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.
Friday, November 05, 2010
Surprise! I'm A Shrink and I'm Here to See ME!
The title of this post is a take off on the title of my last post, Suprise! I'm a Shrink and I'm Here to See You!
Today, I went to work at my office, and mostly, I saw me. All of my patients either didn't show up or canceled their appointments, except, of course, for my last patient. It was a really weird day.
I don't have an internet connection in the office and I don't have a TV. I don't even have a desk. My office mates weren't there. It was me. I made phone calls. I texted my friends. I vacuumed the carpet. I made hot tea. I talked to Clink. I thought about Roy. I listened to NPR on the radio in the waiting room. I went to lunch at a cafe in the neighborhood, chatted with the owners and checked my email on the free WiFi. I rested on the couch. It was all kind of serene. In my younger days, I would have been upset, and if I had my car, I probably would have gone home and fiddled on the Internet and done housework. I saw my last patient who said, "You should go home now, it's Friday." I did. As I locked up the office, I thought, well I didn't have to cook and I didn't have to do laundry and with limited on-line access, it was sort of like being on vacation.
Posted by Dinah on Friday, November 05, 2010
Labels: private practice, vacation
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I had an even weirder day, Dinah. Everybody showed up. Well, one was via Skype. You should bring your dog to the office. Ever feel like Rodney Dangerfield, MD?
One of unappreciated advantages of not doing psychotherapy is when a patient doesn't show up for a med management visit you only lose a 15' slot instead of 34-60'.
I got a bit annoyed at my psychologist for being ten minutes late the other day; yeah, I've been late over the years, but I was and have been on time for the most part these last 18 months, and when he seemed to think, with all that I'd been late in the past, that my being annoyed with him when I said so in therapy, was a bit ironic or . . well I felt invalidated, because of how late I'd been in the past . . ..
Well, it's HIS JOB to be there. He's been a few minutes late a couple times recently, which is very unusual for him, so it's not like me being annoyed this time is getting peeved at the first little thing.
Again, kind of an "opposite" version of your post, this situation.
But yeah, it's a minor annoyance, anyway. Just, since our therapeutic relationship is still getting patched up and there's trust issues and it's all kind of got cracks in it still, this isn't the way I'd like him to just . . . make me feel invalidated, you know? Rather, brush off my feelings as unjustified, or, well, YOU'VE been late alot more than ME, so that's ironic . .
then again, i'm hypersensitive and rather fragile right now and the therapeutic relationship is not in the best shape, so it's kind of a big hot mess, lol.
Of course, re moviedoc's comment, a lot of docs don't do 15 min med checks anymore, preferring scheduling a half-hour slot because there's more to a med check than just checking a med.
And the most ironic part: all the no shows/cancellations were psychotherapy patients, the one patient who came at the end of the day was one of the few people I see for "meds only"...I worked for 20 minutes yesterday.
Two dogs...one never sits still (think doggy ritalin anyone?). Max has been to the office once on a weekend....he was terrified in the elevator. And he sheds black hair everywhere, hates being confined in a room with closed doors, and once peed on a parent's leg at a softball game (thankfully the parent belonged to the opposing team). Oh, and I won't mention his run in with my office mate's toddler, so I think Max and the office are not happening.
Sarebear: in general, doctors don't run late because of something personal towards a patient, usually they run late because: they have to use the restroom, they got stuck on a phone call, they spent more time with an earlier patient and are playing 'catch up' all day, they aren't that tuned in to having to be everywhere at the precise time, it took longer to write a note, or to do something else than they had intended. It's really hard to get everything in life to gel all the time and some people are better at being precisely punctual than others. It would be a very short friendship with Roy if Clink and I got upset every time he was running a half hour late.
Sarebear, my psychiatrist is almost never late, but occasionally he schedules 2 people in the same slot. He is not wanting to do that and is not punishing either of us. I think what happens is that he forgets to write in all his regular appointments or forgets to reschedule the regular appointment when he needs a 2-hour time slot. I have to drive a half hour to get there so if I am asked to come back the next day I lose over an hour of travel time and cost. Also my schedule is already bursting, so one time I did get mad at him briefly. Mostly I understand how hard it is to schedule and be there and find his normal adherence to time schedules amazing.
Do you charge people who stand you up or cancel at the last minute? I had never canceled my psychiatrist at the last minute until I started working at a charter school and twice they have scheduled last minute faculty meetings after school that conflicted. My shrink had about 24-hour notice, the same as I did. I wouldn't do that to him, but as a first year teacher, I want to keep my job and feel I am constantly on trial.
I'm so glad that sometimes my brain care team (shrink & therapist) gets some unexpected personal time. It usually works to my advantage as well as their own. After all, mental health workers are spending brain and emotional resources at a high rate. When they can save a bit, stock up some extra time to process their interactions with clients--and friends, colleagues, families, etc-- they're more able to be present when I come along.
There's your problem Dinah, the dogs. I have come to accept the fact that my patients keep their appointments, not because I'm so great, but because they want to see my dog who will remain anonymous. I don't want to have to deal with Max trying to friend him on Facebook.
