Delaying Sessions

[EEGNeurofeedback]

I do 15 minute (sometimes sessions extend to 20) med checks at my private practice. Does anyone experience this and thus feel this way? I am asking patients questions (i.e. what has your mood been like), and they answer it and go on and on in a tangent about other things. I get frustrated because I am trying to type into my computer while trying to deal with medication problems/issues and feel very rushed. And it is the same patients that prolong the sessions? These patients seem to have very productive sessions with their therapist. They just want to chat it seems like. Does this happen to anyone else?

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[nitemagi]

Yes, sometimes patients like to actually talk about themselves and not just answer symptom inventories.

People do not think of themselves as a cluster of symptoms. Get what you needed during a normal conversation, rather than forcing them to fit into your mold.

 

[Shikima]

I do 15 minute (sometimes sessions extend to 20) med checks at my private practice. Does anyone experience this and thus feel this way? I am asking patients questions (i.e. what has your mood been like), and they answer it and go on and on in a tangent about other things. I get frustrated because I am trying to type into my computer while trying to deal with medication problems/issues and feel very rushed. And it is the same patients that prolong the sessions? These patients seem to have very productive sessions with their therapist. They just want to chat it seems like. Does this happen to anyone else?

EVERY.SINGLE.DAY!

There is no nice way to interrupt them either, and I hate that. And if they're post hospitalization, being scheduled for only 15 mins? WTF man! I told the secretaries to give me 45 mins with anyone coming out of hospitalization since the inpt units just suck here.

 

[erg923]

I do 15 minute (sometimes sessions extend to 20) med checks at my private practice. Does anyone experience this and thus feel this way? I am asking patients questions (i.e. what has your mood been like), and they answer it and go on and on in a tangent about other things. I get frustrated because I am trying to type into my computer while trying to deal with medication problems/issues and feel very rushed. And it is the same patients that prolong the sessions? These patients seem to have very productive sessions with their therapist. They just want to chat it seems like. Does this happen to anyone else?

Why are you typing on a computer during a session with a patient? If its only 15 minutes, is that not something you can remember? Even legal pad and pen seems better than interacting with the computer during a session.

 

[Chimed]

I can't imagine doing 15 min med checks! Without even doing it, I can say that I would be burned out in 2 weeks and looking for another position. Luckily, the jobs I'm looking at allow for 30 minutes and will allow more time if they're complex.

 

[mgdsh]

Give patients some time to speak in free form... say the first 5 minutes (if the session is 15 minutes).

 

[hamstergang]

Why are you typing on a computer during a session with a patient? If its only 15 minutes, is that not something you can remember? Even legal pad and pen seems better than interacting with the computer during a session.

At the VA, I have to type my notes in session or I never get out. Other times, I need to take notes or else I end up confusing patients by the end of the day.

I asked one patient about it. He said he didn't mind since I still looked at him. He was mostly just impressed that I could type while engaging with him.

 

[Shikima]

At the VA, I have to type my notes in session or I never get out. Other times, I need to take notes or else I end up confusing patients by the end of the day.

I asked one patient about it. He said he didn't mind since I still looked at him. He was mostly just impressed that I could type while engaging with him.

It's a good skill that'll serve you well. I do the same.

 

[erg923]

I am in the VA too and I suppose this is simply a stylistic/bedside manners issue that comes from how I was trained.

Personally, when a patient is in my office, I want them to feel like I am 100% focused on them. We are probably the last bastion of this and I would like to keep it. Obviously, at initials/intake I take notes. But I keep alot of focus on them, and I usually just scribble notes off to the side rather than having a clip board in front of my face. I would never dream of typing in my template with them there. I know that's not uncommon in PC medicine (and frankly it annoys me even then when my doc does it), but we aren't dealing with the same kind of stuff, and I would argue that it behooves us to focus on the patient as much as possible when they are in the room with us. How can I be with them in their emotional world if I am looking to and from a computer screen constantly?

I suppose a big caveat here is that I have quite a bit of admin time built into by schedule. If you dont, and are litterally stacked back-to-back all day, then I can see the problem.

 

[EEGNeurofeedback]

I only work at my private practice in the afternoon till evening. I see patients back to back for 15 minutes. This is the only time that I can type in my computer. Since, I don't like doing psychotherapy very much and the reimbursements are better for 15 minute med checks, I ended up doing things this way.

