I am a licensed clinician and adjunct instructor in behavioral sciences.
The Small Details No One Mentions
The first time I walked into my own office, then went into the waiting room to get my first patient, I quickly discovered a lot had been left out of my graduate education. I felt overwhelmed with clinic procedures, meeting 10 to 15 other staff a day and trying to remember their names, learning my way around a maze-like building, and learning new terminology.
Walking into a clinic for the first time is exciting and nerve wracking. You may quickly learn your graduate program did not prepare you for everything. Nobody taught me many of the things I needed to do my job. I had to rely on observation, asking a lot of questions, taking notes, intuition and trial and error. Some of these points will be obvious, others less so.
I am offering a list of items I wish I knew the first day I walked into a clinic that can make your experience a little easier.
1) Always be Neatly Dressed and Groomed, and Squared Away.
Your appearance matters a great deal, as it reflects your deeper attributes and qualities such as attention to detail, organization, self-respect, and consideration of others. Develop and maintain immaculate hygiene, and a very neat, meticulous, and professional appearance. You don't have to wear designer label clothing, but make sure everything is clean, well-fitting, and tucked in. I keep a drawer full of hygiene items in my desk drawer to freshen up between appointments.
2) .Stand up Straight, Look People in the Eye and Project your Voice When You Speak
This applies to communicating with patients and peers. Project confidence and competence. You may not know a lot of what you are doing yet, but present yourself well. Never slouch, avoid eye contact, or murmur or mumble. Confidence is knowing your place on the social and workplace hierarchy, and your current level of knowledge and skill. It is not arrogance or narcissism, nor false humility.
3) Develop and Maintain the Highest Degree of Physical Fitness possible.
Once again, your appearance matters. This includes what kind of shape you are in. Your clothes will fit better, and you will project an image of confidence and someone who has their act together. People regard those who are very fit with more respect. This will cause you to respond with more confidence and self-assurance. You will model an image of capability which will inspire confidence in your patients and other staff. When you are at an optimal level of fitness, you are also more resistant to the effects of stress.
4) Be on Time. Better Yet, Be 15 Minutes Early.
When you have an appointment with a patient, peer or supervisor, be there when you are supposed to. Give yourself more time than you need. When you have an appointment with a patient, end the prior session on time so you are not late for the next one and playing catch-up.
5) Return Phone Calls and Emails Within 24 Hours.
Don't keep people waiting. Respond as soon as you can, never more than 24 hours.
6) Communicate Concisely.
When you leave a voice mail, don't tell a story. Come directly to the point. Leave your name, your number and a sentence or two why you are calling. Keep your message down to 10 seconds or less.
When you send an email, always include a relevant subject heading, which you may change in a thread as the topic changes. Always include a salutation or greeting, and sign off with your full name, title, position and business address.
7) Expect Barriers to Communication
Expect no voice mail set up, and out of service numbers when you call a patient. When you call another agency, organization, or peer, expect to be put on hold for a long time, and to navigate lengthy call menus instead of being able to talk to a live person. Anticipate horrendous hold music.
8) Keep Notes to Learn Abbreviations, Acronyms, Clinical terms and Slang.
Make a list so you can quickly sound like you know what you are talking about. What you learned in grad school about psychological theory and counseling theory is not the same way professionals communicate, nor how patients will communicate with you. You will immediately discredit yourself and be marked as an amateur if you are not familiar with common acronyms and slang. You need to develop credibility when you are new, and maintain it throughout your career. Learn some medical and legal terminology as you will be communicating with physicians and probably attorneys, depending on the nature of the population you see.
9) Observe and Listen More Than You Talk.
This point is closely related to Point #8. Keep your eyes open, your mouth closed, and pay attention. Learn from everyone around you, from the CEO, to your clinical supervisor, peers, the groundskeeper, and your patients.
10) Keep Snacks in Your Office Drawer.
You will have busy days where you can't leave the office and get something to eat. You will also have days where you have to come in early and stay late. Keep snacks and non-perishable foods in a drawer.
11) Offer your Patient Coffee.
