Personal/professional update

[lockian]

I used to agonize a lot about my psychiatry practice and the field of psychiatry in general. Then a few months ago I had a medical event. I recovered, but it did for me much more than years of therapy and medication had done. I realized life is too short and there are better things to spend mental energy on than obscure worries about unlikely medical outcomes, whether patients like me or not, or being sued or reported to the board. Of course, being sued or reported or having bad medical outcomes are still important to avoid as best you can, but they don't need to be all-consuming concerns.

Suddenly, my notes are getting done faster, I am barely ever late unless there's a really hairy clinical situation or other emergency, and my patient rating, for what that's worth, has no dropped but actually improved. As long as I know I am providing standard of care (which is actually quite a large ballpark, as I'm learning), I can make a decision, communicate clearly, and move on. I am also better at not taking on too much perceived responsibility. Patient does not like my boundaries? They can see someone else. Patient not following the treatment plan? Well, I guess they are not going to get better. Patient did not do what they needed to do to maintain access to their meds (usually this is cessation of various substances). Well, that is on them.

I even negotiated a later start to my day and a later end time, and that helps because I have always had a delayed sleep cycle and I decided I no longer wanted to keep fighting it to remain a productive member of society. Not being quite so tired helps a lot too.

Some of the above may also be because I know my patient load a better now, and know what to expect from many of my patients, even as they have developed more trust for me.

Are things perfect? No. There are still patients I don't look forward to seeing. I still spend more time than I'd like to on notes, but at least more of them are done by the end of a normal clinic day. I am still frustrated that medications don't work as well as we hope a lot of the time, and time and other systemic constraints prevent us from engaging in enough therapy. But it's ok, for the time being, and I'm ok, doing the best I can with the tools I have.

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[nexus73]

Glad to hear you’re finding a groove!

 

[annoyedpsychiatrist]

I think there will inevitably be periods where you feel down/miserable and leave work feeling overwhelmed and defeated. Like you I had so many of these days this year, that was worsened when they introduced patient review scoring and i started getting more and more adderall/xanax dumps from PCPs.

ultimately things are going to happen the way theyre going to happen. We cant fix borderline with meds and 30 min evals. Were not magic.

The patient rating metric is such a stupid metric, but it actually will go higher with time, as you build a larger patient base of people who trust you and believe in you, these reviews will slowly outweight the garbage reviews that the xanax dumps give you. Its very hard with patient reviews in the beginning, because everyone is new, no one trusts you, and you're getting dumps left and right. I have months of 100% excellent and other months of 70% excellent, theres really not much I can change besides more butt kissing. What helps me is i just dont open the email from patient reviews half the time lol. Though i do get a lot of good comments and that can be touching. Ultimately, I think you found the right approach and I agree with it: "just letting go". Because there isnt anything you can do to control any of this. The more you care about it, the more it burns you. If you accept you have pretty much zero control over it and what will happen, will happen, that tends to help me. Even if the **** hit the fan, always remember theres more jobs than there are psychiatrists in most places

 

[calvnandhobbs68]

The patient review thing is idiotic. Example: I have a patient ive been seeing for years, pretty difficult to engage with anyone, variably taking meds, I finally got him consistently seeing a therapist I know internally but it would have pretty easy at any point to just drop this case and say come back when you want to. Something else happens administratively (some billing thing) with someone else in the family who saw someone else in the same group and the family goes and writes a review ****ting on the whole practice talking about how terrible this place is.

 

[smalltownpsych]

As I tell my patients when they make some positive shifts and it’s the same with my own experience, these will wax and wane and in a couple of weeks when something stressful happens, it’s likley to have the old negative thoughts and patterns come back. Now you know that they aren’t permanent or inevitable so it should be easier to get back on track. The goal is not to eliminate negative patterns so much as to decrease the frequency, intensity, and duration of those times.
So glad that you are growing and learning as you practice. The growth mindset is what makes for the amazing healers as opposed to the mediocre. I think we get a little bit of an oversampling of the former on SDN because a big reason we continue to participate is we love to learn and teach and share in that process.

 

[clozareal]

The patient review thing is idiotic. Example: I have a patient ive been seeing for years, pretty difficult to engage with anyone, variably taking meds, I finally got him consistently seeing a therapist I know internally but it would have pretty easy at any point to just drop this case and say come back when you want to. Something else happens administratively (some billing thing) with someone else in the family who saw someone else in the same group and the family goes and writes a review ****ting on the whole practice talking about how terrible this place is.

I hate patient reviews for this reason. It doesn't even have to be with you. It could be with a front desk staff. It could do with parking. It can be entirely the patient's fault (no show and then complaining about the no show fee) and they can externalize it to make it seem like you're the most horrible psychiatrist that ever existed.

 

[lockian]

Yeah, I just kind of offhand mentioned that my patient reviews are better than ever, but in the spirit of my Peter Gibbons from Office Space style transformation, I now care less about them. My boss told me that in psychiatry the reviews are to be taken with a huge grain of salt and are no reflection on our practice, and I actually believe him now.

I do agree it's not perfect but I am able to bounce back from difficult days better and let things roll off my back more readily, which is good news. But I think due to my medical event I still matured about 5 years on fast forward.

 

[Candidate2017]

I used to agonize a lot about my psychiatry practice and the field of psychiatry in general. Then a few months ago I had a medical event. I recovered, but it did for me much more than years of therapy and medication had done. I realized life is too short and there are better things to spend mental energy on than obscure worries about unlikely medical outcomes, whether patients like me or not, or being sued or reported to the board.

There's the concept that the root of all anxiety is death. Coming out unscathed from a brush with death makes everything in life much more clearer in terms of whether something is important or not. Most people can benefit from a near death experience every now and then. It's probably the closest thing to being born again, but with full consciousness.

If you had a crystal ball that accurately forecasted the exact date and time of your death, the things that were at the top of your anxiety rank order list (like writing perfect notes, getting bad reviews, being liked, or getting sued frivolously) would fall to the bottom to make way for things that actually matter. And you'd speak your mind more often, as well as demand what you want.