Sunday, February 17, 2013

It's Not So Bad, Hon

Here in B'more, it's not uncommon for people to call each other "hon," especially strangers.  So the checkout person at the grocery store may well say, "Have a good day, hon."  It's kind of endearing.

So here at Shrink Rap we've been discussing some difficult things going on in psychiatry -- major changes in the way we code appointments -- I'll avoid the 3 letter acronym we've all come to dread -- and gun legislation that targets, and therefore stigmatizes, those with mental illnesses.  I, for one, have been among those ranting, and it's for that reason that I have a blog: I like to rant.

Our commenters have joined me in kvetching about changes and possible changes.  I have to say, though, that I don't think things are so bad, hon.

So I've learned how to use the new codes and I've learned to incorporate this into my practice so that I'm doing nothing different when I see patients, which is good, because I was worried that the new coding would force me to derail part of the session to ask questions or do things that are irrelevant to the individual patient's care, and so far they haven't.  I've computerized my progress notes, and the first couple of weeks were very painful. I was in the office hours longer each day, but now I have a rhythm.  What still hasn't been sorted out is how to code so that insurance companies will reimburse patients, and at this point it seems that some insurance companies are reimbursing significantly better, some are disallowing psychotherapy, and some don't even have prices assigned to the codes and have all claims as "pending."  Through our state listserv, we've engaged with the Insurance Commissioner's office, and at least they know there are problems.  But I do think that in a few months it will just be what we do and psychiatry will move on, hopefully with sustained and improved reimbursements.  At this point, I still think it was a bad move to do this -- more paperwork with unclear gains -- but it is what it is and I don't think this will be a devastating change for psychiatry.  If you're still confused, my YouTube tutorials have had over 2800 views, and when once it falls out as to what insurers will reimburse, I may do a quick and easy synopsis. 

Regarding upcoming legislation, I remain annoyed at the quick response of our legislators.  I've rejoined our psychiatric society's legislative committee, and I wrote an op ed piece in our local paper.  One commenter noted they didn't think it would do any good, but I remain optimistic that these efforts have some meaning.  Of course, no one wins all the time in going against a system, but last year Clink and I wrote a joint op ed piece opposing legislation to make marijuana legal, it was run the day the legislature voted, and it was defeated.  When my op ed piece ran last week discussing why it's a bad idea to mandate that psychiatrists report patients, I got a lot of emails, including one from one of the governor's appointees asking how I thought the Firearms Bill should be changed.  I may not win on my issues, but I'm planning to go down making a lot of noise, and I'm not at all hopeless. And if you have a cause or an issue, please, please: DO SOMETHING.  People who say "you can't fight the system," don't fight the system.  It's not always fun and it's not always gratifying, but at least you can say you tried and you might just make a difference.

At the end of the day, I still like my job, hon.


Anonymous said...

Maybe there's a difference in how things are interpreted in the North versus the South, but if a psychiatrist said, "It's not so bad, hon," when I felt things were bad, not only would I not find it endearing I would find it condescending.

I really do hope that all psychiatrists stand up against legislation like this, because if they don't patients will leave and/or avoid care. I know they will, because I will be among them.

I do think things are bad. I am disheartened that there is even a discussion about taking away more rights of people who have committed no crime because someone else massacred people. I am waiting to see what my state does with all of this. The decisions legislators make around this issue will determine if I continue or discontinue care. I am not interested in losing more of my rights because of someone else's crime.

I wish that I could stand up publicly against legislation that stigmatizes and discriminates against people with mental illness, but I would do so at great risk to my career. If I were public about my diagnosis, I doubt seriously I would be employable. There aren't a whole lot of people with serious mental illness who can be open about their diagnoses if they intend to work.

Dinah said...

Sweetheart, I don't tell patients "it's not so bad" (that would be dismissive of their problems and is rarely helpful), I tell blog readers that life is not so bad. You may be a patient, but to the best that I know, you're not my patient.

Anonymous said...

You're correct, I'm not your patient or your sweetheart. Not sure why this had to descend into a disrespectful discussion, as I was not disrespectful to you. These are concerns that are important to many patients not just me.

Dinah said...

My intent was playful teasing since I thought you misunderstood and thought I would actually say "It's not so bad, hon" to one of my patients.

People periodically think that my blog persona is my doctor persona, and it's not. My apologies if that came off as disrespectful, that was not the intent.

CatLover said...

Well, I read it's not so bad, hon, the way it was meant in the post.

I emailed a couple legislators about how the mentally ill are getting scapegoated (I was specific), and got no email or letter back. So I don't know if I'm shouting in the wind or not.

I'm working on a strategy to get out of treatment if some worst case scenario legislation gets passed. My therapist doesn't think that will happen in our state because there are too many hunters, but she's as rural as I am and maybe we are living in our rural bubble where everyone we know plinks at targets with a .22. Most of the legislature is city folk and sometimes laws they come up with don't translate to rural areas very well. I'm not the only patient who brought up the issue.

Anonymous said...

Brava to you for taking action.
If more of your co-professionals
acted similarly, the mental health
system and psychiatry would be
in better shape.

Anonymous said...

My apologies for misinterpreting "it's not so bad, hon."

I am very glad that you are standing up against legislation like this. Hopefully there will be many who do.

jesse said...

It's hard to explain "hon" to non-Baltimoreans. I am by birth a New Yorker and it took me quite a bit of time to get it.

"Hon" is representative of old blue collar Baltimore, as represented by areas such as Essex and Hampden. Imagine a woman in a beehive hairdo (from a John Waters film), with a warm heart, with totally unsophisticated garish taste. A waitress in Hampden or a cashier at a restaurant. "Thanks, Hon" she says as you leave a tip on the counter.

One entrepreneurial woman in Hampden, Denise Whiting, even tried to copyright the word "Hon" after starting a restaurant called Cafe Hon and creating an annual HonFest there.

Denise Whiting is the woman Dinah used at the beginning of this blog. Google her and Hon, Hampden to see more.

Dinah said...

Jesse, thanks for helping to explain this, hon.

Anonymous said...

"a joint op ed piece opposing legislation to make marijuana legal."

Really. How many 'joint pieces' did it take?

Anonymous said...

I am a patient under the care of an outstanding therapist and amazing psychiatrist. Both have helped me through several rough days over the past years. This year however is going to be different due to these new codes.

Please forgive my ignorance about these codes but apparently they changed from one code for a psychiatrist visit to two codes for a visit. Because of this change my insurance company has decided that I should pay two copays for every 15min session with the doctor instead of one. With the increase in price I am unable to afford seeing the doctor without help from their practice (went from $25 to $50 under new system).

I am very grateful to have health insurance but it makes absolutely no sense to me why I should even have it when I can't afford the copays they are setting. It also seems so unethical for the insurance company (or whomever creates these codes) to make these changes without notifying all those that will be affected by them. Any suggestions?