Tools of the Trade


I have had some of you ask me what I use day-to-day to get my job done. In other words, what are the tools of the trade for a psychiatrist as he goes about the business of seeing patients in the clinic and the emergency room?

Although the personal interview and personal attention to patients is my stock-in-trade, I could not survive nowadays without technology.

I use a new twenty-one inch iMac in my home office, the machine I use to do most of these posts. I have two 4 TB hard drives attached to it for extra storage of music, video, and other items, as well as to back up my data. Everything is backed up three times, twice on my desktop on two different drives and once in a cloud service off site.

I have a set of harman-kardon speakers as well as a DVD drive attached to this machine for enjoyment of music, as well as for viewing videos, doing continuing medical education and the like.

There is a copier/scanner, a stand alone printer and a Fujitsu ScanSnap iX 500 on another desk adjacent to my main workspace. A shredder lets me securely get rid of paper that needs to be destroyed. I am transitioning to a completely paperless home office, so the last two remaining piles of charts and supporting documents on the floor will find their way into the ScanSnap and from there to my iMac as soon as time permits. 

My iPhone has been my primary go-to computing device on the road since 2007. When I leave home, the iPhone goes with me. Everywhere. Everything that I do on the iMac syncs wirelessly at home and through the cloud without me thinking about it. When I pick up the phone, I can get right back to a post, a project or anything else I was doing on the main machine at home before I walked out the door. Believe me, I have tried more configurations of more machines than you can shake a stick at, including desktops, laptops, phones and tablets. For me, having one main machine at home and one device to take with me just works better overall. 

Of course, you have seen me post about the setup at work, including the Polycom system, an HP laptop, a Dell desktop, fax machine, printers and the like. This is in my telepsychiatry office and is a static configuration that I leave on and operational all the time. As you know, I am an Apple guy, I use PCs and supporting peripherals to do my day job by default, trying not to whine too much about it! Another Dell desktop lives at the clinic office and is tied into the department network, so I can access all databases and notes for either job from either site. 

So tech is cool, but what about analog tools? Is there still a place for them in the twenty-first century? Of course there is! I also love paper, notebooks, pens and other analog tools almost as much as I do my tech toys. In the home office, I always have a couple of Field Notes notebooks and a large cup full of pens around for jotting down ideas as they come to me, later to be captured in my electronic devices for processing. I have a large whiteboard on an easel right behind my desk, so that I can stand up, think about projects on my feet and jot down outlines or notes as I go. On this board I also note books that I’m reading, places I want to visit, and a working budget for my daughter’s upcoming wedding! There’s something about having a large  white space like that that promotes brainstorming and planning for me, which can be very helpful in a way that a blinking cursor or mouse pointer cannot. 

When interviewing patients, especially new patients I meet for the first time, I’m still a clipboard and template sheet kind of dinosaur. I have an interview template that I’ve used on and off, with multiple modifications, for over twenty-five years. It keeps me on track, helps me to remember overall areas that I want to cover, and is sprinkled with mnemonics for various assessment tools that I might want to use. When I get to the bottom of the stack of papers on that clipboard, I make fifty more copies and keep going. 

I also have Field Notes notebooks in my bag for on the go, plus an assortment of charging cables, batteries, pens, paperwork and other goodies that I grab as I go out the door. I keep this bag stocked all the time, so that I never have to remember whether or not I have a USB cable or a uni ball Vision Elite pen or some other equipment that I might need when I’m away from home. 

Prescription pads, printed schedules, paper projects that need to be top-of-mind and various other stuff take up the remainder of the room in my bag. There is always something to send to someone, process, respond to or to read. 

I haven’t covered absolutely everything, but you get the gist of what I grab and go with almost every day as I go about the business of working, writing, reading, seeing patients and living. 

One day soon, I’ll share with you the applications that I use on my iPhone every day. That little device connects me with the world and keeps me organized and productive in ways that I would never have imagined even five years ago. 

What do you use as you go about your day? Are you a digital or analog person, or do you rely on both to keep you productive? 

I’d love to hear from you. 

You Can’t Go Home Again


Good morning, good evening, and good night, dear readers, wherever you might be.

So, you know that I have been thinking about working from home. As I have told you previously, the powers that be in our fair state who administer the telepsychiatry program I work in have decided that it is okay for some of us, or all of us as the case may be, to work from our homes. Telepsychiatry is one of those jobs that can really be done from anywhere, as long as the right equipment is available and the internet connection is fast and robust enough to allow for crystal clear, true-to-life video interaction between patient and doctor. 

When I got this news from my supervisor I was giddy at first. How wonderful to be able to get up, make the coffee, take my time getting ready, and then, at the appointed hour, to walk just a few steps to my home office, sit down, and begin to work. Then, at the end of my shift, be it eight or sixteen hours, to get up from my chair, walk out of my office, pour myself a beverage, and sit outside on the porch in my rocker to unwind. Nice, huh? Of course. 

Like tightrope walking, this whole work at home decision is not as easy as it looks. 

The things above are upsides, for sure. There are others.

Being available to cover for a few hours if one of my colleagues falls ill suddenly and coverage is needed. Not having to drive anywhere, saving on gas and time. Preparing lunch or other meals at home, instead of suffering through the usual fast food or other fare. Being able to control the thermostat to maintain comfort throughout the shift. And did I mention making my own coffee? Yeah, I thought I did. 

What are the downsides, some of which you, my readers, friends, and family, have already made me aware of?

Isolation is a huge deal already with a telepsychiatry job. We see hundreds, nay thousands of patients a year, sitting in a chair in front of a high definition monitor and seeing the patient, but blocking out most of the rest of the world in the process. This tends to be great for focusing on what is going on in twenty-five hospitals that are hundreds of miles away from us throughout the state, but terrible for seeing what is happening ten feet from us, right outside our door. 

Social interaction, even for a few minutes out of every hour, is important to my own mental health. At the mental health center, where my current telepsychiatry office is, I can get up, open my office door, step out into the hallway, and speak with colleagues who work on the same hallway or happen to be passing by on their way somewhere else. These little emotional breaks, no matter how small time-wise, mean a lot. 

Another big downside for me is blurring the boundaries between my own space and my work space. Right now, my home office is my sanctuary. I’m sitting in my chair in front of my iMac right now, typing out this missive to you, drinking a glass of grapefruit juice, listening to Chanticleer in the background through my beloved harman/kardon Soundsticks (Best desktop speakers ever. Go buy some right now. I’ll wait) and just enjoying being in this space. It’s the place I think, dream, read, enjoy my music, organize my life, pay my bills, write letters, and sometimes fall asleep in my chair. It’s my space, and I guard it jealousy. Bringing my work into it would violate it in a hard-to-express way that I’m not sure I’m ready for. 

So, the bottom line, dear readers? 

You already know my decision.

For now, home and work will remain separate places with separate feels and separate functions. I will continue to get up, enjoy talking to you in this way in the early morning, drinking juice and listening to the birds wake up outside my window. I will get dressed, take the short six minute drive to my telepsychiatry office, see patients there, and then enjoy the short ride back to the place that is, day by day, becoming my new home.

For now, that’s just the way it should be.