A Day in the Life of a Generalist Department Therapist: An internal dialogue
Waking up, it’s 7am on Tuesday. I start work with my first patient at 9am and off at 6:30*.
I really should get a run in or at least some yoga before I start work. Im so tired from yesterday though, I don't think I have it in me. Ugh, Ive gained 15 pounds since the start of the Pandemic.
Walk to my work computer.
I really should do my “2 sips of coffee before I get on my computer” rule, but Im so anxious to check my Health Connect messages; Jane messaged me yesterday, relapsed on alcohol and binge/purged again. I hope she did ok over night.
She doesn't qualify for IOP right now and Community Stabilization group is full until next week, so its all on me.
How do I have 8 new HC patient messages over night!? …Ok she wrote back. Damn, she drank again. Yup, I need my coffee.
9am. These 30 minute sessions are frustrating, but its the only way I can see John more frequently than every 8 weeks, he lost his wife to cancer, they’re only in their late 30’s, that kinda hits home. I wish I had a few minutes for myself after this session.
…Shit, its 9:31, we went over. Im late for my next 30 minute. Zero time in between these two sessions.
Also went over with my 9:30 to make up for being late. Was really hoping to use the restroom and get more coffee, but I don't have time bc right after this is my10am intake with Sally.
I was only able to take a quick glance on her C2C intake note. Didn't have enough time.
In the meantime I just received another referral for CPT group I need to add to the group database. Log back in.
Sally is understanding, though already pretty frustrated bc she had to wait 8 weeks for this intake appointment.
Complex PTSD, she could really benefit from EMDR, but I can’t meet with her frequently enough to do it. I’ll add her to my PTSD Skills class.
Needing to multitask during our session, trying to add her to the group database. It signed me out after 30 minutes of inactivity. Sooooo slow loading it back up.
“Sally Ive added you to the waitlist for my group, I'm so sorry, you’re 20th on the waitlist, so it’s going to be about 3 to 4 weeks until you can start my group.”
In the meantime, its all on me.
She’s really struggling with her symptoms right now. ….checking my calendar to see if there is any IPC space I can force book her into.
….of course I lost internet connection again…. Ok back on.
Teams message pops up about a patient.
Nope, no IPC that Im willing to give up, I keep having to book more and more patients into remaining IPC.
We barely have enough IPC as it is.
I just cant do it.
“And Im so sorry Sally, my next appointment is 7 weeks from now, but I can put you on my waitlist”. Sally is really upset at me now, she’s yelling. This feels awful.
I wish I could take a quick walk after this session to re-center, but I only have 3 minutes before my 11:00 and I have three notes now to write, still need to use the restroom (damnit, that coffee!) and I want water.
Only 3 minutes before my next session.
11:00 session with Billy, Im still flustered from being yelled at. I had to multitask and do his chart noting during our session, that sort of helped me ground again at least.
More multitasking bc I wont have time after this appointment.
It feels like I never have enough time.
Im adding him to DBT Skills class, waitlist of 10. The database logged me out after 30 minutes of inactivity. Logging back in….sooo slow. I have to reboot and re-log into Mainframe after I lost internet connection to get his email.
…just got a Teams message from a colleague asking where their patient is on my group waitlist. I don’t have time right now, I’ll have to get to that later.
Finishing up this session to schedule next appointment. Ok I have 7 minutes until my next session. Breathe.
Another Teams message just popped up from a psychiatrist asking if I can add their patient to my PTSD Skills class. Happy to do it, psychiatrists are super swamped too. Database signed me out again. Signing back on. What was the MRN again? They forgot to fill out the PCL. I need to contact the patient now and ask them to fill it out in order to be added to the group.
Only 3 minutes open now before my 12:00.
12:00 session. In the meantime I just received an urgent staff message on a Critical Alert that a patient endorsed SI on her AOQ.…Ok, I need to find time to call her.
Its all on me.
Focus on the session right now.…
I really wish I hadn't had to force book into this IPC time, I really want to add a new section to my PTSD Skills group powerpoint. We’re covering PTSD and Relationships tonight, I heard a great podcast over the weekend and would love to add some new info into tonight’s curriculum. I’ll have to multitask during our Team Huddle later today to do it.
Bob is really struggling and needs the extra support.
I wish I could do trauma treatment on him, too, but I can’t do trauma treatment with anyone unless I can do it every 1 or 2 weeks. …So he’s been on my caseload for 3 years now. I feel so defeated.
I still need to pee.
Ok, finally IPC! 30 minutes. Hustle time - How much can I squeeze in only 30 minutes - Im so hungry. Ok, restroom, then heat up my leftovers for lunch, eat at desk so I can attend to my other patient messages. I need to check my voicemail too. Send messages to our new CPT group roster to remind them of the start date. Cath up with chart notes. And check on Jane.
…back at desk.
Crap, my food isn't warmed up all the way. Cold tacos are the worst. F$ck it, I don't want to waste time going back downstairs. Keep charting. What’s that dot phrase again for the medication referral I need to fill out and send for my intake? I can never remember. I’ll ask on Teams.
