Practical Provider Group
New Grad Guide — Quick Reference
New Grad Survival Kit
What to do in the first-week scenarios nobody prepared you for. Keep this open during your first month.
Scenario 01
Patient discloses active suicidal ideation in a routine follow-up
- Stay calm. Your calm is the first intervention. Don't show panic.
- Ask directly: "Are you thinking about ending your life right now?"
- Assess plan, means, intent, and timeline using Columbia (C-SSRS).
- Do not leave the patient alone. If telehealth, keep them on screen.
- Determine level of care: outpatient safety plan, ED, or mobile crisis.
- Document everything: what was said, your assessment, your reasoning, the plan.
- Call a colleague or supervisor if unsure about level of care decision.
"I'm glad you told me this. I want to make sure we figure out together what's going to keep you safe."
Do not promise confidentiality before assessing risk. Do not end the session without a documented safety plan.
Scenario 02
Patient asks you to be their friend on social media
- Decline immediately and kindly. Do not say "maybe later."
- Explain briefly: "I keep my professional and personal accounts separate."
- Do not follow them either, even if their account is public.
- Document the request and your response in the clinical note.
"I appreciate that, but I keep my social media completely separate from my practice. That's true for all my patients."
Do not accept. Do not explain in detail. Do not make it personal. One sentence, then redirect.
Scenario 03
A patient's family member calls and demands information about their care
- Do not confirm the person is a patient. Do not deny it either.
- Say: "I'm not able to share any information without a signed release from the patient."
- If they escalate or are calling about a safety concern, take their information.
- You CAN receive information even without a release — you just can't share any.
- Document the call: who called, what they said, how you responded.
"I understand your concern. I'm not able to confirm or share any information about a patient without written authorization. I'm happy to take your name and number."
Do not say "they're not a patient here." Do not confirm the name. You have not violated HIPAA by listening. You violate it by disclosing.
Scenario 04
You're not sure if the medication you're about to prescribe is right
- Stop. Uncertainty before prescribing is exactly the right moment to pause.
- Check your reference: Epocrates, UpToDate, or your formulary.
- If still unsure, call a colleague before the patient leaves.
- It is acceptable to say: "I want to review this before we finalize the plan."
- Document that you reviewed the medication decision and any consultation.
"I want to make sure I'm giving you the most accurate recommendation. Let me take a moment to confirm something before we wrap up."
Do not prescribe when genuinely uncertain to avoid looking unsure. Uncertainty acknowledged is patient safety. Uncertainty ignored is liability.
Scenario 05
Patient no-shows repeatedly and you're not sure what to do
- Check your practice's no-show policy — follow it consistently for all patients.
- Document every no-show with a brief note (date, no contact, attempts made).
- After 2–3 no-shows, send a registered letter or make a documented call.
- Do not discharge without documented outreach attempts — this is abandonment risk.
- If the patient is high risk, escalate your outreach steps accordingly.
Discharge letter template: "This letter is to inform you that [practice name] will no longer be able to serve as your psychiatric provider after [date], due to inability to maintain scheduled appointments. We recommend you seek ongoing care with [resource]. We are available for urgent needs until [date]."
Do not discharge a high-risk patient over a no-show without documented alternative care and proper notice period. Abandonment claims are real.
Scenario 06
Patient disagrees with your diagnosis and gets angry
- Stay calm. Don't get defensive or over-explain.
- Acknowledge their perspective: "I hear that this doesn't feel right to you."
- Explain your reasoning briefly, without lecturing.
- Invite dialogue: "What would be most helpful to you?"
- You do not have to change your clinical assessment because a patient disagrees.
- Document: the patient's disagreement, your response, the clinical rationale.
"I understand this feels different from what you expected. I want to walk you through my thinking and hear your perspective."
Do not change a diagnosis under social pressure. Do not dismiss their disagreement either. The clinical record should reflect both your assessment and the patient's stated perspective.