Happy Anniversary to ME!

As of today, I have been on this job for 52 weeks. This is the longest I have had a 'real' job. Granted, this is only my second job- I don't count residency, because one continues one's education during residency and one cannot be sued as a resident (only the attending gets sued...usually, I think.) I am amazed I have held on to this job for this long... A colleague asked me today if I had thought about leaving, I honestly told her, with a grin, 'almost everyday.'

The thing is, with this job, my patients don't leave me, my case load just gets bigger, people don't really get better, and it just goes on, and on, and on.

As for the patient who was glad I went looking for my groove- it is actually interesting to think about this diagnostically. Essentially, all the patients who say these inappropriate, out of boundary things, are either personality disordered, or manic.

I have had patients who tell me their opinions about my clothes, weight, hair... and inevitably, only people with very loose boundaries (or any) will say that to their physician. So I bet you are wondering if you have those thoughts about your doctors... It is ok to have a personality disorder. 1 out of 10 people meet diagnostic criteria. And actually, I think, all politicians have some sort of personality disorder, I mean, you don't get to such powerful positions without pushing boundaries. The important thing is to use your personality traits (doesn't that sound so much better than 'disorder'?) to your advantage.

Strangely, while the prevalence is about 10% in the community, my case load has about 70% personality disordered people... very exhausting...

On a lighter note, I would like to talk about my charting practices. (SO exciting, I am sure.)
Sometimes I use our electronic charting program- then print out a copy of it to put in the chart. Not paperless, at all. I find it rude to type while I am listening to a patient, so I have to wait to do my charting after the patient walks out, which doesn't save me time. So if I am in a big hurry, I write as I listen, which I don't find rude at all. (Okay, it is still really rude to do this...) but I have to keep up with the flow! I find that I write in greater detail when I am writing as the patient is going along, I write things like "wearing a totally different outfit today than ever, a shirt with flames on it." I know, really useful stuff. I can already picture this, "Your Honor, I did write that. He was wearing a different outfit. Usually he wears dirty pants, but on 9/2/2008, the pants were different."

The trouble with writing the note as I go, is that a patient might start off very cooperative (so my mental status exam says, "Cooperative, polite, well related." But then I say something about tapering their hypnotic, or some other habit-forming medication, or discuss their Mary Jane usage, which then makes them unhappy and less cooperative. However, I can't go back and say that patient was irritable, uncooperative, and rude. I have to write so many other words, to make a smooth transition. Smooth transition in charting is what is really on my mind...

The electronic charting option is very useful for returning phone messages. As I dial, I start typing what they said in their message to me, and then I type as I talk, and hope that they can't hear the clicking of my keyboard.

Okay, enough about charting. I gotta go clear the dinner table.