Saturday, October 9, 2010

Thought on Returning from Sabbatical

It is both wonderful and weird to be back.

Wonderful because I really enjoy working with patients. For those of you who don't want to go back into ancient blogging history, I left Massachusetts last September to go to Washington and work in the Federal Government as a Robert Wood Johnson Health Policy Fellow. As part of that deal, I too a year off of patient care, and left my practice, where I had worked for 18 years. One of the things that surprised me in DC was that I didn't seem to miss the day-to-day doings of seeing patients. So I was concerned that, when I got back to Massachusetts, I wouldn't either remember how or enjoy doing that anymore.

Turns out I needn't have worried. The give and take of the clinical encounter really grounds me in reality, in a way that detached policy discussions don't. Now, I am not back in my old practice in Webster- South County has continued to flourish in my absence and has recently added a third doctor to its group. I couldn't ask those patients to put their lives on hold while I was away. Since I am now working on policy stuff within UMass Medical School's Commonwealth Medicine, a great organization that lets us bring clinical and analytic expertise to the service of state government, I need to be in Worcester more. So I am working in another practice within our clinical system. And, it turns out, I really do like seeing patients.

In my new role, mental health has not been as large a part as it was in my old practice. We are screening for behavioral health issues, as one would expect from in these days of the Rosie D rollout. I am still not finding the screening terribly useful. Most of the kids I've been seeing are pretty well plugged into services, and have already been diagnosed. The system continues to work for them in its own creaky way, and I am incredibly conscious that we in Massachusetts have a lot more in our system than does any other State in the Union. Despite all that we do, it is not yet enough to calm the feeling of dread that course through a parent's heart whenever they take one step forward and two steps back. Much work to do.

What is weird about being back is that I have now travelled over the whole landscape of 90,000 foot high grand policy decisions (like mental health parity and children's mental health reform) at the Federal and State levels, seen the agencies where they are implemented (like HHS and SAMSHA and the CBHI) and been to the meetings where decisions are made that affect the lives of millions of children (no, I didn't make any of the decisions, and I don't think that I influenced them much- but I have seen the process). So now, when I am seeing a patient, and trying to figure out how to make that system work for them, I sometimes visualize it as the end of a long web of decisions that stretch from the halls of Congress to my examining room. It is an odd and vertiginous perspective, but I am getting used to it.

I did manage to attend the MCAAP Mental Health Task Force meeting a few weeks back. There is still much energy in that group, and they continue to focus on early childhood mental health. There was talk of aligning that work with the push for early childhood education, which I think is important. More on that in another post.

Not sure how often I will post in the future, but I will try to post things that are useful.

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