Helping the Injured Athlete Return to Play

The Injured Athlete: Getting Back: in the Saddle, on the Slopes, on the Field, on the Track (You Get The Idea!): A talk presented at the Vail Summit Orthopedics CATA conference, Edwards Colorado, November 17, 2012

Take a moment to imagine the following: You've been playing your sport as far back as you can remember. You’ve built strength, and endurance and you’ve perfected your technique. Your entire life revolves around practice, performance and competition. You love your sport. It’s who you are! It’s the most important part of your life and your identity.  Its how you spend your time and what you’ve built your plans and dreams around. 

Then the unimaginable happens. Suddenly you're injured and you can’t play.

For a serious athlete the physical pain of an injury is only one VERY small part of the suffering experienced as a result of that injury. The severity and impact of the emotional pain and the temporary or permanent loss of your sport can far exceed any physical discomfort from the physical injury. Emotional suffering must be addressed for rehabilitation to be successful. Coaches, trainers and rehab professionals who are sensitive to these issues facilitate the rehab process. Professionals and loved ones who don’t recognize the importance of emotional issues in recovery can further traumatize the injured athlete and may compromise the healing process.

To better understand what happens psychologically when an athlete is kept out of action because of an injury, it's important to consider three major roles that sports play in the life of a serious athlete.

•       Sports fulfill multiple needs for athletes

•       The injured athlete experiences multiple losses:

•       Sense of identity / role / teammate

•       Loss of physical health / invincibility

•       Loss of Independence

•       Sense of alienation and isolation

•       Loss of recognition / esteem

•       Loss of major way they spend time

•       Loss of constructive outlet for stress

•       Sports fulfill multiple needs for athletes

Identity – For serious athletes the sport is their life. They’ve invested years of time, energy and pain. It's how they see themselves and how others see them.

Self-esteem - For most dedicated athletes, sports provide ongoing positive reinforcement and feedback. The enjoyment and self-satisfaction that come from mastering new skills, overcoming new challenges and progressively growing stronger and better is a central source of self-esteem. The recognition of your accomplishments by friends, family and members of the community feed the athlete’s sense of joy and accomplishment. A well-played game, race or match feels fantastic and provides tangible evidence that the athlete’s hard work has paid off.

Stress-managment - Physical exertion is a great stress reliever. When people have no physical outlets they tend to internalize their stress, often leading to headaches, GI complaints or other physical symptoms. Many athletes find that their involvement in sports also provides an escape from family, school or relationship problems. Participation in sports is also a healthy way for athletes to manage frustration and anger.

Normal Reactions to Injury may include: Initial denial / minimizing  - Grief and mourning - Sadness - Anger - Questioning - Frustration- Loneliness- Helplessness - Disillusionment - Boredom - Anxiety - Fear

Worrisome Reactions to Injury

•       Prolonged denial of the injury itself, injury severity and / or response to recovery or limitations

•       Obsession with return to play

•       Extreme guilt

•       Rebelliousness

•       Impatience and Irritability

•       Rapid mood swings

•       Hopelessness

•       Suicidal Ideation

•       Apathy

•       Panic Attacks

•       Depression

•       PTSD

•       Aggression and Raging

Depression: What to Watch For: Low self-esteem - Sadness - Irritability - Hopelessness -Tearfulness - Indecisiveness - Difficulty Concentrating - Guilt - Lack of Motivation - Agitation/anxiety - Loss of sex-drive - Suicidal thoughts - Loss of interest - Lack of Energy - Unexplained Aches and Pains - Disturbed sleep or appetite - slowed speech or movement - Social withdrawal - impaired school or work performance

Negative thoughts often accompany depression: Why me? -  It’s not fair - Why now? - If only… - But now I can’t / won't - I’ve worked too hard for this to happen to me! - I’ve let everybody down - Nobody cares - Nobody understands - Nobody can help me - I can’t handle this -  It will never get better - I’m being punished for my sins -  I’m a loser - It’s hopeless - I can’t take it anymore - Everyone would be better off without me - I’m a burden -The future holds nothing. - What now?

