Big Mistake

[PA-CtoMD]

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I told my receptionist that I was getting burnt out doing medication management visits. I work full time during the day. I do ECT and see patients on the wards. The receptionist told a couple of patients this and now one has left and the other is debating leaving. Two patients reported this to me and told me that they are uncomfortable staying with a burnt out psychiatrist. One said that I looked tired. This patient left after that visit. The other is searching for another doctor.

I made a big mistake. On the other hand, I thought she knew better than to share that with patients. I think she gets to close with them.

 

[Yoyomama88]

that's a "big" mistake? It's two patients, so what.

 

[Ceke2002]

This is coming from a patient's perspective, but first of all WHOA! Way for that receptionist to be inappropriate. Now as for patients leaving, it might not be because they think you feeling burnt out = bad doctor, sometimes if us patients get word or sense that our Psychiatrists are under extra stress, or ill, or having a family crisis, or feeling burnt out, or any other type of stressor, our first instinct is to want to be protective of our Doctors by removing what we think is some of the cause of that stress - ie extra workload, meaning us. Not all patients of course, but you'd be surprised how many patients do feel a certain sense of responsibility for their Psychs, or at least a sense of wanting them to be happy. If I was you I would be honest with the patient debating leaving, and try to reassure them. Open up a dialogue about what they've heard, and say that yes things are a little stressful for you at the moment, but that's the way things go sometimes, and you're dealing with it, no big deal, don't feel you have to leave just because work's a bit hectic right now' (or something like that). If the cats already out of the bag, just try to give the patient a bit of reassurance that they don't have to take care of you by cancelling appointments, if that is what they are doing.

 

[IamPsychiatrist]

Well, this is a good sign.

It's a sign to change and that you need to address the burnout. In 10 years a few patients won't matter, but burnout can ruin a career. Find your solution.

Good luck.

 

[PA-CtoMD]

that's a "big" mistake? It's two patients, so what.

The point is that I shouldn't be sharing this type of thing with my staff.

 

[PA-CtoMD]

This is coming from a patient's perspective, but first of all WHOA! Way for that receptionist to be inappropriate. Now as for patients leaving, it might not be because they think you feeling burnt out = bad doctor, sometimes if us patients get word or sense that our Psychiatrists are under extra stress, or ill, or having a family crisis, or feeling burnt out, or any other type of stressor, our first instinct is to want to be protective of our Doctors by removing what we think is some of the cause of that stress - ie extra workload, meaning us. Not all patients of course, but you'd be surprised how many patients do feel a certain sense of responsibility for their Psychs, or at least a sense of wanting them to be happy. If I was you I would be honest with the patient debating leaving, and try to reassure them. Open up a dialogue about what they've heard, and say that yes things are a little stressful for you at the moment, but that's the way things go sometimes, and you're dealing with it, no big deal, don't feel you have to leave just because work's a bit hectic right now' (or something like that). If the cats already out of the bag, just try to give the patient a bit of reassurance that they don't have to take care of you by cancelling appointments, if that is what they are doing.

Thanks for your response! Good to hear it from a patient's perspective. I appreciate it. Well, the patients told me that they don't want to deal with a doctor that is burnt out. One already had a bad experience dealing with a burnt out psychiatrist. They feel that there is a likelihood that I would possibly take my stress out on them or possibly miss things. I tried reassuring them that they are in good hands.

I do ECT in the mornings at the hospital and see patients on the wards (same hospital) for the rest of the day. I do this Monday thru Friday. Sometimes I provide coverage on the weekends.

After I leave the hospital, I go to my clinic to do medication management followups on a 15 minute basis (Mon to Fri).

So, that is basically the source of my stress. It is ongoing.

 

[Bartelby]

Well, this is a good sign.

It's a sign to change and that you need to address the burnout. In 10 years a few patients won't matter, but burnout can ruin a career. Find your solution.

Good luck.

I agree. In all likelihood the secretary mentioning a comment about burnout to those patients was not the only reason they left. They probably saw the burnout firsthand (and may have fished for it in conversation to elicit the secretary's comment in the first place).

Doing an ECT clinic followed by inpatient rounding and management followed by an outpatient clinic followed by weekend work sounds like almost guaranteed burnout. Is dropping one of the above (inpatient, outpatient, or to a lesser extent ECT clinic) a viable option?

