Table 2 Participant Perceptions of Their Experiences and Expectations of Physician(s) Care in Skilled Nursing Facilities

Poor awareness of the physician(s) in charge of their care at the skilled nursing facility

Inability to name or otherwise identify the physician(s) overseeing their care

“I’ve never really talked to him...I didn’t even know he was a doctor.” – Female, 70’s-80’s years old

Expectation that external providers (i.e. their surgeons, hospitalist, or primary care provider) would be directing their post-acute care at the skilled nursing facility

“From what I’ve been told there’s a separate physician here. It’s not my surgeon, which I’m not crazy about. I mean, he gave me the surgery, he should be in here to check on meat least once or twice during the 10 days I’m here. But he hasn’t been. It’s been a different doctor who was only here one time.” - Female, 60’s-70’s year old

Confusion about the distinct roles of physicians, nurse practitioners, nurses, and nursing assistants on the care team

“It’s very hard to tell who’s a doctor. That person, I guess, he’s a doctor, it happens every once in a while, a guy comes in with a suit and tie on and he doesn’t really introduce himself. He just sits down and we start talking about things. I wish they would announce themselves - exactly who they are.” – Male, 60’s-70’s years old

Distress associated with the lack of understanding about the physician(s) coordinating their care

“I don’t know [if there is a separate doctor or nurse practitioner who coordinates my care in this facility]. I don’t know. I feel kind of stupid not knowing.” - Female, 70’s-80’s years old

Frequency and quality of communication with the physician did not meet participants’ expectations

Frequency of communication did not meet expectations

“I mean, if I need a question they always tell me to ask the nurse. And Dr. [last name], I only saw him once and I probably won’t see him again this week.” – Male, 50’s-60’s years old

Quality of communication did not meet expectations: perceived to be rushed, superficial, insufficient to learn patient preferences for care

“I think that [physicians] can stay on top of stuff a little bit more. I know they have a lot of patients here and I know they’re really busy, but I just feel like I’m like their supervisor and I’m keeping on top of them and making sure they do their job. And I don’t think I should be doing that. I don’t want to have to be burdened with that mindset that I need to stay on top of these people in order for them to do what I need to have done.” – Female, 60’s-70’s years old

Caregivers expected more frequent and detailed communication with the physician

“I thought [the physician] should have had a little more [communication] with me when I asked him a question. I told him, ‘[My father] is an [80’s] year-old man. If you have a question, you need to call me.’”– Female, 30’s-40’s (caregiver)

Participants valued care that was perceived to be individualized to their needs by the physician(s) in the facility

Perception of physician(s) being dismissive of the patients’ symptoms

“I didn’t care for the doctor there because she acted like I didn’t know my own body and I didn’t know what I was talking about. And I know how much insulin I need, because I give it to myself, because I’ve been a diabetic for [many] years, which is a long time.” – Female, 70’s-80’s years old

Appreciation of specialized care to meet individual needs

“And [the physician] is very understanding of my father and how he thinks. And thinking so much about my father and then specifically understanding of his needs, like the [diet] element, things like that. Some people really shake that off like it’s not important – he has to eat – but for a man who spent his life that way, it is important.” – Female, [declined to provide age] (caregiver)

Patients felt they were a burden due to their medical complexity or custodial needs

“You know one thing I think about this place – they knew that I was [medically complex and high needs] – why did they accept me? Don’t accept people because you need patients. You accept them because you wanna help them.” – Female, 70’s-80’s years old