Depression in Athletes after Injury: Statistics

–      Over half become depressed

–      10-15% seriously depressed

–      80 % experience symptoms of depression

–      Suicide is rare

–      Time frame determined by physical recovery time frame

–      Highly treatable with psychotherapy

PTSD

•       Intense memories, dreams, nightmares

•       Uncontrollable strong feelings

•       Flashbacks

•       Avoidance

•       Pushing people away

•       Negative thoughts

•       Hyper-arousal and agitation

•       Concentration problems

•       Sleep disturbance

•       Fear of re-injury

Substance Abuse Issues in Athletes Recovering From Injury
Alcohol abuse
Illicit drug abuse
Prescription drug abuse: easy for professionals, coaches and trainers to be complicit in prescription drug abuse or even encourage it.  Must challenge the athlete about abuse

Psychotherapy can be highly effective in helping people cope with injuries, overcome depression or PTSD from their injuries and recover more quickly and completely from their injuries.  Of course, psychotherapy is very cost-effective too.  A course of psychotherapy to assist an athlete in recovering from injury will often cost less than a single MRI.

Psychotherapy techniques to assist athletes in recovery from injury

•       Supportive listening

•       Cognitive-restructuring

•       Coping skills training

•       Problem solving and planning

•       Self-management

•       Relaxation skills

•       Communication skills

•       Mood regulation

•       Visualization and hypnosis to facilitate recovery and return to play

Advice for the Athlete Recovering From Injury

•       Accept your feelings

•       Learn about your injury

•       Learn about your treatment

•       Be an active participant in your care

•       Take responsibility

•       Set achievable goals

•       Maintain a positive attitude

•       Follow treatment recommendations

•       Self monitor

•       Work hard within guidelines

•       Practice patience, with yourself and with your body

•       Seek and accept social support

Social Support after Injury Can:

•       Maintain a connection with the team during rehabilitation and recovery

•       Help with treatment

•       Help with daily tasks

•       Make the athlete comfortable asking for help

•       Provide education and answers

•       Offer empathic listening and opportunity to vent

•       Be encouraging

•       Provide a positive opportunity for distraction / fun / pleasure

Suggestions For Recovering Athletes

•       Bring a list of questions to your doctor’s appointment or therapy sessions

•       Participate with your team in non-active ways

•       Have friends / team mates / coaches check in with you

•       Schedule activities with friends

•       Plan ahead and ask for help if you will have mobility issues

•       Get assistance with transportation needs

Set Appropriate Goals

•       Injury can be another training challenge

–      Focus on recovery rather than performance

•       Maintain motivation

•       Focus on small incremental improvement

•       Work closely with therapist or doctor

•       Obey doctor’s orders about pace of rehab

•       Accept injury and know your limits

•       Maintain fitness while injured

•       Knowing what to expect can facilitate sense of control and agency

How can medical professionals facilitate recovery in injured athletes?

•       Build trust and rapport with the injured athlete

•       Listen to concerns and provide honest answers

•       Assess and monitor the athlete’s emotional state

•       Educate the athlete about the injury

•       Identify misinformation

•       Involve the athlete’s family, coach and trainer

•       Prepare the athlete and coach for the recovery process

•       Encourage the development and use of coping skills

•       Recognize return to play issues

•       Screen for depression and other mental health concerns

•       Refer to a psychologist with expertise in sports psychology and / or rehabilitation psychology     if needed

How can Trainers and Coaches Facilitate Recovery?

•       Be empathic and caring

•       Build up the athlete’s self-esteem

•       Discourage self pity

•       Take an interest in the recovery process

•       Encourage realistic goals

•       Offer general encouragement and emotional support

•       Listen to the athletes concerns and feelings

•       Encourage optimistic ways of thinking and discourage pessimism

•       Discourage maladaptive ways of thinking such as “no pain-no gain” or “suck it up”

•       Monitor athlete for depression, substance abuse or other mental health problems

•       Encourage acceptance of help from a psychologist if indicated

•       Encourage patience and realistic expectations

How can Trainers and Coaches Facilitate Recovery?

