Doing more, but noticing less
THERE IS a training course for psychiatric residents on Thursdays from 9 to 9:55 a.m. Staff members give lectures on their areas of interest: medications, forensics, public policy, substance abuse. My interests are vague, and topics have ranged through the years: psychotic language, secrets, mistakes, lies, weeping.
I had come to the clinic an hour and a half before talking. In the mailbox, there were lab codes to fill out and fax, group home orders to sign, visiting nurse orders to review, an 11-page form from a lawyer seeking to overturn his client’s rejection for Social Security Disability Insurance, and numerous faxes from pharmacies requiring insurance prior approvals for various medications.
On the computer, there were treatment plans and guardianship affidavits, a mandatory online course about workplace harassment, and two weeks of Medicare time-study sheets. Also, as if someone had realized they were launching an airplane without an engine, there was an e-mail about a meeting that would be held to explain how to complete the time-study sheets correctly.
Many mornings, before the clinic door has opened for human contact, the day already requires deep breathing in a dark room. Each form and fax is equally important and equally unimportant. Their collective bulkiness fractures attention. We are bombarded with information from a hundred overseers, meant to improve what we know and do.
As a result, we do more, but we also notice less, which is unfortunate in psychiatry. That was the meandering point of the morning’s talk; under the weight of these mountain ranges of forms, how was it possible to concentrate in an undivided way, in order to listen to someone else? How could we hear one person at a time?
While I talked, most of the residents were listening in their way, which happens not to be mine. Hands under the conference table, they were deftly scrolling down e-mails, checking their own paperwork, calendars, and deadlines. I did not envy them their deftness. Undivided concentration is an antiquated concept. For me - someone wistful for an anachronism - bombardment is a breaking point. For them, it’s a day.
Elissa Ely is a psychiatrist.