 

[PA-CtoMD]

Well, this is a good sign.

It's a sign to change and that you need to address the burnout. In 10 years a few patients won't matter, but burnout can ruin a career. Find your solution.

Good luck.

Thank you for your response. I am actually stressed because of doing inpatient work and ECT (at the same hospital) on Mon-Friday (sometimes on weekends) and going to my clinic (mon-fri) and seeing patients for about 3 to 4 hours. I leave my clinic at 7:30.

This is why I want to hire a couple of doctors: one full-time, the other will be a child psychiatrist working on Saturdays. I will not be seeing patients at my clinic. Just doing administrative duties. It takes a lot of headaches to bring on a doctor.

 

[PA-CtoMD]

I agree. In all likelihood the secretary mentioning a comment about burnout to those patients was not the only reason they left. They probably saw the burnout firsthand (and may have fished for it in conversation to elicit the secretary's comment in the first place).

Doing an ECT clinic followed by inpatient rounding and management followed by an outpatient clinic followed by weekend work sounds like almost guaranteed burnout. Is dropping one of the above (inpatient, outpatient, or to a lesser extent ECT clinic) a viable option?

I will hire doctors to work in the clinic. I will only oversee the day to day operations of my practice. One will work full-time, Mon-Fri, a child psychiatrist will work on Saturdays. It is a lot of headache to bring providers on. I also have high expenses for my clinic. I remodeled and did a lot of things.

 

[PA-CtoMD]

I am wondering if I should approach my receptionist. I think I should let her know that it is not a good idea to give so much information about me and the practice. It is correct that some patients ask a lot of questions about the staff, me, and how things are run, what is going to happen.

I must admit though I am different than I was when I started the practice (2 and a half years ago). One patient said that I am now less empathetic. Back then I ran my followups for 30 minutes. Now it is 15.

 

[notdeadyet]

I must admit though I am different than I was when I started the practice (2 and a half years ago). One patient said that I am now less empathetic. Back then I ran my followups for 30 minutes. Now it is 15.

Noticing you're burned out and telling patients you're burned out are two different things. The latter is unprofessional. I'd talk to her.

 

[IamPsychiatrist]

Noticing you're burned out and telling patients you're burned out are two different things. The latter is unprofessional. I'd talk to her.

Honestly, I feel like it's grounds for termination. There would have to be an amazing reason she was gossiping with patients. 1 patient is a mistake. 2 patients is a pattern.

Often, there are other little things that you don't hear about. You only hear about the big things.

 

[PA-CtoMD]

Honestly, I feel like it's grounds for termination. There would have to be an amazing reason she was gossiping with patients. 1 patient is a mistake. 2 patients is a pattern.

Often, there are other little things that you don't hear about. You only hear about the big things.

I think you are right. That is gossiping. When patients ask about the practice, she gives them detailed answers. She told one patient that I was going to hire a child psychiatrist to work in my clinic so it would bring in more money. I did tell her that, but she didn't have to mention it to anyone.

I don't know how she has the time to talk to patients. I give her a lot of work to do!

 

[SteinUmStein]

That is completely inappropriate on her part. Not only does the content of her gossip sound bad, the fact that she's still employed while saying these things routinely makes you look either clueless or apathetic. I'd say she's the second biggest mistake, next to your working yourself into the ground.

 

[billypilgrim37]

The fact that the receptionist hasn't been fired in this thread is shocking. There's got to be a zero tolerance policy on a receptionist undermining your ability to give care.

 

[Shikima]

Thank you for your response. I am actually stressed because of doing inpatient work and ECT (at the same hospital) on Mon-Friday (sometimes on weekends) and going to my clinic (mon-fri) and seeing patients for about 3 to 4 hours. I leave my clinic at 7:30.

This is why I want to hire a couple of doctors: one full-time, the other will be a child psychiatrist working on Saturdays. I will not be seeing patients at my clinic. Just doing administrative duties. It takes a lot of headaches to bring on a doctor.

I feel your pain, I've got a similar boat with my PP.

 

[OldPsychDoc]

The fact that the receptionist hasn't been fired in this thread is shocking. There's got to be a zero tolerance policy on a receptionist undermining your ability to give care.

