Monday, August 15, 2011

My Next Appointment Is..

I've been at it a long time, and one thing (of many things) that I still have not gotten down is scheduling.  I seem to have a method to my own madness, but somehow I imagine it's not how other people do this.  I've heard other shrinks say, "I'm booked for the next 4 weeks" or say they aren't taking any new patients.  Some people put a "no new patients" message on their answering machine.  Wait, so no appointments for 4 weeks?  What if a patient calls and needs to be seen very soon? Like this week?  If you can't wait, go to the ER?  I thought the point of having a private doc was that you didn't have to go to the ER unless something couldn't be handled safely as an outpatient.  And if you tell the world that you don't take new patients, then don't people stop referring to you?  It seems to me that patients will come in and announce, "I'm doing better and want to come less often,"  "I'm moving,"  "I'm done," or they will cancel an appointment, not call back, and not be heard from again for weeks or months.  Sometimes it all happens on very short notice and life can be very unpredictable.

In my pre-shrink days, I thought that psychiatry worked such that patients came every week (or twice a week, or whatever) and had their own slots.  Tuesday at 1, that's me!  So a psychiatrist had every slot full with patients this way, and could be "full," until a patient finished and stopped coming, and then another soul was let in to the Tuesday at 1 slot.  Gosh that would be nice, but it doesn't seem to work that way.  Patients have job obligations or class schedules or sick relatives or childcare responsibilities or they have treatment for other medical conditions that have to be scheduled.

Prospective Patient:  "Are you taking new patients?"
Shrink:  "Yes.  I have Tuesday at 1 available."  
PP: "Every Tuesday?  I'm a college student and I have a class that meets Tuesdays at 1.  And I'm not sure I need to be seen every week, don't you need to evaluate me to know if I even need therapy?  Or, I can't afford to come every week."

So what does the shrink do?  Turn that patient away?  He has a class at the only open time.  And when the neighborhood internist asks, "Are you taking new patients?"  Does he say, only if they will come every Tuesday at 1 pm?  Funny, answering machines never seem to say, "I'm only in the Blue Heart Insurance network and I only have one opening for Tuesdays at 1."

I tend to keep things looser.  Some patients have set time blocks, but with most people, even my weekly patients, I've found it works best --for me, in my own chaos-- to set appointments as we meet.  I generally have space in my schedule so that if someone (an existing patient) calls and says "I need to come in" and they can be flexible, I can fit them in within a day or two.  And even though much of my scheduling is done at the last minute, my schedule end up mostly full.  When it gets very full, I start wishing I was a little more organized about it.  You want an appointment in two months?  Oh, call a week or two before you want to come in.

The truth is-- and it took me a while to get here-- this fits in best with my personality.  If something fun comes up, I don't have to say "sorry can't do that" because my schedule is etched in stone.  I once moved all my patients to fly to Boston and sit in Green Monster seats (Rob, that's for you).  I like being able to roll things around, and I can't ever get my act together to plan vacations far in advance.  So when a patient comes in and says "I can't keep coming Fridays at 1 because I have a new job," or someone calls with a problem and wants to come in, I like being able to accommodate them.  And am I taking new patients?  If I'm feeling rushed and over-scheduled, then I'm not. especially if I already have any new evaluations in my schedule... but next week, who knows?

You'll tell me what works for you?