To the Editor: — Communication between nurse and physician is the cornerstone of good patient care in any long-term care facility and must be dealt with seriously. From the nursing staff's viewpoint, the key factor is being organized. General alertness and common sense should lead one to have an overview of existing and potential problems as the day begins and try to lump them together in one call, if possible, instead of rushing to the phone each time a problem is encountered. There is often an ongoing argument between the primary physician and nursing staff of any nursing home as to whether calls made to the physician were justifiable. On the other hand, the physician may complain that certain situations were not called to his attention. The following are my recommendations to physicians and nursing home staffs as to when the physician should be called. . Stat Call every 5 minutes until you hear from the physician, and also call the paramedics; for life-threatening conditions (eg, cardiopulmonary arrest, shock, etc) . Immediate Call every 30 minutes until you hear from the physician. ) Significant and acute changes in the patient's condition and/or behavior ) Grossly abnormal laboratory values requiring immediate action ) Unauthorized (not ordered) pass ) Falls and incidents associated with injury ) Death ) Absence ) Suicidal . Urgent Call every 2 hours until you hear from the physician. ) Five percent weight gain or loss ) Updating medications ) Discontinuation of unnecessary medications ) Discontinuation of PRN medications not used for 60 days ) Discontinuation and/or substitution of medications not paid by public sources (Medicaid, etc) ) Verification of new admission orders ) Three consecutive refusals of essential medications (anticonvulsants, anticoagulants, insulin, cardiac medications, antihypertensives, steroids, etc) ) Abnormal laboratory values falling outside the accepted range, per nursing home policy . Nonurgent Discuss with the physician when he calls in for any other reasons ) Consultant's recommendations ) Overdue history and physicals or missing monthly progress notes ) Changes in diet recommended by dietary consultant ) Various clinic appointments ) Poor appetite for two consecutive meals . Elective Can wait until the physician visits facility ) Slow growing problems and complaints ) Lumps and tumors and swelling of chronic onset ) Chronic skin changes ) Need for eye examination ) Need for dental evaluation ) Need for multivitamin ) Chronic pain ) Insomnia ) Constipation ) Depression ) Fair appetite ) Consideration of discharge to community ) Signing telephone orders and incident reports and Public Aid recertification ) Messages from families and family members Editor: — Do all of our readers agree with Dr Rezvan's recommendations? Other opinions will be published in this column. Perhaps we will learn whether there is a consensus on when the physician should be called.