psychiatrist retirement – Go Retire Psychiatrist

Coming to Terms with Retirement

I’m in the off phase of phased retirement right now. It reminds me of the consuming question, “What are you going to do when you’re retired.” Coming to terms with retirement is not a one-step thing.

It’s probably easier to think of things I’m not going to do. I can think of at least a couple of books I’m probably not going to finish reading: “The Social Transformation of American Medicine” by Paul Starr and another title I rather not type but the picture of which I’m not squeamish about showing.

Deep
Also deep

I’ve already read a new book by Dave Barry, “Lessons from Lucy,” which is about coming to terms with getting older. And I’m going to reread a book I read years ago, “The Ultimate Hitchhiker’s Guide to the Galaxy” by Douglas Adams.

Wise booger jokes
Autographed
Worth re-reading

I read the Hitchhiker’s Guide and lost it in one of our many moves. I bought a new hardback copy a few days ago and just restarted it.

I can’t remember when I got The Ultimate Hitchhiker’s Guide. It was published in 1986. Around that time, I had graduated from Iowa State University and could not find employment for about a year. It was a difficult time. Anyone who has been through something like that might understand how hard it could be to retire.

I’m not going to write another work-related book. Editing a multi-author book was too much like herding cats. And as one of my friends put it, once you’ve done that, you ask, “Now what?”

I’m still checking my office email every day. You never know. It’s FOMO, I realize; on the other hand, there are still legitimate work-related things I need to do and some have deadlines.

This makes me think of my YouTube video, “A Day in the Life of a C-L Psychiatrist.” It’s a little tough to come up with something like “A Day in the Life of a Retired C-L Psychiatrist.” Of course, there would be nothing connected with psychiatry in it.

My day in the life after C-L Psychiatry?

I’m reminded of an exchange between Men in Black agents J and K (2^nd sequel) after K is deneuralized out of “retirement” to return to the active job of defending this little green planet from aliens.

Agent J: “So what was it like on the outside, not doing this every day?”

Agent K: “It was nice; Sleep late on the weekends, watch the Weather Channel.”

My life is more or less like that, except every day is a weekend day…sort of. And the Weather Channel has gotten way too political for me.

I watch Men in Black reruns. I wait for the garbage truck. How does that guy know exactly where to brake in order to operate the automated side load mechanical arm grabber? I carry my POS camera on my belt. You just never know when an opportunity for great snapshots might arise. I trim and edge the lawn boundaries. I vacuum. I fold the fitted sheets, Hondo. I really don’t cook; I stick frozen pizzas in the oven and make microwave popcorn—not very often, Slick. I exercise and do mindfulness meditation and yoga. I take clothes out of the dryer and put away. I dry the dishes and put away. No, we do not use the dishwasher, pal. It’s about coordination and timing.

I realize that I might sound like Agent K. But I’m more like Agent J—still a rookie around the house and in the yard. This is going to take a while.

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.

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

Exercise daily and you can look like me!
Meditating makes my head radiate like this.

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’m not a yard kind of guy…
Tree Swallow peeking

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.

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.

What?
You gotta be kidding!
You’re not kidding…

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 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.

Minority Diversity in Medicine

The featured image for this post is that of a Painted Lady butterfly, one beautiful member of a hugely diverse group of such creatures. It reminded me of the state of our physician supply, which is not so very diverse when it comes to inclusion of minorities.

Even though I’m moving into the final year of my phased retirement contract in July and I’m off service—I still check my office email several times every single day. It’s a hard habit to break after 23 years, not counting 4 years each of residency and medical school. So, I get a pang every time I see a news item in my inbox about the shortage of physicians, especially the shortage of minority physicians. The challenge to increase diversity of race and ethnicity in the supply of American doctors is a big one.

The Greenville News in South Carolina posted a long article about this issue on May 13, 2019 (“Despite efforts to boost their numbers, blacks account for just 6% of doctors in SC” by Liv Osby). Even though blacks make up 13% of the U.S. population, only about 6% of the doctors in Greenville, S.C. are black. Many members of minority groups do not recall seeing a doctor who looked like them while they were growing up. Minority role models for the goal of becoming physicians have always been few and far-between.

