Abstract
ABSTRACTDespite the increasing complexity of nursing home care, the role of physicians caring for residents is largely unexplored. This international, exploratory study sought to learn about physicians' roles, responsibilities, and tasks as well as investigate the unique qualities of medical practice in nursing homes. We conducted interviews with 18 physicians, who reported making important contributions to the quality of resident care, including clarifying the goals of care, working to reduce unnecessary medication and hospitalization, as well as contributing to staff education. Nursing home practice involved physicians in networks of relations that were instrumental to the quality of medical care and physicians' job satisfaction. The importance of these relationships disrupts the oft-drawn boundary between the medical and the social, suggesting that good medical practice depends on good social practice. Reflecting the exploratory nature of the study, we recommend research to better understand and support the relational dimensions of nursing home medicine.
Highlights
The role of physicians in nursing homes is largely unexplored
In an effort to contribute to our understanding of the role of nursing home physicians, we present in this article the results of an exploratory qualitative study of physicians caring for residents in nursing homes across six countries
One point of resistance to greater physician presence in nursing homes has been the concern that their involvement will lead to medicalization, with a focus on pathology, resulting in increased testing and treatment (Stone, 2006, pp. 460–461)
Summary
The role of physicians in nursing homes is largely unexplored. Reflecting on the work of nursing home physicians, Katz and Karuza (2015, p. 728) observed that “there are few, if any, data sources that accurately portray extant practice patterns.” Schnelle (2006, p. 398) remarked that it is “surprising that we do not have better information about pivotal questions” such as the type of work physicians engage in, the outcomes of their practice, and what might constitute optimal performance.By contrast, a robust and important literature has developed on nursing home staffing and, in particular, its relation to quality (cf. Castle, 2008; Harrington et al, 2012). A robust and important literature has developed on nursing home staffing and, in particular, its relation to quality (cf Castle, 2008; Harrington et al, 2012). This literature typically does not include physicians. Much of the literature on staffing focuses on the role of nurses and, to a lesser degree, that of care aides (cf Castle & Engberg, 2007; Dellefield, 2000; Hsu, Berta, Coyte, & Laporte, 2016)
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