Last Saturday, I got caught in the snowstorm on my way to work. The clinic is a considerable hike from the subway, and my clothing was soaked through by the time I arrived.
The building is old, and its heating system is rickety at best. On Saturday, it had cut out completely and was blowing cold air through the radiators. We used to have space heaters in the therapy rooms, but last year the state Office of Mental Health declared that they are a fire hazard and banned them from any room where patients are seen. So on Saturday those therapists lucky enough to have arrived before the deluge worked in their coats and gloves; the rest of us just shivered. On breaks we huddled around the photocopier for warmth or stuck various body parts under the hand dryers in the washrooms.
We are preparing for a state audit. Our clinic does excellent work, but everyone is terrified that the auditors will find a serious mistake and we will be severely penalized. "Serious mistakes" don't have to do with committing insurance fraud or mistreating patients--it goes without saying that we don't do those things--but with failing to document a session properly, miscalculating an admission date, or forgetting to get all of the indicated staff signatures on a treatment plan.
Because of this, my role as clinical supervisor has shifted from providing much needed guidance on addressing pressing treatment issues to obsessively going over paperwork. My supervisees keep telling me they can't wait until the audit is over so we can talk about patients again. We have been preparing like this for over a year, and I find myself hoping I can remember how to talk about patients productively.
I gave up a much more lucrative job as a speechwriter to return to school, accumulating a huge debt, because I wanted to do meaningful work. I love what I do, and I am proud of my work in the clinic. Yet I find that I miss amenities such as heat, and even more, I miss being respected and trusted. My colleagues and clients respect and trust me, of course, but the clear attitude of the state is that we are all slackers, if not frauds, who need to be kept in line through harsh interrogation and oversight. It is draining and demoralizing, and I have started advising younger people who are considering going on for their PhDs to think very hard about what they are taking on.
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