 

[EEGNeurofeedback]

EVERY.SINGLE.DAY!

There is no nice way to interrupt them either, and I hate that. And if they're post hospitalization, being scheduled for only 15 mins? WTF man! I told the secretaries to give me 45 mins with anyone coming out of hospitalization since the inpt units just suck here.

Do you do only med checks in your practice?

 

[birchswing]

As a patient, I can give you a lot of feedback on this and on what different people do. One place I went had a person (not a nurse, not sure what she was), ask all those questions, and then I would see the doctor for 15 minutes. One used an audio recorder, and presumably someone dictated what our session was later on. Some have scheduled longer blocks for me (30 minutes) on occasion. One place I went you only saw the psychiatrist the very first time and every time after that was with a nurse-practitioner who prescribed meds. One place I went saw 30 patients at once. You probably won't believe me on that one. But yes, he did med checks with the whole group at once. I probably shouldn't say his name on here, but he still does practice in southeastern Virginia and exclusively does "group psychiatry" (it's even worse than it sounds).

Lots of options. I would say that the best is obviously a 30 minute appointment. When I did tech support for Apple, our target was a 15 minute phone call, and that was to fix something simple like an iPhone, not a person's mental health (although interestingly, our training emphasized you first fix the person, then the problem). And we also had training on how to handle suicide and bomb threats, so maybe not so different from being a psychiatrist after all.

 

[EEGNeurofeedback]

As a patient, I can give you a lot of feedback on this and on what different people do. One place I went had a person (not a nurse, not sure what she was), ask all those questions, and then I would see the doctor for 15 minutes. One used an audio recorder, and presumably someone dictated what our session was later on. Some have scheduled longer blocks for me (30 minutes) on occasion. One place I went you only saw the psychiatrist the very first time and every time after that was with a nurse-practitioner who prescribed meds. One place I went saw 30 patients at once. You probably won't believe me on that one. But yes, he did med checks with the whole group at once. I probably shouldn't say his name on here, but he still does practice in southeastern Virginia and exclusively does "group psychiatry" (it's even worse than it sounds).

Lots of options. I would say that the best is obviously a 30 minute appointment. When I did tech support for Apple, our target was a 15 minute phone call, and that was to fix something simple like an iPhone, not a person's mental health (although interestingly, our training emphasized you first fix the person, then the problem). And we also had training on how to handle suicide and bomb threats, so maybe not so different from being a psychiatrist after all.

This is an interesting post! As a resident, I rotated through a day treatment center where a psychiatrist once did med checks on a group of patients at once. He went around the table and addressed each patient's med issues one at a time. But, it sure wasn't thirty people at someone's practice. That must have been something!

I used to do 30 minute med followups. But, I started getting so many patients and with the limited time that I had, I switched to doing 15 min sessions.

 

[vistaril]

EVERY.SINGLE.DAY!

There is no nice way to interrupt them either, and I hate that. And if they're post hospitalization, being scheduled for only 15 mins? WTF man! I told the secretaries to give me 45 mins with anyone coming out of hospitalization since the inpt units just suck here.

I do 15 minute (sometimes sessions extend to 20) med checks at my private practice. Does anyone experience this and thus feel this way? I am asking patients questions (i.e. what has your mood been like), and they answer it and go on and on in a tangent about other things. I get frustrated because I am trying to type into my computer while trying to deal with medication problems/issues and feel very rushed. And it is the same patients that prolong the sessions? These patients seem to have very productive sessions with their therapist. They just want to chat it seems like. Does this happen to anyone else?

it's pretty clear that the patients have a very different goal than you do. They want you to listen to them and to be able to tell you what is important *to them*. To really make an attempt to understand them in a meaningful way.

You want to get them answer rapid fire:

'no, I haven't been sleeping good and yes I do have problems both falling asleep and staying asleep'
'no, no suicidal thoughts'
'energy is a 5 on a scale of 1-10'
'my interest in doing things I really used to like is down a lot lately'

in a way that is convenient for you, for whatever it is you are trying to accomplish by getting that information quickly.

 

[erg923]

I only work at my private practice in the afternoon till evening. I see patients back to back for 15 minutes. This is the only time that I can type in my computer. Since, I don't like doing psychotherapy very much and the reimbursements are better for 15 minute med checks, I ended up doing things this way.

