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Editor's Correspondence |

Nursing Home Culture Discourages Physician Involvement

Marshall B. Kapp, JD, MPH
Arch Intern Med. 2010;170(15):1405-1406. doi:10.1001/archinternmed.2010.277.
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In her excellent recent editorial, Johnson1 describes the vital role of the physician in changing the culture of nursing homes in a positive direction. The problem is that, in recent history, it has been very difficult in many places to entice physicians to become and remain involved, as either medical directors or attending physicians, in providing medical care to nursing home residents. In a research project a several years ago, I tried to identify some of the explanations for the complex “missing in action” phenomenon2 largely characterizing physician noninvolvement in nursing homes. The primary impediments to physicians' willingness to care for nursing home residents appeared to be a lack of pertinent professional training and acculturation, strong financial disincentives, the relatively low status of nursing home physicians within the medical professional hierarchy, negative premium rate and availability signals sent by liability insurance carriers, and physicians' apprehensions about potential legal (mainly malpractice lawsuit) entanglements.3 Many of the physicians interviewed for this project cited the dominant nursing home culture as an overall “downer,” discouraging more physician involvement in this setting. Thus, physician participation in changing nursing home culture and changes in nursing home culture that encourage greater physician participation are mutually reinforcing factors in the pursuit of a better quality of care and quality of life for nursing home residents.

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