Back in the Saddle Again

This is just a short update on how phased retirement is going. I’m back in the saddle. Last Friday I went back on duty on the Consultation-Liaison Psychiatry service. I’m at 50% time. My step counter today shows about 2 miles and 17 floors—a slow day. That’s fine with me.

Colleagues pass me in the hall and say, “I thought you were retired.” They don’t look happy when I tell them I’ll be fully retired in June next year.

But I’m a little happier. It’s taking a long time to get used to not being a fireman, which is what it means around here to be a C-L psychiatrist.

How’s the cooking going? Miserable but getting better, in a way. I can deal with things like “Just Crack an Egg,” which my wife, Sena got for me, as a sort of sympathy gift, I guess. I can handle it. And I made an omelet the other day, my first ever. The kitchen was not filled with smoke and it was edible.

How’s the exercise routine going? I’m still at it, 20 minutes every day, along with my mindfulness practice.

As I was giving my usual orientation remarks to the new trainees coming on the service this morning, I caught myself saying “I do it for the juice” when telling them why I do this schtick. I’ve said that to a lot of residents and medical students over the years.

I guess I should rethink that remark and the mindset that makes me say it so often. Pretty soon, I won’t be chasing all over the hospital anymore— “for the juice.”

I’ve been trying hard to find something else for the juice. Sena and I’ve rediscovered card games we haven’t played in over 20 years: Pinochle and Gin Rummy. I lost track of time playing Gin yesterday, I had so much fun. We just celebrated our 42nd anniversary. It was magical.

I’m probably going to be OK.

If You Can’t Stand the Heat…

We saw this rabbit in our front yard today, stretched out on the grass under our crabapple tree. It’s 117 degrees this afternoon with the heat index and we won’t get out from under the Excessive Heat Warning until later this evening. Thank goodness for air conditioning. Rabbits don’t have air conditioning and can’t escape the heat.

Sena stands the heat better than I do; she waters the lawn and garden, keeping it beautiful. On the other hand, I felt body-slammed just walking out to get the mail.

Out in Sena’s garden

The old saying goes, “If you can’t stand the heat, get out of the kitchen.” It means you if you can’t take the pressure of a situation, then you should move and let somebody else take over. It was popularized by President Harry S. Truman, who said the originator of the proverb was Judge Buck Purcell of the Jackson County, Missouri Court—whoever he was.

Anyway, I’m on call this weekend and got to talking with a colleague who is thinking about retirement. We go back a long way in our education and careers. He asked me about what phased retirement is like. I told him I thought if I’d tried to retire outright, I probably would have just come back to work.

That’s a twist on standing the heat. As a psychiatric consultant, I’m like a fireman (get it?) in the general hospital, putting out fires, so to speak, all over the hospital. Most often the problem still tends to be delirium, an acute change in mental status that should be considered a medical emergency rather than a psychiatric problem per se. It’s just one of many crises that I encounter every day. Over 23 years (not counting residency), I learned how to stand the heat in that kitchen. When I retire, somebody else will have to get in there and cook. Speaking of cooking—I still can’t.

I guess I’m mixing my metaphors (fireman and kitchens, etc.). So what? I’m a retiring geezer and I guess I’ve earned the right to mix my metaphors as much as I want.

But in my first year of the 3-year phased retirement contract, I felt a different kind of heat–the heat of trying to find something to do with my unstructured time. It was a struggle for a guy who’s accustomed to being in almost constant motion, climbing up and down 20-30 floors (I hate waiting for elevators) and covering 2-3 miles a day.

The only trouble is—I can’t get out of the kitchen of retirement. I’m getting up there in age and even though most of the time, I seem to leave some of the trainees huffing and puffing getting up the stairs, I know they’ll replace me someday. But I can’t find a replacement to do my retirement time for me.

I have 11 months to go before I retire. I can feel the heat.

Back in the Saddle

Well, I’m pretty tapped out, so it’ll be a short post today. I’m back in the saddle, running around the hospital on the psychiatry consult service. This is my last year of phased retirement and in 11 months—I’ll be fully retired.

