Stress, Communications and the Rapid Pace of Change

New Year’s Day, 2015.  A new year and new responsibilities.  Waking up to a cup of coffee, reading the newspaper with my wife, HGTV on in the background, and soaking in the relaxation on one of those rare “unscheduled” days that I truly enjoy.  Thinking about my new role as President of the Minnesota Psychological Association (MPA) was not a high priority on my mind on January 1, yet it was something I did think about.  Ah, yes.  January 1, 2015.  I am now MPA’s President.  I want to be a great President for MPA. Being a psychologist is something I am truly proud of, and being the ambassador for psychologists in this State is an honor.  It really is!

Reality check 

The responsibility of representing MPA’s membership became very real.  In 2007 the Minnesota Legislature mandated the Electronic Health Record Technology Statute §62J.495, also known as the 2015 EHR Mandate, which states “[b]y  January 1, 2015, all hospitals and health care providers must have in place an interoperable electronic health records system within their hospital system or clinical practice setting.”  Starting my role as MPA President on the same day as the 2015 EHR Mandate?  Was this destiny?  Fate?  A very bad coincidence?  A payback for some wrong that I may or may not have committed in my youth?

Let’s back up 

A few questions and concerns about the EHR mandate surfaced from our MPA members and leadership shortly after the Electronic Health Record Technology Statute became law in 2007.  What will this cost?  Do we really have to do this?  What about hackers and privacy?  Can my patients choose to opt out?  Who are the vendors for EHR?  Again, what will this cost and is there any financial help since large hospital systems seem to be getting help?  Can psychologists opt out or choose whether or not they implement EHR?  Some great questions!

MPA responded with a number of education and training sessions and also set up opportunities to meet and consult with various vendors of EHR.  Check out those First Friday Forums and break-out sessions at our Annual Conventions.  MPA’s 2015 Susan T. Rydell Award winner, Dr. Trisha Stark, has been instrumental in setting up connections with various vendors of EHR and also educating our membership on EHR.  Thank you Trisha and congratulations on a well-deserved honor!

Change and Stress

Psychologists are the experts on the impact of change and information overload.  Whether things evolve in a positive or in a negative way, change itself constitutes a problem and especially when social media, scientific, technical, and cultural innovations are taking place at such a rapid pace that no one can really keep up with them.  The Affordable Care Act is changing the delivery of our health care system at a rapid pace, so much that it feels overwhelming for many health care providers, including psychologists, who aren’t sure how this will impact their practice and their livelihood.

The acceleration of change and its psychological effects has been studied for a long time.  Concerned about the rapid pace of change in the 1960s and 1970s and its psychological effects, futurologist Alvin Toffler (1970) suggested that the acceleration of change would lead to a set of severe physical and mental disturbances, which he called the “future shock” syndrome.  Just like people exposed to war or disaster may develop “shell-shock” or a “nervous breakdown,” Toffler concluded that people exposed to too much change in too short a period of time may develop a state of helplessness and inadequacy.

Perhaps Toffler’s research applies to today.  Do we embrace change in this day and age where we are being asked to show our effectiveness through outcome measures?  The research shows that psychologists are effective in what we do, so perhaps there is nothing to worry about.  Do we accept that we live in a day and age of accountability, where we may experience an occasional audit of our work along with documentation that supports our billing?  Is it time to invest in electronic health records to comply with the 2015 EHR mandate or do we wait?  These questions are scary and make psychologists want to hop on a sailboat in the British Virgin Islands, sucking down the BVI’s favorite drink, “the painkiller.”

As MPA’s President, I want to validate that these advances in technology have been stressful.  The full impact of the Accountable Care Act is not fully known by our large health care systems in Minnesota let alone those providers in smaller group or solo practices.  I can fully understand why some of the discussions on our MPA listservs have been spirited, especially on the topic of electronic health records.  For the most part, the dialogue has been excellent and reflects thoughtfulness, compassion, and a desire to do things right.

Hostile communications have no place in MPA.  We know because we are the experts in communication and behavior.  The MPA listserv should be a wonderful tool for MPA members.  For many, it’s a way to get help when you are trying to make a referral to connect your patient with a psychologist with specialty expertise.  It’s a way to welcome new psychologists to MPA.  It’s a way to dialogue on current issues, and since I took over as MPA President there have been a number of posts regarding the requirement to include the WHODAS in our diagnostic assessments for Medicaid, the 2015 Mandate for electronic health records for all providers, and what appears to be an increased frequency of audits.  For the most part, these communications have been helpful, interesting, and an excellent way for psychologists to express opinion, share ideas, and offer support.

