Dinah, ClinkShrink, & Roy produce Shrink Rap: a blog by Psychiatrists for Psychiatrists, interested bystanders are also welcome. A place to talk; no one has to listen.
Monday, December 07, 2009
Please Print Legibly
I'm not much for paperwork. In fact, I hate it.
In my private practice, I give people directions on the phone: how to get to my office, where to park, what to bring, what to do about their health insurance, yadayadayada.... It's a lot of information. I don't have forms, except for an Authorization to Obtain/Release Psychiatric Information, and I give people a single sheet of Office Policies with my cancellation policy and how to reach me: cell phone, home phone.
No other forms, and a few times I've wished I had an emergency contact or some piece of information I didn't have at my fingertips. So I'm moving this month and I'm re-thinking my professional life. Mostly, I've funneled my anxiety into the decor--I'm now on my 5th and 6th quarts of sample paint. Why does taupe look purple when you put it on the wall?
Oh yeah, I was talking about forms. So I'm going to try sending out a few sheets of information before the first appointment: directions, where to park, what to expect, what to bring, and a form requesting some basic contact info. I've been wondering what other people do, and so I've been surfing other shrinks' websites to see what they do: a lot of them have their forms up, some even have their fees listed. This is interesting.
So the forms thing also gets interesting. Some people have really extensive, all-inclusive, no-issue-left-unaddressed forms. One doc asks people to circle the name of any psychotropic they've ever been on, and he lists the name of every psychiatric medication. Here's the list:
Abilify diazepam metamphetamine Rozeram Adderall divalproex sodium Methylin Serax alprazolam doxepin methylphenidate Serentil Ambien Effexor mirtazapine Seroquel amitriptyline Elavil Moban sertraline amoxapine escitralopram Modafanil Serzone amphetamine Eskalith molindone Sinequan Anafranil fluoxetine Nardil Stelazine Antabuse fluphenazine Navane Strattera Asendin flurazepam nefazodone Surmontil atenolol fluvoxamine Neurontin Tegretol Ativan Focalin Norpramin temazepam atomoxetine gabapentin nortriptyline Tenormin Aventyl Geodon olanzapine thioridazine bupropion Halcion Orap thiothixene Buspar Haldol oxazepam Thorazine buspirone haloperidol Pamelor Tofranil carbamazepine imipramine Parnate Topamax Carbatrol Inderal paroxetine topiramate Celexa Klonopin Paxil Tranxene Centrax Lamictal pemoline tranylcypromine chlordiazepoxide lamotrigine perphenazine trazodone chlorpromazine Lexapro phenelzine triazolam citalopram Librium Pimozide trifluoperazine clomipramine lithium prazepam Trilafon clonazepam Lithobid Prolixin trimipramine clorazepate Lithonate Primidone Valium clozapine Lithotabs propranolol valproic acid Clozaril lorazepam protriptyline venlafaxine Concerta loxapine Provigil Vivactil Cylert Loxitane Prozac Wellbutrin Dalmane ludiomil quetiapine Xanax Depakene Lunesta Remeron ziprasidone Depakote Luvox Restoril Zoloft desipramine maprotiline Risperdal zopiclone Desyrel Mellaril risperidone Zydis Dexedrine mesoridazine Ritalin Zyprexa dextroamphetamine Metadate
Just in case you were interested.
Other shrinks have fewer forms, but still post some very interesting stuff. One has photos of herself in a red leather skirt on an analyst's couch (I thought it was an ad for a TV show about a psychiatrist!), another includes his resume and mentions he was an Eagle Scout.
Okay, so tell me if you have a shrinky website, I'd love to look at it. And since I've always just asked people questions and never asked them to fill out forms, tell me how you feel about forms, both from the doc's point of view, and also from the patient's perspective. Thank you!
Oy, the Ravens, they aren't doing so well. I think they got the wrong forms.
Posted by Dinah on Monday, December 07, 2009
Labels: paperwork, private practice
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As a patient, I like filling out forms or even worksheets. For me, it helps broach the topic, and it is easier for me to broach the topic in writing than aloud. (Even now, when I have mostly gotten over that intense social anxiety, broaching difficult topics in writing is easier than aloud.)
Some professionals have absolutely refused to let me do this, and I made no progress with them. They saw writing as "cheating" or something and wouldn't read what I wrote, insisting that I speak. Perhaps this would have been appropriate later on, if I had eased into it, but not letting me write meant I didn't broach any topics at all. Needless to say, those therapists were not helpful at all.
I'm fine with forms... but I do get rather annoyed when I spend the first 10-15min of my appointment time carefully filling out questionnaires, only to have them vanish into oblivion, never even being mentioned again. Why am I wasting my/our time filling these out if you're not even going to look at them?
So, if you're going to use questionnaires and such, make it worthwhile. Give some indication that you looked at them... that you learned something about me, that something piqued your interest, or whatever. If you never bring it up, the patient wonders why you asked him/her to fill it out, and it's like you're already not listening to what he/she is telling you, even before the actual conversation starts.
No one likes meaningless paperwork.
You've seen my site, but a few comments: First, posting my fees online was yet another way a doc can flirt with felony: I'm told that if I post my new, presumably higher, fees before I actually increase them I can be charged with some kind of antitrust crime.
Second, my handwriting is so illegible it should be accommodated under the ADA, and when was the last time you even saw a typewriter. I think everyone that uses forms should have the kind you can complete with your keyboard before printing or sending. It's on my to do list for mine.
