Docsplainin' -- it's what I do

Docsplainin'--it's what I do.
After all, I'm a doc, aren't I?



Friday, August 22, 2008

Blonde moment, 33 copies

It never fails. I always leave for a trip knowing I've forgotten something, and it's kind of a relief when I figure out what that something is and it's a minor something, like a toothbrush, rather than some disastrous thing, like forgetting to unplug the iron.

My syllabi are something like that: There's always an error somewhere. This one says that my Ethics students' reaction papers should use their student ID numbers in place of the Running Head as their only identifier---which does me no good at all should the pages of a paper become separated, because the Running Head only appears on the front! I meant to say, "manuscript page header", which appears on every page.

E-mailed everybody and got that straightened out before the first paper is due. Heaved a big sigh of relief.

If that's my only misstatement, we'll be in good shape.

Monday, August 18, 2008

And You Know It's STILL Monday

when at 11:12 p.m. you've spent what seems like forever trying to copy and scan an article from the textbook that didn't get ordered, on the world's possibly slowest home copier/scanner, so your students can read it before Wednesday because you've based almost your whole lesson plan around discussing it and you finally get it ready to upload and then the school's frickin' website won't let you because it's too big so you try to e-mail it but that won't work either because the school's e-mail system has the same 20MB size limit so you send all your students an e-mail saying you give up but you'll try again from the office tomorrow where you have a faster copier/scanner and maybe you can get the article into some other file format that will go.

Maybe.

If you're lucky, and Tuesday goes better than Monday did.

It's Definitely Still Monday If...

  • ... you spend 20 minutes circling the parking deck looking for a parking place.
  • You give up and spend another 20 minutes just trying to get out of the parking deck, which by now is a three-story traffic jam.
  • You drive over to the alternative parking lot you used last year and find that it is now closed to faculty.
  • You finally, in desperation, park illegally and are still five minutes late to class.

You Know It's a Monday When...

  1. It's the first day of class, and you can't find your ID--which unfortunately, is also your key to your classroom.
  2. You aren't even at your first class yet, and you're already getting e-mails from students saying that the book orders--for both classes, no less--are screwed up.

Saturday, August 16, 2008

Professors From Hell

I'm really excited about school starting Monday. I love teaching.

When I went back to grad school (for my 2nd masters & my doctorate) my first professor on the first day was John P., Ph.D. John was, without question, one of the best instructors at any level on any subject that I have ever had. Watching him teach was like watching a piece of performance art--every single class, he gave his all. High energy, encyclopedic knowledge, a sense of humor, passion, style--that was John. And one day in class, I remember thinking, "That looks like fun."

My first year out of school, I was lucky if I had six clients in a week, so in order to keep body and soul together, I decided to look for part-time teaching work. As it happened, a local commuter college was looking for someone to take over a course at the last minute, and I got the job. But I had gone to a professional school, and they don't have any interest in teaching teaching, so I graduated without any experience at all. As a result, I was pretty awful. I read a joke to open my first class. But I was right about one thing: This is fun! I loved it from the get-go.

Now, as I wrap up preparations for starting another semester, I think not only about how I wish to teach, which is to say, 'like John', but also about the burden on me how not to teach. Which brings us to the first Professor From Hell. (Further installments to come.)

This gal nearly drove us all crazy. We were beginning a series of three classes about which I was pretty excited as the topic had not received much coverage in my first Masters degree program. I was looking forward to this class. Boy was I disappointed. This instructor was a student of the Dean's from her grad school days at his previous place of employment, and I believe he'd hired her because he liked her rather than for her talents she had as a teacher, since we could never detect that she possessed any.

In preparing for her lectures, she xeroxed the text, then literally cut and pasted sections of it onto legal pad pages and read it to us! Talk about tedious. Hour after hour, she would read. Watching her was more painful than watching grass grow. We asked her not to, but it made no difference. On she read, relentlessly. We complained to the Dean, but it made no difference. She kept on reading. This was back before everybody had cellphones in their pockets or laptops in their backpacks, so we were hard-pressed to find ways to entertain ourselves. Two or three people would fall asleep every class period. Our class clown tried to lighten things up, but after the first few weeks she took him aside during a break and told him if he kept it up all the professors in the department would hate him and it would affect his grades. This reduced him to gloomy silence punctuated by snoring, and left the rest of us to our own devices to stay awake.

I can't say I learned much on the topic in her class, but I did learn something about how not to teach: Every semester I vow that whatever else happens, "I will not be boring!"

Friday, August 15, 2008

Managed Care is Killing Me

The economy is going into free-fall. The cost of consumer goods is up 5.6% this year, the worst it's been in 17 years. Tax collections in our state are down by more than 6%. Population growth has slowed in the 10-county Metro area. Home values are plummeting in the midst of rising foreclosures. Our state's jobless rate is at a 15-year high and expected to get worse. Everywhere you look there's more bad news.

In the meantime, what insurance will pay for our services has remained stagnant--or declined. Psychologists are probably the only professional group that has lost ground in the last few decades. Managed care is killing us.

One way in which it is doing so is by adding significantly to the paperwork/case management burden that we face. Just one small example is this fax memo I received from one company:
  • Wellness Assessments are to be completed in your office at the time of the initial evaluation and faxed to [insurance company]
  • A second Wellness Assessment is to be completed in your office during the 3rd, 4th, or 5th session and faxed to [insurance company]
  • A set of algorithms are applied to all Wellness Assessments designed to identify potential clinical risk
    • Some potential risks yield a letter that requires you to determine whether the identified concern has been fully assessed and, if applicable, addressed in the treatment plan. It is strongly recommended that you file the letter and document that the risk is being addressed in treatment or has been ruled out in the course of assessment/treatment
    • Potential risks that yield a Care Advocate outreach call require you to complete a brief clinical review
For members who have seen you in the past and return to treatment, representing a new episode of care, the Wellness Assessment should be completed even if the member completed Wellness Assessments during a previous treatment episode.

During the first two quarters of this new initiative, you have seen between one and five new referrals. In all or most cases, a Wellness Assessment was not sent. Please review these requirements to support your implementation of this process.

This is a level of supervision which I have not received since I was in grad school. Let me just say that I don't need an insurance company computer to tell me when a client is at risk or a Care Advocate to tell me--after the fact--what to do about it!

A Wellness Assessment, by the way, asks some very intrusive questions of the client:
  • In the past month have you felt you ought to cut down on your drinking/drug use?
  • In the past month have you felt annoyed by people criticizing your drinking/drug use?
  • In the past month have you felt bad or guilty about your drinking/drug use?
  • In the past week, approximately how many drinks of alcohol did you have?
This is protected information that is now going to be faxed to... who? A clerk? I certainly don't know. And besides running algorithms on it, what will they do with this information? It's not anonymous: It asks for complete identifying information at the top.

These are actually useful questions, as are the others on this sheet, but they are also questions that competent therapists routinely ask. Why we should have to ask them twice and fax them in for someone to second-guess us (we are, after all, fully licensed to practice psychology independently) is beyond me. Besides which, all this c**p takes time I could be spending with the patient! Actually helping them with these problems!!

Thursday, August 14, 2008

Never a dull moment in this job!

Just when you think you've seen it all, the Forest Service brings a handcuffed guy in for an evaluation: Seems he spent the night in a tree overhanging the river that runs through our National Forest, and the Service was concerned about his mental status.

He's still brushing twigs and duff from the forest floor off of his clothes and knocking stuff out of his hair while you're doing the interview.

When you're done, he bows and kisses your hand like a knight of old.

Then the county sheriff handcuffs him and takes him off to the state hospital.

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