Episode 4.1 David Baptist: A social worker who started a non-profit to help his patients

Hosts Maurice Carlisle and Ira McAliley welcome recurring guest Paul Terry. 

Transcript

SPEAKER_03 0:21

Um well I'll I'll give you my spiel and then David can tell you his side of it. Um uh there's like a 90-day process when a patient first starts. They're kind of part of a process that's gonna introduce them to the social worker and the dietitian and that process, and then there's these goals that they have within that 90 day, that first 90 days. And they call those impact patients for us, and they have different, you know, language for you know, depending on where you work, I'm sure. Um, but those impact patients are then kind of taken through a process which you know they're gonna meet with the social worker and they're gonna have these certain conversations, but there's nothing before that. So um when I get a patient, um I may not notice anything that's going on for maybe the first three or four months. And then I may say something to David at that point, but you know, at the beginning, the process is that they're gonna see the social worker. And when that happens, I don't even really know. You know, I'm just kind of like initiating and discontinuing treatments and you know, trying to give them some helpful hints about diet. But, you know, the dietitian comes out and has that conversation. And and where I work right now, there is no pressure in education from the tech at all. So we don't even participate in that part of the education. And so David can allude to you know how that process works for them.

SPEAKER_00 1:48

Yeah, and I would say that a technician spends the most time with a patient of anybody in the entire dialysis center. Yes, and they probably have the least voice in the treatment decisions made for that patient. Yes, yeah, so that's that's the ratio of importance versus time. I value my technicians because they come to me with issues that they see. I don't know at all places if they have that kind of openness and relationship. I've known social workers who have an opinion about technicians that I don't agree with and pretty much see it as a bother. Um, but it's different at different places. Our treatment team, like we sit down, deal with these impact patients, or reviewing somebody annually after that impact period of 90 days that you're talking about. The people making the decisions and discussing are the dietitian, the social worker, the nurse, and the doctor. That's the group that gets together and come up with a care plan for this person based on the needs that they've seen. I would say if we implemented anything, we should add the technician to that group. They have a relationship. And as a social worker, we know more than anything that if you want to impact change, the way to do it is through a relationship. So, Maurice, you as a technician can do way more than me coming maybe once or twice a month and seeing a patient. You can implement all that change.

SPEAKER_02 3:32

So, given that, um, what do you think the response would be if you brought that up to your team and said, you know what, I would love to have a technician in this conversation? Would do you think they'd be open to that? Is that something that is a possibility?

SPEAKER_00 3:49

I think it's more of a requirement that they're meeting than actually the need of the patient. So it may be they would probably say something like, oh, well, they could uh write us a note or something and we'll take it into consideration. But I don't think they would invite technicians into the care conference meeting.

SPEAKER_03 4:13

Right, right. And I've never said in one. So just to give you an example, but when I started in dialysis, um, I was pretty lucky. I worked with a doctor who actually did that on the floor. And so when he went around and made rounds, he had everybody in the care team with him. And then they had that conversation right in front of the patient, and I thought he was phenomenal for doing that because now that's something that happens without the patient. You know what I mean? They have all those conversations and then they give them a care plan and they say, and there's a little stickies on there that says where to sign. And the patient signs, I think you've seen it, David. So they sign that care plan, they don't read it, they just know that they're asked, and usually it's given to them while they're coming off treatment. Hey, we need you to sign this before you go. So, um, you know, and you got these little stickies, and they just go to where the sticks are. The person hands them a pen, stands over them while they're writing. So, you know, that's that other kind of, you know, you don't have time to read this, right? Because someone's standing over you, and then they sign it and that's it.

SPEAKER_00 5:30

Yeah, and from their subjective experience, they've been ready to leave dialysis for the last hour at least.

SPEAKER_03 5:37

Yes.

SPEAKER_00 5:38

And they're so ready to get out of there, they would sign their house away to leave. So it's not really a fair game, and a lot of that care plan itself is written in this medical jargon that people aren't educated, they don't have the medical literacy. I mean, especially in some of these populations that we're hitting, which is people with some mental health issues, low socioeconomic status. These people, with when this jargon is thrown at them, they're like, I guess this is just what I'm supposed to do. Nobody explained it thoroughly enough, but I'll sign it and let's go.

SPEAKER_03 6:15

Yeah, yeah, yeah. That that is absolutely true.

SPEAKER_02 6:19

Wow. So um, you know, I'm a solution, you know, oriented person. I'm like, all right, how can we affect change? And and I like really love to empower you guys to like just have that, you know, find a way to include the technician in that conversation. Like, well, you're talking about Maurice, just doing it on the floor, making it a less formal thing, but having it happen anyway. Um, you know, that that seems like a way to shift best practices in a way that would be beneficial to the patient and and might even infuse a little bit more of the patient perspective, you know, because you know, part of the reason why what's the deal with dialysis exists is because you know, Maurice as a human being dealing with other human beings, like just felt like these are people that need to have information and that need to be cared for in a more humane way. Like that to me feels simple, but I understand in in you know, in a in a system in a in like a medical system or whatever it is, when it's driven by numbers and driven by you know bureaucracies and and filling out contract and forms and numbers, like that humanity kind of gets left. So um, I'm like, all right, how can we like just how do we fix that? Yeah, well, um, so I'll challenge you guys. Just I know that's not what I do day to day, but like if you can get that conversation and have it happen for one person, maybe somebody goes, Hey, let's try this a little bit more. I don't know.

