YOUR MEDICAL TEAM
First, let’s define what is meant by medical team. In the current medical climate, medical team encompasses physicians as well as what are called physician extenders, including certified physician assistants and nurse practitioners. These specialists are well-trained members of the medical community who are qualified to provide supplemental support for physicians. They can take medical histories, conduct physical examinations, write prescriptions, and answer health questions of the people for whom they care. The hope is that physician extenders have more time to spend with patients to ensure that their needs are met and questions are answered. They stay in close communication with the physicians on the team, and consult with them if there are questions about diagnosis or treatment. With overwhelming demands on many doctors’ time, physician extenders are a reality of modern medicine. Patients and family, especially the elderly who can remember when doctors made house calls, should try to adjust to this change in the practice of medicine. There are physician extenders in nephrology practices as well as in kidney-transplant-surgery practices.
A nephrology team also includes nurses, renal dietitians, and social workers, each with his/her own specialized knowledge and skills. The team works in a coordinated manner, meeting frequently to discuss care strategies for their patients. Their goal is to provide the best possible health care and quality of life for patients with chronic kidney disease (CKD).
As a review, the kidney transplant team consists of a transplant surgeon and a transplant nephrologist. Together they can address the complexity of both surgical and medical aspects of CKD. Transplant coordinators—both pre-transplant and post-transplant— are usually responsible for the day-to-day contact with the patient. They are the front-line people to see the patient in clinic. You’ll recall a transplant team also has a social worker to address social and economic needs, and a financial advisor.
So what should a person with CKD and his/her family members be able to expect from the medical team?
Good communication between the medical team, the patient and involved family members is key to fostering trust and respect for all parties and to allow for effective communication of important information. Doctors and other renal specialists have an obligation to explain information in terms that can be understood by the patient and family.
Medical team members should be accessible to their patients. Quality of care depends on it. Phone calls should be returned in a timely manner. Adequate time should be spent with the patient, whether in person or via telephone, to ensure that the patient has his/her concerns addressed and has a clear understanding of the disease, treatment options, and what is expected of them.
Privacy considerations must be addressed if the patient wishes to hear information privately, rather than in the presence of family members. If someone has a question or concern that is outside of the medical team’s realm, the patient should be referred to the appropriate source.
Medical team members should show sensitivity. When confronted with the diagnosis of CKD, a patient and family members experience a variety of emotions. The medical team should be willing to listen to their concerns. (Physician extenders may actually do this best.) Something that is considered a minor concern by the medical team may be a major concern to the patient and his/her family. CKD can be life-changing after all.
The physical and emotional stamina of the patient should be taken into consideration when the medical team is communicating with him/her. The medical team should try to determine the approach that is most effective when presenting information to an individual—that is being very straight forward and detailed about the disease and its possible effects versus hearing small pieces of information and having a basic understanding of the disease and how it will be treated. Individualizing care takes more time, but this kind of sensitivity can help patients to reach a point of acceptance and better prepare the patient and family members to cope.
The medical team should help to educate the patient and family about chronic kidney disease and how to take the best possible care of him or herself. It is important for the patient to be an active part of the medical-care team. Having questions answered and having pertinent informational materials provided will help patients to take the best possible care of themselves. Patients need to understand their particular form of (1) chronic kidney disease, (2) treatment options, (3) complications and side effects, and (4) possible outcome scenarios.
Quality of Care
The medical team has a responsibility to give patients the best possible quality of care available by staying abreast of medical breakthroughs and updating practice protocols as need. Sharing what they’ve learned with patients and families increases patient confidence in the medical team and the care being provided.