I put 36 floors and 3 miles on the step counter. I’m feeling every one of those. Sena bought me some banded collar shirts and I’m wearing those instead of a shirt with a necktie. I don’t need a tie bar.

And I don’t worry about a delirious, violent patient strangling me with my necktie.

We had a small scare tonight. We were looking at my total compensation statement (the last one) and got the Sharp Elsi Mate EL-505 vintage calculator out to crunch some figures. The calculator went dead.

Still going…

I put some new batteries in it, hopeful. It still didn’t work. We’ve had this calculator for over 30 years and it ran more than a decade on the first set of AA batteries.

I tried another pair of batteries. It worked! The vintage calculator lasted longer than the batteries. It’s nice to know that just because something’s old doesn’t mean it’s useless.

That’s all I got.

Just an Introduction

Hello again

Well, it has been about 3 months since I opened this blog. My YouTube channel needed an updated channel trailer, so I’m posting it here as well. Why not?

I was surprised at how long a minute and a half channel trailer took to make, even with the aid of video editing software (maybe because of it, partly).

In my situation, a channel trailer is sort of a mini biography. It’s hard to compress a career into a short clip that takes about 5 minutes to upload to YouTube–after a few hours of what was essentially cut and paste.

As you can gather, my path is changing. Over the next 12 months, I’ll be half off and half on the consultation-liaison psychiatry service. That’s according to the terms of my phased retirement contract.

This is really a re-introduction, of course. I’m slowly evolving–not in any big way. I’m still a geezer.

On the other hand, I have found that I’m much more comfortable being on some kind of schedule. I still get up early, only by about an hour later. I generally arise between 5:30 and 6:00 a.m. That may seem very early to some.

I eat less when I’m off service (which I’ll call “retired” for simplicity). That’s probably why my trousers fit more loosely.

I need to have something to do. I exercise daily, for about 20 minutes. I do mindfulness meditation and yoga. I blog. I photograph and film, mainly birds, which I post to YouTube.

The only reason I ‘m not a disaster in the kitchen is because you generally can’t get me within 10 yards of it unless I need a snack I can immediately eat (like an apple). I still don’t cook–not really. It’s embarrassing.

I trim the lawn and by that, I mean just around the walkway edges and some of the garden margins. I don’t mow the lawn because my wife does a much better job, by mutual agreement.

I’m not a gardener. I’m a garden appreciation expert. That means I watch gardening that is done by others.

I suppose a lot of this adds up to laziness.

My Perspective on FOMO

I just saw a great post on Fear of Missing Out (FOMO) on Bob Lowry’s blog, Satisfying Retirement. The link is on my home page and it’s a great read, along with many of his other posts.

FOMO for me is different because I’m not actually retired yet. Bob has been retired for a long time and knows what he’s talking about. I’m still just trying to get used to the idea of being retired for now.

Even though I’ve been in phased retirement for over two years now and this coming year is my last before full retirement (see my countdown!), I’m still coping with FOMO.

I check my email several times a day, even when I’m not on service. My position will likely be filled with my replacement well before the year is out. Occasionally I’ll find a trainee evaluation that is time sensitive that I have to complete. I updated the guide to the psychiatry consultation service and notified others about that just yesterday.

What am I going to do when I’m retired? That’s what so many ask me and which I sometimes ask myself. I’m actually having a pretty good time now that I’m finally adjusting to phased retirement. According to the 2018 Report on U.S. Physicians’ Financial Preparedness: Retired Physicians Segment, one suggestion is that physicians try to retire gradually rather than abruptly.

I agree with that and the phased retirement program I’m in has felt right for me. It hasn’t stopped me from FOMO so far, but I’m gradually getting more and more enjoyment from doing things that are not work-related—even though FOMO makes me check my email and the electronic medical record every day.

My wife and I started saving very early on in my medical training and we were fortunate enough to eliminate educational debt early. We’ve always lived simply and don’t need a lot of expensive toys.

Feed me!

I find ways to build a schedule into my day. I exercise and meditate.

I’m not much for yard work, but I try. I get a big kick out of hobbies I’ve rediscovered such as bird-watching.

