Skills for Long-Term Residential Care: Doctors

Bob JamesJoel LexchinMargaret McGregor

Which Categories Should Be Present & Why

• Doctors– Legislation in at least three Canadian provinces

requires a medical director • Not necessarily the case in other countries

– Doctors needed for medical decision-making • Some could be done remotely by RNs but doctors would be

uncomfortable if they were not physically present some of the time

• In some provinces NPs can fulfill doctor role

– Can sometimes help avoid hospitalizations and complications

Question – Level of Training & Full vs Part-time

Type of doctor

General Practitioner Geriatrician

Full time Geriatric training No geriatric training

Yes ? ? ?

No ? ? ?

How Should Work Be Divided & Coordinated

• Doctors typically do things such as admission physicals, annual reviews and medication reviews

• Ideally provide pro-active longitudinal care & develop relationships with residents & families

• Provide care for acute events on a 24/7 basis• Medical directors, where present, in Canada coordinate work of all

doctors– In other countries may be done by administrators

• In some LTC homes Medical Advisory Committee generates medical policy

• Doctors & other care staff– Communication with senior nursing staff usually face-to-face– Communication with other staff through “communication book”

Questions

• Should doctors just be involved with narrow medical issues or wider social issues?

• How do doctors organize their time in the nursing home versus what nurses need in terms of doctor time?

• Who should doctors be accountable to?

Gender and Racialization

• Primarily older white male doctors versus primarily female staff often from developing world countries

• Administrative and leadership staff tend not to come from visible minorities

Questions

• Are these differences expressed in power relationships?

• Do female doctors interact differently with other staff & patients compared to male doctors?