Covering Another Doctor's Patients: Keep It Simple, Document Well
When you cover a colleague's clinic, you inherit their patients and their treatment plans for a temporary period (days, weeks, or months depending on your assignment length). I think how you handle medical management for their patients should come down to two general principles: change as little as you reasonably need to, and document whatever you do carefully. None of this is unique to locums. "If it isn't broken, don't fix it" applies in any practice. It just carries more weight when the doctor who owns the relationship is coming back and you won't be there to explain yourself.
Leave working plans alone
If a patient's plan is reasonable and they're doing well, I leave it where it is, even when it isn't what I would have chosen. Dermatology usually offers several sound ways to manage the same condition. A psoriasis patient well controlled on a biologic I wouldn't have picked first is not a problem to solve. An acne regimen that's a little different from mine but clearly working doesn't need my edits.
Changing a working plan for no real reason just creates friction. The patient wonders why the fill-in doctor undid what their regular doctor set up, and the colleague I'm covering for comes back to a pile of altered regimens to untangle. Minimizing superfluous clinical decision making and keeping things stable is simpler for the patient and considerate to the doctor returning to them.
When to change something
Obviously, clinical restraint doesn't mean doing nothing. I step in when a plan is failing, when there's a safety issue, or when a patient clearly isn't improving on something that isn't working. When I do, I read the prior notes first. The original derm sometimes documents their next move: "if inadequate response, step up to clobetasol cream" or "if not improved, discuss dupilumab." If they had a reasonable plan for one of the aforementioned situations, I strongly consider implementing their plan before developing my own. Often, they have good reasons for their thinking (knowledge of local insurer denial patterns based on the patient’s insurance, cost and accessibility of certain prescriptions in their area, and other variables that I’m agnostic to as a locums), so it’s good to see if they had something in mind.
Document considerately for the derm coming back
This is the part that matters most. Whenever I change something meaningful, or a patient is complicated, I leave a detailed note. I write down the actual reasoning: what I found, what I changed, why, and what to watch for next. The goal is for the returning doctor to open the chart and understand the whole story in two minutes. They shouldn’t need to trudge through templated slop or have to call the patient back to figure out what happened.
Covering someone's patients well is mostly about continuity. You're the temporary steward of a relationship you didn't build and won't keep. Keep the good plans running, intervene where it counts, and above all, leave a clear record of anything you touched. Not only is this considerate to your colleague, it’s good patient care and will make clinics want to call you back in the future.
I'm a dermatologist sharing my own experience, not a lawyer, accountant, or financial advisor, and nothing here is legal, tax, financial, or medical advice. Consult a qualified professional about your specific situation.
