I Hate Dialysis!

According to the American Kidney Fund, there are over 557,000 people in the United States currently on dialysis. It is estimated that 35.5 million people currently have kidney disease, and those numbers are increasing even as we speak.1 For this month's issue, the question was posed: “What is important to patients undergoing dialysis?” Quite honestly, that question has a varied number of answers, but for the most part, the majority of patients want the same things. However, let us look at a few facts. Dialysis can be administered one of two ways. Hemodialysis can be performed at an in-center facility, hospital, or at home. Hemodialysis is the process by which blood will circulate outside of the body. A flexible tube or catheter is inserted into the patient's vein and their blood goes through a machine called a dialyzer that filters the blood and returns it back to the body. You could consider it like an artificial kidney. Dialysis can also be administered through peritoneal dialysis (PD). This process can be performed at home as long as it is in a sterile environment, but can be performed in the hospital as well under certain circumstances. PD, unlike hemodialysis, uses a sterile solution called dialysate that is rich in minerals and sugar. It goes through a tube into the peritoneal cavity, the abdominal body cavity that surrounds the intestine. PD uses the natural filtering ability of the peritoneum to filter waste from the blood. The dialysate is left in the peritoneal cavity for some time so that it can absorb waste products. Then it is drained out through a tube and discarded.2 Do not forget that patients are people too. Acknowledge them. Have a pleasant disposition when they enter your facility. Let them know that you are glad to assist them with their care. Be genuine. Be kind. Patients in these situations have a variety of emotions and thoughts going through their minds. They are also very vulnerable having to entrust their lives into someone else's hands. Knowing that someone is genuinely there for them can provide some degree of comfort. Make your patients feel at ease especially when they are having to complete treatment at an in-center facility. Patients also want to be heard. Check on your patients regularly. Actively and intently listen to your patients. Yes, you have the medical knowledge, and we appreciate the fact that you do, but we are living in the body. We are going through the process. We have to deal with the aftereffects. When patients are experiencing certain issues, such as low BP, dry weights, or fainting, hear them. When there is issue with staff, PLEASE hear YOUR patients. Everything is not just a petty issue. I have learned that small issues not addressed can become big issues later and, in some cases, can potentially be a legal problem. Listen to your patients. I know there are patients who are defiant and noncompliant, but there are some who may be having mental, emotional, or even financial struggles. Listening to your patients will build trust and rapport with them. I would much rather have a doctor and staff who I can trust. We must work together as a team to make sure the patient receives the best care possible. There are many career choices that require some degree of empathy; health care is at the top of the list. To some extent, you really have to put yourself in your patient's shoes. Would you want to feel neglected, ignored, or dismissed? Would you want someone to make you feel like you are less than just because you may have to have treatment in a facility that caters to a certain demographic? Now, let me just say, this does not apply to all hospitals, clinics, providers, or staff. There are some amazing health care facilities, physicians, and other health care professionals that exhibit excellent patient care and provide patients with outstanding experiences. Unfortunately, we do not always hear about those cases. Because patients are in this vulnerable state, they do want to feel like they are important. I know, there is a fine line between feeling important and feeling entitled. Even in those instances, there are ways to navigate and still provide a diplomatic outcome. In my own personal experience, I have been a patient of both hemodialysis and peritoneal dialysis. All of the things mentioned above were and are still important to me. However, the one vital thing that I truly value is the consistency in the quality of my care. A comfy chair is nice, a blanket and headphones from the center for a Christmas present I would not take for granted at all, but the CONSISTENCY in the QUALITY of care is paramount. In hemodialysis, there had been many times where one week, I would have a great staff. Attentive, caring, friendly, and the like. The next week, the staff are all there to collect a check and it translates in every interaction. While I was on PD, my overall experience was great. I had the best nurse in the world. However, one time I was switched to a different nurse who changed my transfer set and did not secure it properly. It fell off in my kitchen. Within 30 minutes I had peritonitis (an infection of the peritoneum). Carelessness and neglect is something that patients undergoing dialysis of any kind cannot afford. In conclusion, we are all in this together. Patients need you, and if you are honest, you need healthy and happy patients. Make sure they are seen, heard, and felt. I guarantee you will improve your patient experiences and, in turn, you will be encouraged to become even better every day.