Top Communication Strategies For Chronic Kidney Disease Patients

A few months ago, a friend of mine referred a patient to me. This patient was introduced to my friend through one of his acquaintances. Like many other patients, he was eager to get an appointment immediately, expecting overnight results. However, my friend explained to him the philosophy of our practice—how we work, and that we strictly follow protocols based on merit and order of appointments. After some persuasion, the patient agreed to wait, and eventually came to see us, following our instructions carefully.

From the initial assessment, I had a suspicion that the patient’s kidney function had rapidly deteriorated over the past few months. This suspicion was based on clinical judgment and experience, which I will explain in detail as we move forward. After conducting a comprehensive workup, no autoimmune disorder was detected in his blood tests. However, his diabetes and blood pressure were alarmingly out of control, and despite my initial instincts suggesting there might still be a chance to save his kidney function, the biopsy results confirmed the worst: his kidneys were 90-95% damaged due to diabetes, a condition known as fibrosis. This meant that his kidneys had become severely scarred and had lost almost all their functional capacity.

At this stage, it was clear that there was no possibility of reversing the damage. I recommended dialysis, a treatment he had already started due to his deteriorating health. I also advised him to begin preparing for a kidney transplant.

The Emotional and Psychological Impact of a Diagnosis

In Pakistan, when a patient ends up needing dialysis despite a doctor's best efforts, it often results in a negative attitude towards the healthcare provider, at least initially. This reaction is quite common until the patient fully accepts their condition. However, despite being on dialysis, this patient was surprisingly satisfied with our care. He had been following up with us regularly over the past few months and even conveyed his appreciation through the person who initially referred him. He praised our system and expressed that he was quite content with the care he was receiving.

This leads to an important question: What is it that builds such trust between a doctor and a patient, especially in a culture like ours, where mistrust in healthcare is rampant? What creates this sense of satisfaction, even in the face of such a grim diagnosis? The answer isn't simple, and there isn’t a specific formula. It’s more of a rough sketch—a blend of communication, empathy, and patient education that a doctor develops over time. If a doctor has the capacity and willingness, these elements can be applied effectively, even in a challenging cultural context.

The Role of Trust in Patient Care

Trust between a doctor and a patient does more than just foster a good reputation; it influences patient outcomes. When a patient trusts their doctor, they are more likely to follow the recommended course of treatment, even when it's difficult. This trust is crucial because the patient, in most cases, doesn't fully understand the complexities of their condition. They rely on the doctor's intellectual judgment, which is based on the patient's situation and the best available scientific evidence.

Without this trust, a patient might never fully commit to the treatment plan, constantly second-guessing the doctor's advice. This is the key difference between a dialysis patient who is satisfied with their care, and a patient with stage 3 chronic kidney disease (CKD) who, despite having a relatively less severe condition, is perpetually stressed and unhappy. The latter may not even have to worry about their condition for the next 15-20 years, yet they are overwhelmed with anxiety, often to the point of significant lifestyle deterioration.

Effective Doctor-Patient Communication

In this video, I want to discuss how effective communication between a doctor and a patient can make a significant difference, especially in cases of chronic illness. It’s crucial to understand that when a patient is first diagnosed with a chronic condition—something that is going to change their life permanently—it is incredibly difficult for them to accept it.

Think of it like this: if you were to fall and realize you were about to hit the ground, your natural reflex would be to put your hands out in front of you. This reflex is your body’s way of protecting you from harm. Similarly, when the brain receives news of a life-changing diagnosis, its first defense mechanism is denial. This is a natural reaction that every patient goes through.

The challenge for doctors is to help patients move beyond this denial, allowing them to make informed decisions about their health. The aim is to ensure that the patient does not place blame on themselves or others, but rather, understands the reality of their situation and what steps they need to take moving forward.

Steps to Educate and Empower the Patient

1. Assess the Patient’s Understanding: The first step is to gauge how much the patient knows about their condition. When a new patient comes to me, I always start by asking them what they understand about their kidney disease. Do they know their diagnosis? Are they aware of the stage of their disease? Do they understand why they have kidney disease, how severe it is, and where it might be heading?

2. Clear Communication: Once I understand their level of knowledge, the next step is to explain their condition in detail. This is a critical and sensitive task. It involves spending time with the patient, sharing clinical data with them, and ensuring they understand it. Whether the patient is highly educated or not, when you show them their reports, scans, and test results, you help them make sense of their condition. For instance, I might show them their creatinine levels, explain what the normal range is, and where their levels stand.

3. Building Trust Through Transparency: The process of educating a patient should always be transparent. This involves walking them through every aspect of their diagnosis and treatment plan. When patients see that you are willing to take the time to explain things to them, they are more likely to trust your recommendations.

4. Encouraging Acceptance: The ultimate goal is to help the patient come to terms with their condition. This doesn’t happen overnight. It requires continuous support and communication. Patients need to feel that their doctor is not just treating a disease, but is also concerned about their overall well-being.

Conclusion

In conclusion, the relationship between a doctor and a patient, especially one with a chronic illness, is built on trust, communication, and mutual understanding. This trust is not just important for maintaining a good reputation but is crucial for the patient’s well-being. A patient who trusts their doctor is more likely to follow the prescribed treatment plan, leading to better health outcomes. On the other hand, a lack of trust can result in a patient feeling anxious, stressed, and ultimately dissatisfied with their care, regardless of the actual severity of their condition.

As doctors, it’s our responsibility to not only treat the disease but also to educate and empower our patients, helping them navigate the complexities of their diagnosis and treatment. This approach not only improves the patient’s quality of life but also strengthens the doctor-patient relationship, making it a crucial aspect of effective healthcare.