PT Medical Director Empowers Staff, Boosts Effectiveness

Abstract

DALLAS — Being a part-time medical director at a long-term care facility can be daunting at times, but there are ways to ease the burden, Dr. David A. Brechtelsbauer said at the annual symposium of the American Medical Directors Association. Physicians need to learn to build on work already being done by consultants and other staff, and take advantage of resources from AMDA, said Dr. Brechtelsbauer, who is director of geriatric training for the Sioux Falls (S.D.) Family Medicine Residency, medical adviser for this publication, and a part-time medical director. For example, pain is often an overlooked and undertreated condition in the nursing home, he said. If the medical director notices that pain is not being addressed in some patients, the best way to approach it is from a system perspective and involve staff from around the facility. “One equals zero,” Dr. Brechtelsbauer said. If the problem of pain is assigned to one person, that person can burn out quickly, he said. In many cases, the answer is to empower all employees, agreed Dr. George N. Smith, president of the Texas Medical Directors Association. Aides working in the facility see the residents most and know when someone is not acting normally, he said. Dr. Smith suggests encouraging the staff to report such changes to quickly identify unaddressed pain. And the aides know when a solution isn't practical, so their honest feedback is key, he added. “The aides really like to be involved,” Dr. Smith said. “They are our eyes and ears.” Physical therapists are another resource to help better detect and monitor pain among residents, Dr. Brechtelsbauer said. “We can engage our professional colleagues,” he said. It's okay for physicians not to have all the ideas and solutions, said Dr. Janice A. Knebl, chief of the division of geriatrics at the Texas College of Osteopathic Medicine, Fort Worth, and part-time medical director. Dr. Brechtelsbauer pointed out that consultant pharmacists can also be a resource for the medical director. One of the medical director's responsibilities is to identify clinical conditions and risks that are relevant to the facility population, from falls to influenza. One way to make that easier is to look at the facility's monthly infections by getting data from the consultant pharmacist on the antibiotics that have been prescribed. Engaging facility staff is also key to being an effective medical director, and physicians have the opportunity to do that even in routine interactions with staff. For example, in a situation where a resident falls out of a wheelchair and has no apparent injury, the medical director can open up a dialogue with the staff. Instead of instructing the staff to call if there are any changes, the medical director could ask for suggestions from the staff, such as, “Should the resident wear hip protectors?” and “Is there anything else that can be done for the resident?” This type of response leads to a more engaged employee and puts the patients on a path to a true clinical plan, Dr. Brechtelsbauer said.