I like to make silly videos as some of my medical students have noticed. One of them learned how to fold a fitted sheet from one of my YouTube videos. I really enjoy blogging and combining that with my mostly short YouTube movies. You’ll notice I do have some work-related videos, though, some of them fairly recent.

Hey, here’s how to fold a fitted sheet!

The featured image for this post was actually partly a creation of one the residents a few years ago, who by some miracle found a way to combine my photo with a picture of a smartphone. I added a little more to it to make the point about FOMO.

My FOMO nightmare, once upon a time.

I actually didn’t have a smartphone until about 4 years ago. And I still mainly use it just as a phone. I check the step counter when I’m staffing the psychiatry consultation service, but I’ll quit doing that.

In fact, the residents persuaded me to get a smartphone. I had a flip phone for a few years prior to that mainly because a snowstorm caught my wife out on the road while she was driving to the hospital to pick me up from work. I had no way of knowing where she was and was worried out of my mind. That convinced me we needed more than land lines.

I may go back to the flip phone after I fully retire.

I still use a desk phone at work. For the first time in my career, last weekend it just quit working. You can’t imagine how happy I was.

Whenever I drop my pager, I always say out loud to the trainees, “Oh my gosh, I hope it’s broken!” I’m only half-joking.

I won’t miss pagers when I retire.

I dropped most of my social media accounts over a year ago, including Facebook, LinkedIn, Twitter, and even Doximity believe it or not. I don’t miss them.

I’ll keep you posted on how my struggle with FOMO goes.

Gauging My Readiness for Retirement

I’m noticing something about my readiness for retirement. Certain activities are starting to be at least as interesting as my work as a consultation-liaison psychiatrist at the hospital—maybe even more so.

For example, my wife and I are hoping that the cardinals will come back to our backyard evergreen tree. They were building a Hoorah’s Nest in there a week ago, which I took a picture of and then they left when they saw us spying on them. This evening, my wife noticed they were back. We rushed to the window (me with camera in hand) and I swear, they peered at us with intense suspicion. Pretty soon, they flew off in a huff.

They are among the most stand-offish backyard birds I’ve ever seen.

Why is this so important? It’s because I am getting so absorbed in birdwatching again now that I’m in phased retirement that I find it fascinating enough to look forward to more than going to work. I think that’s a sign I’m finally beginning to adjust to retirement.

I spent 4 years in medical school, 4 years in residency, and have worked for more than 23 years as a psychiatrist, mostly as a general hospital consultant. Nothing used to jazz me as much as running around the hospital, seeing patients in nearly all specialties, evaluating and helping treat many fascinating neuropsychiatric syndromes, teaching medical students and residents, and I even wrote a book.

On the other hand, I don’t want to hang on too long. When people ask me why I’m retiring so early (“You’re so young!”), I just tell them most physicians retire at my age, around 65. I also say that I want to leave at the top of my game—and not nudged out because I’m faltering.

I saw a blog post that identified that reason for retirement. It was entitled “When Physicians Reach Their Use-By Date,” by James Allen, MD. The site is identified as “Not secure” unfortunately, so I’m not giving a link to it. However, the web site is The Hospital Medical Director and it’s sponsored by Ohio State University–so it’s probably safe.

Now if you do read Dr. Allen’s post, you’ll think I’m flattering myself as a “master clinician.” I don’t think of myself that way. I’m actually more of a demigod.

I’m just kidding. The descriptions of how physicians finally reach retirement sound fascinating. I’m not sure I could just abruptly stop—that’s why I chose phased retirement. Staying on as a preceptor is not appealing to me because I liked the clinical action too much. I’m actually afraid of becoming someone who knows only medicine. It’s one of the best reasons for me to retire sooner rather than later. You’d think I’d identify with the consultant model; I’ve briefly thought of carrying my resignation letter around with me, although not in my coat pocket and not with malice in my heart.

Although I joined the fraternity of medicine, so to speak, I’m really not a joiner. In fact, I’ve gradually given up membership in organizations like the Academy of Consultation-Liaison Psychiatry, the American Psychiatric Association, and the American Medical Association. I’ve let go of social media accounts like Doximity and LinkedIn—all of them actually, including Twitter and Facebook; I just couldn’t get the hang of those.