 Reach out to the athlete, do not wait for him to reach out to you

–      If the athlete is in the hospital, visit, bring greetings from the team

–      Participate in family conference if invited

–      Visit at home during recovery

–      Accompany to physical therapy if appropriate

Keep the athlete involved with the team

–      Keep athlete in touch with team activities and issues

–      Give the inured athlete achievable team related tasks

–      Have the injured athlete participate in team activities in non-injurious ways

–      When appropriate expect the athlete to participate in practice (with modifications) 

Do not allow social isolation and withdrawal
–      If necessary assign team mates to check up on or provide practical help
Make the athlete accountable for participation in rehab

Participate in return to play issues and decisions
Encourage athlete to maintain fitness during rehabilitation

How can Trainers and Coaches Facilitate Recovery?

Gently help the athlete get in touch with other areas of personal strength, creativity, interests and ways to participate in their sport in new ways if they are faced with a long-term recovery or permanent disability

I hope you help the athletes you work with fulfill their dreams.  I hope some of the information I’ve shared today will help you do that even better than you might have imagined. 
I will end with another quote from the same person who’s quote introduced this talk.

Wise words for recovering athletes:

 “Speak quietly to yourself and promise there will be better days. Whisper gently to yourself and provide assurance that you really are extending your best effort. Console your bruised and tender spirit with reminders of many other successes. Offer comfort in practical and tangible ways — as if you were encouraging your dearest friend. Recognize that on certain days, the greatest grace is that the day is over and you get to close your eyes. Tomorrow comes more brightly.”

 *** Mary Anne Radmacher:

I hope in your work you help athletes have tomorrows that come more brightly.

That is the most precious gift you have to give.  Thank you for your attention and may your tomorrow burn more brightly too.

drjsquyres@mac.com

www.drjillsquyrespsychologist.com

Twitter: @drjsquyres    Facebook: JillSquyresPhD

Not to be copied without written permission.

Text copyright 2012 by Jill Squyres, PhD.  All Rights Reserved

What One Jill Learned From Another: on Skiing and Recovery from Spinal Cord Injury

What one Jill learned from another: on Skiing and recovery from Spinal Cord Injury

“Courage doesn’t always roar. Sometimes courage is the little voice at the end of the day that says, ‘I’ll try again tomorrow.’” Mary Anne Radmacher

When I was a teenager, I was looking through the TV Guide and saw that the Sunday Night Movie was about a teenager named Jill who suffered a ski accident.  I’d never been skiing but I didn’t know too many other Jills so I thought I would watch the movie.  It was a life changing experience.  As some of you may guess, the movie was called “The Other Side of The Mountain” and it was about a skier name Jill Kinmont. 

Jill Kinmont Boothe was the national women's slalom champion and on the cover of Sports Illustrated when she competed in a 1955 race to qualify for the U.S. Olympic ski team. Speeding down an icy Utah ski slope, she lost control, struck a spectator, crashed and hit a tree. She broke her neck and suffered high level quadriplegia.

 

I was transfixed by her story.  She suffered multiple tragedies beyond her initial injury and yet her strength and resilience kept rebounding and she found ways to go on with a meaningful and productive life, although she never skied again.  I read her books and watched the movie’s sequel.  I thought she was amazing.  Whenever I felt like I couldn’t do something because it was too hard, I imagined how she pushed herself and I pushed myself too.  I also became fascinated with skiing, which I’d never tried.  I learned to ski and fell in love with the sport.

In 1982, I was spending a research year at Stanford while getting my doctorate from USC.  I was driving my car on El Camino Real in Mountain View California.  The person driving the car behind me didn’t realize I was stopped at a red light.  He slammed into me going 35 miles per hour.  Initially, I thought I was fine and I went home.  In the morning, I awakened with pain and numbness in my hands and arms.  X-rays at Stanford University Hospital (this was pre-MRI) revealed a C-7 “clay-shovelers” fracture.  I cried when I thought about skiing and the bike that I might never ride again.  And then I remembered Jill Kinmont.  If she could prevail I could too.