I always read what the patient writes, but most patients cannot recall all the drugs they've tried, and beware that women do not consider oral contraceptives to be drugs/meds, so you have to ask separately.
BTW: That drug list is incomplete.
Here's a bigger list. It's incomplete, too, but at least the drug names are spelled correctly: http://behavenet.com/capsules/treatments/drugs/drug.htm
As a patient, I prefer the no-paperwork approach, though my psychiatrist got the spelling of my name wrong for the longest time.
I would never have gotten through even a tiny portion what I have told my psychiatrist on a form that asked me to describe my problems.
You know, I think that it's great to have a few forms and it's great for a shrink to have a website. Mine does (with a CV, couple of patient links, small page about office policy, phone numbers, and I see he has added some forms for printing). Frankly, I think that psychiatrists who don't have websites (I'm not saying the have to blog or anything) are behind the times and old-fashioned. That would be a turnoff for me in choosing a doctor. And I'm in my
40s, so it's not a Gen-Y thing when I have to have everything in electronic format in my face at all times.
I think it's appropriate for the shrink to ask patients to complete demographic-type forms and questions about past treatment. I think people are more truthful on forms and try to give more accurate answers than if they were just asked directly and they answer with, "Oh, I guess my last period of depression was a coupke of years ago." On the form, the patient may actually supply a date after careful reflection.
But I hope that clinicians accept what the patient supplies on the form as true and don't disregard it after obtaining hospital discharge records or something: Because my records are disturbingly inaccurate and say things like "the patient had a 2-year history of paranoia," when in truth, I had a 1-week history of paranoia. And if you should put that on your form, I'd tell it to you straight. If you just accepted the records over me, that smacks of a relationship with trust issues. If you don't trust me as a reporter, how in the bleeping world can I trust you?
Have you seen Keely Kolmes' website?
She has her forms and info laid out in a really straight-forward, intuitive way.
She's a psychologist in California.
Also, about circling the meds on the forms... doesn't that induce bias in regards to an initial appointment/assessment - ie: if you see that a patient has 5 different SSRIs circled, an alarm bell screaming "DEPRESSION" or "ANXIETY" will go off in your head?
If you are going to make yourself a website, can I suggest that you post links to various mental health organizations and places where patients can get information - sites/organizations you trust. If my shrink suggests I read something, I usually do so - if only for being informed.
If you ask people to fill out forms, then be sure to read them.
A lot of businesses put little videos up of staff folks. It's weird to see how many people seem to think that their church, number of children, or marital status is appropriate for a professional site. What does that information have to do with your competence as a doctor or realtor?
The psychiatrist i'm seeing now for therapy sent me several forms to fill out, before i first saw him. (Well, actually, i printed them off the computer, after he sent them). They varied, from basic information, to background questions, to a couple of "mini-tests". Actually, i kind of enjoyed doing them. Self-obsessed? Who, me? :p
I have a practice website with a few forms (contract, HIPAA, & patient info). The patients like it because they can read and fill them out in advance. I like it because it's more likely they've actually read the fine print about confidentiality, payment policies, etc.(no one really does in a waiting room).
As a patient myself, I don't like being given multi-page medical history forms to complete in the waiting room (I can't easily remember everything from several decades!) Echoing one of the other comments, if I'm going to fill it out, don't ask me the same questions during the exam. This past year, I went to the primary doc for a physical with my completed, detailed medical history form they mailed me. When I got in the exam room, the P.A. sat there with her electronic tablet & started to ask me the same questions . After my 5th response of "it's on the form I filled out" she got the idea & started to look at it. When she got to something that I couldn't remember the year it happened, she LOOKED it up in my electronic record! I think maybe they don't get the point of EMR!
Oh, here's my website www.columbiachildpsychologist.com if you want to see how I do it.
This was an interesting question. I see one of your previous commenters, Rach, referenced my site.
I do have forms on my site, although I am a psychologist, and not a psychiatrist. I choose to use them for a variety of reasons:
1) I believe that filling out the forms allows patients to prepare themselves for therapy. I ask questions about things we will usually get around to face-to-face, and I like that my clients have a chance to think more carefully about what they are bringing in and what may come up.
2) By doing this in advance, I can spend less of the initial intake time asking a rigid set of questions and letting the session unfold more organically. This may be more important to me as it is to you, as a psychiatrist (depending, of course, on your approach). I have done intakes for brief therapy which have included going over a checklist with a client in our first session, and I have found that I prefer to obtain that information via the form and just let a client come in and tell their story. Of course, I still have questions, but it allows a bit more breathing room. So it allows some space both in terms of time limits and process.
3) I think it's easier for me (and for my clients) if we both know where my forms are and how to access them. Most of my clients are on the Internet, so having them download and fill out a form saves me time and energy. If they lost eh form, they can go to my site and get it.
One last thing I'll add: occasionally, I'll speak to someone on the phone and s/he is tentative about therapy or very concerned about privacy. Maybe it's this person's first time coming to a therapist and s/he feels weird about providing all of this information to a person s/he hasn't yet met. In those cases, I let people know they can just fill in their name and contact info and we can complete the form together, over the course of the assessment period if they choose to continue with me. This seems to soothe some fears. But most people seem fine with filling it out and choosing how much they wish to share.
Hope that's helpful. Love the blog!
--Keely Kolmes, Psy.D.
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