There’s a National Association of Retired Physicians (NAORP) that I’ve peeked at. There’s the University of Iowa Retiree Association (UIRA) that I learned about a couple of years ago when my wife and I attended a seminar about retiring from the university. I probably won’t join either one.

I’ve been getting invitations from AARP for many years now (who doesn’t?). The tote bags look nice and I am glad that somebody is lobbying for people my age. I haven’t joined so far.

And I joke about my own fictional organization, Retiree On My Own Time (ROMOT). No dues, no meetings, no minutes, no Robert’s Rules of Order. I’m the President, Secretary, Treasurer (Har!), and the only member—for now.

I’m keeping my schedule open.

Mindfully Retiring from Psychiatry

I’ve been off service for months and I’ll return to staff the general hospital psychiatry consultation service on Monday. It can be a stressful role and I’m “mindful” of how helpful mindfulness meditation has been. The featured image above shows my yoga mat and some might say a much too comfortable chair for sitting meditation. And of course, mindfulness is not really about relaxation; that’s just an old pillow.

 About 5 years ago the editors of the Arnold P. Gold Foundation Humanism in Medicine Blog saw one of my blog posts (from a previous blog) describing my path to mindfulness practice, which included burnout, a problem for nearly half of all physicians, the causes of which include the health care system itself as well as physician vulnerabilities. It was posted under the title “How I left the walking dead for the walking dead meditation.” I was also the recipient of what was called in 2007 the Leonard Tow Humanism in Medicine Award, sponsored by the Gold Foundation.

Leonard Tow Humanism in Medicine pin
Getting the Humanism in Medicine Pin

This has me thinking about my motivations for retiring and what I’m going to do after I’m fully retired. Interestingly, the phased retirement program I’ve been in has given me a strong sense of how difficult this transition from full-time doctor to retired doctor entails. The meaning and purpose gap require more than a bridge made of recreational pastimes. The breath of relief after the great escape from work can soon become the sigh of boredom. On the other hand, my work as a psychiatric consultant has also been an enormous source of personal satisfaction. The video below gives a sort of Pecha Kucha account of what a Consultation-Liaison Psychiatrist does.

What C-L Psychiatry is about

It can get pretty hectic. Over the last two years of the phased retirement schedule, I’ve struggled to craft a daily routine at home that replaces the sense of accomplishment my work schedule provided—despite the pressures it exerted on my sense of well-being. Only now, in my third and final year am I starting to wonder the opposite.

For example, I’ve been exercising daily as well as practicing my mindfulness meditation. I’ve actually lost a little weight and my wife has noticed my shrinking paunch. I’m not laboring on my workouts by any means; my quads are not flopping over my knees. But I used to think that by climbing all those stairs and running all over the hospital I was staying in pretty good shape. It looked pretty impressive that my smartphone step counter logged around 20 floors and 2-3 miles a day. However, the consult service work demand can run hot and cold. It just doesn’t beat daily exercise.

How do I keep my daily exercise routine? I can hear myself saying that I won’t have time for it. I think my mindfulness teacher would probably remind me that my response could be to make time for it—just as I learned how to make time for mindfulness.

I’m looking for guidance in the literature on retiring psychiatrists, especially C-L specialists, and it’s pretty scant. So far, the best summary of it I’ve found were a couple of blog posts by H. Steven Moffic, MD on the Psychiatric Times web site. You can easily view them for free. In the first one, “Mental Bootcamp: Today is the First Day of Your Retirement,” published in 2012, he highlights the difficulty of psychological adjustment to retirement for psychiatrists. He advises, “Plan how to replace financial, personal, social, and generative needs that work has fulfilled.” There is no doubt I could do a better planning job.

In the second one, “Reviewing Retirement,” which was posted in 2014 (two years after he retired), he advises “Retire, even if you are not retired. Take enough time off periodically, and completely, with no connections to work, so that you can feel emotionally free from concerns about patients and practice.”

