Thursday, July 24, 2008

A Day in the Life: How Would the Reform Help Us in the Field?

Today, I see patients.  (As opposed to yesterday, when I was stirring about to see that most of Massachusetts is not so worried about children's mental health as an issue).  I want to blog my day, talking about how the CBHI and SB 2804 will affect what I do.
8:50 AM:  I come into phone calls.  A child psychologist note about one of my patients with anxiety disorder is on my desk for review- he outlines in messy handwriting (like I should talk!) what behavioral health interventions he has been able to do with a 12 year old patient of mine.  Interestingly, the psychologist has this tagged as 314 (ADHD) now, whereas three months ago, he had both anxiety disorder and ADHD listed.  We've talked meds in the past, this family and I, but are trying to avoid them.  Nice to get interdisciplinary communication.
9:10 AM:  Wrestled with the Electronic Medical Record, and got it to renew a prescription!   Many doctors are trying to make sense of these systems- the one we use is not bad, but has "quirks" that require insight and work-arounds that definitely slow up the day a little.  Of course, blogging the day slows one up a bit.  My 9 AM physicals (brothers in the first two slots) are still being checked in.
It is 11 PM now.  I really had every intention of blogging the day, but events just sort of took off.  Let me see if any of the stories stuck in my head:
- 13 physicals, with 8 PSCs and 5 PEDs, none of which were positive.  Including a young man who had been caught drinking by his folks, and a boy who's grades are dropping while he becomes increasingly oppositional.  I guess they don't have serious emotional disturbance, but it would be nice to be able to let them talk to a therapist once or twice to be sure that we are adequately addressing these things.
- A teem on antidepressants, who seems to be making remarkable progress.
- A toddler who doesn't talk but seems otherwise fine (letting EI ponder over that one).
All of this over the din of the Electronic Medical Record....
Actually, it was a calm day.  But, as always, mental health issues trumped the physical ones by a long shot.  School based MCPAP, better collaboration between psychiatrists and pediatricians would be a good thing.
Tired.  Off to the Falcon Ridge folk festival tommorrow.

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