Poppin In

I want to write a quick follow-up to my Pharmaphenalia post. For those who missed it, I selflessly sacrificed my tried and true Zyprexa clipboard, in the name of not running ads for Eli Lilly. And I purchased a clipboard from Poppin, to replace it.

I also bought a few other things for my office, including these cool pens:

They write decently, although they were a little scratchy to begin with, but that seems to have smoothed out. The thing is, I write a lot of process notes, so I started going through them pretty quickly. I tried to find refills for them, but I couldn't, so I emailed Poppin about it. They didn't get back to me, so I kind of forgot about it (they are, after all, just pens, and cheap, at that).

Then, on Friday, I got this email:

First of all, I want to say how sorry I am that this email is so incredibly delayed. I got your original email, wrote you what I consider to be an awesome response, hit send but just found out it never went through! I am so sorry we left you hanging! Here is what I originally had to say about our Gel Luxe Pens. 

Those pens are actually intended to be single use. But, I did do some digging and searching with our product team to hunt down replacement cartridges and unfortunately came up short. They don't quite fit standard refills and I even took one of our Luxe pens to the art and stationary store next to our office hoping they might have a suggestion but no such luck.

Your best bet is to get some brand new ones from us! Since my email never got out to you and I know exactly how great those pens are, I am going to make sure that is exactly what happens. I am sending you two boxes of our White Gel Luxe Pens plus a Pen Cup so you have somewhere to put them...on us! I want you writing happy and I would hate for you to think that your email was ignored.

This is my definition of exceptional customer service. And I've since received another email letting me know that the package has been shipped.

The expression, "The customer is always right," was coined by Sears President, Julius Rosenwald. It seems like the kind of idea that shouldn't need to be coined as an expression, it should just be intuitive. But then, as now, it was necessary. 

And Poppin seems to get it. Insurance companies could take a lesson from them.

Pharmaphenalia

I've posted a fair amount about Big Pharma, and how they market drugs they know to be ineffective, or even unsafe, how they buy off doctors to be Key Opinion Leaders, or just active prescribers of their drugs.
And I've been smugly patting myself on the back for not using drug pens or post-its, etc. But not quite. When I meet with a new patient, I tend to take notes. And since I don't have a chart yet for that patient, I use a clipboard with plain, looseleaf paper. I don't pay much attention to the clipboard, because I've been using it so long I don't even notice it. How long? Since residency. I know this because it's a Zyprexa clipboard, and I haven't gotten stuff from drug reps since I was a resident.

Sorry for the crappy photo, but it's some pretty glaring advertising, no? I don't understand what the little dude at the bottom is supposed to symbolize.

Is it a big deal that I use a zyprexa clipboard? I don't know. I feel like I should be more cognizant of what it might mean to patients. Does it make them think I'm going to throw an antipsychotic at them? That I get lots of stuff from drug reps?

Regardless of what it means to my patients, I think there's something to the fact that it's insinuated itself so thoroughly into my work life that I don't notice it anymore. It seems broadly emblematic of the situation with drug companies. They're part of our thinking. They're just there, no questioning required. Of course I use a Zyprexa clipboard, who doesn't use all that cool, free stuff the drug reps give away?

I decided to make my own symbolic gesture, and get rid of it. But I do need a clipboard. I can probably dig up some old thing at home, but I thought I'd get a really fun clipboard, to make up for my loss.

And this is it:

the hold-tight

Lime Green Clipboard

From Poppin. Set me back all of $5, a small price to pay for ejecting Big Pharma from my office.

While I was at it, I decided to get some fun office stuff:

the cut-above

White Scissors

This pair will beat rock and paper every time.

the most-writeous

White Letter Size Writing Pads

the write-away

Bikini Medium Spiral Notebook

the always-on-point

White Retractable Gel Luxe Pen

The clipboard is simple and perfectly functional. The scissors work well and have white blades. The paper is dense and has a nice hand. The notebook is cheerful. And the pens are cool-looking but write scratchily.

And not only is Poppin not paying me to write this, but they don't even know I exist. Which is good, because that way they can't target their marketing at me, like the Lilly rep who gave me the Zyprexa clipboard.

Chairs

What kind of chair do you use in your office?

Like most shrinks in private practice, I sit a lot. And I happen to have back problems (old muscle injury). So it's been hard to find the right chair.

The way my (small) office is set up, I use the same chair for sitting in when I'm seeing patients face to face, and when I'm working at my desk. At the moment, I'm using a Setu Chair.

I got the kind without the arms, because I thought it would give me more freedom of movement, but I think it makes it harder for me to take notes, or even just sit back comfortably. It's also not height adjustable (this model), so I use a footrest with it. The nice thing about it is that the instructions consist of two words: Sit Down! No adjustable doodads. Nothing complicated. And it does mold to your back nicely. But I still seem to ache a lot, even with stretching and strength training.