That speaks to me. In fact, the title of my blog site, Go Retire Psychiatrist, actually echoes this suggestion, although I never made the title with that connection in mind. I wish it were that easy to follow. You would be very lucky in today’s work environment to pull that off, even in academia. Phased retirement programs are one approach to preparing for retirement and could be effective for preventing burnout.

Go retire, psychiatrist.

Lifelong Learning “Not Excessively Rare”

As I get ready to go back on service at the hospital as a psychiatric consultant, I’m trying to get my head back into the game by reading papers like Psychiatric News. The March 15, 2019 issue (volume 54, number 6) has an interesting article about how medical students are learning these days, entitled “Wright State Adopts Curriculum Without Lectures,” written by Mark Moran. You can easily access this article on the web for free by just searching with the term “Psychiatric News.”

The article mentions the pathology textbook, Robbins’ Pathologic Basis of Disease. My class used the nearly 7 pound red 3rd edition containing 1,467 pages. This book is hailed as an outstanding foundational text, which it is. Dr Stanley Robbins has been eulogized as an exacting editor who championed writing of the type espoused by Will Strunk in The Elements of Style.

Not to be picky, but the book contained the phrase “not excessively rare” in reference to some process or disease which I can’t recall. I do recall that a majority of our class howled about this verbiage, which seemed the antithesis of what Strunk tried to teach.

Robbins book is described as “dense” in the article. It’s probably still pretty tough to wade through. I admire any medical student who can teach peers about its contents using only a study guide. I saw a used copy for sale a few years ago in a bookstore in Madison, Wisconsin.

Wright State University is using Team-Based Learning (TBL) which allows medical students to teach each other in small groups. They prepare by reading on their own about topics and come prepared to teach their peers who participate in discussions. This is thought to promote a better way to promote lifelong learning and to be more effective than the lecture style—which is how I learned.

Another point in the article is that the lecture-based approach is pretty inefficient, which is true in my opinion. I remember it often resulted in poor lecture attendance and cramming before exams. It spawned the sometimes-controversial Note Service (which I think a lot of medical schools had and may still have), in which class members take turns taking notes in lectures, which are then cleaned up and distributed to the rest of the members of the class who sign up for the Note Service.

Wright University also has a problem-based learning exercise in which small groups discuss a clinical case with a faculty facilitator. Students come up with learning objectives, search the medical literature, and then present to each other about evidence-based approaches to real-world clinical challenges which physicians encounter in practice.

It turns out this problem-based learning method is not really new and not excessively rare. It happens to have been the approach used by one of my teachers during my residency rotation through the consultation-liaison psychiatry service. It was eventually called Clinical Problems in Consultation Psychiatry (CPCP). I continue to use this model, although general hospital psychiatry has gotten very busy over the years, making it difficult to do regularly. Medical students and residents have given many outstanding CPCP presentations, often using PowerPoint slides and generating stimulating discussions. The video below is an example to give you the idea of one component.

And this post reminds me that the phased retirement process involves periodically flipping between my work identity and my retiree identity. I suspect this experience is not excessively rare.

Yates, W. R. and T. T. Gerdes (1996). “Problem-based learning in consultation psychiatry.” Gen Hosp Psychiatry 18(3): 139-144.

            Problem-based learning (PBL) is a method of instruction gaining increased attention and implementation in medical education. In PBL there is increased emphasis on the development of problem-solving skills, small group dynamics, and self-directed methods of education. A weekly PBL conference was started by a university consultation psychiatry team. One active consultation service problem was identified each week for study. Multiple computerized and library resources provided access to additional information for problem solving. After 1 year of the PBL conference, an evaluation was performed to determine the effectiveness of this approach. We reviewed the content of problems identified, and conducted a survey of conference participants. The most common types of problem categories identified for the conference were pharmacology of psychiatric and medical drugs (28%), mental status effects of medical illnesses (28%), consultation psychiatry process issues (20%), and diagnostic issues (13%). Computerized literature searches provided significant assistance for some problems and less for other problems. The PBL conference was ranked the highest of all the psychiatry resident educational formats. PBL appears to be a successful method for assisting in patient management and in resident and medical student psychiatry education.

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