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)