Completing Paperwork or Preventing Suicide: Which is More Important in the Shrink’s World?

I was running late to the hospital because I needed to have an emergency session with a teenager in crisis. Her mother had called the evening before and asked if her daughter could be seen first thing in the morning. I often leave one slot available on the mornings I go to the hospital in case of an emergency or if a client needs to cancel a session during the week and wants to reschedule. Unfortunately when a client like this young woman is having suicidal thoughts you can’t always predict that she will be feeling better after 45 minutes. So I reserved a larger block of time for us and notified the hospital staff that I would likely be late the next morning. “Is that because you’ll be hung over like me?” the secretary asked. She’s a very unhappy person.

People can entertain suicidal thoughts about almost any topic under the sun: money, career, academics, relationships that are collegial, romantic, or platonic, family matters, religion and/or sexuality. I touched on the handling of suicidal issues here so I will just say here that after an hour or so of talking with the young woman, she felt somewhat better. Good enough to confidently state that suicide is not something she wanted for herself and she agreed not to act upon any thoughts of self-harm. Between the end of our meeting and the next day when we would speak on the phone, she would contact her Psychiatrist to discuss any relevant medical issues and would spend the day with friends and family. It’s pivotal to have a concrete, manageable plan in place for a client who is entertaining suicide before leaving them until the next appointment.

After the session ended I took off for the hospital. Through the use of blazing speed down a major avenue, darting past the suits, hipsters and everyone in between on the crowded streets of New York City, I was officially 55 minutes late. Fortunately the three people who I was scheduled to see for weight loss surgery evaluations were also behind schedule, so essentially this was a “no harm, no foul” situation. However, there was one gentleman who had come into the office to begin completing various forms and documents as part of early preparation for surgery. He took off from work to do so and needed a doctor’s note to give to his office. There were no doctors available at the time – at a hospital, strangely – so a member of the staff who was ignorant to my tardiness assured him that I could write the note “in just a second.” That was exactly 56 minutes before I arrived.

When I got into the suite and the secretary told me what the man wanted, I told her that he could come into my office as soon as I had a chance to put my coat on the rack, turn on the computer, pant for a few seconds and sit down. “He’s already in there,” she said.

“In my office?”

“Yes, he insisted.”

The secretary was never good at setting boundaries so this was to be expected. But thinking about the Rock Band 2 for Wii instruction manual sitting on my desk made me wonder if I’d have any credibility when we met face-to-face.

I went into my office where the man was waiting. Impatiently, with a tapping foot. He was wearing an impressive charcoal suit with matching tie and matching Blackberry, holding a cup of Starbucks coffee.

In a classic Armani vs. Gap exchange, I spoke. “Hello, I’m Dr. Dobrenski.”

“You’re late,” he said, annoyed. “I’m paying for this surgery out of pocket. I expect good service.”

“I apologize although, truth be told, I wasn’t expecting you,” I said.

“You doctors always do this. Why were you late?” the man asked. “Out golfing?”

Fair or not, this initial exchange led me to me believe he held a sense of self-entitlement and importance. Like I discussed here, entitlement is something one learns and shrinks are trained to be more empathic/less disdainful toward that personality type. Yet my first thought was a wish that the steam coming out of the coffee cup would float up and burn the retina in his left eye.

I understand the frustration patients have with doctors who don’t keep reasonable schedules. My dentist once decided to go out for lunch after I was seated in the exam chair, bib around my neck, mouth open. He came back a half hour later with horrible Taco Bell breath and not so much as an apology. My dermatologist books four people for each fifteen minute slot so she is assured of not having any down time due to patients not showing up. This leaves at least a dozen people in the office who end up late for work or other commitments, yet the doctor has not a trace of self-consciousness about how her actions affect others.

However, what many people do not understand is that most – and I’ll emphasize most because I’m sure Dr. Steve is an exception – shrinks don’t run their practices in such a manner. Despite all the bashing I do to mental health professionals, we don’t overbook appointment slots and generally keep a schedule that benefits everyone involved. When exceptions arise it’s usually for a solid reason. In my case it was the young woman in crisis.

I’m not sure if it was the suit, the slicked-back mobster hair, or simply the adrenaline from working with a suicidal teenager that morning, but I simply answered. “I had to deal with an emergency.”