Have been seeing the same psychiatrist for 7 years. He's quite competent. I've never been late, canceled last minute, or been a no show. I pay my bills on time, in full. In fact, this year through confusion with my insurance company he was overpaid $700. Extended family member has brain tumor and had an emergency run to out-of-town hospital. I was responsible for 2- and 4-year old. Since it was less than 24 hours, I had to scramble to find someone who could fill in for my babysitting chores. When I asked the MD if he could put a note in my chart stating I could possibly have a last minute cancellation due to an already documented, critical emergency, he stated he wouldn't charge me $70--only $45 for late cancellation. ONLY $45! That's a co-pay for one of his multiple prescriptions. I know MD's have a rough gig in today's insurance climate--and I'm being sincere here--not all patients are dead weights! PAA
PAA: nothing to do with rough gigs -- his or yours. If you have an agreement you should (both) adhere to it. If you don't like his terms, find another doc. Remember the Pied Piper.
Movie Doc: My endocrinologist, gynecologist, general practitioner, and dentist do not charge for canceled appointments AND they call and remind me a few days ahead with a reminder. Why is it different for psych? In fact, my own psychiatrist is reasonable about rescheduling me when something blocks my ability to come to "pre-scheduled" appointment times. Other than the unemployed, who can make a specific day and time every week?
Oh, I don't get peeved when he's late because of a patient needed to talk 5-10 minutes over (10 is very rare for him to let it go that far, but it happens occasionally).
This situation, and the recent ones proceeding it, were him showing up to the place late, as if I was the first (at 11 am) appointment of his day, which I might have been if he either had a personal appointment elsewhere or just an empty calendar that morning.
So I'm left wondering, being scared that I've forgotten the right time or day, since he's not even THERE, being scared that he'll not show up because I got it wrong or something, I don't know. Or worried he crashed, which of course that or a tire flat or whatnot he couldn't control .. . . but it seemed to be more about him showing up to work on time, which is why I got peeved, not about being late for other reasons.
Then again I guess I wouldn't know why he was showing up to work late, either.
But feeling left in the lurch, and alone and scared, is different than feeling like he's behind on his schedule with patients, or whatnot.
BUT I get Dinah's point, too.
I guess I felt like there was no room for my feeling scared to be acknowledged before he was like, well that's ironic since you used to be late alot . . . then again I hadn't spit it out yet, about being scared. And wasn't about to, after that.
THAT's why I need to talk to him about it again, it's not like I'm majorly angry at him about it, it's more because I need to not let things keep me from talking to him and opening up . . . it's hard to feel vulnerable and like you might be judged and can't trust someone after working with them for so long but recently it just felt busted, our therapeutic relationship, so putting it back together kinda makes me sensitive, I guess. Especially when I'm scared.
This seems to be the season for blog posts on this topic...or maybe clients are catching the flu early! There's a few constructive thoughts at http://wp.me/p10rZX-4O and a bit of humor at http://is.gd/gKHaO
"there's more to a med check than just checking a med."
Roy, so well put.Thank you.
I know dentists and other docs call with appointment reminders and largely do not charge for missed appointments.
Here is another difference. Most of them double or triple book your appointment slot. Yup, I have heard it from the horses' mouths.
Psychiatrists book your slot just for you. If you are not there, no one is. 24 hours is not enough time to rebook another patient, but it is enough time to eat lunch or return phone calls.
If the gynecologist has three people booked for one time slot and only one shows, someone gets seen. If all three show up, then everyone waits but all get seen.
PAA, I don't think you're wrong to be a little miffed about that. People are human and things happen. I think part of being human is being able on occasion to extend grace to someone. My therapist has had to cancel last minute on occasion for illness or personal reasons. It's rare but it happens, and I don't get upset by it. She has also been understanding when I have in rare instances had to cancel or missed an appointment. I think part of a healthy relationship is being able to extend grace to each other on occasion. We're all human.
My shrink has a cancellation list - meaning if he gets a cancellation, he'll call you. But that call might come at 7:30 in the morning, or 45 minutes before said appointment time.
Wow.... You spent the day killing time. Dinah, I am insanely jealous. No scripts to call in? No disability paperwork to fill out? No letters excusing patients from jury duty? Explaining to an employer that the patient's urine was positive for dexedrine because she's in treatment for ADD? No phone calls to return? You actually went out to lunch? I am running my practice wrong. Even with multiple no-shows in a day, I am never caught up. What's your secret? Is it that you slaves (a.k.a. residents and/or externs) doing your paperwork scut for you? Do tell!!! Enquiring minds need to know!
Is anyone else shocked that Dinah does NOT have wi-fi at her new office? Come on Dinah ... how can you survive without wi-fi. At least buy a card for your computer.
Oracle at D and last anon:
No Wifi. No computer. No fax machine.
Why? One would think I'd like those things.
For a time, I used to be able to access my email on my cell phone. I couldn't wait until my patients left to check my email. While I love the internet, it makes me nuts, and I've decided to leave my office as an internet-free zone, a haven of sanity where I don't email and I don't surf, and my concentration is totally committed to my patients and their worlds, and when I have down time, I chill, (or I go home and come back).
Office mate has wifi. She's been told not to give me the password.
Home office with phone/fax/internet/computer/ paperwork. And I'm too compulsive to let too much pile up. I did catch up on phone calls.
Sunny CA: Policy is to charge anyone who doesn't give 24 hours notice-- with the exception of unanticipated illness (translation: don't vomit on me or give me your febrile illness) or weather events, --or anyone who simply doesn't show up. I'm not very strict on this stuff (so I don't charge for 22 hour's notice), especially if there's a sympathetic excuse or for first-time offenders. Repeat No Shows get billed.
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