The work Isn't Done until the Paperwork is Completeed

The Work isn't Done until the Paperwork is Completed

When I was a mental health clinic manager I had one therapist who did not comply with the simple concept stated in the title. She had no problem with seeing clients. Her clients liked her. She was open to feedback about clinical issues and became a better therapist while she worked in the office. But she did not write progress notes about each and every visit as required by every insurance company and mental health provider organization.

Apparently shortly before every chart audit she would hurriedly compose notes for every client she had seen during the time being audited. When the auditors told us in advance what specific charts would be reviewed, she would write notes in only those charts. She wrote intakes, which were always monitored, treatment plans and updates, which were reviewed frequently, and occasionally she would write discharge summaries, which, you guessed it, were seldom reviewed.

I was blissfully unaware of the situation (everybody else wrote progress notes) until she went on vacation. One of her clients had a crisis. I saw the client and smoothed things over until her next scheduled appointment. Then I wrote a progress note and went to put it in the client's chart. I noticed that for a long-term client she had a very thin chart. When I opened the chart to insert my note, I noticed that the most recent note was dated several months earlier. The client had told me she had been coming in regularly. The clinic was small enough that I had often seen her in the waiting room waiting for her session. I pulled other charts of clients she was working with and found that none of them contained current progress notes. All were months behind. I borrowed a key and inspected her office (but not her locked desk.) If she had written but not filed the notes there should have been reams of notes. There were not.

I called my boss. He went through all the cabinets in her office (but not her locked desk.) The therapist had not written the notes. My boss wrote up a plan of correction with the therapist. Under his weekly guidance and monitoring, she did catch up and write current notes. She promised she would keep up the paperwork, and was notified in writing that failing to do so would be grounds for losing her job. She continued to write notes until the day he stopped personally reviewing her charts. Then she stopped.

My boss instructed me to keep closer track of her paperwork performance. I did. I discovered her lapse. She was eventually fired. She appealed to the powers that be and lost.

At another job one of my duties was to complete internal chart audits as practice for when the real auditors came. I discovered that one of the psychiatrists wrote a progress note for every therapy session. The problem was that he wrote exactly the same note, word for word, each time. I discussed it with him. He said he did not see that as a problem. I suggested it might be. I left it to him and his supervisor to sort it out.

What has this got to do with writing? The novel isn’t done until all the incidental work is completed. Once you finish writing a great novel, you still have paperwork to complete. A publisher may or may not help you find a cover and get the cover formatted. The publisher will not write the description on the cover, front and back. Nobody else will write the one to three paragraph synopses that will be in the publisher’s catalog. Nobody else will write answers to interview questions that will grab potential readers by the collar and have them thinking, “I gotta read this.”

As unfair as it seems, after you worn your fingerprints off typing and poured your very soul into your writing, you need to sweat the remaining details with every fiber of your being. Especially if you are a new writer, the cover art, the words on the outside and your words about your book will have a great deal to do with whether or not someone who has never heard of you will actually put money down and buy your book.