MGH: Outpatient Clinic

(for details, refer to the MGH Dept. of Psychiatry Outpatient Department Orientation Program, given to new residents during orientation)

Schedule

PGY2’s spend one afternoon a week in clinic from 12-6pm.

Supervision

For therapy, 2 hours of individual supervision, 1 hour of primary (shared) supervision. For psychopharmacology, 30 minutes of supervision weekly.

Structure

The clinic is located in the Wang Building in suites 805 and 815 with the mail room and resident room in suite 812. In the past, 815 was the psychopharm clinic and 805 was the psychotherapy clinic, but this distinction is fading. All resident patients are registered in 805.

Acquiring new patients

Initially the chief residents will assign one psychotherapy patient and a few psychopharmacology patients to each PGY2. Most of these patients are transferred from attendings or departing senior residents, and should be relatively stable. Their outpatient (“green”) charts will appear in your mailbox on WACC 812 for you to review and then schedule an appointment.

Subsequently, new patients are referred from several sources:

· The chiefs will let people know in person, voicemail or email of patients needing referrals (eg, via other clinicians or through the central triage service (724-PSYC)

· It is also possible to follow a patient first encountered in APS or one of the inpatient units. However, APS patients tend to be less stable and reliable.

Scheduling appointments

Residents at MGH are responsible for scheduling their own sessions. Generally therapy patients are seen for 50 minutes, with psychopharmacology appointments lasting 20 minutes; the additional 10 minutes of time is used to complete paperwork.

The receptionists must be informed of all appointments, by one of two means:

· fill out a yellow appointment slip; don’t forget appointment type (LTX=therapy, NEW=initial evaluation, PPC=pharmacology). The top copy is given to the patient; the bottom two copies go in a box on the receptionist’s desk.

· call 724-5001 x1331103#; at the prompt, leave all necessary information.

New patients may get directions to MGH by calling 724-1666.

Room assignments

Each PGY2 is assigned an office to be used one afternoon a week. For additional time, a sign-up sheet is posted near the reception area in suite 805.

Documentation

1. Patient encounter form (the Blue Form)

REFERRAL SOURCE = 1

DISMISSAL DISPOSITION = 30

PROVIDER CODE = (same as MGH dictation ID)

COST CTR = 617

VISIT TYPE, check off the appointment type

DIAGNOSIS = ICD9/DSM-IV code

2. Progress note

Generally in SOAP format. Essential elements to document:

· Meds and dosages

· Brief mental status exam

· Absence of suicidal/homicidal ideation

· Plan (including med changes, follow-up)

For psychotherapy documentation, consult appropriate supervisor.

For initial evaluations, two hour-long appointments are generally allotted. While the evaluation form is useful for notetaking, a full note (similar to an admission note) should be dictated on mini-cassette and given to the transcriptionist, Rita Hynes.

Emergencies

· Security 726-2121 (if you can’t speak freely, ask for “Dr. Johnson” to come to the office)

· Some patients may be able to be walked down to APS.

· Don’t worry alone.

Labs

The outpatient lab is located on the 2^nd floor of the Wang Building with the EKG service on the same floor. To get labs or an EKG, fill out a lab slip located in the reception areas and give the patient instructions about when to get them drawn. Other studies (EEG, MRI) may obtained by calling the service directly and then filling out the appropriate form.

Financial problems

Some patients who are listed as Self Pay and get large bills may qualify for Mass. Health or MGH Free Care; they should be referred to Patient Financial Services located in the Wang Building on the lobby level. Social Services are also located on the lobby level. Additionally, most drug companies have programs in which patients can get free meds.

Medication Samples

Available in the medication cabinet in the back hallway; get the keys from the 815 desk. Don’t forget to fill out the log.