I like to think that as rapping shrinks go, I am reasonably accessible. My office line is a cell phone-- "it goes where I go"-- and just in case, I give patients my home phone number. There are times I'm completely unreachable: I turn the phone off during sessions, when I'm at the movies, on airplanes, and when I sleep at night (ah, that's why folks have my home number). If I'm somewhere I can't talk privately, I let the phone ring through to voicemail and I listen to the message soon after. Anything urgent, I return right away; I generally return all calls by the end of the day, and most of my messages have to do with scheduling or rescheduling appointments.
Anything urgent I return right away. I said that already. It leaves the question of what is urgent and how one defines this. Shiny Happy Person--my favorite shrink blogger across the pond where things seem to work a little differently and people say things like "bugger all"-- likes to run polls about the odd things nurses call to request of her. GirlMD likes to blog about the silly phone calls she gets in the pediatric ER. The tone of both bloggers is one of frustration, even annoyance, and may I borrow a little of that for this post? Please forgive me, even (or especially?) psychiatrists can have trying moments.
So confabulated patient calls last week-- her sister is in an awful bind with her boyfriend. She needs my advise on what sister should say to fix this awful affair. The message ends with "Call me ASAP."
I don't call back. But it nags at me all day. She's my patient and she wants me to call back. The request, however, seems so unreasonable, that I don't. She calls again, "Call me ASAP, my sister needs your suggestions." I can't take it. I call back, happy to get a machine, and leave a message saying something to the effect of I've never met your sister, I've never met her boyfriend, and I have no idea what she should say to fix the problem.
I will add that I'd gotten a similar call from another patient the week before with a similar request to help a friend who was being actively threatened by a untreated mentally ill spouse: in this case I did call back and tell her what agencies could offer help. I refused to speak with the friend, however, but I told my patient what avenues the friend could take.
It's Friday night. The phone rings, I let it go to voicemail and check it. I've run some labs on a patient, I've told him I'll call if there are any problems, otherwise he should assume they are normal (there's no reason they wouldn't be, and hey, this is a confabulated story) and I'll discuss them with him next session. His message says he wants to know what his blood sugar was. It was normal, I don't remember the exact value; I remember it was normal. He wants me to call him back (he doesn't say urgently, but my understanding is he feels this can't wait until Tuesday's session). He's not diabetic, he's never been diabetic, he's never worried about being diabetic or hypoglycemic, and I don't feel like being obligated on a weekend. It is more, I know, with this particular patient, about the connection than it is about the lab value.
I didn't call him back. While mostly I like that patients sometimes get comfort from our interactions, sometimes feeling so needed is a bit overwhelming. Sometimes I'd like to be just a little less connected, especially on a Friday night.