Thoughts on the new job (in no particular order.)

I love what I do. I love seeing patients, love figuring out what’s going on, love working with them to get to a medication that works.

I hate ‘administration’. This is important to know, because I entertained delusions of being an administrator-clinician for a while. That is not me.

The existing evidence no longer applies. I’m seeing patients, lots of patients, every day. These patients do not fit the DSM criteria. These patients do not fit the profile for any one medication. Often, they come to me already on a combination of medications that reflect the desperation of clinicians past to try something, anything. Yet, these patients are not unique. They are similar. To each other. I’m starting to see patterns that I have no name for, but they exist just the same. I doubt these will ever make their way to the DSM-V, or VI. I have to find a way to document them.

For the past couple of weeks, I’ve considered going old school. Keeping clinical notes. Of syndromes, patterns that I see. What works. What doesn’t work. To see if a plan emerges. To see if I can help.

It’s going to be a long, interesting journey. I only hope that something useful emerges at the end.



About purplesque

Psychiatrist, cook, bookworm, photographer. Not necessarily in that order.
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17 Responses to Thoughts on the new job (in no particular order.)

  1. Knot Telling says:

    First – yay! A post!

    I am old school, and old, I guess. Is most clinic work protocol-based these days? Is keeping that kind of clinical note unusual now?

    ‘Scuse me now while I get some youngster with good eyes to thread a needle for me. 😉

    • purplesque says:

      Thank you. Keeping personal clinical notes is definitely unusual now. While I do write patient notes for the chart, they are heavily protocol/insurance requirements driven and not really useful for this purpose.

      Shall I mail you a self-threading needle? 😉

  2. Zotta says:

    Purplesque, you are right. My shrink thought your presentation at the APA was cutting -edge, and he was right. It sounds like you are pioneering, and who knows you may have new entries
    for the next DSM. Or perhaps web updates for in-between print editions. You go. Right on! Not everyone who’s been in it for thirty years keeps up with new developments(in life) or in the field. Yes, OMG, yes. Keeping that kind of clinical note is so very important(IMHO- to use an old term).

    • Vijay says:

      What is this presentation that you speak of? How come we haven’t heard a croak out of the froggy about that?!

      • jaklumen says:

        Yeah, I missed this, too.

        So… how come I don’t hear croaking, either? Croak, froggy, croak! (I mean, I might be able to *use* this information, y’know?)

      • purplesque says:

        You did. This is what I went to Hawaii for, remember? I studied if the MoCA (which is a cognitive screen similar to the MMSE) could be used to assess cognitive impairment in people with mood disorders, mostly because it has a big executive component that the MMSE doesn’t. *sigh* Should publish that paper.

        • jaklumen says:

          I need reminders now and then, for although my memory is said to be elephantine, it’s not perfect. Perhaps Vijay has similar sentiments.

          I would think if you could re-summarize it for us again, that might help you publish that paper?

          • jaklumen says:

            p.s. I’ve been discussing paraphrasing and effective communication with my therapist, as well as with my father (for his own reasons and needs). Don’t want to take precious time away from you but I do think it would be beneficial for you, as certainly all the more for us, to summarize what you have studied and will be writing (as much as you can and are allowed to).

    • purplesque says:

      🙂 You’re always sweet to me, Z. Thanks.

  3. Lurkertype says:

    You might end up really helping a lot of people you don’t ever see and influencing the next DSM. Do please keep notes! It’s the only way other syndromes are ever discovered.

  4. I’ve noticed that the physicians at my parents’ HMO enter all of their notes on a computer right there in the examination room. It made me wonder if that made taking notes easier for the doctor, or if it encouraged him/her to keep them brief and minimalist. What if I found out the doctor was writing in text-speak? “Patient LOL @my jokes!”

    I’m happy you’re still interested in doing academic research and presentations. Is your APA presentation online, as text or video?

    • purplesque says:

      🙂 You got me! I always take brief notes now when interviewing patients, to help with my more extensive chart notes later. There’s a lot of shorthand, and definitely using @ for at. I wouldn’t use my instant notes as the final ones, though- they need a lot of rearranging/tweaking to tell the full story.

      The presentation is not online as far as I know; I’d hoped to write that paper and have it published long before now. *kicking self gently*

  5. The pure joy of enjoying your work – it is a precious gift. So glad that you are sharing with us.

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