43 Folders post on blogging ideas and thoughts

20 02 2007

In my previous post, I explained how I described what professional idea blogs (and are not) to my colleagues. Merlin Mann at 43 Folders has a nice post on Blogs: Watching passionate thoughts evolve (in public). In it he, offers a nice description of a new-blogger’s experience, and this advice to bloggers:

“Remember that your blog is only incidentally a publishing system or a public website. At its heart, your blog represents the evolving expression of your most passionately held ideas. It’s a conversation you’re holding up with the world and with yourself — a place where you can watch your own thoughts take different shapes and occasionally surprise you with where they end up…”


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Categories : blogging

Blogging out in the open in a clinical setting

20 02 2007

Roy from Shrink Rap’s commented on my post about Web 2.0 opportunities that he has “not EVEN mentioned to anyone about our psychiatry podcast.” That surprised me, given how significant his web presence is. But that was certainly true of my blog until a couple of weeks ago, when I finally “decloaked” my blog to my colleagues.

I decloaked during a presentation to our group that focuses on evidence-based practice. This group includes several key leaders in our department. I was giving a progress update about my work toward our shared goal of improving the training and documentation tools for suicide risk assessment, documentation, and response. Thankfully, the project is progressing, and I had several steps forward to present. On the mindmap I was using to present, (as I’ve noted in a previous post, I use MindManager for presentationg), I reported progress on steps forward that I had previously committed to, then added a bubble reporting the development of this blog (along with a link to it).

I introduced it with some trepidation. By way of disclaimer, I started by recognizing that the image some think of when they hear the word “blog” (if they think of anything) is a “navel-gazing, exhibitionist teenager” sharing stories about weekend parties and rants about parents. I explained that blogs have evolved in many professional and academic circles as a way of journaling ideas and sharing emerging trends with like-minded people. I showed some sample posts and sample comments. I referred people to the About this blog page if they wanted to learn more about what I’m up to with this experiment.

The response was mostly positive–probably best described as a mixture of amusement and curiosity. No one was openly critical, and some of my colleagues thought it was pretty cool. There was one appropriate and constructive question raised about liability issues for me (what if someone follows my clinical advice and something goes wrong), but no other public comments. One colleague later comment that she had never read a blog before, and I suspect that was true for many people in the room.

Being out in the open feels good, although it has already changed the way I think about my blog. I don’t think the change is good or bad, but it does change my mindset to think that my colleagues and superiors might read what I write here. Then again, they might not!


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Categories : blogging, professional culture, technology

How clinicians learn: Web 2.0 Opportunities?

8 02 2007

A thoughtful colleague of mine observed yesterday that, although there is a range of ways clinicians get clinical information about suicide (articles, workshops, books, practice manuals), a lot of clinical learning takes place informally–by doing the work and by talking with other clinicians. That is probably especially true for the busiest front-line clinicians.

I later reflected about what this could mean in terms of Web 2.0 opportunities to change clinician behavior. First, the narrative, personal feel of blogs might appeal to clinicians in a way that practice manuals and official websites don’t.   Second, the conversational opportunities of wiki (Wiki in wikipedia, Using Wiki in Education), RSS feeds, podcasts, and other Web 2.0 venues also have potential to reach people in a fresh way.

Would a front-line clinician who does not regularly read research journals subscribe to a weekly 10 minute podcast conversation between a suicide researcher and a clinician who works with high-risk patients? Maybe. It’s mostly an empirical question at this point, but there are several experiments going on in the field, some of which are on my blogroll.


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Categories : blogging, dissemination, mapping/visualization, teaching/training, technology

Tech tools for clinical thinking and training

8 02 2007

Whenever I present, I get questions about the technology I use. I work on a Fujitsu T Series Lifebook (T is for Tablet PC), and use MindManger by Mindjet for almost everything I think about or present. I’m happy to let people know what I use because I think they are tools that lend themselves well to the clinical enterprise.

I like using a Tablet for presenting or for taking notes when meeting with families because it sits in front of my like a pad of paper. For some reason, I am also able to listen better when I’m only working with one hand on a computer. It’s hard for me to listen, write, and engage when I’m using both hands on a keyboard.

