Professional Wills . . .
Denial is Great, but Our Patients, Families and Colleagues Need Our Attention – First in a series of articles on “professional wills, wonts and won’ts.”
A. Steven Frankel, Ph.D., J.D.[i]
I’m writing to you two months after turning 71 years of age. I’ve been a licensed, practicing psychologist in California since 1970, I am an attorney at law in legal practice since 1997. and am a member of both the California and D.C. Bars.
This is the first in a series of articles I’ve been welcomed to write for your Newsletter on the topic of planning for/ and/or coping with an unanticipated terminations of practice, due to death or disability. You might not be surprised by the tendency to turn the page in this Newsletter, to see what else might be fun to read, but try to hang in there for at least a few more sentences so I can tell you how I got to be the person who’s raising this issue with and for you.
I began my psychology career as an academic – in the Department of Psychology at USC. After12 years of full time university service, I realized that teaching was fun , but I needed to make a living. I went into clinical practice, which I still enjoy, but which I now practice only on Wednesdays. The rest of the week, I’m in the practice of forensic psychology or health care law ( where my primary area of legal practice involves defending health care professionals facing licensing board actions).
Shortly after finishing my legal education, I began to receive calls from the spouses and partners of mental health professionals in California – very disturbing calls – centered around the tragic losses of a spouse or partner due to unanticipated death or disability. In the midst of their grief, they also faced enormous additional distress over how to handle calls from patients, insurance companies, landlords, debt collectors, and a host of others. They were also concerned about demands for records, Were they permitted to see the records, or to be in contact with patients who were demanding records and who were suffering in their own grief over the loss of their treating professional. How were they to navigate all of these issues while grieving. It might not surprise you to know that I didn’t know what to tell them or how to advise them, nor did anyone else I contacted whom I thought might know.
Another post-law school development was that I was invited to develop and teach post-licensure programs for mental health professionals in lawsand ethics, programs which many colleagues must take for license renewal. That meant, of course, that I had to learn the minutiae of legal and ethical principles that guide our practices so I could assist colleagues with that knowledge, in the service of safe and ethical practice. As I began these studies, I discovered that all of the professional societies’ ethics codes for non-physicians require licentiates to prepare for unanticipated terminations of practice due to death or disability, and I also learned that an increasing number of states have enacted laws that impose the same requirements, also including physicians. Finally, I became aware that there is a group within organized psychiatry that is creating a new ethics code with the goal of having it adopted as the ethics code for psychiatrists, as a replacement for the “Annotations to the AMA Ethical Code, as Applied to Psychiatry”. The proposed code will include this same ethical obligation.
As I taught this material in my law and ethics courses, I began to see eyes glaze over at the mention of the topic . When I began to ask how many colleagues had taken steps to address the issues, fewer than one out of every hundred attendees raised their hands.
I tried everything I could think of to raise the consciousness of colleagues and to explore ways that the issues could be addressed – how to break through the denial. I read (and taught about) “professional wills” – documents that professionals would create that articulated their wishes for what could most benefit their patients, families and colleagues, in the event of an “event.” I read (and taught) about how to work with a single colleague or groups or “teams” of colleagues, about what to do and how to plan for “events.” Over the past decade, I have been gratified to see an increase from less than one per hundred course attendees who had addressed these issues in their practices, to the present time, when there are approximately three out of every hundred attendees who had developed plans.
My phone continued (and continues) to ring. Significant others of colleagues continue to call, frantic, grieving, angry, frightened and lost as to how to cope with the issues that arise as a result of an event. Surviving colleagues call when they wish to intervene at the time a colleague of theirs has an event, wanting to know how to help and shuddering at the nature of the tasks involved. To whom should patients be referred, can they actually talk to patients with no without a releases, what about current records, what about the old records, what about furniture, furnishings, bank accounts, art on the walls, office leases, telephone numbers, accounts receivable/payable, and on and on….
I finally “got” that the majority of our colleagues, particularly our seniors colleagues, were not able or willing to come to these issues and tasks without assistance, and that there appears to be a distribution of willingness and ability to embrace the tasks and develop and implement a plan. Some of us respond to good old-fashioned shame (e.g. “How could you subject me – your partner/spouse/colleague/patient – to coping with both your loss and the desperate practical needs I have to deal with, now that you cannot help?”)
Others respond to contacts from colleagues, such as ”Let’s work together on this – I’ll do it for you if you do it for me.” Of course, they soon realize that one of them will be doing it for someone else, in the future, since one will invariably pre-decease the other.
Still others respond to something like “Let’s form a team of colleagues who take on the task of anticipating and coping with such events. With a team, the loads for each of us to carry are significantly less than if we do this as pairs, and, similarly, the pain is more broadly shared.”
Finally, there is the emergence of a company that is creating a national network of experienced senior (in the sense of having been in practice for at least 20 years) colleagues who work, in coordination with an administrator and an office staff member, to manage the transition of a professional practice when an event has taken place. Some may find this the most efficient way of handling the issues and worth the financial cost.
In future articles, I’ll address each of these coping strategies and attempt to make the approaches I’ve outlined above more real and clear. I’ll point out the up-sides and the down-sides of each approach and will try to be as concrete as I can, regarding supportive elements available through colleagues, through the internet and beyond.