Contingency Planning for a Pandemic

Claire Zilber, MD, DFAPA

April 2020

Not long ago, yet in the uncanny distortion of pandemic time it seems like an eon
ago, I wrote a column on Occupational Advance Directives that describes a
mechanism for ensuring that trusted colleagues will intervene if we become
incapacitated. In this global moment of anxiety about our health and welfare, a
different kind of contingency planning is required, one that will prepare us for
sudden respiratory compromise. I propose three elements to a Pandemic
Contingency Plan: a brief personal health history, a document that details how to
contact patients and manage the practice if need be, and a will.

The health history should be short and contain only the essentials: date of birth,
notable medical history and diagnoses, medications and allergies, name and
contact information for your primary care provider, and names and contact
information for your closest family members. If you have a medical advance
directive, you could attach it to the health history. My health history fits on a
single page so that harried providers won’t have to wade through excessive
detail to find what’s truly important. Share this document with your spouse or
another person who is most likely to be communicating with hospital personnel
should you become seriously ill. Also, print a copy and keep it somewhere very
accessible, so that if you do need to call 911, you can grab the health history to
bring it with you without having to climb an extra flight of stairs.

Next, create a document that contains very specific and concrete details about
your office, who to notify, to whom to delegate tasks, how to access patients’
contact information, and a sample letter to patients. Ask the colleague who
usually covers for you when you’re on vacation (remember vacation?), or a
person or two from your call group, or your peer supervisor for their permission to
include them in this process. Review with them their roles in your contingency
plan and offer to reciprocate. Under the current shelter-in-place order, my
husband has physical access to my appointment calendar, patient charts, and
their contact information, but he could ask a designated colleague to make the
calls by sharing names and phone numbers. Hopefully, the calls are only to
postpone appointments and determine any immediate needs.

Create a sample letter to your patients in case your practice needs to be closed,
for it is the only way to ensure that they will be communicated with in the manner
you would want. The letter I wrote starts with “I regret to inform you,” but goes on
to list the arrangements that have been made to facilitate my patients’ transition
to a new psychiatrist: who will provide interim refills on their medication, who will
help them find a new provider, and how to obtain copies of their medical record.
It closes with a couple of sentences about how much I valued working with each
of my patients, and how I would have wanted a more gradual transition. It is my
hope that in these last two lines my patients will recognize my voice and feel
comforted.

The plan I wrote is designed for a private practice; however, psychiatrists working
for institutions, where the availability of support staff at least takes the burden off
of the family, might still have information to transmit in a contingency plan format.
For example, if you are in an academic setting, who will take over your grant so
your project can continue, and how does that person access your grant reports
and data? In a community health center, even though the medical director will
reassign all your patients, wouldn’t it be nice for your patients to receive a letter
that includes some of your own words, rather than a more impersonal notice?

Even more important than our responsibility to our patients is that to our children.
Especially if you have minor children, it is wise to designate who will take care of
them in your absence, which may be different if the absence is temporary rather
than permanent. If you don’t already have one, write a will. If you do have one,
consider reviewing it to be sure it still reflects your final wishes.

As with all pandemic planning, we hope that the precautions we take are
excessive, not insufficient. Far better to have too many ICU beds and ventilators
than too few. Far better to have wasted a little time creating a contingency plan
that isn’t used, than to have none and need it.