Have there been hostile communications?  Unfortunately, there have been.  As MPA President, this saddens me.  While the actual number of overtly hostile communications is small, they are hurtful and sometimes meant to be hurtful or even intimidating.  Using communication tools to intimidate is not what we want on our listserv or for any communication connected to MPA.  Communications that reinforce an atmosphere of gloom and doom are sometimes intentional and foster anxiety and fear.  MPA leadership will review our bylaws, our policies and procedures, and will post an MPA Code of Conduct for our communications so that our listservs and backchannel communications remain helpful and supportive.

Current issues like the EHR mandate and having to do more outcomes measures in a reimbursement world that seems to be shrinking will obviously be contentious, and it is certain that there will be future contentious issues.  By the way, MPA is working hard to increase our reimbursement.  It’s a parity issue isn’t it?

Psychologists Supporting Psychologists during Times of Stress and Change

MPA is committed to setting up a process to listen to your ideas and provide support at a time when the pace of change is rapid.  As a collective group of psychologists, we have a significant amount of expertise and if we need outside help, many psychologists have connections that help us find answers that make sense.

Since becoming your MPA President, I have been asked a number of questions that need the collective thinking of many psychologists.  Do we support a ban on sexual orientation conversion efforts (SOCE)?  Do we support the 2015 EHR mandate?  Do we support amending this mandate so that providers in solo or small practices have a choice?  Do we support Department of Human Service requirements to use the WHODAS or the SDQ or the CASII or the CAGE-AID when completing diagnostic assessments?  Do we support a partnership with the American Academy of Pediatrics on a grant in order to develop a process that would connect psychologists who might be willing to have hours in smaller pediatric clinics so that the concept of integrated care can move forward?  Do we support prescriptive privileges?   Some of these questions are easier than others.  Some of these questions require the collective thinking of psychologists who are willing to review data and sit at the table and talk.  Requests to provide a position statement require the approval of the Governing Council.

Change is indeed difficult, and when you use the listservs, please enjoy this as an opportunity to connect, learn, mentor, and support.  I would ask that our communications remain respectful even when the topic is contentious.  As psychologists, we strive to set better examples for our colleagues and for the next generation by being civil to those with whom we interact.

As MPA President, I am thrilled that the Affordable Care Act embraces the important role of psychologists as valued health care providers.  I enjoyed meeting many of you at our 2015 MPA Annual Convention and I look forward to meeting you at future MPA events.

Scott Palmer, Ph.D. L.P., is the Director of the Behavioral Health Clinic at St. Cloud Hospital, an assistant adjunct professor at the College of St. Benedict/St. John’s University, and is President of the Minnesota Psychological Association.  He is a volunteer member of the Red Cross, where he provides psychological first aid to survivors of local or national disasters.  He is a member of the Motivational Interviewing Network of Trainers (MINT) and uses MI in his practice to help people move toward positive change.

References 

Toffler, Alvin.  Future Shock, Random House, 1970.

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Diversity Statement

The Minnesota Psychological Association actively encourages the participation of all psychologists regardless of age, creed, race, ethnic background, gender, socio-economic status, region of residence, physical or mental status, political beliefs, religious or spiritual affiliation, and sexual or affectional orientation.Although we are an organization of individuals from diverse cultures and backgrounds, the Minnesota Psychological Association also recognizes our core unifying identities as Psychologists who practice in America. We also recognize that we may hold unintentional attitudes and beliefs that influence our perceptions of and interactions with others. Within this context of unity and self-exploration, we are committed to increasing our sensitivity to all aspects of diversity as well as our knowledge and appreciation of the unique qualities of different cultures and backgrounds.We aspire to becoming alert to aspects of diversity, previously unseen or unacknowledged in our culture. In this spirit, we are committed to collaborating with multicultural groups to combat racism and other forms of prejudice as we seek to promote diversity in our society. To this end, we are dedicated to increasing our multicultural competencies and effectiveness as educators, researchers, administrators, policy makers, and practitioners.