How do you figure out which chair works for you? If you go to a store to try it out, it's not like you're going to sit there for 3 hours to see how it feels.

In the past, I've used a Mirra chair:

But the controls were too cumbersome, and it wasn't all that comfortable.

My husband uses an Aeron at his desk:

I've never found it that comfy.

I recently read about the second iteration of the Think Chair:

This looks promising, but again, how do you know until you've sat in it for several hours straight?

One day, in the far off future, when I have a big enough office to fit both a desk chair and a sitting chair, what I want is the Saarinen Womb Chair with Ottoman:

I also love the idea of an Eames Chair with Ottoman:

In all honesty, I'm crazy about this chair, but I've wondered what it would do to my back to sit in it all day.

That's the thing. There are all these different ergonomic desk chairs, but they're made for working at...wait for it...desks!

And the lounge chairs are more for reading.

It reminds me of doctor shoes. I learned this as a medical student and resident. There are great shoes for running. And there are great shoes for walking. But what you need when you work in a hospital are great shoes for standing. Because that's mostly what you do. I used to think those Dansko clogs looked silly on surgeons, and the Merrell clogs are ugly. But they work for standing.

Is there such a thing as a shrink's chair? One that's designed for attentive listening in a not completely reclined position, that lets you move around a little, and doesn't let you sink down til it's bad for your posture? This could be a challenge for Herman Miller.

Just for fun, here are some of my other favorite chairs:

The Swan

The Egg

The Marshmallow

The Flight Recliner

The Papa Bear

Do other people have similar sitting issues? And if so, how have you solved them?

Skype-chiatry Link

Thanks to Dinah, from Shrink Rap, for her comment on Tele Me More. The podcast includes an interesting discussion of the more technical aspects of Skype-chiatry (In the future, will people practice Skypoanalysis?). Check it out, episode #49.

Artwork for the Office

Enough already with the E&M coding. It's time for some pretty pictures.

What artwork do psychiatrists have in their offices?

I always wonder what the impact of the artwork is, which has made me very particular about what I choose to put on my walls.

In my first office, which was in the hospital I was working for, I had a painting that I bought from a man in the park across from the hospital. His name is Alan Streets, and here's a link to his site.

This is a painting he did of the Brooklyn Bridge, in the same style:

The one I have is this awesome painting of the buildings on the park across from the hospital, except that everything is just a little crooked, like the one above, and I watched him paint it.

But when I moved to my own office, it seemed a bit too personal (and a little too creepy), to put on my wall. I wanted something brighter, and maybe thought provoking. But not too thought provoking.

Well, I couldn't find anything like that, so then I just bought some nice paper that I happened to like and framed it.

It seemed fairly innocuous, and I still think it looks like balanced stones. My patients commented on it occasionally.

In my current office, I really wanted something special, that I liked looking at. But it couldn't be too personal or showcase my tastes too much. It could be thought provoking for my patients, but not too controversial or "out there". I wanted it to be colorful. I wanted it to be a real "work", but not too valuable, especially since I can't afford anything like that. And I wanted it to not scare anyone.

I had purchased another painting on the street about a year before the Alan Streets one. It was by a man named Ivan Jenson. It's very similar to this one:

I really like it, and I had intended it for my office, but on looking at it, there's something disturbing. Maybe that's what I like about it. But I couldn't see subjecting paranoid patients to it, or even regressed analytic patients on the couch.

I also bought a poster from him, that looks a lot like this, except with bolder strokes and more brown than blue:

This one's called "Bearded Man", and I suspect mine is, too, and that they're not intended to be anyone in particular. A little Van Gogh, a little Stalin when he still had hair. But it was a little too "Freud" for me to be comfortable putting it in my office with my analytic couch. I already feel like something out of a Woody Allen movie.


I thought about going the standard New Yorker route. You know:

Or:

They were just too predictable. And I didn't want anything silly.

I liked the idea of having something New Yorky, though. Ikea has this one:

But it's a bit too Ikea.


I did buy a little 10x8 painting from a young man who was selling his work on Union Square. The poor guy was trying to make rent, and I didn't have much cash on me, so he sold it to me for whatever I had, I think $30. I offered to bring him more money the next day-he was just a kid-but I never saw him again. It's a great painting of the Bushwick Subway Station, slightly impressionistic, in muted blues and purples, like it was raining the day he painted it. But it's tiny, and it sits on my desk. I doubt most of my patients can even see it well.  I don't remember his name or I'd list it, because the kid has talent.

Then what?

I love Charlie Harper

but I thought that would be too specialized.

