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Thursday, July 16, 2009

Traffic and Weather

I’m taking a 7th inning stretch, moseying into my colleague’s office to say hi. She’s aggravated because patients aren’t showing up.

“Do I charge them?” she asks.

“For sure! Charge ‘em!”

I’m in a take-no-prisoners mood, who knows, why, but have spent a good deal of the day working without a break. And the day started at the hospital, checking on my father. Every morning this week is at the hospital, which I don't mind, but I've been driving there, which is bad enough, and hate the parking lot, going around and around and around and around and around.

And there's no time to get home after the visit to change clothes to ride my bike to the office. There just isn’t time to waste.

So in general, I’m a little out of sorts. And some of the crank, for sure, is my father’s because he’s the helpless one lying around in a hospital bed.

I haven’t even told my colleague this, none of it, because (a) there hasn't been a lot of time to talk, and (b) I don’t want to talk about it. That’s what a blog is for anyway.

She says, “Charge them? How do I charge them? Should I call them up on the phone right now?”

“Don’t be silly! When you can talk to me? You'll get a call for another appointment and will say, ‘By the way, you know you owe me for the last visit. You didn’t show.’

And your patient will say, 'Oh, drat! I forgot!' or will spill out some excuse. Then you'll give that little speech we give." (Most professionals have a variation of this one.)
Sure, I understand, but you're supposed to at least call, we had a deal, even if you're sick, or have a funeral you have to go to, and you stole another patient’s time, because there's always someone who wants a cancellation. But no one could take your spot because it wasn't open cuz that didn't happen. That's why we charge, it's why I charge. Makes people more sensitive to other people the next time.
"You deliver the lecture," I tell her, "get paid and are no longer resentful and grumpy. The world is beautiful again."

“I’ll try it,” she says.

She might, but she probably won't charge. We social workers can be all mush.

ANOTHER STORY

So today I say to FD, “I’ve had it with driving. I’m riding my bike to the hospital and from there I’ll ride it to work. I’ll leave early so there's plenty of time.”

He’s skeptical, “Uh, that adds 11 miles to your bike ride.”

“No way,” I say. “And anyway, it’s all bike trail.”

For the most part it is bike trail by the river, meaning easy riding, and the only real danger is urban cougar, the feline species, and an occasional tricyclist. (By this we mean child on a tricycle, not someone on an antidepressant).

“You’ll see how far it is. It’s going to be tough. I can drive you, do what I have to do, then pick you up at the hospital. Then you can drop me off at work and have the car,” he continues.

“Senseless. It’s a beautiful day. Birds gotta’ sing, girl’s gotta’ fly.”

And it is fine, it truly is, for the first mile and a half. I’m very out of shape, have had no time this summer to get on my bike most days, and when I have done it, it’s been slow going. I’m not the person I was even a year ago. Enjoy your youth, my friends.

But I get to the hospital, no worse for the wear, and lock up my bike, take off my helmet and take a deep breath. I’m a half an hour late and for sure have missed the doctors. I want to talk to one of them, at least. Anyone on the team will do.

I get up to my father’s room and he’s rearranging the hoses and tubes that are sticking out of his arms so that he can sit down comfortably in his recliner. The drips are full of diuretics to get the excess water out of his body. The kidneys aren’t working, the heart’s not working, nothing’s exactly doing what it’s supposed to do. He’s braced himself for disaster and has been very philosophical.

“The food here is good, but I’m not hungry.”

“You’re sick,” I say.

“Yeah.”

“And it’s sickening, right, being sick, so how could you have an appetite? It would be weird to have an appetite, I feel.”

He laughs and shows me the paper and pencil review he’s given the nurses and the doctors so far. He has been very positive, very happy with his care-givers.

“I love it," I say. "You know, there are people who won’t give a positive review. No matter what, they will find something wrong with the people who are just trying to get through their day, trying to be helpful.”