There's that--but are we expecting too much from a (presumably) part-time hourly worker who maybe has a Medical Secretary Certificate from a vocational school and probably thinks of herself as "trying to be helpful"? I don't get the sense from the OP's posts that they are well-trained in things like personnel selection and training matters, and I doubt that this receptionist has the same understanding of professional boundaries, etc that we have had instilled in us from Day One. Clearly there's a need for a long talk with this person--but I'm not sure that immediate termination is the answer here. (Unless he wants to add to his problems a reputation as a bad employer!)

(Just more reason why I'm personally befuddled by the rush to private practice on this board...)

 

[vistaril]

There's that--but are we expecting too much from a (presumably) part-time hourly worker who maybe has a Medical Secretary Certificate from a vocational school and probably thinks of herself as "trying to be helpful"? I don't get the sense from the OP's posts that they are well-trained in things like personnel selection and training matters, and I doubt that this receptionist has the same understanding of professional boundaries, etc that we have had instilled in us from Day One. Clearly there's a need for a long talk with this person--but I'm not sure that immediate termination is the answer here. (Unless he wants to add to his problems a reputation as a bad employer!)

(Just more reason why I'm personally befuddled by the rush to private practice on this board...)

regarding the last point(and going off topic from the main thread), one of the biggest positives about outpt private practice as opposed to working for a larger organization is that you don't have a boss. Yes, you're still somewhat constrained by the rules of your state medical board I guess, but this is much different than having a boss. And I suspect that a lot of us really value that freedom.

but everyone who has their paycheck signed by another person has a boss they have to answer to. That's not something many people prefer.

 

[IamPsychiatrist]

Some have said that the best business owners aren't necessarily the smartest people, but they are the best at hiring and finding the right people to complete jobs.

Many people don't know this, but Henry Ford was at one point taken to court for not being smart or knowledgeable enough to run such a big corporation. They asked him many questions he was ignorant about, finally exasperated he responded that he had a set of buttons on his desk that could page any number of employees that could answer any question he needed answered.

That's smart.

 

[Zenman1]

I think you are right. That is gossiping. When patients ask about the practice, she gives them detailed answers. She told one patient that I was going to hire a child psychiatrist to work in my clinic so it would bring in more money. I did tell her that, but she didn't have to mention it to anyone.

I don't know how she has the time to talk to patients. I give her a lot of work to do!

I'd give her a warning first and write up that you did so. Use progressive disclipine so you have a paper trail and show fairness. I'd also inform her that not a word of what is said in the office is to be repeated to patients unless you say so. And do need to see someone for therapy?

 

[OldPsychDoc]

regarding the last point(and going off topic from the main thread), one of the biggest positives about outpt private practice as opposed to working for a larger organization is that you don't have a boss. Yes, you're still somewhat constrained by the rules of your state medical board I guess, but this is much different than having a boss. And I suspect that a lot of us really value that freedom.

but everyone who has their paycheck signed by another person has a boss they have to answer to. That's not something many people prefer.

What the OP is discovering is that his patients are ultimately his boss. And he will have to adjust his attitudes and behavior to please them if he wishes them to continue signing his paychecks.

 

[notdeadyet]

There's that--but are we expecting too much from a (presumably) part-time hourly worker who maybe has a Medical Secretary Certificate from a vocational school and probably thinks of herself as "trying to be helpful"?

Agree ^^^. This is one of the reasons why private practice has a unique learning curve. Residency programs don't train residents on how to actually manage a business.

Your employees are responsible for their actions, but you are responsible for your employees. This employee may have a long track record of inappropriate comments and/or behavior (and if so, it's hopefully been documented). But more likely, she never received specific training in what is appropriate and inappropriate to share with patients. She may have been fielding a patient complaint and shared that the OP was overworked in a misguided effort to help.

Or not. The point is that the instinct to fire an employee for committing one flavor of mistake is a bad one. This could be more an indication of bad training or unclear responsibilities and could potentially be easily reconciled.

 

[billypilgrim37]

Your employees are responsible for their actions, but you are responsible for your employees. This employee may have a long track record of inappropriate comments and/or behavior (and if so, it's hopefully been documented). But more likely, she never received specific training in what is appropriate and inappropriate to share with patients. She may have been fielding a patient complaint and shared that the OP was overworked in a misguided effort to help.

Maybe I would be expecting too much, that just seems like some really terrible judgment, and having someone with that bad of judgment being the face of your office seems really risky.

