Yes, it’s already that time of year again! If you’re like most busy psychiatrists, you may not yet have had a chance to implement last year’s risk management resolutions, or maybe even those of the year before that. Don’t worry – we’re not here to make you feel bad. In fact, this year we’re recommending a slightly different approach. Rather than looking at ways to improve your practice, we think this year’s resolutions should center around your most important risk management resource – you. And to make it as stress-free as possible, we’re suggesting 12 resolutions so you can aim to do just one each month rather than try to implement them all at once.

1. Plan some time away from your practice.

Planning ahead is important - it not only helps to ensure that you will actually get away, but it also gives you time to obtain any necessary coverage and prepare patients for your absence. For suggestions on how to make time away pleasurable instead of problematic, see our article, "Practical Pointers While on Vacation." 

2. Consider whether it‘s time to get some help. 

Particularly if you are an early career psychiatrist who has not yet established a full practice, you may be trying to go it alone, taking on the additional duties of billing, scheduling, administrative support, HIPAA privacy officer, etc., all in addition to seeing patients. Perhaps you have more patients than you can comfortably handle and would benefit from employing a nurse practitioner or a PA. When adding someone new to your practice in either an administrative or clinical capacity, you will want to take have the time to thoroughly vet your candidates, so don’t wait until you are so overwhelmed that you feel compelled to hire someone who is less than ideal for the position. For an overview of risks and how to avoid them, see our article, "Supervision of Nurse Practitioners." 

3. Get familiar with your professional liability insurance company.

You already know that your carrier is there to protect you in the event of a claim or a lawsuit, but are there other things they can help you with? It’s good to know ahead of time what additional services they offer so you know who to turn to when a problem arises. Even if your carrier cannot assist you with a particular issue, they may be able suggest other resources. Make sure you have contact information for your carrier’s underwriting, claims, and risk management departments.

4. Develop a contingency plan.

We frequently receive calls from family members, office staff, and even estate attorneys trying to figure out how to close down a psychiatrist’s practice and find care for patients following the provider’s sudden incapacity or death. It’s a tragic situation made more so by the fact that the psychiatrist oftentimes has not provided any instructions, thus leaving it to the office staff or family members (who are dealing with their own worry and grief) to determine what the psychiatrist would have wanted and how best to manage patients. Create at least a basic written plan to ensure this doesn’t happen to you, your staff, your family, and your patients. Think of it as an “advance directive” for your medical practice and let someone - be it your spouse, office manager, or another physician covering for you - know of its existence and where to find it. For additional information, see our article "Failing to Plan" and our Initiating My Contingency Plan tool.

5. Learn that it’s okay to say no to patients.

While it’s understandable that you want to accommodate your patients whenever possible, remember you are the doctor and you are the one in charge. You get to choose the prescription, how long you’re willing to prescribe between visits, what you are going to document in the patient’s chart, you are no longer able to meet a patient’s clinical needs, and when it’s time to refer them to a higher level of care. For additional information see our article, "It's Nice to be Nice, But..."

6. Take steps to keep drug seekers and other problem patients out of your practice.

Take a look at how you market your practice to see if your advertised areas of expertise are drawing patients you would prefer not to treat. For example, a stated expertise in ADHD may attract patients not interested in actual treatment and simply seeking stimulants. Consider telling prospective patients that you will not prescribe controlled substances at the first appointment and that you check the PMP before prescribing. Consider also letting them know that the first appointment does not necessarily mean they will be accepted as patients, that treatment will not begin until you have determined you can help the patient, and that there is at least an initial agreement to the treatment plan. For information on avoiding risk when marketing your practice, see our article, here

7. Make sure you’re receiving your information from reliable sources.

When you hear of changes to state and federal laws that impact your practice, make sure you are getting all the facts. Rather than risk taking the wrong steps or worrying unnecessarily, reach out to your malpractice carrier or your professional organizations for their guidance.

8. Learn to ignore physician rating sites.

While the vast majority of online reviews about healthcare professionals are positive, it can be very frustrating to see false, negative, and/or unfair comments posted about your professionalism and/or your or your clinic’s treatment practices. Keep in mind that there are very few options in terms of response  some responses will very likely generate more attention to the accusations in the post or may cause the poster to write additional bad reviews. For additional information, see our article here and the APA’s resource document on Responding to Negative Online Reviews.  

9. Connect with colleagues.

Over the last couple of years, many psychiatrists have decided to make changes to their practices, including moving to another location or retiring completely. This may mean that the doctors you’ve always relied upon for a curbside consult or to cover you when you are out of town are no longer available. Think about getting involved with your local district branch, regional organization, or other professional groups.

10. Take a look at your active patient load.

Are there certain patients whose demands are beginning to affect your enjoyment with your work? Do you have other patients whose conditions have become too complicated for one person to manage? Consider whether it would be in everyone’s best interest to transition these patients to another psychiatrist, or as necessary, terminate them from your practice. For tips on terminating treatment without abandoning the patient click here

11. Make those doctor’s appointments you’ve been putting off.

In order to be your best for your patients, you have to take care of yourself first.

12. Avoid getting involved in your patients’ legal matters.

Are there certain patients whose demands are beginning to affect your enjoyment with your work? Do you have other patients whose conditions have become too complicated for one person to manage? Consider whether it would be in everyone’s best interest to transition these patients to another psychiatrist, or as necessary, terminate them from your practice. For additional information on dual roles see our article, "Myths and Misconceptions: the Treating vs the Forensic Role." 

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