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When should we ask for a Consulting Physician to Evaluate our Patients in a Chronic Care Facility?

Daniel Davidson, MD, MBA, DBA, PHD


Providing people with thorough and efficient care is a complex undertaking in long-term care institutions. Although the day-to-day needs of residents are primarily managed by the primary care team, there are times when seeking medical advice from a physician is required to guarantee the best possible care and results. In order to handle complicated medical concerns and improve the general standard of care in chronic care settings, it is crucial to know when to seek the advice of a consulting physician.

Complexity of Medical Conditions:

The combination of several health problems or variables that make diagnosis, treatment, and management more difficult is referred to as the complexity of medical conditions. Patients with complicated medical illnesses frequently present to healthcare settings with a combination of chronic diseases, comorbidities, or other contributing factors that necessitate close evaluation and care coordination.


People with complicated medical conditions may suffer from several chronic illnesses at the same time. For instance, a patient may have heart disease, diabetes, hypertension, or arthritis, all of which call for different approaches to care and therapy. Because of the possibility of interactions between medicines and the requirement for provider cooperation, managing multiple illnesses concurrently might provide difficulties.

Disease Severity:

Patients with complicated medical demands may have quite different levels of severity for any given medical problem. While some individuals may have illnesses that are under control and have few symptoms, others may have more serious issues that need close observation and extensive care. Prognosis, total care complexity, and therapy choices are all influenced by the severity of the disease.

Treatment Complexity:

Treatment plans combining various drugs, therapies, or interventions are often necessary for complicated medical diseases. Effective management of these medications needs close coordination, adherence to drug regimens, side effect monitoring, and modification based on patient response. Factors including food restrictions, lifestyle changes, and pharmaceutical combinations might significantly impact the complexity of treatment.

Psychological Factors:

Patients with complicated medical diseases may experience psychological difficulties in addition to physical health issues, which can affect their general well-being and treatment results. Social class, mental health issues, social support systems, cultural values, and health literacy levels are a few examples of these variables. Improving patient-centered, comprehensive treatment and health outcomes need addressing psychological variables.

Care Coordination:

Coordinating treatment for patients with complicated medical issues frequently calls for cooperation between several medical professionals from various settings and specializations. To guarantee continuity of care, reduce treatment gaps, and avoid unfavorable outcomes, effective communication, collaborative decision-making, and care coordination procedures are crucial.

Changes in Clinical Status:

Any detectable changes in a patient’s health state, symptoms, or vital signs are referred to as changes in clinical status. These variations may be a sign of variations in the patient’s general health and may call for more testing or medical attention.

Clinical status is a broad term that includes several different indicators, such as:

Physical Symptoms:

Pain, dyspnea, exhaustion, nausea, or lightheadedness are examples of new or worsening symptoms that could indicate a change in the patient’s clinical status. These signs may point to problems or underlying medical conditions that need to be attended to.

Vital Signs:

Variations in the patient’s blood pressure, heart rate, breathing rate, temperature, and oxygen saturation levels might reveal important information about their physiological state. Vital sign abnormalities may be a symptom of physiological discomfort or instability and call for quick diagnosis and treatment.

Functional state:

Modifications in the patient’s mobility, cognitive function, or capacity to carry out activities of daily living (ADLs) may also indicate alterations in their clinical state. Acute sickness, the worsening of long-term conditions, or unfavorable occurrences can all cause declines in functional status, which call for a review and adjustment of the care plan.

Laboratory and Diagnostic Findings:

 Modifications in the outcomes of laboratory tests, including imaging investigations, blood tests, and other diagnostic exams, might offer factual proof of modifications in the patient’s state of health. Unusual results could necessitate more research or modifying treatment plans.

Mental Health and Psychosocial Factors:

When evaluating a patient’s clinical status, changes in their mental health, mood, behavior, or psychosocial functioning should also be taken into account. Depression, anxiety, disorientation, and social disengagement symptoms can be signs of psychological issues or emotional suffering that need to be addressed.

Medication Management Challenges:

Effective drug management is essential to maintaining patients’ health and wellbeing in long-term care institutions. However, there are a number of issues related to medication management that need for skill and close attention.

The intricacy of medications is one frequent problem. To treat acute diseases, chronic disorders, and symptom management, many residents in long-term care institutions are given many prescriptions for drugs. It can be difficult for residents, caregivers, and healthcare professionals to manage many drugs. Medication management in these situations requires careful attention to detail, including scheduling medication delivery precisely, avoiding drug interactions, and keeping an eye out for side effects.

Compliance to medication is another difficulty. Some residents may experience cognitive impairments, physical limits, or other obstacles that make it difficult for them to follow their drug regimens. It can be difficult to make sure residents take their medications as directed; to help with adherence, techniques including pill organizers, medication reminders, and caregiver support are needed.

Another major worry in chronic care institutions is medication safety. Given the intricacy of prescription regimens and the susceptibility of the residents, there is an increased risk of medication errors in these settings, including missed doses, wrong dosages, and pharmaceutical mix-ups. Preventing errors and guaranteeing resident safety require the implementation of strong pharmaceutical safety standards, including as medication reconciliation procedures, double-checking procedures, and staff education on medication administration best practices.

Diagnostic and Therapeutic Procedures:

A variety of medical treatments are included in diagnostic and therapeutic processes with the goal of identifying and treating various health issues. These processes are essential to patient care because they enable medical professionals to evaluate patients’ health, find underlying conditions, and carry out suitable treatment programs.

In order to learn more about a patient’s health, diagnostic procedures are carried out, frequently in reaction to symptoms, abnormal results, or particular clinical queries. These could include laboratory tests like blood tests and urine analysis, imaging investigations like MRIs, CT scans, and X-rays, as well as diagnostic procedures like biopsies and endoscopies. Healthcare providers can make well-informed judgments regarding patient management and treatment by acquiring precise diagnostic information.

Treatments used in therapeutic settings aim to cure or lessen medical problems. These procedures can be as minimally invasive as giving shots or delivering medication, or they can be as invasive as having surgery or other interventional procedures. The goals of therapeutic procedures are to treat the underlying cause of a patient’s symptoms, reduce pain or discomfort, enhance functional skills, or bring back a patient’s health and wellbeing.

To guarantee both their safety and effectiveness, therapeutic and diagnostic procedures need to be carefully planned, carried out, and monitored. In addition to the patient’s medical history, the healthcare provider must take into account the procedure’s possible risks and benefits as well as any applicable guidelines or protocols. For the healthcare team to coordinate treatment and improve patient outcomes, communication and teamwork are crucial.

Palliative and terminal illness care:

A doctor with expertise in hospice or palliative medicine can offer residents vital assistance and direction when they need palliative or end-of-life care. These medical professionals are skilled in symptom management, pain and discomfort relief, and attending to the spiritual and emotional needs of residents as they near death. By seeking the advice of a palliative care specialist, people and their families can be certain to get compassionate, all-encompassing care that respects their desires and improves their quality of life.


Providing complete and superior care to residents in a chronic care facility requires understanding when to get an evaluation from a consultant physician. Optimizing residents’ health outcomes and overall well-being in chronic care settings is greatly aided by consulting physicians’ ability to recognize the complexity of medical conditions, monitor changes in clinical status, address medication management challenges, facilitate diagnostic and therapeutic procedures, and provide palliative and end-of-life care.

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