I recall being one of a handful of minority students entering the summer enrichment program in 1988 at the University of Iowa. The summer enrichment opportunity was intended to be one way to assist minority students excel in the basic sciences courses that we would be facing in the upcoming regular academic year.

I have always appreciated that boost but not all of my peers saw it that way. One young man said simply, “I’ll see you in the fall,” evidently meaning he would not be attending the summer enrichment program. It was clear from talking with him that he thought the program sent the wrong message to the majority students—that we were getting an unfair advantage. I’m pretty sure that the summer enrichment program ended many years ago, at least in part because of that negative perception.

This reminded me of my undergraduate experience at Huston-Tillotson (H-T) College (now H-T University) when the controversy about affirmative action was prominent. I recall only one black student who was planning to go to medical school and hoped to get into the University of Texas. In fact, even though the term is no longer used, the Greenville News story mentioned that Texas Tech last year eliminated race as a consideration for admission to its Health Sciences Center. This indicates ongoing discomfort about the perception of favoritism or special treatment being given to minorities.

I still see one of my summer enrichment program professors in the hospital hallways every so often. He even remembers my name. We exchange friendly greetings.

And I’m painfully aware that there may be only one other black psychiatrist in Iowa—and I think he’s also a baby boomer.

As I head for retirement, I remember a line from one of the final scenes in the movie Men in Black, “I haven’t been training a partner; I’ve been training a replacement.” I’m not sure if there will be someone to replace me.

More Time for Birds

I’m off service for a while, which means I have more time for birds. Right now, my wife and I are trying not to spook the cardinals. It looks like they’ve finished the nest and we’re waiting for the eggs.

This will be the first time we’ve seen cardinals nesting in our yard. It’s a little strange, because the cardinals chose the same evergreen tree as the robins did last year.

The robins built a pretty sturdy nest but the cardinals just threw one together. It looks pretty flimsy.

A couple of years ago, chipping sparrows raised chicks in one of our front yard evergreen trees. They were cute.

But the baby robins looked like little dinosaurs.

I imagine the new cardinals will look pretty scruffy.

The Last White Coat I’ll Ever Wear

I’m a big fan of the Men in Black movies. I’m not going to tell you how many times I’ve watched them on TV (78 million and if that number reminds you of a scene from Men in Black, you’re just as much a fan as I am, if not worse). One of my favorite lines is when Zed says to Edwards, “Edwards. Let’s put it on.” Edwards asks, “Put what on?” And Zed says, “The last suit you’ll ever wear.”

Today, I asked my secretary to order some new white coats for me. I went down to the Uniform Shop and checked on it. All they need is the requisition and they’ll get it.

Since I’m retiring after this year, these are the last white coats I’ll ever wear. There’s no Zed to tell me that. The Uniform Shop staff person won’t know it when the coats arrive—unless I tell her, of course.

I found a very long, involved discussion on the web about the meaning of Zed’s “last suit you’ll ever wear” statement. All I got out of it was that some people take that movie way too seriously.

But for me the last white coat I’ll ever wear means exactly that. I’m going to wear the coat until I retire (in about 14 months according to the countdown)—and then I’m never going to wear white coats again.

I can almost hear certain persons snickering in the background. I suspect there may be a few bets about this retirement thing being another temporary leave-taking, like the times I left for private practice and came back, sort of like bringing Agent K back after neuralyzing him at his request. He really did retire—temporarily.

But nobody is going to neuralyze me. I’ll keep a lot of memories about my time as a Consultation-liaison (C-L) Psychiatrist, even though some of them are sort of like Agent K’s memories of being swallowed by a giant interstellar cockroach.

However, that reminds me of a few thoughts I have about institutional memory. I’ve mentioned my concerns about being practically the only C-L Psychiatrist in a pretty big hospital and retiring. I’m a geezer, but I know a lot about the ins and outs and moving parts and what it means to be a one-man hit-and-run fireman psychiatric consultant in a large academic medical center.

Institutional memory has been defined as “the collective knowledge and learned experiences of a group. As turnover occurs among group members, these concepts must be transitioned. Knowledge management tools aim to capture and preserve these memories.”

