Notes from the office: why people don’t return

Mistress Maddie (the dear!) wondered the other day why people (meaning patients) don’t come back to me. MM is better than The Muses (and dressed better too) to get me thinking. This entry won’t be particularly entertaining to the average Spo-fan but it’s good exercise for me to write out my thoughts.

Being a scientist at heart, I want data to hypothesize why folks don’t return, and I haven’t any, worse luck! I don’t know the percentage of patience who are seen once for an evaluation and don’t return. Established patients drop out of treatment all the time as all and I don’t know why either. Very few if any of them tell me or the office ‘why I ain’t coming back”. Some businesses send out surveys to clients hoping to get such information. The Boss and The Overlords aren’t curious enough to look into these matters – that or they are busy enough as it is handling the ones who keep coming. I know there are some nasty reviews online about me – all doctors have some – but these aren’t enough apparently to keep away new patients. There is no lack of customers; I don’t lack for business. If one drops out there are two or three looking to come in.

I believe the majority of folks who don’t return do so from of simple economics – they can’t afford it. Their insurance changes or other matters take precedence. In some ways Psychiatry is a ‘luxury’ specialty. If you can only afford only one, the dentist or the shrink, the former wins hands down. There is also the ongoing belief depression/anxiety are things one can do on their own, pull yourself up by your boot straps why don’t you.

Another factor is people move away. About once a month a patient announces they are moving out of state and this is farewell. Before video and telephone appointments became available, a move across town was enough to change doctors, especially if you have driving anxiety.

When I am aware of someone having dropped out without explanation of course I wonder if I did something wrong. It’s human nature to project into a black box worse-case scenarios and personal short-comings. Both are probably not true or not much of a factor.

In Medicine there is something called ‘goodness of click’ where you ‘gel’ or not with your doctor. The physician before you may be brilliant but if they don’t feel ‘right’ you aren’t going to stick around. Sometimes patients of the female persuasion I sense transfer onto me their trauma emotions upon seeing a male and this is too upsetting. In the men folk (the straight ones) they sometimes pick up I am not (the red high heel shoe-shaped door stop keeps giving me away) and they don’t feel comfortable with a queer shrink or won’t work with me out of moral indignation.*

Another factor is along the line of ‘getting more than you bargained for”. Sometimes folks come in with a superficial complaint such as insomnia and in the evaluation process all sorts of stuff comes up like trauma, drug/alcohol factors, or subconscious issues now revealed. Working on the real problems and not patching the symptom, is too much for some; they get scared and run off. Sometimes these types return in time when they feel more ready. For them I leave the porch light on.

After thirty years of shrinking heads I don’t fool myself I have things down right. If I am doing something wrong that turns folks away I would like to know so I can better myself. This sort of data just isn’t available to me. My intuition tells me I am not doing anything grossly wrong other than failing to dress up to contemporary professional standards.**

Jungians have a sort-of cosmic approach the patients who need me will come, and the ones who go and return do so when they are ready. Thems unhappy with me find someone else. So I don’t worry about the ones who don’t return. I work with the ones who are there. Considering my full dance card it’s good as it is.

*While I won’t discuss politics with patients on occasion patients perceive I am a tree-hugging-save-the whales liberal and they won’t return for that reason. These sorts are rare cases, for right-leaning types seldom if ever seek out mental health care. They either don’t believe in mental illness or see it as a moral deficit they ought to fix themselves. If they can’t they commit suicide using the guns they all have. Death before admitting frailty.

**At least in the eyes of the The APA Secret Police. On the whole patients like my Spo-shirts and The Bosses not once have told me to put on dress shirt/tie and trousers for appearance sake. There is some value in ‘dressing the part’ to convey authority but this has never been my style.