I agree with many of the ideas advanced here help to address the issues raised by the "senior nephrologist" (please, give us a name
).
As stated by Bert and John, a comparison to the paper system is often instructive. Currently, if a patient calls with chest pain or a lab reports a K of 7 while a doc is away, you do NOT want that message put on the doctor's desk or inbox, only to be reviewed when they return. By the same token, your staff must be careful not to send such a message through AC to a vacationing doctor's inbox. Liability is essentially the same in each instance, and appropriate precautions are also the same: messages go to a covering doc when someone is on vacation.
So the differentiating issue is messages that are put into a box in automated fashion. Neil, as Indy says, how often this occurs is determined by your set-up. Labs coming in by fax or paper or imported by a staff member (with or without Updox) and they chose whose box to put them in for sign-off. In that case, again, instruct staff: "Dr. Kidney is on vacation this week so be sure to put his labs in Dr. Nephron's box". If you have a lab interface, then some labs will be coming into a doc's chart in automated fashion without anyone routing them. If you really don't want to let other docs get in and sign them off, then let someone (e.g. the office manager) have the doc's password. (Someone will already need to have this anyway.) Their job is to go in daily and forward all imported lab messages to one of the other docs for review. You have a record that the messages were forwarded and a record of who signed them off. Not ideal, but pretty minimal liability.
I would respectfully suggest that if your "real worry is a mentally unstable doc", then the potential damage done by inappropriately signed-off messages is the least of your concerns as that scenario plays itself out.
