dude, i was itching for a fight today. sometimes when i get super frustrated, i wish i could find an argument to have with somebody – anybody! and i did have a disagreement…
one of my clinic patients is notorious for missing his appts. he never calls me beforehand or on the day of right, but he’ll call me like 2-3 weeks later apologizing and saying that “he missed” the appt. why? oh, i went away to this place and that place. hmmm, okay. so while i was on night float, i turned off my pager and when patients leave messages on my voice mail, a message is sent to my pager so i know. well, i called it today and had 8 messages. yikes.
two of them were from this notorious patient. i knew i was going to call him to reschedule for sometime in the next 3-4 weeks b/c i’m on night float next week and the week after that who knows…anyway, he came into clinic today and they called me in the office. i informed them that i would contact the pt at a later date to schedule a time to meet with him. fine. they call back to say that he’s “out of meds”. i tell them to send the patient to crisis to get meds.
as i’m leaving about 4:00 (clinic ends at 4:30), crisis pages me and before i get a chance to respond the clinic pages me. so i call the clinic. the attending asks me what’s going on with this pt b/c he went to crisis and crisis won’t give him the script.
i tell him about the pt and i tell him that i’m gone. he tells me that the clinic hrs are until 4:30pm, that crisis will see pts after hours but not during clinic hours and that i need to be there.
i told him in no uncertain terms that even if i were there i wouldn’t see the pt b/c it’s not appropriate THERAPEUTIC behavior. here’s a pt who continually does the wrong thing and has gotten away with it b/c i’ve been lenient w/ him but i will no longer accept that kind of behavior. [he knows when his appts are b/c i give him a slip w/ the appt date on it, i tell him to his face and i even told him last time that i would be unavailable b/c i was going to work nights so he needed to come to his appt!!!!] if this were a PROPER clinic, he wouldn’t pull that crap!
then the attending tells me that he will see the pt. i said okay. i also told him that as far as i know if the MD can’t see the pt, the pt could go to crisis. that’s the way it’s been since i’ve been here and if the rules were changed then someone needs to tell someone else b/c it SURELY wasn’t relayed to me. and if i’m one then there’s more. he says that he’s surprised that the staff in the clinic didn’t inform me of that. dude, i don’t know why they do or don’t do anything. i’m just telling him that it ain’t right.
the attending replies that while he understands that, the pts will mess up and that we need to see them and that we don’t want to precipitate a “crisis” dude, this patient was SUPPOSED to be seen back in LATE APRIL!!!! so how long has he been off his meds hunh? he couldn’t have come in earlier? obviously i gave him enough medication such that if something were to happen to him he could have some extra. you know he had left me a message and then the second message he said (paraphrasing) “i know you’re angry with me for not coming to the appt but i was tired and didn’t feel like coming in”
oh really? oh really? does that sound like someone who DOESN’T know what he’s doing? this is a guy who is going to school, who was working part-time and who recently went on a trip to Europe! this is NOT a stupid man! this is a guy who is able to do all kinds of other things but gets “tired” so doesn’t want to come in to see me??!!! you’ve got to be kidding me!!! i’m not seeing him for therapy. i see him for med mngmnt but that doesn’t mean that he can act this way and NOT have consequences.
now the attending has seen the pt. now the attending has to schedule the pt to see him again b/c i have my own schedule. hey, so if anything happens and he gets stuck dude, it ain’t my wahalla!
we have waaaay too many pts who abuse the system b/c they don’t have to pay a single red cent. they waltz in and out whenever they want to and expect to be seen by their doctors! no man! i don’t care if you DO have a mental illness – YOU AIN’T STUPID! granted, you may be a little off–even crazy but your butt is NOT STUPID! don’t give me that crapola about “precipitating” a crisis! that man KNEW what he was doing when he decided not only NOT to come to his appt but he also knew he should have contacted me to let me know what was going on instead of calling me 3 weeks later!
naw man, i ain’t playing this game anymore. i’m not catering to these manipulative patients anymore! if i can’t at least teach them that their actions have consequences then there’s no need for them to come in b/c a lot of their problems stem from the maladaptive coping skills that they use to get by. i’m not a pill pusher. when you come to a psychiatrist you’re not coming to me so i can JUST give you medication, pat your hand and tell you you’re a good guy. it’s part of my job to help you help yourself and learning that there are consequences to your actions is part of it.
what if i have a long list of patients that i have to see? then i finally finish w/ my patients at 5 or 5:30 and i have to see this patient? are you crazy? you want to help me prepare for the real world? well baby, that surely ain’t the real world. in the real world the pt gets the appt whenever and that’s that. what madness is this?