Feelings about self-referral communication
Self-referral seemed to increase challenges on staff-patient communication because of unfamiliar background and style, gap between communication expectation and busy clinical practice. Patients described that they dealt consultation with physician gingerly, because they didn’t quite clear physicians’ styles.
“I was dying to communicate with doctors about my illness, However, I didn’t know how to organize accurate words. Besides, the biggest problem was I had little chance to talk with my visiting staffs, they were so busy.” (P4)
Two physicians reported the numbers of experienced referral affected the predialysis patients’ disease informing, while patients described the first dialogue about treatment decision as sudden and expected experience.
“I felt a little hard to communicate with first-time referral patients. You know, dialysis wasn’t accepted easily (by patients), maybe second only to cancer, I didn’t sure the first-time referral patients’ responses…hum, crying, anger…” (N8)
“I have already perceived the real situation, but I didn’t want to hear the verdict. However, self-referral has made clinic visit colder for chief physicians’ businesslike manner and stiff communication pattern…” (P10)
Different mastery of CKD disease knowledge among patients determined complexity of communication, especially risk communication. Participants reported there was a contradiction between poor mastery of CKD knowledge and an urgent information desire among more self-referral patients.
“I have little concept about CKD or ESRD, because I was diagnosed advanced CKD several month ago, I even don’t know what is renal replacement treatment. When doctors talked with me, I felt terrible and confused…” (P13)
One nephrologist noticed that the family members of self-referral advanced CKD patients played crucial role during staff-patient communication.
“Sometimes, the families were main interlocutor when we talked about dialysis or other examination and treatment.” (N12)