Lifestyle / Medicine

A Psychiatrist’s Perspective of Time

As a psychiatrist, time dictates my day in the office.  My schedule is divided into 20-minute increments for patient follow-up visits and 40-minute blocks for new patient evaluations.  I try my best to stay within the specific time limits, but sometimes patients require a bit more time in order to effectively convey & discuss the diagnosis and treatment plan.  If a few minutes overtime are needed, I allow it, however, it’s also necessary for a psychiatrist to set boundaries on time because it can take away from each successive patient’s appointment time.  Even though some patients may take up more time than allowed, it’s my job as a psychiatrist to direct the interview and complete the entire session within a reasonable timeframe.

Sometimes patients are so anxious about disclosing information that they wait until the last minute when the session is almost over.  A psychiatrist should acknowledge the patient’s disclosure and triage/judge whether or not the issue is emergent and must be addressed, or if the issue can wait until the next appointment.  I’ve had to remain in the office after hours several times, mostly when a patient is an imminent risk and needs to be assessed for possible hospitalization.

If you don’t feel like you get enough time with your doctor, then you’re not alone.  Most doctors wish they could spend more time with their patients, but the pressures to see a patient within a short amount of time exists.  Over the past four years that I’ve been in practice, I’ve developed my own therapeutic style that allows me to to efficiently ask necessary questions while maintaining a connection with my patients (hint: such techniques involve direct eye contact, spending the first few minutes allowing the patient to talk uninterrupted, acknowledging factors in their lives other than solely discussing meds, etc).  In a 20-minute session, I probably average spending 25% of the time discussing medications.  A psychiatrist’s job isn’t easy — I may be a physician, but I’m also a human being and can’t help but be impacted by my patient’s heartbreaking issues. Therefore, prioritizing time for self-care is absolutely necessary.

I utilize my weekends doing non-psychiatry activities (with the exception of blogging & social media).  I used to be on-call at my previous job, but realized I needed weekends off to maintain my sanity.  I admire anybody who takes call on weekends, but for me there was nothing worse than getting paged at 2 am and driving to the hospital half asleep.

Having made career decisions that doesn’t compromise on providing the best quality of care I can nor the people and activities that are important to me, I feel much more balanced with my current part-time schedule.  I used to feel extremely constrained by time (I still feel that way, but not nearly as much), but these days I am far more in control of how I choose to spend it.

Watch: c/o JORD (For the link to my watch, click here)

 

9 thoughts on “A Psychiatrist’s Perspective of Time

  1. My pdoc works 20 hours a week and he’s very much into self-care – I know he used to work much more than that & it burned him out! 🙂 He’s a wonderful, inspiring, grounded person….just like you!

  2. Where do the constraints of time come from, if I can ask? Is it having to make the bills and keep the lights on, or is it insurance making medicine a commodity, or some other reason? 20 minutes is so short of a time period. Apologies for sounding jaded, we have been having a time of finding a new psychiatrist for my wife to see. My wife’s old psychiatrist moved out of state, and the “new” psychiatrist(s), really don’t have experience dealing with grief. On a positive note my wife’s old psychiatrist is working over Skype, so she may have a way of seeing her again. BTW love the time piece, I got a add last week from Woodford Reserve that a artist was using their old bourbon barrels in making his watches.

    • Hi Bob, i apologize for the extremely late reply as I’ve been sidetracked from prioritizing my blog in the last few mos. As far as time constraints, I’d say it’s the factors you listed. In order for private practices to stay afloat, it’s a balance between maintaining quality of care, being able to meet the high demand (there’s a shortage of psychiatrists who esp accept insurance), and insurance reimbursement.
      Glad your wife was able to continue seeing her previous psychiatrist…telepsychiatry is definitely growing! And yes, it’s hard to find a clinician who has experience with grief, which is why i’m continuing to try my best to educate our future docs/therapists about grief via social media (and you’ve helped me gain experience with this topic as well by sharing your experience and i’m so appreciative of that).
      And what a unique watch to use old bourbon barrels — what a great idea! Hope you and your family are well.

  3. Although I am a therapist, I share with you the pressures that come from constraints of time. It is incredibly difficulty to say no to patients who need services and the only time available is that dedicated to completing notes and assessments – which in my opinion are equally important for the continuity of care. I don’t comment often, but wanted to share that I appreciate your transparency and willingness to share your experiences. I always learn something and feel a sense of community while reading your contributions. Be well,
    Anna

    • Hi Anna, thank you so much for your kind comment. The work we do is rewarding, yet hard knowing there’s such a huge need for mental health services. But yes, we must prioritize our own time as well otherwise our own wellbeing & productivity becomes impacted.

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