RESTRAINT OF TONGUE AND PEN

Over the years, I have learned everything I think does not require my expression. If I do not practice restraint of tongue and pen, I will have to apologize for my ill-tempered words. I certainly had a close call last week.

Earlier in the year, I had seen a depressed, young man and received many phone calls from his distraught mother. Her son kept two therapy appointments. As we approached his issues, he became a phantom patient. He missed his three subsequent visits and followed none of my recommendations. Occasionally, he would call for an appointment. When I returned his call, he did not answer and his message machine was full.

I had not seen him for six months. Last week, he called, left a message and urgently requested/demanded that I write a letter on his behalf and fax it to his attorney. First, I always see the patient immediately prior to preparing a letter for the court. Second, I'm like a Missouri mule. A patient can politely ask me for a favor, and I will usually accommodate them. However, I refuse to respond to a demand.

Weary of being treated like a free Psychiatric 7-11, I promptly returned the call. To my surprise, I could leave a message. I reminded him that he had missed several appointments, and I was not a get-out-of-jail-free card. Yes, I was a little over the top, but he was the end of a long line of entitled young men, who have paraded through my office and mistook me for their mother.

A few hours later, after a long day of seeing patients, I received a voice message from the young man's mother. She was irate and unkind. As it often happens, the young "adults," problems stem from overly indulgent caregivers.

I was exhausted, infuriated and hurt. I wanted to call her back and tell her what I thought, but I refrained. I knew I needed to sleep on the situation.

The following morning, I composed a rational, professional letter for the mother and itemized the series of events that led up to previous day. I was grateful that I used restraint of tongue and pen, because I did not want to apologize to her or her recalcitrant offspring.