Friday, November 30, 2007

You Have to Fill This Form Out

Oh my, whose idea was it to mandate that psychiatrists need to fill out certain forms? I work in a clinic where people often walk in with disability forms. I don't know them, how do I know they're disabled? Maybe my great interventions will cure them and they can go back to work. "But I need the form tomorrow, doc, or I can't get my check." I filled one out the other day, feeling rather pressured-- it was on someone I was seeing for the second time, and the first time she'd sat there angry and hadn't spoken. So I put in my best guess at diagnosis, but you know, they all ask for the dates of disability, with a maximum of 12 months, and how would I know this??? That crystal ball, didn't I leave it in the top drawer? The patient became agitated, she needed the form for tomorrow or she'd lose her check. I had 4 patients who'd shown up simultaneously, and she'd also brought poetry to show me. She was getting agitated, I was telling her the therapist needed to do these forms, she was saying she'd lose her check if she didn't have it by tomorrow (now how can that be and why was that my problem? at 4 pm no less). I scrawled "unclear" for the dates of disability and she was livid. Oy. Maybe I should have just written a year, she was homeless in a shelter and hadn't worked in a zillion, and she had some mental illness where she was angry, irritable, sullen, and refusing to give information one day and effusive with poetry to share on another. I wish I just hadn't felt so cornered.

Oh, but then there's my favorite form the psychiatrist "HAS" to fill out. The payee form. My patient (a homeless woman with multiple medical problems and a fondness for crack cocaine and malt liquor) wants to be her own payee---she doesn't like that her daughter currently doles out the dough.

"You gotta fill the form out," she says.

"I don't do those forms, " I say.

"They say my psychiatrist has to fill the form out."

Whose bright Idea was that, I have no clue if people can manage their money. Plenty of folks I know with psychiatric disorders manage their finances fine. And plenty of folks I know without psychiatric disorders are financial disasters. I don't follow these people around to see how they manage, I see them for 20 minutes in a clinic to ask how their mood is and if they're having and hallucinations or side effects. I suppose if any ever had command auditory hallucinations to turn over their family trust funds to me personally, I might consider it.

"I don't know if you can manage your money I say." She stares at me. "Do you know if I can manage my money? I never said you need a payee in the first place. Go find who ever said you need a payee and have them say you don't."

"My psychiatrist has to fill it out," she insists.

No, your psychiatrist doesn't.

Oh here, read this: CLICK