Long term care

As I mentioned I am in long term care at the moment. I went to a treatment team/ care team meeting today. There is a stark contrast between the treatment meetings in LTC verses those in acute care, and I think one of the biggest contributing factors is the role of the MD.

In acute care the representatives from the different disciplines gather and then wait until the doctor is ready to see them. The doctor updates the group on his/her patients and leaves. Then the next doctor is called to repeat the process. Occasionally the doctor seeks advice or asks how things are progressing with respect to other aspects of the patient’s care, but the MD is definitely in charge and does the majority of the talking. The dietitian I followed to these meetings almost never said a word in the presence of the MD, though sometimes we talked with the pharmacist afterwards.

In LTC the MD is only occasionally present at the meetings. There are representatives from nursing, RT, Pharmacy, dietetics, social work, PT? OT? Etc. The nurses sometimes run the show, but everyone seems to be on an even playing field and the dietitian seems more involved. It seems more like a democracy and less like a dictatorship. Even when the MD is present in the meetings he/she seems to hold less authority.

I do not mean to be critical in any way. There is nothing wrong with either approach, and I guess the meetings do serve different purposes. I am simply pointing out the differences that I have noticed. Some people probably like one style and some prefer the other, but it has definitely been good for me to see the different styles of collaboration.

I previously mentioned that they spend a lot of time getting LTC patient’s meal preferences right. This makes sense seeing as they are there for an extended period of time and it is their temporary or permanent home. Along with this comes the issue of patient’s rights. How much freedom should patients be given in terms of their access to food? Some patients do not have the mental capability to remember when they last ate; others have trouble controlling their impulses, and may hoard the snacks. What snacks should be available to all patients for free, and what should be available in vending machines if they choose to purchase food? What about ordering pizza? These freedoms, and the social living environment in which some patients give food to others, make it difficult to control some of the medical conditions. This kind of environment can lead to unwanted weight gain and uncontrolled diabetes. Where do you draw the line between providing the best treatment and allowing freedoms which may enhance quality of life?