Institutional memory can also be characterized briefly as:

Accumulated knowledge, skills, “this is the way we do things”
Some of it gets hardened into policies and procedures
Much of it “…resides in the heads, hands, and hearts of individual managers and functional experts.”- “How to Preserve Institutional Knowledge” by Ron Ashkenas, Harvard Business Review, 2013
Too much of anything for too long can be bad, including institutional memory

The bullet point that Ron Ashkenas makes above is relevant to employers of baby boomers like me who know informal procedures, and have the skills (and they chose us so they recognized the skills, so don’t be calling us sport, feisty, hon, sweetie, or anything like that) and knowledge that’s in our heads but may not be stored anywhere else.

That makes the baby boomer retirement phenomenon a real challenge. About 10,000 boomers will reach the age of 65 every day for the next 15 years. And most of us aren’t kidding around. There’s no way to just deneuralyze us to make us come back. You can’t make it happ’n Cap’n.

There are ways to package institutional memory into handy things like mentoring partnerships, knowledge wikis, snappy videos (just shoot the damn thing!) and other media that are easily accessible and geared for the adult learner.

You can’t beat the Internet Archives for history. You can borrow and read the first edition of the Massachusetts General Hospital Handbook of general hospital psychiatry published in 1978, just like checking it out from a public library. Read the chapter, “Beginnings: liaison psychiatry in a general hospital.” You can learn from Dr. Thomas P. Hackett about the difference between a consultation service and a liaison service:

“A distinction must be made between a consultation service and a consultation liaison service. A consultation service is a rescue squad. It responds to requests from other services for help with the diagnosis, treatment, or disposition of perplexing patients. At worst, consultation work is nothing more than a brief foray into the territory of another service, usually ending with a note written in the chart outlining a plan of action. The actual intervention is left to the consultee. Like a volunteer firefighter, a consultant puts out the blaze and then returns home. Like a volunteer fire brigade, a consultation service seldom has the time or manpower to set up fire prevention programs or to educate the citizenry about fireproofing. A consultation service is the most common type of psychiatric-medical interface found in departments of psychiatry around the United States today.

A liaison service requires manpower, money, and motivation. Sufficient personnel are necessary to allow the psychiatric consultant time to perform services other than simply interviewing troublesome patients in the area assigned. He must be able to attend rounds, discuss patients individually with house officers, and hold teaching sessions for nurses. Liaison work is further distinguished from consultation activity in that patients are seen at the discretion of the psychiatric consultant as well as the referring physician. Because the consultant attends social service rounds with the house officers, he is able to spot potential psychiatric problems.”—T. P. Hackett, MD.

By the way, have you seen my YouTube Channel? I’ve been beaming me up into educational videos for residents and medical students for a while now.

Next year I’ll be doffing the white coat for good—but I’ll be on THIS planet.

Reference:

Hackett, T. P., MD (1978). Beginnings: liaison psychiatry in a general hospital. Massachusetts General Hospital: Handbook of general hospital psychiatry. T. P. Hackett, MD and N. H. Cassem, MD. St. Louis, Missouri, The C.V. Mosby Company: 1-14.

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.

Meaning and Purpose in Retirement

As you know, I’m back in the saddle at work, according to the terms of my phased retirement contract. When I’m off service, I feel less pressured. However, when I’m on service, I’m like a fireman, thriving on pressure. I’ve done Consultation-Liaison (C-L) Psychiatry for so many years that, when I stop to think about it, I realize I get a good deal of my sense of meaning and purpose through my job.

I sometimes tell residents and medical students that I “do it for the juice.” That means I work for the adrenaline: rushing to emergencies, making quick decisions (some of them far from perfect), teaching on the run, telling funny stories about how my work as evolved over the years.

When I spent less time on the job during the first two years of phased retirement, I felt lost. There’s no better word for it. That’s not as much of a challenge now, but meaning and purpose in retirement can be difficult for a fireman to define.

I had a blog called The Practical C-L Psychiatrist until I dropped it last year. There were a couple of reasons. One of them was the expectation that bloggers write their own Privacy Policies in response to the European Union’s General Data Protection Regulation (GDPR) going into effect. I rebelled against it.

Please read my Privacy Policy on this blog. I worked pretty hard at it. I asked a few attorneys for guidance and only one of them got back to me, humbly admitting he didn’t know anything about it really, but had a helpful suggestion nonetheless.

The other reason I dropped The Practical C-L Psychiatrist was that it was less relevant to my stage of life in that I’m not racing all over the hospital nearly as much nowadays. I don’t have as much to write about that life anymore.

