At the age of retirement, I was unceremoniously and discourteously given 2-weeks’ notice. I was medical director of a struggling community mental health center stealthily down-sizing to show profit to then find a buyer, and I’d been deliberately kept out of that loop. I never saw it coming. Embarrassed and angry I impulsively signed up with a temp agency and became a locum tenens, a first for me, to get away and forget what had just happened, block it out of my mind. I joined our medical “Foreign Legion,” as it were—home for misfits and adventurers as I’d imagined this practice—to disappear and not have to deal with my shame, pain, and loss.
I took my first assignment in another state. Once I began seeing patients, I couldn’t help but view them as having been thrown under a bus just like me. They were stuck there and coming to me for help getting unstuck and back on course; I began keeping a journal. I had to. The familiar issue of boundaries was not only germane, it was a minefield.
Many months and several assignments later when I began to process what had happened to me; I discovered I didn’t want to stop this locum work. It wasn’t the novelty, salary, or perks. It was the renewal I’d begun experiencing as a physician and mental healer. But how is that possible for someone who is always a stranger, outsider, and about to leave, three obvious psychiatrist liabilities? The answer, I realized, lay in my attitude. Would I see myself as there to hold down a fort until help arrived, or would I be the help they’d been waiting for, meaning that if the fort wasn’t protecting it would be my responsibility to tear it down. If a treatment wasn’t working, it would fall to me to change it.
The following is what I discovered during my 5 years of locum practice: there are unexpected and unheralded benefits to both doctor and patient: to being a locum psychiatrist and for having a locum psychiatrist.
As an outsider and stranger you bring fresh eyes. The question is will you apply them, especially to patients who are floundering, that haven’t had psychiatric input for a long time or even, never had psychiatric input? Or cases seen by a succession of locums who’d dutifully held down a dysfunctional fort? I found at team meetings about such cases that simply saying I saw the case differently drew and held everyone’s attention. And explaining my formulation and its implications for treatment—the changes they’d have to make—were usually met with relief and support. When cases flounder and staff are demoralized, simply validating that reality can restore hope and boost morale.
For patients, too. Temporal lobe epilepsy (TLE) mimics neurotic symptoms, psychotic symptoms, behavior disorders, and personality disorders. It can destroy a life and ruin a family. It is easy to diagnose, easy to treat, the prognosis is often good for relief and improved functioning, but you have to think of it. Once I started thinking of it, I started finding it. And I started thinking of it because so many of my patients came from poor families that featured frequent childhood ear infections and inadequate access to pediatric care, well-known TLE antecedents.
Dr Climo is the author of Psychiatrist on the Road: Encounters in Healing and Healthcare, an account of his Locum Tenens experience. Dr Climo reports no conflicts of interest concerning the subject matter of this article.