 

This sparked my lifelong interest in behavioral medicine and rehabilitation psychology.  By the end of 1983, I was back on my bike and the following winter I was back on my skis.  I chose to specialize in spinal cord injury psychology and chronic pain management during my psychology residency.  In 1990, I took a job as the psychologist on the Spinal Cord Injury Unit at the VA Hospital in San Antonio, TX.  In 1997, I spoke at the American Association of Spinal Cord Injury Psychologists and Social Workers conference.  The speaker who followed my talk was Jill Kinmont Booth.  After she finished, I walked up to her put out my hand to shake hers (she had learned a graceful way to do this, as many people with quadriplegia do).  I said “Hi Jill, I’m Jill and I’ve been wanting to meet you since I was a young teenager.”  I got to spend time with her and her husband, snapped some priceless photos and was able to share my story.  It was a wonderful moment for us both. 

Jill Kinmont Boothe (who sadly passed away this February at the age of 75) and I were both featured speakers at the American Association of Spinal Cord Injury Professionals conference in September 1997 in Las Vegas, NV

On Christmas Eve 2001, I suddenly experienced the spontaneous rupture of two discs in my cervical spine at C4-5 and C5-6.  I had an emergency discectomy and fusion the first week in January and had to start my rehabilitation from scratch with significant weakness, some neurological symptoms and pain.  I was able to see and read my MRIs so I knew what damage Dr. Swan had to fix.  Little pieces of the ruptured discs had to be delicately extricated from my spinal cord before the fusion could take place.  I adjusted my attitude in the positive direction and spent the time prior to my surgery visualizing the upcoming repair and restoration of my spinal cord. 

Post-up, Dr. Swan came to check on me shaking his head.  When he realized he’d frightened me he quickly clarified my misperception.  He said “Its remarkable.  What I saw when I went in bore only slight resemblance to what the MRI showed.  I actually made them pull a fresh copy of the films to verify I had the right patients films and I did.  The site I was operating on was much cleaner and easier to work with than I had been lead to believe from the imaging studies.  As a result, a projected 4+ hour surgery was successfully completed in 90 minutes.” 

When I had awakened from the anesthesia, I could move my arms and feel my fingers again.  And Dr. Swan had (appropriately, given his name) appreciated the importance of a lovely neck so he brought in a top plastic surgeon to close my incision.  Usually a dry pragmatic man, my neurosurgeon was floored by my amazing recovery.  I went through extensive PT (at Health South where the San Antonio Spurs go) to overcome weakness in my arms and a drop foot on the right.  Once again, I had been told “no more skiing”.

I finally got to test my compliance to the doctor’s order last year when we came to use our time share in Avon Colorado and ski at Beaver Creek.  I was apprehensive.  I relished the cold smoothness of my skis as I put them on and the satisfying snap as the boots locked into the bindings, I took it easy and only got a bunny slope ticket to give a nod to caution.  I got to the top of the slope, pointed my skis in the right direction and ‘woosh', I was flying.  For the first time in over 20 years I have my own equipment again and nothing except common sense will hold me back.  I’m a skier again and I’m a skier who now lives in the Vail Valley.  A dream come true!

drjsquyres@mac.com

www.drjillsquyrespsychologist.com

Twitter: @drjsquyres    Facebook: JillSquyresPhD

Not to be copied without written permission.

Text copyright 2012 by Jill Squyres, PhD.  All Rights Reserved

On Therapy Pets

On one of my clinical psychology practice list serves, the question came up about whether any members used therapy pets in their private practices. One specific issue raised in the post was how to be sensitive to clients with animal allergies if you kept a pet in your office, which is, of course, a very legitimate concern.  I used to have a therapy pet in my office in San Antonio.  It was a Chinchilla named "Neo".  Chinchillas are pretty hypoallergenic so the issue of allergies wasn't especially relevant.  Plus, he lived in a cute cage shaped like a little house and we would only take him out when clients wanted to hold or pet him.  He was a great incentive for my teen aged clients to participate because getting to play with Neo became a great positive reinforcer.  However he was really messy so I ultimately found him a new home because cleaning up after him just became too time consuming.  I had a brightly colored little crate I carried him from home to office in.  He was well known at the supermarket and OfficeMax because I couldn't leave him in the car when I ran errands on my way home from work.  I'd put his crate in the seat of the shopping cart and we would run my errands together. 

