Self-referral motives
That was acknowledged upward referral would provide patients more opportunities to seek for high-quality health care resource, including system resources and capacity. Higher healthcare facility was the default choice when kidney disease out of control.
“Whether medical facilities or specialists were advanced than primary hospitals. If it’s inevitable to adopt replacement, diagnosis and operation should be done accurately and successfully.” (P1)
Especially, newly diagnosed ESRD patients, who were at shock and denial stage, have attempted self-referral to reverse progression of kidney disease. Initial self-referral patients expressed that the strongest consideration was to change the status quo.
“We didn’t really believe existing diagnosis and felt a bit chance to bargaining…. We were so indecisive and resist that we didn’t know what to do. We pinned hope on referral hospitals which were famous for kidney diseases to initiate dialysis as late as possible.”(P5)
Several participants described negative self-referral motives, occurring after definite diagnosis. Self-referral was placebo than health seeking behavior.
“Going to this hospital once each month for monitoring creatinine concentration is mymandatory work while waiting for the dialysis. I know I am at stake…I anticipate the deadline for dialysis.” (P13)
Negative self-referral was mainly decided by families while patients didn’t show strong rebuttal.
“In fact, I was reluctant to refer to this hospital because it was the same anywhere. However, my son tried to persuade me more than once… I just didn’t want to disappoint him.” (P9)