07:30am – I leave home to walk to work. I like to walk most places, if the weather allows. Arrive in COMPASS –a 6-month residential program for children up to the age of 12 who have emotional and behavioural problems that have not responded sufficiently to out-patient intervention. The children are with us through the week in an intensive program designed to improve their academic, recreational and interpersonal skills as well acquiring the skills to regulate their emotions. Their parents come on Fridays for group sessions and progress meetings with the clinicians. Throughout the weekend, our transitional support teams visit the homes. This is a demanding program for families and demands a heavy commitment in terms of time and money from the parents. However, the extent of parental involvement correlates with how successful the program will be for the children.
I make a quick sweep through the unit to greet the children and then go over yesterday’s progress reports with nursing staff. There is one medication change required. I review results of lab work that was done yesterday. All is well and so I tell K, who required a great deal of persuasion to have it done. K is quite challenging in her ways (she demanded to see my credentials when she was admitted!). Spoiling for a fight, she comes back with, “I told you I didn’t need it to have it done.” I didn’t bite and again told her I was glad that the results were good. I then called K’s mother to also let her know. I do a quick review of my email and the regular mail messages that had accumulated over the past two days.
08:30am – I’m off to the Health Centre for a Mental Health and Addictions Leadership Team meeting. Our program needs to make major changes to ensure there is better access—we currently have over 1,000 kids waiting for service. A new plan is being devised to eliminate the waiting list. However, we face budget cuts this current fiscal year and have just been made aware that there will be a larger cut next fiscal year. The Department of Health would wish to have the cuts not affect direct service provision, but that is almost impossible.
09:45am – I’m back in Maritime Outpatient Psychiatry for my Tourette’s Disorder clinic. My new patient has been referred by his family physician because of significant obsessive compulsive symptoms in addition to his tics. It also appears from today’s examination that this boy also has ADHD. Despite these problems the patient is cheerful, outgoing and generally well-adjusted. I discuss my findings, encourage questions and then formulate a plan for further treatment, which will likely include cognitive behaviour therapy and medication.
11:30am – I call back some of the people who left me phone messages, including some minor medication adjustments before the next appointment. I try to call a family physician to discuss the progress – or lack of it – with one of our mutual patients. I did not succeed, but did manage to arrange a time when she would be available.
12:00pm – I receive a call from the nurse at the Adolescent Centre for Treatment (ACT), our residential service for adolescents, for which I am providing some coverage during a colleague’s absence. I make my way down to the unit. There is a patient experiencing some side-effects of his new medication. I examine him, review the medication and make the necessary changes.
1:15pm – Back to Maritime Psychiatry. I grab a bowl of soup from Bonne Cuisine and make a call back to the family physician I tried to reach earlier. She and I have a very useful discussion and agree on a plan of management. We reflect that as psychiatrists, we need to collaborate better with family physicians— something we are not very good at. A partial excuse is that sometimes it is frustratingly difficult to get through some office phone systems to speak to the family doctor.
1:30 – 3:30pm – I make a phone call to a teacher to discuss how a patient is doing. The best time to get a hold of teachers is right before or just after classes start. I then see patients and families and modify treatment plans as necessary and review some new referrals and assign appointment times with the office staff.
3:45pm – I then make it back to Compass for a tele-health conference. The divorced parents of our patient “J” have been giving mixed messages with regard to her future. The primary clinician and I initially meet with mother and her partner, while father is on the other end of the tele-health link in Cape Breton. Both parents initially insist that their communications have been clear. Soon enough, their unintended inconsistency becomes obvious. With minimal prompting, they came up with a clear message for J when she joined us. The subsequent discussion was positive – and emotional – and the plans for J were clarified. I quickly meet with nursing and youth care staff and had a brief discussion with some of the patients.
5:30pm – I make my way over to our inpatient unit to see how a newly admitted patient was coping with the admission. I had seen her in crisis the previous day at a clinic in the Annapolis Valley where I consult and had arranged for a brief admission. She was a little apprehensive about the unfamiliarity of the unit, but she had connected well with her nurse.
6:00pm – I go back to the office to review emails and call a pharmacy for clarification of a prescription.
6:30pm – I arrive home, but no dinner yet. My dog demands his walk.
8:00pm – I prepare some recent continuing education activities to be recorded in my Royal College Maintenance of Competence account.
Topic: Compulsive Disorders
