You have probably saved this article for last. That is, if you haven't misplaced this issue of TAP altogether. Such responses are hardly to be wondered at when the subject is death.
Some fifteen years ago the widow of a recently deceased analyst approached a number of his colleagues to report the many problems she had encountered in dealing with her husband's practice. Impressed that her experience was all too typical, they put together a set of guidelines which they circulated to members of their society. Chances are you never saw this material, or disregarded it if you did. When I recently sought a fresh copy, the archives had to be searched high and low, so strong is the impulse to put all thoughts of death aside.
As a contributor to the recently published Illness and the Analyst, edited by Ann-Louise Silver and Harvey Schwartz, my assignment was to report on terminations occasioned by an analyst's illness or death. The circumstances I encountered in my research were so disconcerting that I determined to revise those guidelines and distribute them to colleagues. It took only a few months for me to “get around to it.”
Here, then, are suggestions for a set of written instructions, pertaining solely to professional matters, that can be of great help in reducing turmoil for a surviving spouse and the bereaved family, and certainly for the analyst's suddenly abandoned patients. Some of these suggestions can be applied in emergencies other than the analyst's death or incapacity.
In the event I am unable to continue my psychoanalytic practice because of illness or death, please refer to the following recommendations and requests.
I designate the following psychoanalytic colleagues (at least two, of whom one should be younger than you) to inform my patients promptly by telephone, to cancel appointments, and so to protect my patients against the distress of arriving to find the office door mysteriously locked. I have discussed with these colleagues my wish to list them for these purposes. They have agreed to help and, additionally, to offer to my patients the prompt opportunity for consultation to decide how best to meet their continuing clinical needs. These colleagues are fully aware, in instances in which the patient is a candidate at the Institute, of the need for collaboration with the chair of the Education Committee in arranging for continuity of analysis. To assist my colleagues with these tasks, the names, addresses, and phone numbers of all patients are listed in the fee account record book kept in my offices, and my appointment book indicates those with whom I am currently working. (List colleagues' names, addresses, and phone numbers here.)
My answering machine message should be changed immediately, with some wording such as “Dr. As appointment schedule has been canceled. Please telephone Dr. Colleague at (telephone number) for additional information.” (Experience suggests strongly that this task should be taken over by the colleague and not left as a burden for family members, who understandably are preoccupied with their own distress. They cannot be expected to empathize suitably with the dilemmas of patients.)
On the office front door—just in case—place a note that reads, “Dr. As schedule has been canceled. For further information telephone Dr. Colleague at (telephone number).”
Instruct the doorman or elevator operator to say to inquirers, “The doctor's schedule has been canceled. Here is a telephone number to call for more information.”
Keep all my financial records, appointment books, and related records for the duration of the statute of limitations in our state (e.g., six years in New York). If a patient requests substantiation of a claim for insurance benefits, and needs a listing of appointments and fees paid, that patient should be asked to repeat the request by letter. The signed letter becomes that patient's authorization for the release of information that is otherwise kept confidential. (The earlier guidelines include the comment that insurance companies will generally accept a completed claim form signed by the spouse or a designated colleague, along with an explanation that the treating analyst has died.)
As in the case of financial records, keep my clinical records for the duration of the statute of limitations in our state. Some of these records, such as evaluative diagnostic summaries or progress summaries, may be requested by successor analysts or therapists. Only copies may be forwarded to the successor analyst, and only upon receipt of a signed letter of authorization from the patient. The original of the record should be retained.
Process notes are a different matter, as they were comprehensible and useful to me alone. They can be destroyed after a relatively brief interval. (They should usually not be shared with anyone, including the successor analyst, unless specific instructions are left to do so. The Committee on Confidentiality, after a lengthy discussion last winter of the Anne Sexton case, recommended that The American publish a statement that no posthumous disclosures may be made without the patient's specific prior consent and/or instruction. This guideline is in keeping with the principle that although physical records are in all instances the property of the analyst, the information they contain remains the property of the patient.)
Keep any agreements and copyrights of written works, either in progress of already published. You can obtain advice from colleagues.
If a patient seeks family contacts beyond extending condolences, my standby colleague will furnish guidance concerning such requests.
As to obituary notices: the usual notice inserted in the paper by family, the funeral director, or the Institute or Society (by the director or president) is entirely at your discretion.
Please notify the following list of organizations that have been important to me. (List.)
Dues to professional organizations and unexpired journal subscriptions should be refunded in a pro-rated manner. The journals in my library will list their administrative addresses. You need only notify the organizations and the journals. (List.)
My professional library should be donated to (name of institution). (List designee and second, third, and fourth choices in case the designee does not require additional copies of volumes already owned. I plan to donate mine to my institute library with the proviso that unneeded volumes should be sold to candidates and others, the proceeds to go for future acquisitions.)
Well, that's the story, and indeed it is lugubrious. But far better to deal with these matters now than to leave them for those who are grieving and in shock. Just see that this piece doesn't find its way too quickly into your “circular file.”