I think Banksy is great

But he's a little sarcastic.

I'm a huge animation fan

But in my office?

For quite a while, I just left the walls completely blank, other than my diplomas and license registration. Admittedly, there was something soothing about the plain white walls.

Then one day, I was in a store that sells used house stuff, and I saw this up on the wall:

The walls were very high, so I couldn't see it well, and I almost walked away. But I couldn't stop looking at it, and I finally asked the guy to take it down. He wanted $10 for it, and it was already framed, so I figured the frame alone was worth 10 bucks.

I took it home, dusted it off, and looked it up online. It's a poster Frank Stella did for the, obviously, Lincoln Center Festival '67. I don't know if mine's one of the originals, but they sell for $400-$800 online.

This is the one I put on my wall. It's colorful and interesting. It has an intricate graphic pattern and cool lettering (you can't see it in this image, but the background is graph paper). It's cheerful but not silly, and certainly not scary. It's New Yorky, but not in an in-your-face way. And I like it.

Writing this got me thinking about why what decorates the walls of ones office matters. And to whom.

Am I concerned about influencing my patients too much with my tastes? With my self? Am I worried about criticism or ridicule of the things that are important to me? By hiding my aesthetic preferences, do I want to limit my patients' intrusion into my world? Am I trying to get my patients to comment? Or not to comment?

I was thinking that if I really wanted to be non-comital about it, I'd put up a Rothko poster, which doesn't tell you much about what I like. But which one?

And wouldn't my patients just wonder why I picked the pink one rather than the purple?

So what do other shrinks have on their walls? And why? I'd love to hear about it.

For Next Time

I'm posting this so I have a lasting reminder of everything that needs to get done when you move to a new office.

Not that I'm planning to move any time soon. Or ever. But I didn't plan on the last move, either. The people I was subleasing from just didn't realize they had a demolition clause in their lease.

These are the general categories:

Phone Change/Installation
Address Change
Hire Movers
Pack
Get New Stationary

Doesn't look that bad, right? Let's have a closer look, shall we?

These are all the address changes that need to be made:

Post Office
Office Insurance
Malpractice Insurance
License Registration
DEA
New Prescription Pads
Phone Carrier
Professional Organizations
Hospital Affiliations
Medical School Affiliations
Insurance Panels/Medicare/Medicaid.
Tax ID#
NPI
Department of Health

Now be sure to note that you can't get new prescription pads until you have your new DEA documentation, and you can't get that until you have your new license registration.

And I won't even get into what it takes to get your new phone installed. You try to keep your old number, because that's how your patients know to reach you. (Please disregard if you use a cell phone for your office. Ever since the big blackout in 2003, I just prefer a land line.) You wait around all day for them, and instead, they show up the next day when you're with a patient. And then they complain that it's a really complicated job. Or even better, they tell you they don't install in your building.

It feels so good to rant. Really, I just wanted to have all the info in one place.

Moving

I've had to move to a new office three times since I started my private practice. The last time, in particular, was really harrowing, because I found out I needed to move about three weeks before I actually did move.

No, I wasn't behind on my rent. My office was one of three in the suite, and I rented, or I guess, sublet, my office from the other two people, who jointly held the lease (completely legal, BTW). The suite was in a commercial building, and apparently, they had a "demolition clause" in the lease, which stated that the building could decide to demolish the suite, with very little notice, if it felt like it.

It did feel like it. It seems a lowly therapy office doesn't bring in the kind of money that a corporate client does. They basically knocked out the entire floor, on which there were a number of small businesses, including psychotherapists. I understand some of them may be suing. Not my problem.

Bottom line, I had to find a place and move in a hurry, so I thought it might be a good idea to record what was involved in that process, including searching for a new office, and all the changes of address involved.

To start off, I thought I'd list what I would want in my ideal office. I'll probably never have all my wishes come true, but I can dream. And I can even come close.

Ground floor of a residential building with a doorman.
Either no buzzer system, or a silent one.
Bathroom in the suite.
Even better, my own bathroom, in addition to the one in the suite.
Comfortable waiting room.
Air conditioner unit-a quiet one.
Heat I can shut off.
Good natural light.
Good sound insulation.
Nice sized office-not too big, not too small.
Reasonable rent, if I'm renting
I'd love to be the primary renter, or own the space.
Closet in the office.
Kitchen facilities in the suite-microwave, refrigerator, electric kettle.

I got some of the things I wanted. And I do love my new office, even though it's small, has lousy, make that no, natural light, has no closet, no private bathroom, there's no microwave, and there's central air. And I don't own it, and I'm not the primary renter. But maybe in a couple years I'll be able to have it all.

Or not. I really don't want to move again.