“And those people are wrong!“ he confirms quietly. “They should write a good review anyway.” He would tip even the worst waitress. “Even if they’re terrible you tell their bosses how good they are. Then they’re not so terrible. They get better.”

Right, Dad.

We banter about nothing, and I realize that if I don’t get back on my bike I’ll be late for work and can’t let this happen. Mom will take the next shift pretty soon, anyway. I buy a bottle of water at the snack bar before leaving.

The ride to the office is LONG (about seven miles, FD is right on the money) and I have a sandwich in my backpack and I’m thinking maybe I should stop and eat or have a drink. There are plenty of park benches calling my name, but worry that if I do, and something happens, maybe a flat tire, I’ve wasted time eating and drinking. I hate being late. And I’m not hungry, anyway.

But I get to work in plenty of time and my fish (2 baby maroon clowns) are thrilled to see me. I feed them and they think they've died and gone to heaven. There are patients who have been calling all morning long on the office line, my cell phone, too, that I should call back, so I get to that. Eeeny, meeny, minee moe.

By 5:30 my back hurts and I reach for the Advil, pop open some email, too. One says in the subject line, 'I'm venting.' Why not? What's a therapist for?

There’s one more appointment to go, a 5:45. I get the call.

“Doc?”

“Yup, where are you? Caught in traffic?”

“Yes, how did you know?”

“I’m a genius.” (I don’t say this)

The city has been impossible, one of the allures of biking. Chicago has a short summer and construction begins and we end, so to speak, with the good weather. It is possible to spend the best hours of the day behind the wheel.

“Oh, a little birdie told me.”

“By the time I get to your office our time will be up,” he moans, remorsefully.

“We can talk on the phone,” I tentatively suggest.

“Okay!”

“But you’re in traffic, I just remembered, and I want you to pay attention to the road.” And I’m thinking, I can leave! I can go home!

“Can we reschedule?” he asks.

"Lemme look."

I find him a spot next week, knowing there's money lost here. I tell him, “I’m not charging you.”

“Thanks!” He’s so happy.

“Have a great night.”

Fact is, I could have charged him, and he would have gladly paid me. But he is powerless here and I am happy here and why would we punish either of us for either of those things? Hey, and he's called.

I pack it up and am out the door. It’s threatening rain, but you know, it’s that light summer rain that doesn’t bother you, the kind that sort of wakes you up, reminds you what it’s like to be a kid again, not worried about things like rain.

therapydoc

33 comments:

TechnoBabe said...

Your life is packed in heavy duty busy. Why haven't you told your colleague about your dad? Aren't you very close to her? Maybe your bit of crankiness is concern about your dad. He sounds like a positive, caring guy. My hubby is like you regarding bike riding. He will get to the bike trails by riding the bike up and down hilly (too hilly for me) neighborhoods and then ride 10 miles on the bike trail and then head home.
Jeez, you bikey people.

Retriever said...

What a wonderful dad you have! This must be hard for you, but also good moments when you can sit companionably, all dross refined away and a moment of pure love to take you away from tubes and worry and anxietities about being too late or someone being gone.

Brings back memories of when my parents were sick. It helps, I think, to keep the two worlds separate some of the time. Your biking a healthy way of bridging the gap between two very different worlds, each calling to you, but such different tugs at your heart.

When my parents were so ill in British hospitals, I would deliberately walk for miles rather than take the bus (a safe area) to work the knots and kinks out, calm myself down by plodding. That and I would photograph the roses blooming in a riot of beauty as my mom faded and slipped away. Does ypur dad stll smell things well?I remember snapping off a sprig of rosemary from a front garden on one walk and my mom's delight as she inhaled it (she always loved Mediterranean cpooking) and iot blotted tyhe hospital smells and stirred up so many happy memories. I am praying for your dad and for you, that you and all your family feel God's love holding you close, breathing strength into all of your family, helping you hold onto what is precious despite bodily ills. :)

Lisa Marie said...

