Partnering with Patients to Manage their Health

This blog post was made by Beth Witten, MSW, ACSW, LSCSW on December 18th, 2014.
Partnering with Patients to Manage their Health

Think how much more your team might get with honey than vinegar. Scolding home patients for drinking too much or eating the wrong foods may result in them skipping home clinics or coming in waiting for that scolding that may trigger an angry reaction that puts you and everyone else at risk.

I suggest that we try to put ourselves in our patient’s shoes. Consider how closely we follow our doctor’s advice. Does anyone reading this ever forget to take a medication we’re prescribed on schedule? Has anyone ever delayed or postponed a doctor’s appointment because want to exercise more, lose a little more weight or cut back on drinking or smoking? How many of us have passed up healthy choices to eat or drink something that looked too good to pass up? Have any of us ever postponed getting blood drawn until we think our indiscretions won’t show up on labs?

Think about having a chronic life-altering illness like kidney disease. Think about having to perform PD every day or HD multiple days a week. Think about having to see the doctor and other members of the treatment team every month. How would we want our healthcare team to treat us? Wouldn’t we want them to listen to us, to take our knowledge, experience, and wishes into consideration? Wouldn’t we want them to partner with us adult-to-adult and try to get to the bottom of what we didn’t understand or the barriers we faced in following the treatment plan—rather than assuming we just didn’t care? I believe we label far too many patients as “noncompliant” and assume they don’t care about their health when it’s possible that we may not have done the best job of figuring out with them how to help.

When Rick Russo worked at the ESRD Network of New York, he did in-service training with facilities in that Network in an effort to reduce patient grievances. One part of that training was to ask staff to imagine they were on hemodialysis. CNSW members can access the article, Improving Communication in Patient-Provider Relations, that describes this in-service training and includes an appendix on the staff as patient experience. Perhaps if more dialysis staff put themselves in the patient’s shoes it would make them have more empathy for the patients they serve.

Many social workers are learning a cognitive behavioral mindfulness approach called Symptom Targeted Intervention. STI encourages patients and social workers to collaborate to identify the most bothersome problem, to set goals, and to take steps toward reaching the goal using a toolkit of techniques. It uses a blame-free approach recognizing that some techniques will work with some and not others.

It’s time to use the honey vs. vinegar approach to working with patients. It may help us form more effective relationships and achieve better outcome goals.

Click the links below to access some helpful resources.

Tags:

Comments

  • DELORES STEWART

    Dec 19, 8:37 AM

    This article is so very true!!! It is difficult enough having to be on dialysis, I choose to take everyday with a positive attitude, smile & be thankful for Home PD Dialysis!!! But, when we patients go to our Dialysis Center for lab or clinic days & the staff is rushing, frustrated & over worked, this attitude reflects in our care!!! Why do dialysis centers seem to have such an often change in staff... SO often!!! Can these centers not be staffed with the right amount of health care workers so they don't get overwhelmed & leave or let their frustration show when dealing with those of us with CHRONIC KIDNEY DISEASE/FAILURE!!!!!!

    Reply to this Comment

    * All fields are required.

    1. Your email will not be displayed publicly
    • Beth Witten

      Dec 22, 11:35 PM

      The dialysis regulations require that clinics ensure that "An adequate number of qualified personnel are present whenever patients are undergoing dialysis so that the patient/staff ratio is appropriate to the level of dialysis care given and meets the needs of patients." When state surveyors visit a dialysis clinic on behalf of Medicare to make sure the clinic is meeting the regulations and providing high quality care, they review medical records of several patients, observe the care staff provide, and interview patients and staff. They're supposed to interview home dialysis patients as well as in-center patients.

      There are many reasons why staff leave dialysis clinics. Sometimes they leave because they aren't good at their job or they don't like the work. Some leave because they would prefer to work with people that have a short-term illness than working with people who have a chronic disease like kidney failure. Some leave because they don't think they are getting the level of support they need to do a good job. Some leave because they don't like the level of care the clinic is providing. I wish when staff or patients think care is not good or the staffing level not safe that they would contact the state survey agency to alert surveyors to problems. Every dialysis clinic is supposed to have posted in a common area contact numbers for the state survey agency and the ESRD Network. Grievances can be filed anonymously if you'd be afraid to give your name.

      Reply to this Comment

      * All fields are required.

      1. Your email will not be displayed publicly
Leave a New Comment

* All fields are required.

  1. Your email will not be displayed publicly