Whether sitting seaside or backpacking through the mountains, the
long-awaited vacation is the time psychiatrists use to rest, relax, and
However, being away from the office can also increase psychiatrists'
liability risk if they don't take steps ahead of time to ensure that patients
are receiving good care during their absence.
Marynell Hinton, M.A., a senior risk manager with Professional Risk
Management Services Inc. (PRMS), recently shared some risk management advice
with Psychiatric News for psychiatrists about to leave for
PRMS is the company that manages the APA-endorsed liability insurance
program, known as the Psychiatrists' Professional Liability Insurance
Keeping a patient's medical information private is always a top priority
for psychiatrists, but confidential information may be more vulnerable when
the treating psychiatrist is out of the office.
During these times, psychiatrists can take extra steps to preserve
patients' privacy by instructing office staff not to release confidential
information to any person without advance approval.
Hinton advised psychiatrists to be attentive to potential breaches of
confidentiality when using mobile phones, computers, fax machines, or voice
mail because "you may be overheard or the message may be intercepted by
the wrong party."
Documentation, the cornerstone of good risk management practices, is
necessary even when psychiatrists are away.
Before leaving for vacation, psychiatrists should update patient charts for
the benefit of the psychiatrists covering for them.
While away, psychiatrists should document all calls to and from patients
and to and from third parties—such as a pharmacist or covering
physician—concerning patients. Hinton recommended that psychiatrists use
a form the size of an index card with an adhesive backing that easily fits
into a pocket or purse to document calls received outside of the
Upon the physician's return, the cards can be affixed to the patient's
Of course, it's essential to prepare patients for scheduled absences and
make provisions for coverage, Hinton said. "Be specific about the length
of time of the absence and the dates of your departure and return," she
It is also a good idea for psychiatrists to provide patients with written
information, such as a list of names and telephone numbers to call and dates
of absence, to which patients can refer while the psychiatrist is away.
Although it's standard practice in many offices, psychiatrists should leave
specific instructions on voice mail with office staff, and with answering
services as to how patients should be directed to services in the
"Make sure the information includes instructions about where patients
can access care in an emergency, including going to the patient's local
emergency room," Hinton stressed.
It's essential for psychiatrists to provide colleagues who are covering for
them with pertinent information about "at-risk" patients, such as
those who have suicidal or homicidal ideation.
This may include information about what has helped the patient during past
crises, the patient's current stressors, and whom to contact if the patient is
in crises, Hinton said.
It is also important for psychiatrists to leave a number with colleagues
where they can be reached if they need to be consulted in an emergency.
Vacationing psychiatrists should instruct staff on how to deal with
potentially or increasingly suicidal patients and how to notify the
psychiatrist after they take action involving the patient, Hinton said.
She also advised psychiatrists to "be wary of treating patients by
telephone without a follow-up office visit as soon as possible."
Hinton also offered risk management advice about prescriptions: "Try
to anticipate medication refills and determine which of those will require
ongoing monitoring during absences," she said. She warned psychiatrists
to lock up prescription pads while they are out of the office for any length
After returning to the office, psychiatrists should save documentation such
as airplane tickets, hotel bills, and coverage instructions. "These will
come in handy should you be accused of malpractice during a time when you
were, in fact, out of town," she pointed out.
Psychiatrists who fill in for their vacationing colleagues can also benefit
from risk management tips that will protect them from increased liability
"It's a good idea to spend some time with your colleague to learn
more about those patients who might require continued assistance during the
psychiatrist's absence," Hinton said. Also, before the colleague leaves,
covering psychiatrists should find out how to gain access to patients'
pertinent medical information while the treating psychiatrist is away.
It's also useful for covering psychiatrists to know which hospitals their
colleague admits patients to and then determine if they also have admitting
privileges at those hospitals.
Whenever possible, the covering psychiatrist should admit patients to a
hospital where he or she and the colleague both have admitting privileges so
the patient receives uninterrupted care.
At the very least, the covering psychiatrist should admit the patient in
crisis to a hospital where the treating psychiatrist can resume care when he
or she returns from vacation, Hinton said.
When covering for a colleague who has a practice that includes managed care
patients, psychiatrists may want to consider whether they will be paid for
covering these patients.
Hinton said some psychiatrists may be able to bill on an out-of-network
basis, and some managed care networks may have a provision for covering
doctors that aren't designated as panel members.
Finally, if the colleague will be away for more than two weeks, the
covering psychiatrist should know who in the office is designated to handle
nonmedical legal and business matters.
More information on PRMS and the Psychiatrists' Professional
Liability Insurance Program is posted online at<www.prms.com>.▪