Good for you riding your bike and getting some exercise and sun. I've got to find the strength to do this as well.

SocialWkr24/7 said...

Ugh I wish I lived close enough to bike to work. I have a stiff neck, jaw pain, and am cranky as heck by the end of my evening commute. I hate Chicago traffic in the summer! (I hate it in the winter too- but for totally different reasons.)

ejo said...

People actually just don't show up for their appointment? And these are grown-ups? Amazing.
I will say in my experience as therapy user (as opposed to therapy provider which I am not) the two therapists that I've encountered don't seem to be all that consistent with their billing process. Is this something inherent to therapists? Lack of (or denial of...hmm) accounting skills?
If I was a therapist - or any other independent provider of services for that matter I would make sure to write out my billing policy on a lovely piece of professional looking letterhead and hand it to my clients in the end of the first meeting under the guise of "here's my information packet". That way they know up front what the billing policy is and then there doesn't have to be any therapist guilt when they do send a bill for missed appointments with the specified window. There should not be any guilt or doubt about sending a bill in this situation anyway but things being what they are. Perhaps college level social work programs should include several semesters of mandatory accounting and businness training.

therapydoc said...

TECHNO, I love her, but if I'm upset I feel better not thinking about whatever it is, especially if there's nothing I can do about it, and talking belabors things. The truth is there isn't a lot of time for naval gazing at work. If something really bad were to happen, G-d forbid, she would be the first to know. He's getting out today, I'm pretty sure :)

Fact is, I only posted this one because it had something remotely connected to the subject of cancellations. I was going to title the post, "CHARGE 'EM!"

RETRIEVER, thanks! Great idea.

LISA MARIE, go for it.

SW24/7 You would think this could be spread out, the construction, but in the winter they're busy filling potholes. At least the city puts people to work.

therapydoc said...

EJO. You would be right-on with that, the policy blurb, and they will be quick to explain to you why they are the exception to the rule, which is why, we tend to have to make some. But we don't have to do that, make those exceptions, is the truth, and there are people who feel we're a very co-dependent bunch of professionals as a result. And there's some truth in that, maybe. How I'd love to see that study.

Lisa said...

Sickly parents and patients that are no shows. Sounds like my life. Except I don't have the traffic problem. But I DO have two teenage boys, so I count that as often feeling like I'm stuck in a traffic jam.
I try my best to stick to the policy of "no shows get charged" and also "cancelling less than 24 hours, you get charged." It's HARD to do that. But what am I modeling for them if I counsel about boundaries and assertiveness, and then turn around and be a casper milk toast? Also, the problem of, "ummm...I'm not getting paid for an empty chair." But it is so hard sometimes, because those of us in this providing services for those in need thing brings on GUILT...then the parents...then the teenagers.....thank goodness for blogs. It's great venting!

Barfly said...

Thanks for the weather report, Doc.

The Rebbetzin's Husband said...

I sometimes wish I charged people for appointments, just so I could charge them for missing the appointments, or being exceedingly late for them.

But my real peeve is doctors who charge late patients, but who themselves have no problem making you wait an hour...

Lou said...

People who don't call to cancel their appointment are very similar to the people who raise hell if not taken in on the dot.

That's what I like about the ED. Whenever someone starts complaining about how long they have waited, I can say "there was a critical emergency, I'm so sorry."

What can one say to that..
(and no, I don't use that lightly)

Mark said...

You are a busy woman. Hope you Dad does well.
I agree on having people pay for missed appointments. Makes sense.

Mark said...
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Dreaming again said...

I've missed 3 appts ... 2 were their fault ... they told me 3 pm and I showed up at 3 pm ...to find out my appt was 2 pm. Thankfully, I had the card that showed the 3 pm on it!

The other one ... I was incredibly ill and got home from school, dove into bed with 103 degree fever. She emailed me what "what happened" (more precise) and I told her what happened. Thankfully, she let it go because it was a legitimate reason.