Offer water on hot summer days, or coffee or tea on fall or winter days. This is good manners, and helps develop rapport and connection. There is something civilized about two people sipping coffee or another hot beverage while talking. It helps put both of you at ease. The best therapy sessions do not feel like therapy, just two people having a conversation.
12) Be Knowledgeable and Always Know More Than Your Peers.
Become an expert. Read and read and read. Watch educational videos and podcasts. Attend live trainings and webinars. Repeat. Go far beyond the minimum required Continuing Education needed for licensure or license renewal. Develop a reputation as someone who has the answers. Make yourself valuable and indispensable by having knowledge beyond your level of experience, and outside your field. Develop not more than three areas of clinical interest and become a specialist and an expert in these areas.
13) Never Contradict, Undermine, or Argue with Another Staff in Front of a Patient
The only exception is if there is an is an immediate danger.If you have a difference of opinion or conflict with another staff member, address it in private. In front of patients, you always have to look competent. You will diminish patient confidence if you are not united.
14) Stop Worrying About Who you Might Trigger or Offend.
If you have to do this, you are in a toxic workplace. There is way too much emphasis today on sensitivity, and not triggering others. This is making a generation of weak people, and stifling free speech and freedom of expression. Beware of any environment where you have to censor yourself.
15) Don’t Over-pathologize, or Treat People Like They Are Fragile.
Do not treat people like they are broken and fragile. That only makes people weaker. See point # 14. Treat people like they are capable and they will start acting like it.
16) Don’t Trust Your Co-workers or Supervisor Too Much.
Something seldom talked about is the degree of betrayal and lack of loyalty between peers I have observed throughout my career, in multiple work settings. Remember they are not your friends, just people you work with. Consider hiring your own private supervisor. This is a more experienced clinician you will pay to meet with weekly to review cases and get feedback.
Trust is a precious gift. Hand it out slowly, and only when others earn it.
17) Start Making A Personal Unemployment Fund As Soon as You Get Your First Paycheck.
Save a little from each check, invest wisely and watch it grow. This is a private unemployment insurance policy, that will enable you to walk away from an abusive employer or toxic work environment if you need to. There are few things worse than being trapped in a bad workplace because you are financially vulnerable.
18) Many of Your Patients will Fail.
They will relapse, lose their kids to the state, go to prison, get sick, commit suicide, or Overdose. You will not save everyone; you will help some people, some ways, some times. If you are out to save the world, you will burnout out quickly.
19) Taking Good Care of Yourself is Not Optional.
Take care of yourself first. Have multiple ways to relieve stress. As you have your sessions, you will encounter suffering, hardship, loss, and depending on the patient population you work with, malevolence.
Self-care is a requirement. You must prioritize self-care throughout their career, or you will burnout within months.
Be a perpetual student
Develop a reputation as someone who has the answers. Make yourself valuable and indispensable by having knowledge beyond your experience.
Appendix: Clinical symbols & Abbreviations
Clinical Symbols & Abbreviations
Sx Symptoms (or sign, or signature, depending on the context in which it is used)
Tx Terminate, transfer or treatment (depending on context)
Rx Prescription or prescribe, prescribed, depending on the context.
PRN As needed, or as necessary
BID Twice a day
TID Three times a day
QID Four times a day
QOD every other day
Q every- as in Q six hours- every six hours
HS before bed, or before sleep
Hr. (Hrs.) Hour or Hours
Mos. Month or months
Ǿ Null, no, none, negative, absent, zero, not present
(+) Yes, positive, present, found
2 o Secondary
PCP Primary Care Physician
Y/O year old
NOS Not Otherwise Specified
WNL Within Normal Limits
LiCO3 Lithium Carbonate- (medication for tx of pts C Bi-polar D/O) (can you translate this now?)
> More than
< Less than
S/H/I Suicidal /Homicidal Ideation
A/V/H Auditory /Visual Hallucinations
P/I Paranoid Ideation
This article is accurate and true to the best of the author’s knowledge. Content is for informational or entertainment purposes only and does not substitute for personal counsel or professional advice in business, financial, legal, or technical matters.
© 2021 David A Porter