I recently had a conversation with a nurse – we were reviewing medications together to look for ways to simplify medication regimens based on resident specific factors. If they choke on Lactulose, we will try to give other laxatives. If they sleep in during the morning, we will schedule the medications at noon. If they are dozing off during the day, we will look for ways to minimize medications that cause sedation.

We were also chatting about physicians. I don’t consider it gossip. It is a fact of life that we have to work with physicians with different personalities, preferences and sometimes their ability to take on additional workload without giving us a hard time.

We sometimes have to bribe them to attend important meetings with treats, lunches and other rewards.

We were creating work for physicians by changing medication orders… for the ultimate outcome to improve resident care. But we had to evaluate if it was too much work for the physicians. We had to see if we could save some recommendations for a later time.

But why wait? If it is important to consider now for the resident, it is important enough to bring it up now. Why should it matter that Dr. XYZ may be angry or unable to process all the orders?

In fact, that is often the rate limiting step – when will the physician come in to review the orders? When will the physician come in to assess the resident? When? That is the deciding factor.

But should physician be the deciding factor? Shouldn’t it be the resident and his or her clinical status or quality of life that is more important?

That is my thought for the day!

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