In San Antonio, I had several clients who really liked bringing their dogs with them to therapy sessions.  Of course, this could potentially have been an issue for other clients coming in with dog allergies but this never came up.  Now that I live in Colorado, people seem to bring their dogs everywhere.  Even the bank has dog biscuits on the counter instead of lollipops for the people!  Every restaurant has a water bowl outside for the dogs who wait patiently for their owners while they eat.

For the first time in my career, I have a home based practice.  While my office is at the front of my home, it is still in my home.  I have a medium sized westie-poodle mix and two cats.  The cats hide under the bed when clients are here so they are obviously not willing to be therapy pets of any kind.  I was initially putting my dog in the mud room when clients came so they wouldn't be bothered.  Believe it or not, this really bothered my clients!  Every one of them wanted to meet my dog and didn't want my dog locked up on their account.  Now, my dog comes and greets them while they are waiting to see me.  She has become my pseudo-receptionist!  

I keep the dog out of my therapy office so she is not a distraction but if a client (particularly a teen) wanted her there, I would allow her in.  So far, I haven't raised the allergy issue with new clients although I do tell them that my office is in my home before they schedule their first appointment.  So far, everyone seems to assume that I have a dog.  Many of them come with their dogs and leave them in the car in the shade with the windows open while we meet.  Occasionally their dog goes out in the yard to play with my dog.  Of course, this will probably change when it gets colder and snows.

I think this is all really ironic because I am a cat person and I can't quite believe I even have a dog.  I never expected her to be a business asset.  

When a new client brings up the allergy issue, I will offer them online psychotherapy instead.  A highly respected psychologist named Ken Pope, PhD, with whom I am acquainted, keeps therapy cats in his office.  When a potential client has a cat allergy he offers to see them in their home.  The Vail Valley is too spread out for me to offer that routinely but I would consider it as an option as well.

BTW, this all started with a fish tank.  I set up a pretty tank in my first private practice office because it was soothing.  However, I am really bad at keeping fish alive.  One day a particularly difficult 11 year old came in and in a hostile tone of voice said "your fish is dead."  I had just fed the fish a few minutes earlier and before I could stop myself I fired back "No he's not!"  But he was.  Then the kid said "You are traumatizing me with your dead fish."  And then we both cracked up.  I didn't replace the fish and I gave away the tank.  And then I got Neo the chinchilla (see first paragraph).

drjsquyres@mac.com

www.drjillsquyrespsychologist.com

Twitter: @drjsquyres    Facebook: JillSquyresPhD

Not to be copied without written permission.

Text copyright 2012 by Jill Squyres, PhD.  All Rights Reserved

Fast Forward: San Diego California Oct 5-6, 2012

I’m sipping a diet Dr. Pepper and enjoying the view from a window seat on a 737 flying over Utah. I’ve just spent the past few days in San Diego at The American Psychological Association’s Division 42 (Psychologists in Independent Practice) Fast Forward conference.  I attended this inaugural Fast Forward meeting for several reasons.  First and foremost, I am a relatively active member in this division and it’s a good opportunity to participate in the division I consider to be my professional “home”.  Also, psychologists need to get annual continuing education to maintain our licenses to practice.  This conference provided all the CEUs I require for the coming year for my psychology licenses in Colorado and Texas.  I also specifically decided to attend Fast Forward because I was asked to be a speed mentor at an innovative workshop put together by Dr. Heather Wittenberg, a dynamic and creative psychologist lucky enough to live on Maui.  I was honored by the invitation but also delighted to have the opportunity to share my expertise with early career psychologists.  I think the workshop exceeded everyone’s expectations and I hope Dr. Wittenberg feels considerable pride in her accomplishment.

Division 42 has an active and lively list serve that is a professional perk of membership.  Many prominent psychologists make frequent postings.  It’s ironic to feel like you know a colleague well when you’ve never actually met them in person.  This meeting was also appealing because it gave me the chance to get to know some of these delightful people face to face.  What a pleasure it was and, of course, the chance to network is always a nice benefit of attending a professional gathering. 

