that he billed for the time, anyway).

This leads to wondering whether patients are usually honest about the reasons behind their missed sessions, or whether there is sometimes an element of avoidance/resistance involved? Do you address the situation, or accept the patient's excuse at face value?

I don't know what to say about Mr. Fantasy Football. Too funny (and sorry for laughing at your expense).

Unknown said...

hi this is davis.
I've even instituted a no-show policy for my students, where they get a grace of one no-show before being required to pay for missed lessons.

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Anonymous said...

Ooooh, the topic was leaving early, okay.

I treasure the time spent with Dr. B and can't imagine finding something "more important" to do in the middle of an appointment.

OTOH, we have men and sports.

Kinda makes you wonder why he couldn't finalize his picks the night before, rather than dashing out in the middle of a session, especially for something so (dare I say it) trivial? How rude!

Anonymous said...

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Anonymous said...

How about being stood up by your psychotherapist? This happened a few years ago when I was slipping into a state of depression. She worked out of her house, and when I rang the bell her husband(?) had no idea who I was; he said she was out with school friends. My feelings took a severe hit and I missed two hours of work. She never called me to explain, and I never went back.

Aqua said...

Marcia brings up a good point. A previous therapist of mine had my home and work phone numbers. I drove all the way to another city and sat in the waiting room by myself waiting for her to come get me (our usual pattern).

I waited about 1/2 hr and then started to worry. I waited a bit longer and decided to go knock on her door (even though she had chastised me for doing that previously)...and there was a note on the door saying she was sick.

She never called me to reschedule(even though I was suicidally depressed at the time)and I never went back. I felt completely disrespected.

As a patient, I cannot even conceptualize simply not showing up, or leaving my appt early, unless I was in a car crash, or some emergency happened where I had no access to a phone.

My sessions are the 50 most important minutes of my week. They are what helps me do all the things I am learning to do, what keeps me on track. Also, I respect my pdoc too much to not show up.

I would suspect there is a subtext going on if someone doesn't show up, is constantly late, or leaves early. A great topic to discuss in therapy. (if they manage to show up and stay and talk about it :>)

Rach said...

The shrink has started to call when he is running late - even 15 minutes behind schedule. Whereas in previous eras he would be upwards of an hour behind schedule, this slightly altered pattern of behaviour is very, VERY appreciated. I do my best to run on time, and call him if I'm stuck in traffic (even if I end up making it to the office on time in the end)... it's only fair that he's considerate in the same way.

It's the golden rule, no. Respect goes two ways, whether it's for people, places, things, or time.

Anonymous said...

Fantasy picks are important!

My son turned down a perfectly good FREE meal so he could be home into time to do his.

When a young man blows off a meal you know that something real is happening.

jcat said...

Tdoc and I have mis-scheduled a time or two, probably my fault, but easily sorted out. Last week I cancelled an appt the night before because the man and I are doing the end-stages of the relationship, and his plans are quite literally the most important thing in my life at the moment. If he wants to be with me, I would blow off anything and everything. I'm lucky, in that tdoc knows all of what is happening and forgives me for it now.
But football? Nope. Life or death, or you pay for the appt regardless.