 

[whopper]

Employees are supposed to keep certain things within the professional circle. A colleague tells me he's burned out, I don't tell his patients that, I tell the guy to take it easy, take a few days off, at worst re-evaluate if he should be working in that specific venue.

A receptionist is supposed to know these things. Are you responsible? IMHO only if you are the receptionist's boss because then you should've told the receptionist that certain things you say need to keep within the office and not told to patients. If you're not the boss, then you need to go to the boss and tell them what happened.

 

[vistaril]

Maybe I would be expecting too much, that just seems like some really terrible judgment, and having someone with that bad of judgment being the face of your office seems really risky.

to me it would really depend on what sort of office he is running. If it's a very small office(just him and a few therapists for example), they need to run very lean and that means going bare bones on the little staffing(if any) you do.

I know where I work at we have a number of professional people up front who check patients in and would understand not to do those things. Then again we are well staffed and they are paid decently with benefits. That is NOT the way to make money. I don't have access to our outpt clinic financials, but I'm sure they are absolutely dreadful. If someone in the pp world looked at them they would probably be horrified.

So what I'm getting at is that it costs decent money to hire decent people, and in lean/small private practices there may not be decent money if you want to have a lot left over to pay yourself.

 

[PA-CtoMD]

Thanks for the responses!

I agree that her behavior was really inappropriate. I am surprised that this happened. Since she was an RN in the ER, ICU, and psych units, I assumed that she knew what professional boundaries were. She had excellent references from previous employers. Actually, the general population would know about professional boundaries. Some of this knowledge is really common sense. You don't have to be a human resources executive officer to know that.

I spoke to her, and she did mention that one patient dragged it out of her (kept on about the way I looked and acted). I mentioned that she should have established boundaries by saying that she had to get back to work. I told her to keep all office discussions among us. She cried and apologized because she felt badly. I told her not to converse with the patients so much then she would not create situations like this. And that she has a lot of work to do anyway.

Here is the new thing: Her husband is in the military. His tour is almost over. It sounded like he only has a few more weeks left. So, more than likely she won't be working for me much longer.

 

[vistaril]

Thanks for the responses!

I agree that her behavior was really inappropriate. I am surprised that this happened. Since she was an RN in the ER, ICU, and psych units, I assumed that she knew what professional boundaries were. She had excellent references from previous employers. Actually, the general population would know about professional boundaries. Some of this knowledge is really common sense. You don't have to be a human resources executive officer to know that.

I spoke to her, and she did mention that one patient dragged it out of her (kept on about the way I looked and acted). I mentioned that she should have established boundaries by saying that she had to get back to work. I told her to keep all office discussions among us. She cried and apologized because she felt badly. I told her not to converse with the patients so much then she would not create situations like this. And that she has a lot of work to do anyway.

Here is the new thing: Her husband is in the military. His tour is almost over. It sounded like he only has a few more weeks left. So, more than likely she won't be working for me much longer.

you're using an icu rn(so she is at least least a BS rn...with excellent references to boot) as an outpt receptionist? I'm curious how the heck that came about. Maybe I'll to try to get a job as a movie usher.

 

[whopper]

Since she was an RN in the ER, ICU, and psych units, I assumed that she knew what professional boundaries were.

If that's the case it was reasonable for you to expect her to have kept these professional gripes to herself.

Remember, however, that just because someone is a doctor, nurse, what have you that this doesn't mean they do the job as they're supposed to do so. You hire a new nurse, you never really know what they are until they've worked for you for some time. Studies show that LORs have hardly any validity whatsoever.

Maybe I'll to try to get a job as a movie usher.

Agree. Begs the question, just why someone would go from a high paying job to a job that is likely lower paying and doesn't utilize the skills one spent years to get the right expertise to attain. Though most hospitals I know of wouldn't even allow a nurse to be an ICU one in the first place unless they were good. She might've had good skills in training but when doing the job on the floor turned out to be an unstable personality-just a theory.

 

[Bartelby]

I'd give her a warning first and write up that you did so. Use progressive disclipine so you have a paper trail and show fairness. I'd also inform her that not a word of what is said in the office is to be repeated to patients unless you say so.

Agreed, jumping straight to termination is a bit excessive (especially given that the patients almost certainly did not terminate based on the receptionist's comment alone, although it may have given that last little push they needed to trust their gut). I think talking it over with her to explain the situation is the right move, and if the behavior continues then you might have to let her go.

