Archive for the ‘professional behavior’ Category

You’re Going To Charge Me For Missing A Session?

Thursday, May 19th, 2011

Yeah. I am. Can we reschedule? Let’s talk about that later.

I hear ya. Yer doctor just lets you call and say you’re not going to be there and everything is fine. Same thing with the dentist and some other health professionals. Everything is jake. You call up, say you’re not getting there, they cancel your appointment and then you reschedule when you get the chance or whenever what’s bothering you kicks up again.

So what’s this about? Making sure that I don’t lose income? I’ve heard that before and the answer is, “Yes, but that’s not the main reason.” Some people stop at “Yes” and don’t hear the rest. Unfortunate. I do own up to it being, in part, about my income. Your fee is my income. I can’t double book the way physicians and dentists do so, when you don’t show, I don’t get paid for that period of time that I’ve reserved for you.

Ah, there’s another part of the “…not the main reason.” I’ve reserved the time for you. In most cases I can’t rebook the time. I realize this isn’t your problem, except that you want me to keep this time open for you every week, right? If you want me to release the time to someone else, I can do that, but then it’s that person’s if he’s willing to pay for it on a regular basis. Then you & I have to decide on a new schedule and, guess what, it’s still a regular appointment and, you guessed it, you’re going to pay for that missed session.

“Missed” session. Hmmmmm. Yeah, about that. If you don’t show up and you don’t pay it’s not a “missed” session. It becomes a “missing” session. What’s the difference. “Missing” sessions don’t exist. They didn’t happen, there’s nothing to note their passing and there’s nothing to talk about. I know you think there’s nothing to talk about if you miss a session, but that’s not true. There’s plenty to talk about and that’s why it needs to be “missed,” not “missing.” I’ll go further with that another time. Please just take my word on this one for now. If you want to think about it and tell me the difference please feel free to post a comment.

Now, about that rescheduling of our appointment. What are you asking of me with that request? Your asking me to fulfill your wish that you get a Mulligan. The “caring one,” as Harry Stack Sullivan labeled the infant’s primary care giver (often mom but not necessarily,) will do what is wanted. Your wish to be taken care of will be fulfilled no matter what the cost to anyone else. What are you asking of me? You are, in effect, asking me to cut my fee in half by giving you another session (the one you missed plus the”rescheduled” appointment) for the price of one session. Two for one. You’re presuming that I have the open time that will match yours and, maybe, that if I can’t match your time you won’t have to pay because you can’t reschedule and it’s my fault.

That doesn’t answer the question about rescheduling a session. That answer is, if I have time open and it matches your availability then, yes, I will reschedule. Once. Please.

Long ago in a galaxy far, far away I dated a woman who said, in response to my saying I felt “used” about something “Everybody uses everybody. Don’t abuse anybody.” Please.

Comments? Please feel free to post them below.

Therapists Behaving Badly

Wednesday, November 24th, 2010

This one’s gonna be touchy. I’m not all that clear about putting this post up there. It could be nothin’ but net, could be a brick. I’m sure this is going to make some people unhappy on both sides of the couch but, I gotta say something & so, as Wellington said to his mistress when she threatened to make his letters to her public, “Publish and be damned,” though I probably already am. It’s a professional liability.

This is written in part for patients, in part for therapists, and in part to get it off my chest ’cause its been there for a while & it’s startin’ to feel like a 10-ton safe. Here goes and if it bends you out of shape, so be it.

I was in the elevator going up to my office a few weeks, maybe a month and-a-half ago with 3 other people. Two were therapists, one was, I think, a patient. One therapist asked the other about his next patient & the comment came back something along the line of “He’s a real borderline.” The other said something like “yikes,” and then followed with a comment about being told by some mentor that you shouldn’t have more than one on your caseload. The one who made the comment in the first place said something about that being right.  If you’re reading this and you recognize yourselves, I’m not picking on you. I’ve picked you as an example. If you’re offended you can take it up with me. Leave me a comment. Please. If you have an opinion about what I’m saying here, please, leave me a comment.

The whole time this exchange was proceding I was uncomfortable because I wanted to say something to this pair. The other guy in the elevator (remember him, the patient looking guy?) was looking decidedly uncomfortable and unhappy.  I wanted to tell this pair to pipe down, that there’s other people on the elevator. Mind you, they didn’t say anything that might identify the patient (other than that he’s a he.) The behavior broke no privacy or confidentiality rules, HIPAA was certainly not violated. So, what’s my beef?

That’s easy. It makes patients uneasy when they hear this. They already think we talk about them when they’re not present. They have wonderful imaginations and are very sure we talk about them. There’s no need to prove them right. It doesn’t make them happy and gives them a not great opinion of us because, they think, it tells them what we think of them.

We’re not even going to talk about the categorizing of a patient with an unflattering label. We all know what borderline means, and that includes patients. It means difficult, explosive, unmanageable, right? Too bad it didn’t mean that when it was first proposed, but that’s what it’s come to mean. But I digress….

My point here is this: I was fortunate. My first internship was, in part, at the James A. Peters Veterans Medical Center in the Bronx where there were signs on the two side walls of each elevator reminding the staff to not discuss patients in the elevators because staff, patients and patients’ families all share the same elevators. Good signs to post because people forget.

What I’m saying to therapists – pipe down! If you must talk about patients, and I’ll be generous and say that you’re “consulting” with a colleague, do it in your office or your colleagues office and do it with the door closed. Not in the hall. Not in the elevator. Not in the toilet. Let’s show them the respect they deserve.They come to us in pain and we’re not here to add to it by hearing us talk about patients (in the pejorative) in public. We’re not carnies and our patients aren’t Rubes. If you can’t pipe down, and you’re in a public place with me, expect that I’ll ask you to hold it for when you’re alone. I invite any other clinician to do the same when they hear another of us doing this.

By the same token I’m saying to patients that it’s OK to tell the therapists who are having this conversation in front of you that they should zip it. Tell them not to have this discussion in front of the kids. Tell them that you feel disrespected. Tell them that they’re treating you like you’re not there. They may get huffy. Let ’em.