Over the past few days, I’ve listened to presentations that both inspired and sobered me.  I’ve discussed complex ethical issues and features of online and office based practice.  I was privy to fascinating dialogs regarding professional development and ways to think “outside the box” about the practice of psychology.  As a result, I’m contemplating new directions and strategies for my own practice.

I even won a great book in a raffle held during yesterday evening’s social hour: “Financial Success in Mental Health Practice” by Steve Walfish (who graciously autographed my copy) and Jeff Barnett.   That’s the second raffle prize I’ve won in the past few months.  It’s also the second raffle prize I’ve won in my whole life!  And both prizes were something that I could use and really wanted.  Lucky me! 

The food and fellowship were fantastic and the weather was perfect.  The meeting was held at the Rancho Bernardo Inn, which turned out to be an idyllic Southern California venue.   So far, our planes have been on time, our rental car was ready, there was little traffic and my iPhone’s navigation system guided us efficiently where ever we needed to go.    

On a personal note, my sister lives in the San Diego area, so not only did I get to attend Fast Forward, I got to spend several delightful days in her company.  It was also a chance for a whirlwind getaway with my husband who came along so we could enjoy some time together, visit with my sister, relax in sunny San Diego and meet some new friends.  We even got to do a little shopping, which is no longer as easy as it used to be, since we’ve left the “big city” of San Antonio and relocated to the small Colorado town of Eagle.  We are hoping our teenaged daughter will be delighted when we return home this evening with a lovely dress for her to wear to her first homecoming dance.

All in all, an extremely satisfactory few days, wouldn’t you say?

One of the most amusing things I learned at one of the presentations I attended at Fast Forward is that my cat, Pepper, is a "digital native."  Thanks Dr. Ofer Zur (http://www.zurinstitute.com) for the insight!

If you would like to learn more about me, take a look at my website: www.drjillsquyrespsychologist.com

Psychotherapy and Electronic Health Records (EHR) Q & A

EHR Q&A: Answers to Mental Health Practitioner’s Most Frequently Asked Questions

By Jill Squyres, PhD

Lately, there’s been a lot of buzz about electronic health records.  Here are answers to some of the most frequently asked questions about EHRs as they relate to mental health practice.

What’s the difference between an EHR and an EMR? What does this have to do with PII and PHI?

The digital age in health care requires us to keep track of a veritable alphabet soup of acronyms!  While the terms EHR and EMR are often used interchangeably, by the most stringent definition, EHR (Electronic Health Record) refers to all of a person’s health information maintained in an electronic format.  EMR (Electronic Medical Record) generally refers to a patient’s chart maintained by a health care practitioner or organization.  An electronic document that includes data entered by a health care provider as well as information added by the patient would be an EHR by this definition.  Many people are starting to use the term EMR to refer to both as a convenience because when typing in Microsoft Word, the spell check function automatically changes EHR to HER!  PII stands for personally identifiable information and PHI is protected health information, both of which are included in the EMR.  HIPAA guidelines require us to take careful security measures to protect PII and PHI.

Do mental health care practitioners have to use an EMR?

Currently, counselors and psychotherapists are not required to use EMRs.  However there are many benefits to an EMR that may outweigh any drawbacks.  Physicians currently have guidelines requiring them to adopt EMRs.    

I’ve heard the government will pay you a lot of money if you start using an EMR.  Is this true? 

Medicare and Medicaid have initiated an EHR (this is the term these programs use) adoption program that offers substantial cash incentives for meaningful use of electronic health records.  Detailed meaningful use criteria have been developed by Medicare and Medicaid.  At the present time, none of these criteria pertain to mental health practitioners so we are not eligible for these incentive payments.  However, mental health professional organizations, such as the American Psychological Association, are lobbying government agencies to have mental health care criteria included in the next stage of meaningful use incentives.

What are the benefits of using an EMR?

