Okay, so I had this thought, not for the first time I’ll admit, but today at any rate.
I acknowledge that I am a dinosaur.
Now wait, wait, don’t get all up in arms and start spouting stuff at me about being so young and handsome and witty and smart and all that (well if you must, go ahead. I’ll give you a few minutes to get that off your chest, then we can move on.)
I’m actually three dinosaurs, a hat trick for my hockey loving readers in Canada, a trifecta for you gamblers out there. And this is not necessarily a bad thing, but something that I’ve just had to come to terms with, starkly and unavoidably, in the last few weeks as things change in the world of medicine in general and psychiatry and mental health specifically.
My first dino-personality fragment is the Deny-o-pod.
You see, I trained in what I now know and wistfully acknowledge was a golden age for young psychiatrists. We were young and idealistic and had the best of both worlds in our books, our patients, our supervisors and professors. We learned all about psychodynamic theory and we were on the cutting edge of the “new” age of psychopharmacology. We had it all, loved it all, discussed it all in a haze of cigar smoke (yes, Dr. McCranie, I’m thinking of you, wherever you are) and good feelings that made our training class feel more like a very small, tight cadre of lifelong friends than wet-behind-the-ears psychotherapists.
The Deny-o-pod in me wants to think that that time and that feeling will never change, when in reality that train left the station many, many years ago. Oh, we still see the faintest of glows from the tiny red taillights on the caboose, but the freight train that carried the likes of Anna and Sigmund, Adler and Jung, Skinner and Kernberg is fast approaching the roundhouse and will not be sent back. I like to think that I can still take three hours to see a new patient, write my notes at my leisure anytime in the next day or two or three after the visit (or better yet just jot down one sentence, sign it and be done) and have plenty of time to read about the things I see and think on them for a time.
That never happens any more. Visits for new patients are crammed into thirty minutes if that, follow ups can be as little as ten minutes, and the new collaborative documentation standard looming by the new year says that notes are typed while the patient is in the room, with input from the patient and buy-in for the treatment plan in real time. This is supposed to make mental health workers happier, healthier, have loads more hours free to see loads more patients and spend more quality time outside the consulting room doing other things. Time will tell. Deny-o is skeptical at best.
Delay-o-saurus is the second of the Jurassic trilogy that lives in my head and heart.
Even when I think of the fact that times are changing, radically, and that we will never go back to those golden days, and even if I tell myself that I must change along with everyone else if I want to keep working, I manage to tell myself that it is perfectly fine to delay and stall and do things the way I’ve always done them until someone, most likely my boss, drags me kicking and screaming into the next decade with a new set of standards and expectations. This is fallacy, of course, and I know it. I have to get on board just like everyone else, especially my staff, who I must motivate to change too.
The third scaly and lithe beast is one who flies, the screeching, soaring Dive-o-dactyl.
That part of me knows that the only way for me to really get my head in the game when change like this happens is to dive right in and go for it. I know what I have to do. I also know that I don’t like being told what to do! That doesn’t matter in this kind of situation. The change is coming, and it cannot be ignored. It’s time to put my head down and dive right into it.
I’m fifty-seven years old. I would like to work at least twenty more years if I stay healthy.
I know I must change and adapt, or I won’t survive.
At least I know my fate won’t be the same as the dinosaurs of old.
There are no asteroids in South Carolina to my knowledge, and I don’t smoke.
Cartoon by the one and only Gary Larson.