Early Career Support

[nicolascagephd]

I'm thrilled to have started my first grown up job at an academic medical center. However, I am noticing a lot of outdated practices and recently was confronted for not doing things the same way as the senior psychologists (e.g., sending a patient questionnaire via Epic instead of reading it verbatim to the patient in a virtual session; mentioning the potential for differential diagnoses). A meeting was proposed for us to discuss having a uniform protocol, and also to have a uniform way of determining assessment results as a department. I know that this is part of the job, but I am nervous as heck to have this conversation. I do not want to appear overconfident or that I am undermining their experience. However, I have supporting research on my side. I want to preserve the relationship I have with the tiny faculty but I simply do not agree with some of the practices they use. How would you handle this situation? Also, generally how do you cope with early career pressures?

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[Harry3990]

My personal strategy for this as an ECP has been to be relatively honest (but still professional, and appropriate) about my clinical and administrative opinions when asked for them or in a team meeting where the expectation is group discussion. However, I also communicate flexibility in my willingness to defer to the judgement and decisions of my superiors because at the end of the day, it is their call. Especially with the kind of things that you are describing like streamlining how to administer questionnaires, I don't have a problem being more flexible. If it was something I adamantly disagreed with or felt was my call as an individual practitioner providing services, then I might push a bit more assertively, but that has happened rarely in my experience so far luckily.

 

[nicolascagephd]

My personal strategy for this as an ECP has been to be relatively honest (but still professional, and appropriate) about my clinical and administrative opinions when asked for them or in a team meeting where the expectation is group discussion. However, I also communicate flexibility in my willingness to defer to the judgement and decisions of my superiors because at the end of the day, it is their call. Especially with the kind of things that you are describing like streamlining how to administer questionnaires, I don't have a problem being more flexible. If it was something I adamantly disagreed with or felt was my call as an individual practitioner providing services, then I might push a bit more assertively, but that has happened rarely in my experience so far luckily.

This is helpful, thank you. Regarding questionnaires, I know that it is not a big deal at the end of the day, but it is much easier for all involved (in the long run) to have things documented automatically rather than storing paper copies. I could ease up on that for sure. If you had something you disagreed with more fervently, how would you go about it? I work in an area where they want to develop a protocol for all of us to follow for someone to advance to the next step in the program, but their rationale conflicts with updated research.

 

[summerbabe]

If you are bringing up reasonable suggestions or critiques with a reasonable tone and a reasonable degree of tact and can present/maintain an attitude of collaboration, flexibility, and compromise throughout the process (while still pushing for what's right), you should be fine.

Unless your colleagues have major personality disorders, in which case you're boned whether you say something or say nothing.

I'm about 4.5 years out from postdoc and have been in both scenarios many times in my various VA dealings.

 

[PsyDr]

“Will this mean that whoever decides the protocol will accept liability for every patient? No? Cool, then I’m going to practice according to my own acceptance of risk.”

 

[AcronymAllergy]

I can understand wanting to have uniform processes, but at the same time, it's your license. The "...uniform way of determining assessment results" bit also gives me major pause, unless I'm interpreting it incorrectly. A department should generally never be dictating to you how to interpret assessment results. If they're unhappy with your interpretations and/or don't think you're interpreting correctly, that's one thing. But to have a uniform policy about such is, IMO, inappropriate.

I can kinda sorta understand the idea of a uniform protocol. But again, they need to allow for a degree of professional autonomy. Unless you agree with the uniform protocol. But even then, I'd be hesitant to accept a situation in which the entirety of my evaluation is dictated to me in advance, unless it were something like an initial screening visit that could be followed up on later.

When discussing, I think it'll be helpful to ask questions to try to get an idea of where they're coming from and why they think these policies are necessary. If you have concerns or are uncomfortable, voice those concerns/that discomfort in a professional manner. While also understanding that what might seem like an "outdated" process, in some instances, can be just as if not more effective as newer processes.

As a slight aside, I never like sending questionnaires to a patient in advance. Unless it's something like a demographic questionnaire. Otherwise, as the questionnaire is now outside your control, there's ultimately no way to determine they were the ones who completed it. And if it's proprietary, there are of course all sorts of ethical test security concerns.

 

[nicolascagephd]

“Will this mean that whoever decides the protocol will accept liability for every patient? No? Cool, then I’m going to practice according to my own acceptance of risk.”

This was my thought as well.

I can understand wanting to have uniform processes, but at the same time, it's your license. The "...uniform way of determining assessment results" bit also gives me major pause, unless I'm interpreting it incorrectly. A department should generally never be dictating to you how to interpret assessment results. If they're unhappy with your interpretations and/or don't think you're interpreting correctly, that's one thing. But to have a uniform policy about such is, IMO, inappropriate.

I can kinda sorta understand the idea of a uniform protocol. But again, they need to allow for a degree of professional autonomy. Unless you agree with the uniform protocol. But even then, I'd be hesitant to accept a situation in which the entirety of my evaluation is dictated to me in advance, unless it were something like an initial screening visit that could be followed up on later.

When discussing, I think it'll be helpful to ask questions to try to get an idea of where they're coming from and why they think these policies are necessary. If you have concerns or are uncomfortable, voice those concerns/that discomfort in a professional manner. While also understanding that what might seem like an "outdated" process, in some instances, can be just as if not more effective as newer processes.

As a slight aside, I never like sending questionnaires to a patient in advance. Unless it's something like a demographic questionnaire. Otherwise, as the questionnaire is now outside your control, there's ultimately no way to determine they were the ones who completed it. And if it's proprietary, there are of course all sorts of ethical test security concerns.

This is helpful. Thank you very much! I can see the concern from their perspective with things like questionnaires for those reasons you've mentioned, and I am open to compromising on those if needed.

Regarding professional autonomy, I definitely am feeling a bit constricted. When I started working a year ago, it was discussed that we use the same questionnaires but have our own styles for clinical interview, dx, and recs. Now this proposal for all of us to be in agreement with these things (especially dx and recs), I am pausing and thinking if I would be comfortable to work within those limits. I will say that I highly respect my colleagues and why they do what they do, but there seems to be an expectation that I view them as mentors (which I do not - I tend to go to my supervisor or previous supervisors for mentorship). I worry that I am stepping on toes by having a different approach to our work. However, no concerns have been raised about my performance yet, so I think I am generally doing OK here.