Patient-Centered Care, the Next Step: Self-Management

Do you have any patients who take part in their care? We hope so. But often, people who have been doing standard in-center dialysis for years grow helpless and hopeless—because they have not been getting patient-centered care. They don’t do much for themselves, and don’t really want to. They may even say, “Why should I do _____, that’s your job. You’re here to take care of me!” One of your goals of care can be to move patients away from depending just on you and helping them to self-manage.

You may or may not be able to turn all of your patients into high level self-managers. Your clinic might decide to focus most of its efforts on new patients. If they learn to expect to do some of their care themselves, your longer term patients may be intrigued. Here’s how it might work:

You: “Hi, Mrs. Alvarez. It’s great to see you looking so well today.”

Mrs. Alvarez: “Thank you. I was so scared at my first treatment last week, but you helped me to be calm and talked me through it. I do feel a little better now.”

You: “That’s good to hear. I’m glad I could help. Today, I’m going to show you again what I’m doing as we get you on the machine. Do you remember what this is? (Point to blood pump).”

Mrs. Alvarez: “Isn’t that the thing that pushes my blood through the machine?”

You: “Excellent! You’re right, that’s the blood pump. It pushes your blood through, because your heart doesn’t beat fast enough to do it. I’m going to set your fluid goal now. How much weight did you gain since your last treatment?”

Mrs. Alvarez: “I weighed myself, and I gained 2.4 kilos.”

Mr. Knowles (in the next chair): “You weighed yourself? Don’t be doing the tech’s job. They’re here to take care of you! They get paid for that.”

Mrs. Alvarez: “I’m a person who likes to do for myself. That way, I know the number is right.”

Mr. Knowles: “Hmmm. I hadn’t thought of that.”

You: “You know, Mr. Knowles, if you would learn to put in your own needles, you would always have your own best cannulator with you. You’d feel safe enough to travel again.”

Mrs. Alvarez: “People can put in their own needles?”

You: “You bet! It’s the best way to go, and you focus so hard on what you’re doing that you barely feel the needle. No one else can cannulate you better than you—you’re the only one who can feel both ends of the needle. When your access is ready, I’ll be happy to teach you.”

Mr. Knowles: “Well, I’ll think about it. I do want to visit my grandson.”

You: “Just say the word and we’ll get started.”

Self-management is the job of someone who has a chronic disease. Patients are self-managing when they:

  1. Keep themselves safe by preventing medical errors
  2. Manage their symptoms and tell the care team about them
  3. Have input into their treatment plan and then follow it

Some patients, like very old patients or people who are especially debilitated by their kidney disease, may not be able to self-manage. Other patients who do home dialysis manage all of their own care. Most fall in between. Your clinic should be urging patients to learn and manage as much as they are able. The goal is to help empower patients to be as active as they can in their care.