Connected Data

I have been visiting different sites and having staff meetings with different groups of clinicians since I came back to my psychiatric services chief job two weeks ago today. I have noticed something that is very important to the smooth operation of a mental health center, and most likely any health care facility you might look at. 

In order to do the best job possible and help the most people who need us, we must work as a team.

Now, when I trained back in the mid-1980s, the physician was still the head of most teams. He (or she) sat at the head of the table, set the agenda, and ran the meeting. The physician set the tone for what was important, what cases would be presented and what topics of discussion would receive the most time and attention. He would dictate to the social workers and nurses and therapeutic assistants what was important to get done that day, what jobs were assigned to whom, and other details of how the day would go for everybody. The whole process was physician driven. 

Not so today. Yes, I still sat at the head of the table at one of our clinical staffings today, but I did not run the meeting. I asked questions, listened to cases being presented, offered guidance where I thought it was needed or appropriate, and used anecdotes or examples to try to get my point across when I thought a certain point needed to be made. The thing that really hit home for me today was that I was truly an “old dog” in a room full of young, energetic, talented, well-trained clinicians who were in various stages of orientation, training and clinical work in that unit. It was energizing to both try to teach them some things that I have learned over the last three decades, but also to listen to them and their fresh perspectives on current mental health problems, presentations and needs. 

I am learning all over again that we all have areas of expertise, things that we like and don’t like to deal with, work flows that we have worked out for ourselves and that flow smoothly for us, and tips and tricks to share with others. We have knowledge that can be pooled with the knowledge of others, making the one cohesive unit much stronger and helpful than just a loose confederation of people who are trying to get things done on their own.

In other words, we need to make sure our data is accessible to others and is usable. We need to connect. We are much more effective as a team than we are as lone wolves. 

Any Given Day

I love football.

There is one thing that I absolutely believe to be true about the sport I love.

Any given team can beat any other team on any given day. 

Sometimes my love of sports and the little metaphors that sprout from it spill over into my workspace as well. 

At the end of each shift I work in telepsychiatry, one of the last things I do is complete an electronic log of the consults I worked on and completed that day. I list the initials of the patients and the demographic information about them for the bean counters who hang out in Columbia making sense of what we clinicians do every day. I add a few diagnostic codes, and then I also look at a little drop down menu that allows me to describe in a few simple words why they needed to see me in the first place. The reason for the consult. 

On any given day, the pattern that jumps out at me is something like this:

Danger to self.

Danger to self.

Danger to self.

Danger to self.

Danger to self…

In other words, the vast majority of folks I see on any given day want to kill themselves. They are suicidal. They have tried to slit their wrists or overdose with pills or drink bleach or hook hoses up to car tailpipes or shoot themselves in the chest. 

Now, most days I am pretty circumspect about my job. I know that it is stressful. I realize that it puts me at risk myself to hear story after sad story about the woes and trials and tribulations that my patients bring and leave at my feet. Anyone who knows me, has had a conversation with me or reads me knows that I am a person who loves stories. I love to hear them. I love to tell them. I love to write them. I will go back to work at the clinic this morning because I know today, through stories, I will learn something that I did not know yesterday, something that I can use to help someone else tomorrow. 

On any given day, however, the stories can be so bad, so terrible, so hopeless and so horrible that they try their very best to not only beat me up, but to beat me. Finish me. Pummel me. Make me quit. Send me packing. Some days I feel defeated by them. Some days I am flat out of answers, suggestions and positive statements. Some days I slink out the back door, swiping my little electronic card to get out, half hoping that when I come back the next day it will malfunction and not let me back in. 

But you know, if this list of woe, this chronicle of misery can beat me yesterday, then today is a new day. It can be my time to come back, march down the field, score a last minute touchdown and win the game. On any given day, I can be the one who comes out on top, not the misery that the world would throw at me by way of my chosen profession. 

I saw a lady yesterday who is very, very ill. She is sick physically as well as emotionally. She knows this, and it torments her. She cannot do what she used to do, no, she will never be able to do those things again. She is depressed, sad, sometimes hopeless, sometimes suicidal. She has been in counseling. She has taken medications. She is only marginally better. She is worried that nothing is going to work, that she will never feel good again. 

I could sit there with her and commiserate, feeling sorry for us both, the defeated patient and her defeated doctor, helpless in the face of one of the illnesses that lead to more than thirty thousand suicides a year in this country. I could write her off as just another very, very difficult case that I don’t know how to solve, how to fix. 

That’s not why I went into medicine.

On any given day, my job is to be there for her, this lady who came shuffling in with braces and cane and aches and pains and depression to see me when she’d rather have stayed at home hidden away from the world. 

On any given day, my job is to be there with her, to listen to her story, find something in it that will guide me and teach me how to best help her. 

On any given day, my job is to try, and try, and try again, until there is no more time on the clock.

That is the only way to win, in football, medicine and life.