EMRs can make managing client documentation much easier and more convenient.  Most EMRs also include an entire suite of practice management tools including a scheduling calendar, billing module, and online insurance claim filing in addition to the standard chart.  Progress note templates and intake, assessment, and treatment planning forms are often included as well.  Of course, all documentation kept online saves paper, filing space and shredding costs.  Records requests can often be accommodated by faxing the documents directly from your practice computer, saving on mailing costs, paper and postage.  EMR developers are now adding integrated video conferencing modules to their software to make initiating online sessions a point and click option.  Online EMR’s offer the added convenience of being able to access your client’s chart and contact data from any device anywhere with internet access. 

If I use an EMR does it have to be online?

There are several different types of EMR software.  One type is stand-alone software that you load on to one personal computer.  This software does not require an internet connection and all of your data is stored on the single computer it’s loaded on.  Of course, frequent back-ups to a hard drive, data CD and / or a thumb drive will be necessary if you are using this type of system to protect against loss of all of your patient data.  From a HIPAA compliance standpoint, this type of system is the most secure, although a stand-alone computer can still be stolen or accessed by unauthorized personnel resulting in a data breach.  The risk of losing all of your data in a disaster or computer crash is an important consideration from a risk management stand-point as well.  While there are security issues to consider with web-based systems or online back-up, it is not acceptable professionally to lose all of your clients’ mental health care information because your computer died or you experienced a natural disaster or fire.

How do online EMRs work?

Online EMRs are generally accessed over the internet through a secure browser window.  Most will work with any browser software although some programs will only work on PCs, not Macs.  Traditionally, EMR software has not worked on tablets, PDAs or smartphones, however, many vendors are adding apps, which can be purchased for an additional charge, for convenient access on mobile devices. Large medical practices and hospitals often purchase software that is loaded onto a dedicated server which may be physically located on their premises but this is not an affordable option for private practitioners or small group practices.  This set-up allows for an online record that is only accessible to devices on the facility’s private network.

Can I be sure my online EMR is HIPAA compliant?

The developer of your software should provide documentation of their security measures and compliance with HIPAA standards.  Any browser window accessing an online EMR should have an address beginning with https: instead of the usual http.  Your EMR software vendor should also require you to sign a business contract attesting to their security measures for HIPAA compliance.

What about all of my paper notes?

Of course, you can keep all of your paper notes filed the same way you have traditionally kept them and start keeping records electronically from the date you implement your EMR.  Many clinicians purchase a scanner and scan in old records so the paper copies can be disposed of.  Most EMR software allows for easy uploading of paper documents.  Some clinicians even continue to write their notes on paper and then scan them into the client’s EMR when they close out the appointment.

I’m already spending a lot on running my practice.  Is it expensive to adopt and EMR?

There’s a lot of competition in the mental health electronic record market, which helps keep costs down.  For the most part, you will pay more for extra features like patient portals, billing features like automatic credit card payments and insurance filing, templates and state of the art interfaces.  The cost for most software is charged as a monthly fee although some companies charge an additional fee to get your account and data set up.  This set up fee can also include transferring data from old software to your new EMR, which may look expensive but can cost much less than paying someone hourly for data entry to get you up to speed.  The typical monthly cost ranges from $60 - $150 per month depending on what features and technical and administrative support you want from your software provider.  There are also free options, which are not specifically designed for mental health providers but can be easily adapted to our needs.

drjsquyres@mac.com

www.drjillsquyrespsychologist.com

Twitter: @drjsquyres    Facebook: JillSquyresPhD

Not to be copied without written permission.

Text copyright 2012 by Jill Squyres, PhD.  All Rights Reserved

Bibliotherapy and Beyond: A Tribute to Genius

The latest business advice for psychologists encourages us to cultivate a niche of expertise.  A niche will allow your practice to stand out amidst the clutter of treatment options and help potential clients decide whether you are likely to be the psychotherapist best suited for their needs.  My practice niche is helping gifted people cope and thrive in the face of their uniquely rarified universe of talents, challenges and stressors. To further this aim, I love to read biographies of exceptional people who have achieved the outstanding kind of greatness and impact on society that can come from being driven, creative, and intellectually gifted.

