Hospice Physicians

I think there are several factors that will contribute to how helpful the medical directors are at a hospice. 

First of all, if the medical director chose to be involved in hospice care. I've heard of some situations where medical directors were assigned to hospice by their company or they were looking for a side job. It's typically pretty obvious when a provider has a genuine interest in hospice and palliative care. 

Another factor is how much experience a provider has in hospice symptom management. This is something that takes time to develop, hospice symptom management is very different compared to some areas of medicine. If an order isn't appropriate for a given patient or isn't working, initiating a respectful conversation with the provider to discuss it further is an option.

Another consideration is the quality of information the provider is receiving from the nurse. If a hospice nurse has done a comprehensive assessment and anticipates what background information the provider will need it makes it easier to get appropriate orders. Also being respectful of a provider's time if they are balancing several roles - find out the best format and times to communicate with them on non-time sensitive matters. This makes it easier when you urgently need an order if they are familiar with you.

One other thing to consider is to find a pharmacist to use as a resource for tricky symptom management situations. A pharmacist recommendation can be very helpful when discussing symptom management orders.

As far as hospice medical directors go, I've had good experiences. I will say though, it does take some effort on my part as well. 

I have 2 HMDs.  Both have private practices.  Dr. M is an Internal Medicine practitioner and a board certified Hospice physician, Dr. D is board certified pulmonologist.  Both of my docs are very knowledgeable and helpful.

  Before I worked for hospice I dealt with Dr. D at the hospital, I really did not like him, he hated being called in the middle of the night.  I have never had an issue with him when I call him at any hour of the day when it comes to his hospice patients.