Two barriers that keep the team from meeting together with the patient include scheduling a time that works for everyone AND the impression that staff have that patients aren’t interested. Some clinics routinely invite patients to attend care planning meetings and most say patients do not choose to attend. I don’t know if that’s because they’re not informed about why they should be interested in attending or if the timing of the meeting doesn’t fit with their schedules. So far as staff are concerned, there are a limited number of hours in a month and although the home training nurse may stay at the one clinic, many dietitians and social workers cover multiple clinics and doctors have office hours, see patients in the hospital, and have to make rounds in multiple clinics where they have patients.
The ESRD Conditions for Coverage defines the team that is to be involved in care planning and names the physician director, nurse, social worker, dietitian and it even states that the director of a self-care training clinic and transplant surgeon. The assumption is that the team will meet as a group to discuss patient status from all perspectives – which seems to happen less and less. Surveyors look at care planning and how it’s done, including how the patient is involved.
Beth as you said, there are clinics that routinely invite patients to attend careplan meetings. If they can do it seems other units could find a way. But it seems the bigger issue is the derogatory attitudes many professionals have towards patients. They seem to see all patients through the same lense. Because many, or most patients, are apathetic about their care, then all should be punished and no one should expect quality care. It’s ok to get lazy in the delivery of care, because after all, the patient"s" don’t care.
This, of course, is a ridiculous notion. Yes, in some units, if not most, the majority of patients are a real challenge to deal with. But the apathy and prejudicial attitudes that so many of the medical professionals have developed is not healthy. I honestly think they need counseling as they are at a loss for how to professionally deal with patients’ issues so take the path of leaste resistance.
Really and truly, we see all sorts of dysfunctional behaviors on the part of the professionals. They become exasperated with the dysfunctional patients and it becomes like the alcoholic and the enablers. And many medical people come to their careers with problems of their own which become accentuated in the workplace.
All of this has created a dialysis setting where the professionals manage patients health/lives without their input and nothing could be worse. I keep using the word “dysfuntional” as to me that is the best word to describe the situation. I fully realize that many, if not most dialysis patients, fail to take responsibility for their health, but I believe there are patients who would respond to mental health counseling and dialysis education if they were afforded same and were not labeled, their desires for care routinely disrespected.
BTW, about deferring to doctors…Doctors have their area of expertise, but they are not deferred to nowadays as they may have been in the past by past generations. Doctors have the most education of all dialysis staff. However, after the doctor, the masters prepared social worker (what clinics should have) is the next most highly educated staff in the dialysis clinic with 6 years of post-secondary education. When I attended care plan meetings (we had them as a team), I said what needed to be said to advocate for my patients when they weren’t there. I would have preferred them to attend to advocate for themselves. I hope they would have felt confident enough to state their opinion, even if it differed from the doctor or other staff.
Regarding doctors, I meant that in units we have been in, the other team members act rather mouse-like like they are walking on eggshells when the doctor is there. They tend to shut up and let the doctors do most of the talking. When the doctors aren’t there, they open up more and speak more freely. I’m sure this is not the case everywhere, but, unfortunately we have experienced it a lot in the particular units we’ve been in. I’m glad to hear that you advocated for your patients. We have had some wonderful nurses who absolutely advocated for their patients at the risk of their jobs. Patients in most of the type units we have been in know one better watch what one says in negotiation for one’s care or he might be kicked out. As has been said before, it can be devastating to get fired for speaking out, but one can get another job. It is far more serious to be asked to leave a dialysis unit to find care elsewhere.