Skills for LongTerm Residential Care Doctors Bob James
Skills for Long-Term Residential Care: Doctors Bob James Joel Lexchin Margaret Mc. Gregor
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 Full time Geriatric training Geriatrician 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?
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