When I saw her again (she was fairly new at the time, I'd only seen her a handful of times) she said "you just don't seem like the type to just miss ..." um ..no, I don't miss I don't show up even 5 min late. If I have to, I call ...


Thankfully, my reputation held ground.

The clinic policy is $50 before you're seen again for a no show that doesn't have 24 hours notice. (which is a problem since my appt is on Mondays ..and I can't exactly call on Sunday! On Fridays I don't know I'm getting sick over the weekend! So, unless I'm too sick to function ... I go in ...which usually leads to the better sessions!!!! Maybe my guard is down when I'm not feeling my best???)

porcini66 said...

I just got back from visiting my dad, 86 and slowing fading. And, upon landing at the airport, scheduled a meet with my T - I promise not to be a no show. So many hard emotions to cope with as we watch them age and, at least for my folks, rail against their failing physical abilities.

As I left my beloved mountains, I thought to myself that this may well have been the last time that I see him alive. He is slipping pretty quickly now even though his mind and spirit are so strong. Hardest I think, is not being able to be there, to help, to ease the transition, to share in the precious few moments that we have together.

Really, I understand not talking to your colleague about it - some things are just too big to fit into the day to day conversations that you have. I'm glad for you that you can be with your family. Embrace it.

Lisa said...

Yeh, I'm married to a doc. As much as he tries to stay on time, there's always some emergency that takes more of his time than he thought, or a doc calling him about another pt that needs info on immediately, or the mother of the child he's going to be operating on is anxious and asks a million questions....his day is late before he starts sometimes...he tries to have the staff let people know if he's running late, but wow do they get upset. Even if he spends JUST as long with them when it's their turn... And it does seem to be the ones that don't pay...but that's another post. In the therapy world, it's more rare, I think to "run over" the allotted time.

Isle Dance said...

Isn't that the way life goes sometimes? Perfectly imperfect.

therapydoc said...

Thanks, all. You said it, Isle.

Anonymous said...

I miss rain, I love the desert but didn't realize this spot of it was the sunniest with less than 3" a year. I wish I lived in Tucson and it would be cooler to cycle. It's so hot here that yesterday afternoon I was outside in the shade talking and I licked my lips and realized my tongue felt cold on them! Keep biking! Keep blogging! Take care!

therapydoc said...

Thanks, Anon.

Dr. Deb said...

I definitley charge when the behavior warrants it. But as you say, when someone is powerless there are exceptions made.

blognut said...

Sorry your dad hasn't been well - that's a tough one.

As for missing therapy - I wouldn't! Not ever! Well, except that one time when I got in an accident on the way there. I figure I wouldn't be in therapy if I didn't need it, so why would I want to miss it and delay progress?

Also, if I did blow it off or simply forget to call, I wouldn't even wait for the lecture. I'd feel guilty and offer up the check right away. I'm like that. I probably need therapy. :)

Cate Subrosa said...

Great post, I love your story-telling.

Hope your dad feels better, gets his appetite back.

Lisa said...

I had an interesting experience yesterday, and it dawned on me that it happens often. Your taking that 7th inning stretch prompted me to consider the "debriefing" aspect....I did a family group session for chemically dependent kids who are in residential treatment. I do this once every 8 weeks as a consultant. It was a particularly rough group, none of them particularly ready to admit to their addictions. When I came home, I had indigestion, was in a fog, and was a bit nauseous. It took about an hour of sitting outside playing with my dogs to "let that session go." Tuesdays are generally the roughest day of my own practice. I often feel the same way when I come home. There's nothing left of me for awhile. Now, I'm relatively new to private practice (8 months). I'm asking myself, "what am I doing to have this reaction? and what do I need to do different?" My colleagues often hunker down for the day in their own offices doing testing and what not. Plus they are way more experienced...do you need to debrief about clients, or how do you transition back to home life without feeling physically like you've been beat up?

therapydoc said...