But I still love to write and so I swallowed my pride, wrote the Privacy Policy and decided on making a chronicle of my transition into retirement, which is this new blog, Go Retire Psychiatry. So far, I’ve more or less just made jokes about it. I realize that’s a defense. I need to move on and confront the search for meaning and purpose in retirement.

I’ve done a lot of fun things on the job over the years. I used to have mascots for the C-L service, like the one below. You can tell that it was from some time ago. The mascots were usually inflatable animals I bought from the hospital gift shop. The residents, medical students and I gave them silly names. The trouble was that the mascots, being balloons, were always running out of gas.

And that meant that somebody had to take the mascot for a walk all the way across the hospital back to the gift shop to get a healing shot of helium—and walk all the way back. The volunteers there got a big kick out of an old geezer doctor walking the mascot. It was an exercise in humility, which I admit I often needed.

And I took group pictures of trainees and me at the end of rotations by using an app on my old iPad. It’s called CamMe. The way it worked was that I set the iPad up on a stack of books or something; then we all stood for the shot. I would hold up my hand and make a fist to start a 3-2-1 countdown, which gave you just enough time to make a big smile for the automatic group selfies. Everybody got a kick out of it.

I was so proud of those pictures I thought nothing of posting them on my blog, with nary a thought about their privacy. All of them thought they were fun.

That’s about enough on meaning and purpose for today.

Remembering My Calling

Back when I had the blog The Practical C-L Psychiatrist, I wrote a post about the Martin Luther King Jr. Day observation in 2015. It was published in the Iowa City Press-Citizen on January 19, 2015 under the title “Remembering our calling: MLK Day 2015.”

I have a small legacy as a teacher. As I approach retirement next year, I reflect on that. When I entered medical school, I had no idea what I was in for. I struggled, lost faith–almost quit. I’m glad I didn’t because I’ve been privileged to learn from the next generation of doctors.

“Faith is taking the first step, even when you don’t see the whole staircase.”
Martin Luther King, Jr.

As the 2015 Martin Luther King Jr. Day approached, I wondered: What’s the best way for the average person to contribute to lifting this nation to a higher destiny? What’s my role and how do I respond to that call?

I find myself reflecting more about my role as a teacher to our residents and medical students. I wonder every day how I can improve as a role model and, at the same time, let trainees practice both what I preach and listen to their own inner calling. After all, they are the next generation of doctors.

But for now they are under my tutelage. What do I hope for them?

I hope medicine doesn’t destroy itself with empty and dishonest calls for “competence” and “quality,” when excellence is called for.

I hope that when they are on call, they’ll mindfully acknowledge their fatigue and frustration…and sit down when they go and listen to the patient.

I hope they listen inwardly as well, and learn to know the difference between a call for action, and a cautionary whisper to wait and see.

I hope they won’t be paralyzed by doubt when their patients are not able to speak for themselves, and that they’ll call the families who have a stake in whatever doctors do for their loved ones.

And most of all I hope leaders in medicine and psychiatry remember that we chose medicine because we thought it was a calling. Let’s try to keep it that way.

You know, I’m on call at the hospital today and I tried to give my trainees the day off. They came in anyway.

Talk About Change

Let’s talk about change. I’ve had a couple of brand-new tie bars (gifts from my wife) in my dresser drawer for a couple of months now. I’d forgotten them until last night. I used to wear a tie bar many years ago. I’m discovering that I probably wore it wrong, according to fashion experts who know a lot about these things.

I never knew you were supposed to wear a tie bar between the 3^rd and 4th button of your shirt (counting from the neck). I guess I always wore it too low. It was always coming loose from the shirt, and that’s why I quit wearing it for years. It’s long gone. I think I probably just threw it away, or maybe it got lost in one of our many moves. And I never knew that the part of the shirt you attach the tie bar to is called a “placket.”

There are different kinds of tie bars. Most of them are made with what resembles an alligator clip. I guess you’re supposed to call that a slide clasp. Another kind of bar is difficult to manage without wrinkling your tie. It’s an awful lot like a cotter pin, but you’re supposed to call it a pinch clasp—I think. I have one of each. Pictures don’t always seem to match up with the names.

Look close to see the tie bar; it’s there. It’s just not in the right spot according to GQ.