I first learned about MindMapping from a classic book on the subject by Tony Buzon. I use it for brainstorming, project management, and presenting. I’m still in the process of investigating the relationship between visual maps (mind-mapping or concept mapping) and learning complex concepts. I’ve done a partial lit review about it in the educational literature and it seems like there are a lot of theories (and, of course, few data) about why visual maps would promote learning different from plain text. For suicide risk, I think it helps to be able to visualize connections between concepts on a map because it makes complex material more accessible. I have a map of risk factors to consider that somehow enlivens discussion of something that could feel quite rote or overwhelming.

It may be that these tools are also effective because they haven’t yet (and I mean yet) become mainstream. People are intrigued because they are different. I’m OK with that, but I hope that’s not the only factor at play.


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Categories : mapping/visualization, teaching/training, technology

Clinician response to violation of the “social contract”

7 02 2007

I had a stimulating conversation with a senior colleague in the CSPS yesterday. One part of the conversation centered around what happens for us, as clinicians, when the patient does not fulfill his/her end of the “social contract” that is implied when someone goes to a mental health professional. The assumed contract is that the professional gets to ask all kinds of personal questions, make recommendations about intimate details of a person’s life, and the patient is expected to accurately, honestly, and completely answer our questions, cooperate with recommendations, and be appreciative in the process.

In a previous post about risk and patient Choice, I offered ideas about how to approach a particular instance of patient patient choice (sometime known as “noncompliance”), including some initial documentation suggestions. But that post didn’t address how to handle the emotions that accompany working with a patient who exercises his/her freedom by not answering our questions or by refusing our help.

Clinicians experience a range of emotions in these situations under these circumstances. Helplessness, anger, and fear come to mind first. From a family therapy perspective, this calls for what Murray Bowen (1978) called “differentiation”–the ability to remain engaged, present, and available while not becoming reactive, defensive, or distant. Easier said than done! Especially hard when clinicians often feel a duty to protect patients from harm.

The first step is to name what is going on. “This person is violating the ‘social contract’ and it is making me angry. I’m also afraid that this person could die while in treatment with me.” Next is some cognitive work: “This person did not give up the right to direct his life, keep his privacy, and make choices when he sought professional help.” Along with that, your best friend is good old fashion consultation. I plan to post more in the future about how to get consultation from colleagues about suicide risk, but for now, I think the main thing is for us, as clinicians, to explicitly frame the consultation in term of our emotions. “I am afraid and angry because a person I am working with, who has high risk of suicide, is not cooperating with my attempts to assess and intervene.” That frames the consultation discussion as being about “how am I going to work with this person given my emotions?,” rather than “how can I get this person to do what I want, given how difficult he is.”

As always, there is much more to say about this. This discussion of the therapeutic social contract and patient choice is not specific to patients with suicide risk. But it deserves special attention in the context of suicide risk because the stakes are high, the issue is loaded, and medical-legal preoccupations kick in and complicate everything. More to come…

References

Bowen, M. (1978). Family Therapy in Clinical Practice. New York: Aronson Publishers.


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Categories : family, patient choice, psychotherapy, therapeutic alliance, treatment planning

Clinician anxiety–what’s it about?

1 02 2007

When the “S” word comes up, many clinicians feel on edge. I’m sure that more than one factor (and different factors for different people) that contributes to the anxiety, but they are different enough that it affects how we would target training. Here are some possibilities:

  1. Uncomfortable with the pain and despair of another.
  2. Squemish about suicide and it’s morbid implications.
  3. Unsure of having the right skills to assess and treat.
  4. Worried about medical-legal implications of losing a patient to suicide.
  5. Concerned that suicidality will “hijack” the treatment.
  6. Incredulous that someone consider destroying him/herself.
  7. Fearful of losing a person the therapist cares about.
  8. Worried about not being able to help.

As I said, the source of anxiety probably varies, but I think it’s worth asking which is the most prominent so that we can (a) address it in ourselves and (b) target clinician education at the right set of issues.


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Categories : psychotherapy, suicide, teaching/training, therapeutic alliance