“Emergency? You’re a shrink. Did someone hate his mother so much he had a heart attack?”

There is a line that one can cross between acting mildly annoying and simply being a prick, and talking with this man made me realize that my tolerance for people who aren’t actually in my practice is getting lower as the years go by. Why I favor those who are actually on-board isn’t entirely clear but I believe a bulk of it is that once there is an official relationship between us, there’s a bond that I inherently value. This gives the client certain behavioral Mulligans they can cash in. One could argue that I give this benefit because these people actually pay my salary, but that’s not the entire picture.

“That’s not your concern, but if you must know,” I said, confidence (and disdain) rising, “a young woman was suicidal and I was helping her.”

It would be a stretch to say he blushed at that point, but there was a shift in his facial expression. Embarrassment? Maybe. Humility? That was a stretch.

“Just write the note,” he said. “And please hurry up. I have to get back to the office, as you put it…stat,” and he started to walk out.

Technically, I didn’t have an obligation to write anything for him. However the secretary had said that I would, and the truth was that he did need to miss work for medical reasons. Professional responsibility kicked in.

“Okay. Have a seat in the waiting room and I’ll type something out for you,” I said as he vanished into the hallway.

I sat down at the computer, frustrated. Assumptions, entitlement, demanding of instant gratification, arrogance. This all started going through my mind as I thought about the suicidal girl and the man in the waiting room. No person is worth more or less than any other, but suicidality definitely trumps paperwork. Hindsight is always 20/20 but I easily could have told him that I have no accountability to him and put him in his place. I failed in that endeavor. I’m not perfect.

At that point my cell phone rang. “Robert? It’s your mother. I just read your latest piece on the Sex Offenders’ Wives (note: that piece was written about 9 months ago). There are a lot of problems with it. Can you go over them with me now?”

I smiled and looked toward the waiting room. As I said, I’m not perfect. “Sure, Mom, I’m not busy at all. In fact, I’ve got plenty of time.”

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11 Responses to “Completing Paperwork or Preventing Suicide: Which is More Important in the Shrink’s World?”

  1. Crisis intervention + entitlement + Axis-II = 95% of my pt. population. I try and remind myself that the outward abrasiveness is typically a defense mechanism, and that they often in just as much pain as the weeping wallflower. With that being said, I think your guy was just being an ass. Take your time, as jumping up and giving him what he wants is just going to reinforce his bad behavior.


  2. Wayland says:

    Nice. Rock on man.

  3. Amber says:

    Nice, I like how you made him wait longer. You’re such a badass! Does the gap sell anything with little skulls on it? If so you should pick something up and show off your badassness.
    So my friend’s uncle committed suicide a couple nights ago, the same month his Opa did it a few years ago. His uncle’s was a bit more tame with the death by vehicle locked in the garage as his opa put a gun to his head. As this is a slightly different manner of death, what’s the best way to be available and supportive without being…obtuse and pushy? I’m worried about him, he’s my best friend, I just don’t know what to do.

  4. Matt says:

    I think the real question that needs to be asked here is were you able to show proper attention to your Rock Band 2 for Wii instruction manual?

  5. Jenny says:

    Though there are many serious issues and comments here, I’d just like to add that I respect you MORE for being the proud owner of Rock Band 2… even if I prefer Guitar Hero World Tour.

  6. Yasmin says:

    So what happened with the girl? Is she doing better?

  7. Cassandra says:

    I love it when you pull out your inner asshole. It makes me happy to vicariously experience being a jerk to make up for the times when I’m too dumbfounded to respond to such a creep. And I agree with Amber, you should get some skullgear.

  8. Good on ya Dr. Rob! What this guy didn’t realize was that HE NEEDED something FROM YOU. It wasn’t the other way around. Loved your Ryan Holiday interview, btw.

  9. marcia says:

    I can’t believe it! My search tool can’t locate the phrase “passive-aggressive” anywhere on the page!
    I suppose you eventually gave the note to the secretary to pass along to the guy with entitlement issues?

  10. marylou says:

    Why do you people introduce yourselves as Dr. X rather than just John Smith if you did not want to start being a jerk first? You were just as much of a jerk as the client.

  11. virtual guitar…

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