Do Yourself a Favor-Take Care of Nursing-Home Patients

Article excerpt

If you don't, you're missing one of the most rewarding ways to practice medicine, says the author (at left). He shares his time-saving tips-and some advice on coding

There are lots of reasons doctors say No to taking care of nursing-home patients-low reimbursement, demanding families, too much paperwork, the sense that you can't do much for them medically. Some doctors, frankly, find the work depressing.

But I have found more compelling-and rewarding-reasons to say Yes. The truth is, I feel closer to some of my nursing-home patients than to others in my practice. They need me more, and I often make more of a difference in their lives.

Take Bob. This 82-year-old man with severe vascular disease came into the nursing home so depressed that he tried to cut the wires of his pacemaker with a knife. We found the right antidepressant for him, and Bob soon became a favorite around the nursing home, zooming around the halls in his wheelchair with a kind word for everyone.

That was two years ago. Recently, when we talked about replacing his pacemaker, he said he hoped it could be done immediately so that he'd recover in time for the upcoming barbecue. I asked if he remembered trying to cut his pacemaker

"Sure, Doc," Bob said. "But that was before I met you. I couldn't have done this without you."

Nor would I want to do this without Bob. It saddens me to see how many primary-care physicians have opted out of nursing-home care. In my own practice, almost none of the new primary-care doctors are willing to see these patients. That leaves just a few of us to see about 250 patients in 12 local nursing homes.

The situation's pretty similar throughout the country. Most nursing-home care is provided by just a few doctors, some of whom aren't actively involved in the medical community. For instance, I know of a specialist who started providing nursinghome care exclusively after losing his hospital privileges.

This isn't good for patients, physicians, or our profession. As the general population ages, the number of senior citizens in nursing homes will grow from 1.5 million to 5.5 million by the year 2050, according to the American Health Care Association.

Someone is going to have to take care of all those patients. The fewer physicians involved, the less clout medicine will have in bringing about the political and administrative changes needed to ensure the best possible care for the elderly

There's a personal cost, too, in declining to care for nursing-home patients. I know I'd be less of a physician-and less of a person-without this part of my practice. Seeing these patients continues to challenge my medical and interpersonal skills and teaches me a lot about medicine, people, and myself.

Here's what I've learned that can make seeing nursing-home patients a meaningful, efficient, and satisfying part of your practice. (For what I've learned about boosting reimbursements, see page 115.)

Delegate non-emergency requests. There's no reason why non-emergency phone calls and paperwork should interrupt you during working hours or at home in the evening. In our office, we have a clipboard to record all of the questions or requests that come in from the nursing homes. During the day, I'll pick up the board and indicate Yes, No, or "C" if I need to review the chart before I answer

The request might be something like: "Mrs. Jones is having trouble swallowing. Can we get a swallowing exam?" Or "Can Mrs. Jones have a pass to visit her brother?" If you know the facility and the nurses, you can head off a lot of trivial questions. Tell the nurse when she calls that if she encounters a similar situation in the future, she can write the order, and you'll support it.

Near the end of the day, one of my employees phones each of the facilities and runs down the answers to its questions. She also makes the appropriate notations in patients' charts. …