The nursing home doctor is in

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Understanding the role of a nursing home medical director is difficult by any measure. Even the American Medical Directors Association has been trying to redefine the role recently.

Perhaps that’s what makes the book "Living and Dying in a Long-Term Care Facility: Notes From a Nursing Home Doctor" all the more intriguing. Granted, it might not have a book spine you'll feel comfortable showing off on the bus or your coffee table. But it is a page-flipper.

Veteran senior-care physician Dr. Gilah Silber takes us on a first-person journey of one of her typical workdays. Independent and unflinching, she peels away the layers of murkiness at every stop.

At first a bit disconcerting for its unusual mixture of philosophy and slang, this 179-page personal vetting turns out to be surprisingly rich narrative. Like any good observer, Silber calls 'em like she sees 'em.

She takes on the establishment, family members, residents and even her peers. Because she bounces around numerous facilities and encounters all levels of staff, she pokes into the backyard of many, many long-term care professionals.

But she stays just this side of coming off as self-absorbed. Instead, this mother of a middle schooler digresses insightfully into why her residents, colleagues-and even she herself-get into the fixes they do. Sometimes a primer for how a nursing home works, this book provides a mirror for long-term care employees.

She dutifully lays out the history of a scenario so the reader can understand the system and medical director's psyche at every stop.

One of the more interesting approaches she uses is hypothesizing how two or more scenarios for the same resident would unfold, given certain circumstances. Take, for example, what would happen to 82-year-old Parkinson's patient Rose Jamison if she had a) a "normal" care team, b) a bickering, ie., dysfunctional, care team, c) a threatening care team, d) an absent care team, and e) a passive care team or f) no care team. The rundown of the effects of various family types is another memorable dissection, among others.

Consumers and LTC veterans alike will almost always find something worth storing away in the back of the mind from these illustrations.

And while it is a warts-and-all account, Silber emphasizes early on it is not meant to be a negative book.

It is, above all, beautifully candid. You sometimes wonder how this licensed physician can get away with foregoing expected medical advice or prescriptive medicine, as she sometimes does. But she always has her reasons. She is, after all, a person treating other human beings. Sometimes that takes more than the system has to offer.

("Living and Dying in a Long-Term Care Facility: Notes from a Nursing Home Doctor" can be ordered through Simply click on "Books" and enter the title for more information.)

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Daily Editors' Notes

McKnight's Daily Editors' Notes features commentary on the latest in long-term care news and issues. Entries are written by Editorial Director John O'Connor, Editor James M. Berklan, Senior Editor Elizabeth Newman and Staff Writer Marty Stempniak.