• Secured appropriate coverage by another psychiatrist
• Informed your patients
• Advised your staff
• Recorded an “out-of-office” message on your answering machine
• Apprised your answering service

Coverage

The first consideration is for you to engage a psychiatrist in your area offering treatment services similar to yours.  This will be a psychiatrist with whom you are familiar in terms of his/her experience, education and treatment approach.  For example, if you provide treatment for substance abuse, your covering psychiatrist should be knowledgeable of and/or provide similar treatment. 

Prior to your anticipated departure, it is a good idea to have a conversation with the physician covering for you to provide a brief report on each patient you are currently seeing that may be at risk during your absence. “At risk” patients may include those with previous issues regarding harm to self or others, patients who are going through a period of increased stress (such as marital difficulties, job loss, grief, etc.) or those patients for whom you recently prescribed new medications.

This “hand-off” should be accomplished by using a standardized communication protocol to ensure inclusion of important information, such as:

• The patient’s diagnosis, treatment plan and status of treatment/goals (e.g., “patient has developed effective coping skills to manage grief resulting from the recent loss of spouse,” “patient is non-adherent with meds”, etc.).
• The patient’s history (medical, familial, personal) that has relevance to current diagnosis and treatment.
• What must be done in your absence by whom and in what timeframe.

One key to effective communication during a hand-off is to seek a “repeat back”, wherein the physician assuming coverage for you provides feedback with respect to his/her understanding of the information you provided on each of your patients (or at least for those patients who you feel may be most at risk during your absence).  It is this repeating back of your colleague’s understanding of what you have shared that confirms comprehension or suggests you need to clarify. This repeat back step further allows the other psychiatrist to clarify or expand upon anything you’ve discussed.

Finally, be certain your coverage has your full contact information while away in the event an emergency requiring a consult with you should arise.  At a minimum, provide your cell phone number and email address. If possible, provide another contact such as a phone number for your hotel, cruise ship or conference center. Providing more than one means of contact may safeguard against unexpected circumstances, such as problems with your cell phone, or being in an area where cell phone reception is problematic.

Inform Your Patients

While you are arranging for coverage, be sure to give your patients time to prepare for your absence. This will be accomplished as you meet with your patients in the weeks before the anticipated vacation or conference. At each appointment, advise (or remind) the patient that you will be away.  Ask your patients to discuss any concerns they have or problems that they may anticipate. Take time during the appointment to provide information and suggestions as to how they will cope with these possible events.  Information you provide the patient will include such things as the name and phone number of the psychiatrist who will cover for you should the patient encounter a difficulty and other resources that may be available in the community. Talk about prescriptions the patient is taking that have been ordered by you. Make certain the patient has what is necessary until their next scheduled visit with you (realizing, of course, that for certain patients some medications are best prescribed in limited quantities to safeguard the patient from misuse). It is important that you document in each patient record this discussion, noting any patient concerns or questions, including a statement as to how these were addressed by you to the patient’s satisfaction.

Office Staff and Answering Service

Now that you’ve made arrangements for coverage with another physician and you’ve had a conversation with your patients, the other considerations are as follows:

• Educate your office staff (again, as appropriate for your practice) with respect to your absence. Office personnel should know how to respond to patient calls, including the name and contact information for the physician providing coverage. 
• If you do not utilize office staff, and rely upon an answering machine or answering service to field patient calls:
  • Record a message on your answering machine indicating the length of your absence (or your expected date of return), and provide contact information for the psychiatrist covering for you.  Be sure to include the standard message that if the patient requires immediate attention, s/he is to seek treatment at the nearest Emergency Room (or Screening Center, as appropriate).
  • Inform your answering service of your absence, the period of time you will be away from your practice and the contact information for the covering psychiatrist.

The above information can’t cover all contingencies, as some may be patient-specific. But this outline provides a basic framework from which to plan for your upcoming departure, to ensure that your patients know they have options, if needed, while you are away. Then, go and have a great time!