How to prepare for the unexpected

"It's not that I'm afraid to die--I just don't want to be there when it happens." --Woody Allen

No one wants to think about their death, and the thought of dying unexpectedly is even more daunting. But for psychologists--who are more responsible for their clients' well-being than most professionals--it is important to plan for this reality, says Thomas F. McGee, PhD, of the San Diego Psychological Association (SDPA) Committee on Psychologist Retirement, Incapacitation or Death.

That's why every practitioner needs a professional will that spells out how you would like your practice to be handled in the event of your unexpected death or disability, says McGee. Taking this step can help clients make a smooth transition to another mental health professional, while lifting much of the burden of addressing your professional responsibilities from unprepared family members and colleagues.

These documents will vary, of course, depending on your individual preferences, circumstances and state requirements, and there are many resources available to help you create them. (See "Further reading and resources.")

However, they should all include:

• A professional executor. Choose a colleague who can fulfill the instructions you outline in your professional will, says Key West, Fla., practitioner Stephen A. Ragusea, PsyD, who educates colleagues on the topic.

"Find someone you can reciprocate this service with," he says. One logical choice is a trusted office or practice mate. It's wise to select colleagues in your profession rather than friends or family members, McGee says, for emotional as well as practical reasons.

Name one or two backups as well, in case the primary executor is unavailable and to share the workload, McGee adds. "The executor is like a coordinator and should be able to enlist other psychologists or mental health professionals to help," he says.

Then, have your professional executor and backups visit your office together, and walk them through your setup to answer any questions, says former SDPA president and professional will educator Ain Roost, PhD.

• Contact information. In the will, include the name, phone number and address of your executor and your backups. State that the executor has the authority to act on your behalf and to delegate responsibilities. Also provide contact information for your attorney, accountant, billing services, insurance carriers, answering service and practice consultants, says David Ballard, PsyD, MBA, assistant executive director for corporate relations and business strategy in APA's Practice Organization.

• Office information. Note the full address of your practice and any other locations where you keep client records or other practice-related documents. Clearly describe the location of client charts, appointment books, billing and financial records and relevant computer files, Ballard says. Spell out where to find office keys, filing cabinets and storage units, and give instructions for accessing e-mail, voicemail and computer files. Include logon IDs, passwords and PIN codes. Be as explicit as possible, he advises.

• Instructions for contacting clients. Specify how you would like your professional executor to notify clients about your death or disability, keeping clients' particular situations in mind. Ballard suggests contacting current clients by phone before their next appointments, and past clients by mail or phone so they will know how to access their records if necessary.

Include any relevant details about a funeral or memorial service if you want your clients to be included. Some psychologists may wish to hold a separate service for clients, says Roost.

• Plans to facilitate care. A main reason you're creating the professional will is to help your clients transition to new care if necessary, as required by APA's Ethical Standards. Give instructions for how you think continuity of care can best be achieved. As one example, you might want to suggest names of mental health professionals you think would be a good fit for particular clients, says McGee.

• Directions for handling client records. Create a clear plan for transferring and maintaining the confidentiality of client records, including forwarding charts to new providers and maintaining records as required by state law, says Ballard. Before transferring charts, your professional executor will need to obtain written consent from clients, he adds. Records that aren't transferred to new providers should be kept by your professional executor or another qualified mental health professional for the length of time specified in your state. For more information, visit Sections 7 and 13 of the APA Record Keeping Guidelines at http://www.apapracticecentral.org/ce/guidelines/record-keeping.pdf.

Similarly, if you have confidential client information on your home or office computer, your personal digital assistant or your cellphone, note how to access it and how to save or destroy it as appropriate. Relevant data include e-mail exchanges with clients, treatment notes and assessment information gathered on test-scoring software.

If your practice must comply with HIPAA (the Health Insurance Portability and Accountability Act) and you store or transmit electronic patient records, educate yourself on the HIPAA Security Rule requirements related to storing, transmitting and destroying electronic records, adds Alan Nessman, JD, special counsel for legal and regulatory affairs in APA's Practice Directorate. For more information, visit the HIPAA compliance section of APA Practice Central and Sections 8 and 13 of APA's Record Keeping Guidelines (see link above).

• Notification plans. Provide instructions for your professional executor on how to notify your state licensing board, insurance carriers and professional organizations. Include contact information, as well as policy, license, membership and provider numbers, says Ballard.

Also, name colleagues and staff you would like your professional executor to contact.

• Financial issues. In the event of your unexpected death or disability, it is likely your practice will include some financial loose ends. To make sure they're tied up, coordinate financially related information in your professional will with instructions in your personal will.

• Signatures and copies. Although the professional will is not a legal document, sign it and have a witness sign it. Make multiple copies, stating where they are located and who is holding them.

Finally, review your professional will once a year, and update it if your circumstances change, experts advise.

"It is in the ethics of our profession to do no harm," says McGee. "Clearly, creating a professional will is in the best interests of the patient," as well as of colleagues and significant others, he says.

Tori DeAngelis is a writer in Syracuse, N.Y.