Why can you not type on a computer after a certain time of evening? This sounds like a choice that is simply incongruent with what the patient wants or needs from you. Pretty simple.

I agree that patients do not think of themselves as a symptom list and the fact that they want to talk about issues in a narrative form is not at all abnormal. Sorry if that's inconvenient for the way in which you have designed your practice. I might suggest building a practice around patients and patient needs vs the other way around.

 

[EEGNeurofeedback]

It is a whole lot easier for me to do it this way. I need to just get it out of the way and not worry about typing later. I also worry that I may get records confused

I guess it sounds like I am really practicing conveyer belt medicine.

 

[EEGNeurofeedback]

At the VA, I have to type my notes in session or I never get out. Other times, I need to take notes or else I end up confusing patients by the end of the day.

I asked one patient about it. He said he didn't mind since I still looked at him. He was mostly just impressed that I could type while engaging with him.

Yes. This.

 

[LisaLou]

In my outpatient year, I typed during most appointments (subjective only, not a complete note) and I still frequently spent two to three hours per night after work completing documentation. I suppose a good portion of that is personal inefficiency (and an overconcern with grammar), but it still is one of the main reasons I'm leaning away from outpatient psychiatry.

I can empathize with your feelings about patients going on a tangent. I often feel under a lot of time pressure. There are certain things you simply -have- to get answers to during the course of an appointment (such as safety concerns), and it does not feel good to be in a place where you are trying to listen to and understand your patient but you have to keep interrupting them to ensure you get the basics covered, all while knowing that your next patient is waiting and is going to be upset if you're running over time. From talking to older attendings (I'm talking people who practiced 30 years ago), I get the sense that they were able to spend a lot more time with patients, but changes to billing and reimbursement have resulted in our current situation. In addition (though this wouldn't affect you since it seems you are already in private practice), I know that certain attendings who staff my visits have checklists in their head, particularly when it comes to intakes, and I will face criticism if I don't have answers to all their mental checkboxes. Hence the feeling of having to get through the checklist during the appointment, which is also not a good feeling.

 

[erg923]

The orginal poster is speaking of his private practice. He can spend as much time with patients as he chooses. He is choosing not to spend much and is confused about why this is not working out the way he wants it (this damn person is psychic/emotional distress keeps talking).

 

[EEGNeurofeedback]

The orginal poster is speaking of his private practice. He can spend as much time with patients as he chooses. He is choosing not to spend much and is confused about why this is not working out the way he wants it (this damn person is psychic/emotional distress keeps talking).

I have a job during the day that runs from 6 in the morning till 2 in the afternoon. My appointments at my practice start from 3 pm on. I wanted to accommodate as many patients as I could. As my practice grew, I found that I could no longer spend 30 minutes with a followup.

 

[erg923]

I think his post is embarrassing, yes.

 

[Shikima]

Do you do only med checks in your practice?

Yes. That's all employers want. This is ok with me because I suck at CBT (my program's talk therapy training was deplorable at best) and don't even ask me to do psychodynamic psychotherapy. I profess some modicum of expertise with MI, and this could be equated to Luke's control of the force when confronting Vader in ESB.

 

[Shikima]

As someone interested in psychiatry (and currently working in mental health), I find posts like these coming from an attending to be disheartening. I don't mean any personal offense, but this post reads like, "My patients are making it difficult for me to do my job. They are giving me more information than I need to write my note and assessment. They volunteer more than what I specifically ask them - and they do so repeatedly!" And the follow-up posts about how you do 15-minute checks exclusively due to reimbursement is equally disheartening. Am I alone in feeling that way? I try not to post on SDN negatively towards other users, but I'm very interested in hearing from others in psychiatry if this is a common norm to be aware of.

This is the norm. Don't expect reimbursements to be any better. Currently it appears Inpt work is the better gig with reimbursements whereas it wasn't before, but I could be wrong on this.

 

[Shikima]

Why can you not type on a computer after a certain time of evening? This sounds like a choice that is simply incongruent with what the patient wants or needs from you. Pretty simple.

I agree that patients do not think of themselves as a symptom list and the fact that they want to talk about issues in a narrative form is not at all abnormal. Sorry if that's inconvenient for the way in which you have designed your practice. I might suggest building a practice around patients and patient needs vs the other way around.

I can't type any notes when I'm in my private clinic because the computer system sucks big 'ol stinky donkey balls and the hospital admin/IT are boobs at deciding what's best. I have to resort to dictatating.
The VA system is pretty decent, I like it. Except for clinic nomenclature.