Steve Jobs, who passed away October 10, is one such genius. If you would like to better understand what makes people like Steve Jobs tick, you should read Walter Isaacson’s new book “Steve Jobs”.  It can be difficult for most people to fathom the way brilliant, opinionated, persistent, irreverent, visionary people actually think.  You can enjoy a front row seat to the mystery and wonder of an amazing mind when you read this biography.  A compelling biography about the “other” Steve, at Apple, Steve Wozniak, is called “iWoz: How I Invented the Personal Computer and Had Fun Along the Way” by Patrick Lawlor.  While Jobs was moody, charismatic, grandiose and ambitious, Woz, is a sweet, shy, solitary dreamer with an admittedly high level of social awkwardness.  While I don’t diagnose people I’ve never met, he comes across as a classic presentation of high functioning Asperger’s Syndrome.  His autobiography is both touching and inspiring.  Both Apple creator biographies stand well on their own but they convey an interesting synergy when read in tandem.  They chronicle an exciting time in the history of technology and provide an answer to the age-old question, “If things are the way they are because they got that way, how DID they get that way?”…At least with regard to Apple computers, anyway!

The author who wrote “Steve Jobs” also wrote a biography of Albert Einstein (entitled Einstein: His Life and Universe) published in 2007.  Isaacson is particularly skilled at making the minute details of life lyrical and informative.  He integrates great chunks of history into his books and strives to help the reader understand the “theory of mind” of his famous subjects.  He debunks many of the popular myths about Einstein, such as the absurd idea that Einstein failed math in elementary school, which he did not.  As a psychologist, it is especially interesting to understand how visionary men like Einstein, Wozniak and Jobs integrate their exceptional giftedness with the other relatively mundane but meaningful priorities in their lives such as family, relationships, home-life, travel, values and inspirations. 

“A Madman Dreams of Turing Machines”, by Janna Levin, is about Kurt Godel and Alan Turing.  Godel was a mathematician / philosopher who gloried in the café culture of 1930’s Vienna.  Turing was a mathematician / logician / computer scientist who is best known for mechanical decision theory and the Turing Test, which is still the standard by which the quality of artificial intelligence is gauged.  The book is an intriguing foray into the lives of two brilliant but troubled men whose lives had striking similarities and common influences, although they never actually met.  The author’s deft use of alternating chapters about each of her subjects makes for some very engrossing reading.

“End Game: Bobby Fischer’s Remarkable Rise and Fall from America’s Brightest Prodigy to the Edge Of Madness”, by Frank Brady, chronicles the troubled life of chess champion Bobby Fisher, another genius with qualities characteristic of Asperger’s syndrome.  Fischer’s IQ was measured at 181 and his odd, demanding and difficult nature was legendary.  He died in 2008, consumed by feelings of bitterness and alienation.

In my opinion, the most heart-rending biography of genius is “A Beautiful Mind” by Sylvia Nasar about the eccentric Nobel-prize winning Princeton economist John Nash.  While the eponymous movie is fascinating, the book is even better.  It explores the details of Nash’s descent into paranoia and psychosis with a gentleness and wisdom that provides thoughtful insight into the inner experience of schizophrenia.  This remarkable book is a particularly engaging read for mental health professionals wishing to develop a deeper understanding of this terrible illness. 

The poignant struggle that comes with compelling genius seems to separate a person from the rest of his world.  Ultimately, what we call genius appears to be the natural ability to comprehend universal truths and see things in a way that no one else generally does.  This can make for a very turbulent and lonely existence. The isolation, frustration and compulsive drive that characterize the subjects of these biographies shows how giftedness can be a double-edged sword.  Sadly, their greatest challenge may be growing old without becoming paranoid, alienated, delusional or embittered.  It’s always illuminating to really know the actual person behind a legend.  These biographies bring these legendary scientists and inventers alive in a way that will forever change how you perceive the costs and benefits of genius.  Hopefully, reading about their lives will make you further appreciate the price they paid to make the unique contributions that have so enriched our lives.  The insights gleaned can also compassionately inform our work with individuals on the gifted spectrum.

Until next time, happy reading!