Tuesday, February 11, 2014

P.S.A.: Don’t Mess with a Lady Injecting Herself with Mega Amounts of Hormones

I have been making a very conscious effort to remain calm and find my inner zen state. I am focusing on my breathing and on being mindful. I’m trying not to sweat the small stuff, or even the big stuff. I am trusting in the universe. Of all the non-medical adjuncts to infertility treatment, I personally believe that stress reduction will be the most impactful for me.

Yet sometimes it seems like the universe is working against me. My job has been extra stressful lately. I’ve had a lot of requests to take on extra patients, although I don’t have the time, and the expectation is that I “make it work”. My annual performance review is coming up and I have to prepare for that. I need to submit a paper before an approaching deadline. My clinical outcomes were due last week, which required a full extra Saturday of work to complete. I have an upcoming Grand Rounds presentation that I must prepare for. My emails explode each day and it’s nearly impossible to keep up. Patients are stressed out and parents call me in distress.

The biggest frustration at the moment is from our billing department. The expectation is the all charts are closed and billed within 48 hours, although sometimes I’ve heard 24 and my boss has told us he doesn’t really care as long as it’s within a week. Writing notes are the bane of my existence. I hate it. When I’m stressed and had a rough patient day and feel physically shitty (cue infertility drug effects), my chart notes are the first thing that I slack on. The billing department  has taken to sending daily emails to “remind” us of our outstanding notes (as in incomplete, not exceptionally brilliant and well written), which are then CC’d to five other people including my supervisor, administrator, and several other peoples that I don’t even know what they look like! Then, sometimes, these people decide that I need the email forwarded to me again, just to rub it in.

Usually I just ignore these emails. My boss has assured me that he doesn’t care because I always get the notes done in a timely fashion, just not quite as timely as the billing department would like. But coming up on my performance review, it still doesn’t look good. When I open my email on my phone as I’m sitting in the waiting room of the fertility office and see these emails, I can’t help but get annoyed. Plus, the whole principal of the this action gets under my skin. What a horrible way to motivate people! They don’t ever send positive emails, praising me for taking on additional patients, for working 13 hours in a day, and for closing the charts that I do get done on top of this. The system is entirely based on negative reinforcement and, frankly, is horrible for moral.

Plus, I’m jacked on hormones.

Today I decided to change my tactic. I am no longer ignoring the emails. I am now sending emails of my own, a mocking reply if you will. Their emails typically go something like this:

Good morning Dr. Psychologist,

The following charts are open….(bullet pointed list of patients). 

Please complete your documentation and billing. Remember that we are not able to bill for the service until the chart is closed. 

Thank you,
Ms. Billing Person

My nightly emails will be sent out to each of the 5+ people that have been receiving the negative news about me, and will say something along these lines:

Good evening Ms. Billing Person,

The following are charts that have all been completed and billed along with the other services that I provided for today that were not billable… (Bullet pointed list of all patients that I saw or communicated via email/phone...today this amounted to over 9 hours of patient contact). 

I am aware that not all charts are complete, as many of these charts require additional scoring or other follow-up, but I assure you that I am working on these charts and am aware that they cannot billed and I cannot get credit for the hours that I’ve spent with these families until this is complete. 

Thank you, 
Dr. Katie

Yes, I am aware this is passive aggressive. Here are my goal(s): either a) force them to acknowledge or at least be aware of the positives that I do (i.e. reply to the email with positive reinforcement vs negative) or b) annoy the crap out of them so that they see how irritating it is and tell me that nightly emails are not necessary, which I can then reply that daily emails in the morning are equally unnecessary. At the very least, having nightly emails of all the work that I have accomplished each day will make me feel better.

I’m about to force some behavior change here, people. Watch out! And if it all blows up horribly, you bet that I will be blaming the fertility meds and going for pity. Because infertility has to at least be good for a Mulligan every now and again.


  1. Oh boy oh boy oh boy. I HEAR you. I am not working right now, but when I was (as a social worker) I could not get over the negative reinforcement tactics. I LOVE your response and perhaps it is passive-aggressive but who cares? I mean, you are simply playing the game, you know, the one that they created. I don't understand these unrealistic pressures and expectations in our field. I'm so sorry you are dealing with this, but relieved that your boss sounds humane and understanding. Every night DH comes home from his job as a psychologist at the VA and has to bang out some complicated notes because of these arbitrary deadlines he must meet---he has to complete the note for each patient he sees in a day by the end of the day. And he, too, is asked to increase his caseload constantly.
    By the way this is The Unexpected Trip ("TUT") , theunexpectedtrip.wordpress.com. I created a google blogger profile so it is easier for me to comment on blogger blogs.

  2. You are so right, that is a horrible way to motivate people. And to CC 5 other people? Ridiculous.