 

[erg923]

I have a job during the day that runs from 6 in the morning till 2 in the afternoon. My appointments at my practice start from 3 pm on. I wanted to accommodate as many patients as I could. As my practice grew, I found that I could no longer spend 30 minutes with a followup.

Could not, or would not?

Nobody is saying psych patients cant be frustrating. Of course they can. What people are saying is that you are in psychiatry, and the fact that you are complaining and seem dumbfounded by people wanting/needing to talk about their problems shows a poor understanding of your specialty and an indifference to patient needs. Again, I would suggest designing a private practice around patient needs, not your needs/convienence.

 

[erg923]

I asked one patient about it. He said he didn't mind since I still looked at him. He was mostly just impressed that I could type while engaging with him.

Is that really your standard for determining whether your practice habits are offensive or not? Are you suggesting that, given the power differential that exists in that relationship, the onus is on the patient to "speak up" and let you know that he has a problem with what your doing?

 

[285963]

I am asking patients questions (i.e. what has your mood been like), and they answer it and go on and on in a tangent about other things. I get frustrated because I am trying to type into my computer while trying to deal with medication problems/issues and feel very rushed. And it is the same patients that prolong the sessions? [...] They just want to chat it seems like. Does this happen to anyone else?

I don't think this is unique to Psychiatry. There is a reason why a PCP is often 1-2 hours behind schedule. I don't think I've ever rotated through any physician office where they had completely solved this issue. However I've seen some handle it better than others.

 

[vistaril]

As someone interested in psychiatry (and currently working in mental health), I find posts like these coming from an attending to be disheartening. I don't mean any personal offense, but this post reads like, "My patients are making it difficult for me to do my job. They are giving me more information than I need to write my note and assessment. They volunteer more than what I specifically ask them - and they do so repeatedly!" And the follow-up posts about how you do 15-minute checks exclusively due to reimbursement is equally disheartening. Am I alone in feeling that way? I try not to post on SDN negatively towards other users, but I'm very interested in hearing from others in psychiatry if this is a common norm to be aware of.

As another poster said, this is the norm.

 

[vistaril]

I have a job during the day that runs from 6 in the morning till 2 in the afternoon. My appointments at my practice start from 3 pm on. I wanted to accommodate as many patients as I could.

and you wanted to:

1) make more money
2) have an 'easier' job that requires less thinking/skill as well. Let's be real....when you only have 10 actual minutes(which is the case when booking every 15 minutes), you only have time to run through a med rec, symptom checklist, and then talk about tweaking the current meds...that's a relatively straightforward and easy job that appeals to most, even if you are hustling.

there is nothing wrong with admitting the things above. But for god sakes don't frame it in terms of wanting to 'help more patients'.......

 

[erg923]

there is nothing wrong with admitting the things above. But for god sakes don't frame it in terms of wanting to 'help more patients'.......[/quote]

I suppose, although I would add that the poster needs to accept/admit that, at that level of care, one is practicing psychopharmacology, not actual psychiatry. If you think thats psychiatry, you are just deluding yourself. Having this increasingly being "the norm" does not alter the actual definition of psychiatry.

I wholeheartedly agree with the second bolded statement above. In the words of Dave Chapel: Can we be real? Lets be real real, son...

 

[vistaril]

yeah I don't disagree with any of that erg. I would say that most people don't care about definitions. I don't know that it is 'increasingly' being the norm.....I don't think there has really been a trend towards this just recently. I think this shift happened a while ago. I remember shadowing a psychiatrist even before I applied to med school and he had been doing quick med check style of practice for awhile...since the early 90s.

 

[Shikima]

Trends become the norm until a new trend comes along.

 

[michaelrack]

To give the OP the benefit of the doubt, perhaps he truly is trying to help patients and is taking most insurances. If that is true, here is my advice to the OP:

As you can see from the comments on this thread, your efforts are not appreciated. I advise you to schedule appointments of no shorter than 20 minutes (3 per hour). Gradually stop taking the lower paying insurance policies. Make sure to bill appropriately for the services you are providing (which will probably be at a higher level than you are currently providing).

disclaimer: I do not currently practice outpt psychiatry

 

[michaelrack]

Trends become the norm until a new trend comes along.