Also I agree having an ICU nurse as a receptionist is weird, she may have personality issues that led to the drop out of the nursing world and if that's the case starting your paper trail now isn't such a bad idea.

One thing I am curious about: are you offering significantly higher pay for the Saturday child psychiatrist you are trying to hire (kind of like moonlighting level pay)? If not it may be tough finding someone to work only on Saturdays, although I suppose you might get lucky and find someone who wants that.

 

[PikminOC]

Is the OP the one who hired the receptionist? Then she would be able to fire her. If the OP is employed, then it's a different ball of wax. But she is decreasing the number of patients, it doesn't matter how many. I think this is important.

 

[PA-CtoMD]

"What the OP is discovering is that his patients are ultimately his boss. And he will have to adjust his attitudes and behavior to please them if he wishes them to continue signing his paychecks."

While there may be a little truth to this, a patient has a right to choose who they want to see.

 

[PA-CtoMD]

Is the OP the one who hired the receptionist? Then she would be able to fire her. If the OP is employed, then it's a different ball of wax. But she is decreasing the number of patients, it doesn't matter how many. I think this is important.

It is my practice. I think it is too excessive to fire her. She understood her mistake and has agreed to keep all office discussions private. She has also stopped being so "friendly" with the patients. She stopped talking about her personal life with them.

I am looking for a new receptionist because she will be leaving shortly. I will have her train the new receptionist just before she leaves.

 

[PA-CtoMD]

By the way, I am a female. I just thought that I would mention it because many are referring to me as male.

 

[PA-CtoMD]

you're using an icu rn(so she is at least least a BS rn...with excellent references to boot) as an outpt receptionist? I'm curious how the heck that came about. Maybe I'll to try to get a job as a movie usher.

Surprisingly, she hasn't worked at all for three and a half years. She hates nursing with a passion. She would do "anything" but nursing.

 

[Shikima]

I have a few choice thoughts regarding nurses but that's for another discussion and beer. Sounds like you've got a hard choice in admonishing her and let her continue the job or can her for being a ****bird. I'd suggest the latter.

 

[PikminOC]

I think the feedback to her was a good idea. I was just mentioning the issues if you don't have control.

 

[PA-CtoMD]

I have about 300 patients and noone to help out if she leaves now. Since she will be leaving soon (probably won't be here in 2 months), I figure I will keep her until she goes. My practice is really growing.

I would give up the practice, if I didn't spend so much money on the office (remodeling, sound proof walls).

Someone on here said that private practice ws a big hassle, that person wasn't kidding.

 

[Shikima]

Keep up the good work! I'm impressed with your dedication!

 

[notdeadyet]

It is my practice. I think it is too excessive to fire her. She understood her mistake and has agreed to keep all office discussions private. She has also stopped being so "friendly" with the patients. She stopped talking about her personal life with them.

I am looking for a new receptionist because she will be leaving shortly. I will have her train the new receptionist just before she leaves.

Sounds like very solid management.

 

[PA-CtoMD]

Thanks shikima and notdeadyet for your compliments and help regarding my practice!!

shikima, just curious. How did you come up with your username?

 

[Shikima]

Influenced by a Japanese subcultural context. Struck me as funny... both haha and strange.

 

[PA-CtoMD]

Influenced by a Japanese subcultural context. Struck me as funny... both haha and strange.

That's interesting. Your username makes me think that you're Japanese.

 

[PA-CtoMD]

Well here is an update: my receptionist confessed to me that none of the patients dragged anything out of her. So, she basically lied. She claims that it (my being burn't out) just "slipped" out of her mouth without thinking. I won't fire her. But, I will have to make sure that this doesn't happen again with a new worker.

 

[Shikima]

That's interesting. Your username makes me think that you're Japanese.

Not sure if you need reassurance, but I'm not. 😀

 

[PA-CtoMD]

Not sure if you need reassurance, but I'm not. 😀

I guess I thought that because I am part Japanese.🙂

 

[EEGNeurofeedback]

Well here is an update: my receptionist confessed to me that none of the patients dragged anything out of her. So, she basically lied. She claims that it (my being burn't out) just "slipped" out of her mouth without thinking. I won't fire her. But, I will have to make sure that this doesn't happen again with a new worker.

I think it is good that she will be leaving shortly.