In most Virginia nursing homes, there is no doctor on staff. Rather, the facility will subcontract with a doctor to serve as the medical director, who then only enters the facility to see patients when they are sick and a change of condition has occurred, or Medicare paperwork is to be signed and submitted.
Loved ones are often surprised to learn this, and more surprise to learn that typically nursing home residents are only seen by or examined by a physician in the facility once every 30-60 days after admission.
And what happens in busy facilities, where the doctors are on site only a few hours a day or few days a week, is that doctors never look at the patient’s chart when providing care. Nor do they access the records or physician consults when ordering tests, medications, etc. They rely on the nursing staff to tell them the patients medications, co-morbidities, changes in status, etc. They are told bits of patient information by a referring nurse, asked to examine the patient, and 5-10 minutes later they are in another patient’s room, without looking at their chart, listening to the nurse as to why the examination is necessary.
What if our school were run this way?
The math teacher comes in for 1 hour a week, and the really bad math students are lined up, scheduled for 5-10 minute appointments, and the teacher bases their limited instruction not on the student’s written work or test results, but on a tudors’ 1 minute assessment and summary. Think parents would be mad?
So how is this appropriate and best care for our most vulnerable population? It’s not. It’s cheapest and easiest care where the underpaid overworked nurses on the floor, must serve as the eyes, ears and scribes of the visiting physicians who often have no continuity of care with a patient, or time to review their chart.
So no wonder one of the most frequent allegations of malpractice our office pleads against nursing home staff is failure to notify physician of changes in a patient’s condition and or obtain acute medical care.
Or, we allege the physician failed to appreciate the severity of the changes in condition, and should have done more to treat the patient.
Go read a 150 page book. Then sit down and try to summarize as much as you can of the characters, plot, and timeline of the narrative.
Could you do it? Not well. And neither can physicians with 100-300 patients treat patients effectively when they must base that treatment on a summary provided by nursing staff.
Want better care? Find a way to get your loved one to their own primacy care physician for treatment. Don’t rely on the nursing home’s medical team – and make sure you are the eyes and ears for your loved one.