Sustain the Relationship

We have just looked at some important skills that can help you build relationships with your patients.

• Having empathy
• Building trust
• Clear communication

We must also look at what is involved in continuing the relationships you have with your patients. When Terry started dialysis, he was overwhelmed. By showing Terry that you understood his concerns and could be trusted, he began to open up and talk more about his needs. Once you establish a good relationship with a patient your work isn’t over, though!

Look at working with patients who have kidney disease as a marathon, not a sprint. Your patients don’t just need you at the start of the “race.” And, the “race” isn’t over in just a few weeks. Rather, your patients need you to be there with education, support, and encouragement the whole time they are in your clinic.

As you work with patients over time, be consistent, follow up, and ask open-ended questions about how a patient is doing. Many times people with chronic diseases will minimize or not talk about what bothers them. If you ask a patient “How are you doing?” and accept at face value an “I’m fine,” you might miss that a patient isn’t “fine” but is covering up problems. Let’s finish up with Terry to highlight these points.

Terry has now been on dialysis for 4 weeks. He is doing better with following his diet, taking his meds, and coming to all of his treatments. Terry has told you that your checking in with him has helped him a great deal. He really feels like he is part of the team. But Terry has not yet gone back to work and you know this was a priority for him. Your first thought is that maybe Terry just can’t work and you shouldn’t bring it up for fear that you might upset him. But Terry told you how important work is to him and you know that the professional and respectful approach is to bring up the issue.

You: “Terry, when you first started here you told me that you really wanted to go back to work. I just wanted you to know that there are people here in the clinic, like the social worker, who can help you with that.

Terry: “No, I think going back to work would be too hard.”

You: “Sure it would be a challenge, but I know that the other patients in the clinic here who work are really glad they do.”

Terry: “I just don’t know. What if I lose my insurance or something like that.”

You: “You have Medicare because your kidneys failed, and even if you go back to work, you get to keep it. Why not look at your options? What if I have the social worker come talk to you?”

Terry: “I guess I should think about my choices, shouldn’t I?”

You: “Living with kidney disease is hard, but you don’t have to give up everything you did before dialysis. Perhaps you could get a transplant or maybe you will find that doing home dialysis is a better fit for you and makes it easier for you to return to work.”

Terry: “You’re right. I am glad you brought this up. I was sort of getting stuck in a routine and I don’t know that I would have thought about this if you had not raised the issue. Thanks.”

You: “You’re welcome. I know that we get busy and sometimes we don’t always check back with people to see how they are doing. I will have the social worker come talk to you and let’s see if we can’t get you back to work.”

Here, you can see the value of working with patients over time. All too often, our patients get stuck in a routine of “conveyor belt” dialysis. It is our job to help them get unstuck. If you have a good relationship with a patient, you are in a better place to challenge them and encourage them to move forward with their goals. You will be helping the patient, and you will also find greater satisfaction in the work you do.