In this case, the trend is not your friend

 

[vistaril]

To give the OP the benefit of the doubt, perhaps he truly is trying to help patients and is taking most insurances. If that is true, here is my advice to the OP:

As you can see from the comments on this thread, your efforts are not appreciated.

I haven't seen anything that indicates he cares whether his efforts are appreciated, or even if patients are being helped.

And honestly, I don't for that to come across as me being critical.

 

[EEGNeurofeedback]

Could not, or would not?

Nobody is saying psych patients cant be frustrating. Of course they can. What people are saying is that you are in psychiatry, and the fact that you are complaining and seem dumbfounded by people wanting/needing to talk about their problems shows a poor understanding of your specialty and an indifference to patient needs. Again, I would suggest designing a private practice around patient needs, not your needs/convienence.

These are only 15 minute (sometimes 20) medication visits not psychotherapy. There are standard questions that I need to ask. But, if someone is suicidal, I am not going to just "kick the person" out of my office. And I do listen to patients, I don't stop them abruptly. There are times when I have to let them know nicely that we need to stop.

And I don't have a poor understanding of psychiatry.

 

[EEGNeurofeedback]

yeah I don't disagree with any of that erg. I would say that most people don't care about definitions. I don't know that it is 'increasingly' being the norm.....I don't think there has really been a trend towards this just recently. I think this shift happened a while ago. I remember shadowing a psychiatrist even before I applied to med school and he had been doing quick med check style of practice for awhile...since the early 90s.

15-20 minute med checks are very common in my neck of the woods. It has been this way for at least 2 decades. It is not something new.

 

[vistaril]

These are only 15 minute (sometimes 20) medication visits not psychotherapy. There are standard questions that I need to ask.

there are very few(in some cases none) 'standard questions' that you NEED to ask. This isn't a medical school osce or some nonsense. You're not going to get points deducted if the patient doesn't tell you whether his appetite has been good, bad, or just ok the last two weeks.

 

[EEGNeurofeedback]

I haven't seen anything that indicates he cares whether his efforts are appreciated, or even if patients are being helped.

And honestly, I don't for that to come across as me being critical.

Of course I care whether or not I am helping them. That is insulting to say the least.

 

[EEGNeurofeedback]

there are very few(in some cases none) 'standard questions' that you NEED to ask. This isn't a medical school osce or some nonsense. You're not going to get points deducted if the patient doesn't tell you whether his appetite has been good, bad, or just ok the last two weeks.

Alright. The word standard may not be the right term to use. There are things that I need to know. Safety, moods, side effects, etc.

 

[vistaril]

Alright. The word standard may not be the right term to use. There are things that I need to know. Safety, moods, side effects, etc.

no(except for safety in SOME cases) not really.......why do you feel you have to say- 'so what word best describes your mood right now'(or over some previous period)? So you can document in your note whether their one word answer was fine, ok, so-so, great, bad, eh, meh, decent, bored, chillin, angry, sad, pissed? There is no value in that alone. Think about the last 20 times someone passed you and shot out a 'how are you'? Now out of those 20 times you answered, how many times was your answer truly useful in any way? My guess is a lot of the time it wasn't even accurate, and I guarantee a lot of your patients are no different.

Yes, there is obvious value in figuring out what a pt's mood has been like since lcv. But the idea that the best way to accomplish that is to siply make them pick a word(or phrase) to describe their mood is ridiculous imo.

 

[vistaril]

Of course I care whether or not I am helping them. That is insulting to say the least.

I didn't mean it that way......if you care whether or not you are helping them, I would adopt a different approach.

 

[erg923]

And I don't have a poor understanding of psychiatry.

LOL. Dude, your question is essentially, "Why are these psych patients wanting to talk about their problems with me when all I want to do is check status and move on to next patient? Its SO frustrating." Was it not?

 

[F0nzie]

If you absolutely must limit your sessions to 15 min sessions then consider having all of your patients fill out ph9s or some other random custom questionnaire in the waiting room ie. siecaps, avh, SI/HI, med side effects.

I hear the argument that patients will talk more due to an unmet need. I think this statement is true for the most part. "My other psychiatrist never listened to me" is one of the more common complaints I have heard from patients transferring from other psychiatrists.