BlogNut, that conflict avoiding thing is surely not the worst character trait, we like passive over aggressive, any day. But it doesn't always work in a person's best interest. That's why I'm always nagging people to be assertive. just say it, no emotion, jut the facts.

In this case, "Hey, we're a little strapped for cash, can we negotiate a little?" (assuming that's the case and you think it's fair).

CATE, thanks!

Lisa, I tend to hit the pedal and kick up the radio, unless I'm on my bike, in which case I hit the pedals and kick up the radio.

Jim Valeri, LMHC said...

This post totally hit home for me. I can't tell you how many clients take advantage of the idea that we are a "touchy feely profession." On more than one occasion I've had people covered by insurance one minute, and then have a $1500 deductable the next. Once they figure that out, *poof*, they're gone.

This is why I set up a credit card form on the intake. Almost all my clients ask me about it and I'm very upfront about why its there. If they late cancel, I charge them a $25 fee, which I think is reasonable. If their insurance doesn't cover the session, and either they know and don't tell me or don't know period, we're all set. We try to work out a reasonable fee depending on their situation, and as you say "the world is beautiful again."

It just makes that whole process easier. I do get the idea of lenience, and excercise it in certain situations, but sometimes I have to really look at this as my business. If I don't value my time, and don't teach that value, then I won't be in business or helping people very long, will I?

That and my wife does my books. She makes damn sure I charge the fee. I guess that's how we can keep working together.

If you can't pay your bills, you can't keep helping. So I encourage you and your colleague to remember that. Many of my clients have small businesses as well, and they appreciate the honesty right up front. Touchy feely business, but still business.

Keep rockin'!

therapydoc said...

Thanks Jim. You're right, of course, and that policy, $25 is very reasonable, maybe more than reasonable, considering for many it's a "co-pay" so no one gets cheated. But your wife is right that you do, and this is as good a place as any to reiterate that we cannot charge insurance companies for missed visits. It's not an IF at all, it's called insurance fraud. The responsibility for our time remains solely with the one who has contracted to use it.

And you can always blame the boss, your wife, I guess, if someone isn't happy about it.

CBS Radio said...
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April_optimist said...

Just wanted to say I'm sorry your father has been so ill. Also just read your post on endings and found it particularly poignant as my daughter moved away this summer and we're in that process of figuring out what our new relationship/forms of connection will look like.

Tzipporah said...

Your "tricyclist" comment made me actually snort out loud. Thanks for that. :)

Hope things go better for your dad.

Anonymous said...

DIfferent topic I suppose, but I'm wondering if you charge patients for phone calls after hours?

therapydoc said...

APRIL, you'll love this one. On the way home from work I go to the fruit store. I come home with a trunk full of fruits and veges.

The young woman visiting her parents next door (with several children, pooh, pooh, pooh) asks me:

So do ANY of your kids still live at home?

Do I throw the squash? What do I do. I grumble and say we've still got one, thank you, but the rest are all graduated.


TSIP, no lie, I liked it, too. Had to wonder, however, if anyone would be insulted (and if anyone is, please forgive, it's just my way of keeping it light, blame FD who puns over everything.)

ANON, Not generally. I will charge if I've really gone over an hour, and I'll tell people, at some point you know you're paying for this, but generally find that I can talk on the phone and still wash the floor or do some dishes, so the extra words in my brain don't usually bother me.

But if I'm in a bad mood I won't even call anyone back, and people who see me professionally understand this.

Cat said...

I bike the lake path as often as I can and the reason for it initially was because of the exercise but this year it is becuase I really enjoy the morning and afternoon commute on the lake front, out of the traffic of lake Shore drive - getting my vitimin D and my exercise.

Something about that just makes life feel good. Ya know? I think you do.

Your dad sounds like a really loveable kinda guy - we should all be so lucky to have such faith from a stranger!