…waiting ….waiting. Nobody’s getting back to me. Ok, I’ll put that to the side for now and check my voicemail. I only have 15 minutes left. Ah, I forgot my water downstairs.
Ok I only have 2 more minutes until the Team Huddle. I think thats when Im going to multitask and add that new section into my group powerpoint. Wait - I totally forgot it’s my turn to lead the huddle. Where do i find the OneNote document again so I can do this?
I only have 2 minutes left of IPC.
Im still SO behind. I still need to check in on my SI Critical Alert patient too.
And check on Jane.
Wait, how did I get an extra intake tomorrow?!! They force booked another intake into a recently cancelled return slot. I was going to use that slot for Jane. Im late for the Huddle now.
1:30 Team Huddle. I can never remember the order of things to talk about.
How are we still talking about parking cards and notebook orders?!
Ok, 1:58 now. Only 2 minutes before the 2:00 Trauma Team consultation meeting. Im going to have to be late so I can call my Critical Alert patient.
…Ok, she’s alright. Need to document this.
Joining meeting 20 minutes late. We’ve been trying to develop a Trauma Track for the clinic, for years now; we haven't received the green light from upper management, even though we have everything ready to start it! Lately though we keep losing trauma therapists to other departments or leaving the clinic all together. Our trainees are choosing to leave too, they have been amazing. Needing to multitask to finish up notes and to try to catch up with patient messages; received two more just in the last hour.
…Another Teams message from reception about a patient wanting a sooner appointment?
Where am I going to put them in my schedule?!
Back to consult meeting.
Ugh, our morale is SO low right now, we’re all in the same boat; unable to actually do trauma therapy with our patients bc we’re all about 6 to 8 weeks for frequency of appointments.
Patients are PARKED on our caseloads and we keep receiving new ones every day.
We feel so defeated.
One of our newer therapists just got 2 additional intakes forced into her open return slots from two patients that cancelled without the therapist seeing it in time. WTF. So she has 4 intakes in one day?!
Got another Teams message asking about something.
Im so tired. End meeting at 2:29. 1 minute open before my next session
3:00 IPC but had to force book. She’s using her coping skills but still …Really?! Connection lost again. Trying to chart note while we’re in session.
…In the meantime I just received an urgent staff message from a frustrated patient who was given a Beacon referral - he’s called 10 different therapists and nobody is accepting new patients.
Maybe I can try talking him into the Depression Care Pathway again. But the next one doesn't start until 3 weeks from now. Im going to have to force book him into another one of my IPC slots.
It’s all on me.
Its been 6 months and he hasn't been able to reconnect with another therapist since our initial intake.
He feels so defeated.
Our Generalist team still has 11 positions open. People keep leaving. We feel so defeated.
Just received a Teams message to our Generalist group chat from management reminding us we have to complete the Ethics and Compliance training and to fill out the survey about why we aren't using the panel spreadsheet. Sure, with all the time I have….And tell me again, Employer, about ‘ethics and compliance?’?!…
Back to the 3:00 session, its 3:28, we need to wrap things up so I can start my 3:30 on time.
I only have 60 seconds before the next session, and I need to get caught up on her chart since she saw her MD. …scrolling, where’s that chart note…
I have to pee again and Ive only had like 12 oz of water today. That all is just going to have to wait again.
3:30 session, another trauma patient who’s symptoms are getting worse. Im going to add her to an additional group. Group database logged me out again.
I wish they could change the expiration time to 60 minutes instead of 30 minutes. Soooo slow logging back in and getting to the group I need….Gotta wrap up so I can have 10 minutes before I start my group. Im so behind.
2 more new patient messages in the meantime, one more staff message about a transfer. Never did finish checking my voicemail. I only have 5 minutes now before I have to start group
4:30 - Ok, gotta start group now.
My co-facilitator has been out 6 weeks now on medical leave. I love my group, but its so hard to multitask with lecturing for 90 minutes, monitoring the chat box to make sure people aren't saying anything too triggering, answering questions, and then taking down everyone’s names in order to then check everyone in. Usually 45 to 55 people in attendance, with a 20 person waitlist. And it’s all on me.
Just got a Teams message from reception saying a patient is having trouble logging in.
My throat is getting dry. Im so tired.
6:00 - group done. Went well I think. I just winged the new section I wanted to add. Alright, gotta check in my 45-55 patients on Health Connect. ..And finish charting …and the staff and patient messages.
And Check on Jane.
It’s all on me. I don't have enough time. I feel so defeated.
*Schedule:
9:00 - 30 minute session
9:30 - 30 minute session
10:00 - 50 minute intake session
11:00 - 50 minute session
12:00 - 50 minute session (had to force book into my 30 min IPC time)
1:00 - 30 minute IPC
1:30 - 30 minute team huddle
2:00 - hour Trauma Team Consultation meeting
3:00 - 30 minute session (had to force book into my 30 min IPC time)
3:30 - 50 minute session
4:30 to 6:00 - PTSD Skills group (co-facilitator is out on med leave for two months)
6:00 - 30 minute “G” (group admin time, to check in 45-55 patients in attendance)
9.5 hr day: (60 minutes of IPC/G, 7 individual sessions, 1 group, 2 meetings)
(All patient names are fictional)