But also consider undertreated axis 1 that you may be missing due to the limited time you are spending with patients. ie. distractibility, hyperverbal speech, poor focus/concentration may relate to undertreated ADHD, anxiety, or cognitive issues related to depression, mania, substance intoxication/withdrawal. All of these problems can explain why some patients are talking "too much".

Even if you were to offer 1 hour sessions, undertreated axis 1 will limit your patient's capacity to process and integrate information in a meaningful or therapeutic way. Their work with you and their therapist will be suboptimal and may result in complete failure.

15 min med checks work well for brief checks ie. sore throats, runny noses where closed ended questions are the most appropriate. In Psychiatry open ended questions are extremely informative even in cases where the content itself is not clinically relevant.

 

[EEGNeurofeedback]

LOL. Dude, your question is essentially, "Why are these psych patients wanting to talk about their problems with me when all I want to do is check status and move on to next patient? Its SO frustrating." Was it not?

Dude, you are not a psychiatrist so you don't get to say that I don't know my field well. There is a lot about psychiatry that you don't understand because you do not have the medical background of a physician or even a med student. You are annoying, so I have you on ignore.

 

[erg923]

Way to take your Dollies and go home, pal. Very mature. You asked for feedback and you got it. Dont like it? Tough. I didnt say anything much different than many attendings did either.

Friendly advice, if you think the only people that can or will give you feedback on your practice habits are other psychiatrists, you are living in a fantasy land. You are in private practice. Your patients are, essentially, your boss. Get used to feedback from those outside the bubble. It will make you a better clinician.

 

[EEGNeurofeedback]

If you absolutely must limit your sessions to 15 min sessions then consider having all of your patients fill out ph9s or some other random custom questionnaire in the waiting room ie. siecaps, avh, SI/HI, med side effects.

I hear the argument that patients will talk more due to an unmet need. I think this statement is true for the most part. "My other psychiatrist never listened to me" is one of the more common complaints I have heard from patients transferring from other psychiatrists.

But also consider undertreated axis 1 that you may be missing due to the limited time you are spending with patients. ie. distractibility, hyperverbal speech, poor focus/concentration may relate to undertreated ADHD, anxiety, or cognitive issues related to depression, mania, substance intoxication/withdrawal. All of these problems can explain why some patients are talking "too much".

Even if you were to offer 1 hour sessions, undertreated axis 1 will limit your patient's capacity to process and integrate information in a meaningful or therapeutic way. Their work with you and their therapist will be suboptimal and may result in complete failure.

15 min med checks work well for brief checks ie. sore throats, runny noses where closed ended questions are the most appropriate. In Psychiatry open ended questions are extremely informative even in cases where the content itself is not clinically relevant.

In order for me to spend more time with patients I would have to drop some of them. If I spent a half hour with each patient, I would not get home that evening.

I do see your point. However, the patients that are very very chatty have productive sessions with their therapists. I speak with their therapists. Some of these patients are doing so well that they see me every two to three months; they don't need to come every month unless something comes up. When I say chatty I mean they are wanting to discuss their favorite sports team or their favorite type of animal. In one case, I had a woman that was fascinated over the fact that her PCP is no longer in partnership with another physician because they did not work well together. She spent a great deal of time talking about it. The session ended up being 30 minutes long. Admittedly it was interesting because I knew one of the doctors. But, I think you know what I mean.

 

[EEGNeurofeedback]

Way to take your Dollies and go home, pal. Very mature. You asked for feedback and you got it. Dont like it? Tough. I didnt say anything much different than many attendings did either.

Friendly advice, if you think the only people that can or will give you feedback on your practice habits are other psychiatrists, you are living in a fantasy land. You are in private practice. Your patients are, essentially, your boss. Get used to feedback from those outside the bubble. It will make you a better clinician.

I felt that you were being confrontational. That is were I was coming from. I do see your points. I reread your posts.

I was being nasty and immature. I am sorry that I lashed out at you. It is true that it has nothing to do with being a physician. I know that psychologists have a great deal of insight into the field of psychiatry. The two fields work together all the time. I think it would really be hard not to. So, I do appreciate the feedback.

I am thinking about doing this. I could drop my inpatient job and spend more time with my PP patients. I have always wanted to do ECT. So, I could incorporate that into a full-time practice. Just thinking out loud.

Thank you and everyone else responding to my thread.

 

[erg923]

good deal

 

[nitemagi]

To echo one of the great psychiatrists - "There's no such thing as a bad patient, just an inflexible therapist."