I also used to wear bow ties. You don’t need a tie bar for those. They were very colorful. They’re long gone.

I also used to wear the old-style suspenders and even had buttons on the inside of my trousers to secure them. They’re long gone, maybe because I felt insecure without a belt. That was back before I got a paunch—which is now starting to shrink, probably because I’m exercising daily.

And speaking of daily exercise, my wife got me a pair of 5-pound dumbbells. She says pink was the only color left. Anyway, I began using them this evening. I’m not sure, but I may need some liniment.

I used to wear a heavy pair of wingtip Oxford brogues. Believe it or not I would tramp all over the hospital in those shoes. I still thought they looked sharp, but they also looked dated—kind of like me. I used to keep the old-fashioned cedar shoe trees in them, just to keep the creases out of the instep. They’re long gone. Now I wear lighter shoes. When I exercise, I wear Velcro tennis shoes.

My wife also got me an autographed copy of Dave Barry’s new book, Lessons from Lucy: The Simple Joys of an Old, Happy Dog. I’ve always been partial to his sophisticated humor—classic booger joke style.

However, I think Barry’s new book is more about how he’s changing as he ages. I haven’t had chance to read it yet except just enough from the jacket to suspect that the booger joke style will be there, but there’ll be something beyond that. He’s 70 years old and likely reflecting—about the mechanism of action of booger jokes. I used to have nearly all of his books, but they’re long gone. Just like the tie bar, I lost most of them in the many moves we’ve made.

The point is I’m changing in a lot of little ways. The big change coming up is, of course, retirement. I’m changing from a physician to a retiring physician—a retiring psychiatrist. Not all of the changes are to my liking, either about myself or my path.

“A flower falls even though we love it; and a weed grows even though we do not love it.”
Dogen

Change is not always comfortable. I have not stayed the same across the decades. Some changes have been painful. Others have been so much fun that I wouldn’t mind reliving them. They’re all long gone. We’ll just have to make new ones.

Retiring Takes Practice

Retiring takes practice, like a great many skills. I know it’s puzzling to think of retiring as a skill. Skill building feels awkward at first and with time, managing the transition slowly feels more natural. At least that’s what I hope about this retirement thing.

I remember way back in the day of the dinosaurs when I was working for consulting engineers. It was my first real job. I had to learn many new skills in my role as a land surveyor assistant. I started out mainly as a rear chain man and a rod man. These are special tools to measure distance and elevation.

Throwing a chain is a term for wrapping a 100-foot chain. This skill is almost impossible to describe just by writing about it. I could find only one fairly straightforward video about it which shows the proper technique.

Throwing a chain

The last part of it, which is collapsing the figure 8 shape of the chain into a circle is done almost by feel and was easier when I didn’t think about it. Overthinking a technique or skill can get in the way of just doing it.

I did those kinds of things every day for years. I gradually learned other skills until I felt like I fit in with land surveyors. I got a lot of satisfaction out of this kind of work when I was a young man.

But when it was time to move on to college, I found it difficult to adjust initially. I was used to doing work with my hands more than my head. It felt awkward to be in a class with a lot of students who were much younger than I was.

I made the transition and moved on eventually to medical school. That was another difficult transition in which I needed to develop new skill sets. It felt so unnatural that I thought of going back to working for consulting engineers.

But I hung in there and finally settled on being a consultation-liaison psychiatrist. I’ve gone from a consulting engineer world to a consulting psychiatrist world. They both involve consulting. The WHKS company I used to work for has a vision, purpose, and values that are arguably similar to consultation psychiatry in some ways.

I try to listen carefully to my patients and help them shape a better understanding of themselves and their relationships.

I try to provide consultation that ultimately benefits patients, sustains a healthy interpersonal environment for them and clarifies their values, the things that mean the most to them.

I value listening; communicating; being of service to both patients and their physicians, nurses, and other health care professionals; being practical (I used to write the blog The Practical C-L Psychiatrist after all); and I like to think I’m sometimes innovative in my approach to psychiatric assessment, patient care, and teaching the next generation of doctors.

I’ve been a physician for over 26 years counting residency. And of course I spent 4 years in medical school. Retirement is a little jarring and doesn’t yet feel completely natural, frankly. I keep waiting for the chain to just fall into place.

I’m probably overthinking it.