SPEAKER_03 7:53

Yeah, and I and I think, you know, um, and David can speak to this too. Again, when I started in dialysis, these companies were primarily nonprofits. And uh, so there wasn't that drive. That drive wasn't there, you know, that's kind of beneath everything right now. The other thing was is that doctors value technicians' opinions more, I think, than than they do now. Um, I don't know exactly why that is. Maybe dialysis technicians, you know, maybe they're not seeing long-term technicians. It may be that people get into this industry and they're maybe two years in or three years in, and they're not confident enough to have like those sorts of conversations with doctors. Um, but I can remember a time when my doctor would just come into the clinic and if and he was making rounds and he'd come to a patient's side and he'd have a question and he'd say, he'd turn around, he'd say to someone, you know, who's taking care of this patient today? And someone would step up and say, I am, sir, and he'd say, What's going on with this person? And that technician would walk over and have a conversation with the doctor that would be illuminating for the doctor. Maybe pieces of information there uh that, you know, uh maybe in the last, you know, month or so that that technician has been taking care of that patient off and on, he may have some valuable information for the doctor, and the doctor can take that information in. But we see less and less of that.

SPEAKER_00 9:21

Yeah, for me, I'm seeing more. They ask which nurse is taking care of this patient.

SPEAKER_03 9:26

Okay, okay, yeah.

SPEAKER_00 9:28

So they assume that the technician is funneling information to the nurse and they can collect it on multiple patients at the same time. I think it's an efficiency thing.

SPEAKER_03 9:38

Okay.

SPEAKER_00 9:38

So they're like, okay, nurse, walk with me during your section and tell me about these patients.

SPEAKER_03 9:44

Yeah, and you know what's interesting about that is that now there's like one nurse for like 28 patients or 24 patients sometimes. So that one nurse is the only source of information that that doctor is, you know, utilizing, uh, at least at that moment in time. Um, and so we see those ratios are even larger now. I mean, I think they used to be smaller. Uh, I think it was 12 to 1 back in the day. And now I don't know what those ratios look like now.

SPEAKER_00 10:15

Uh I think our max is one nurse to 20 patients.

SPEAKER_03 10:18

Yeah, yeah. So, I mean, I thought that was pretty close.

SPEAKER_02 10:23

So, David, in your work, um describe one of the like a tough situation, like maybe give an example without names or anything, like something that you've had to deal with with a patient, whether old or young, or just like some of your challenges.

SPEAKER_00 10:41

Uh, I would say drug addiction and behavioral issues at the clinic are the toughest for me. Um sometimes the two, of course, go together. Yeah, do you have these people who are self-medicating because they have their own mental health issues, or they're just struggling with addiction and have been for years. Even if they wanted to go into a rehab, they couldn't. And I've had this struggle, like, okay, you know what? I'm ready, I'm ready to quit. Finally, this has taken them like six, eight months. Okay, I know this is really killing me. I call around, try to get a place, but you can't go to a rehab, be locked away for 30 days and still come to dialysis. It just doesn't exist. Wow, I don't know if there is any in Ohio, but if somebody needs to go to a rehab, they can't here. They just cannot.

SPEAKER_03 11:40

Yeah, so I don't know, I don't know much about that, but that's something that I need to check into and see um if there's places where patients that are on dialysis can actually have have uh rehab treatment. That's an interesting uh problem. I I didn't know that problem existed.

SPEAKER_00 11:57

So it's typically for us, we're just like, okay, you're using, you know, here's some outpatient therapy. You could see a substance abuse counselor. Hopefully, that's enough to get you off of the drug and try to live a more stable life. That typically happens until they die, though, on dialysis. They're struggling with that addiction.

SPEAKER_01 12:18

Wow.

SPEAKER_00 12:19

That's something that personally bothers me. Like I can't resolve it. And I know you can't solve every problem, but that's one that I see people continually struggling with that I don't have a solution for. Wow. Um, the other thing is these behavioral issues, people have probably been angry, struggling throughout their lives. You add this on top of that, and they're at their limit. They're so irritable, angry, anything setting them off, and they don't really have a place to go during their cool-off time to get dialysis. So we have these patients who either have personality issues, mental health issues, like your bipolar guy, probably he's going to be kicked out of that clinic before he ever gets mental health treatment. I mean, that's just the reality. He will have burned his bridges at the dialysis center because there's certain expectations of how you're supposed to be at a clinic, which there has to be, but there needs, I think, to be a dialysis clinic for behavioral health needs. Because I'm having more and more of these people, younger people, younger people with mental health needs who have issues, personality conflicts, maybe gang violence in their history. They come in, they threaten any kind of violence, which may be their normal day-to-day interaction with all the people they know, but they come in there to terrorist threat. You're kicked out of the unit. Where do they go? There's not like an official black list of dialysis, but people know, like our clinic, we take anyone. So if somebody isn't voluntarily discharged from our clinic, Davido will never take them. Wow, that's just a given. If you didn't make it at our clinic, no other clinic is gonna take you, which is a sad reality. So, where do these people go? They end up being in the hospital long term. The hospital case planners case planners are going crazy trying to come up with a plan like, where is this person gonna go?

SPEAKER_02 14:46

And and that's what's keeping them alive. So the other alternative is death, basically. Right.

SPEAKER_00 14:54

Wow, yeah. So, I mean, just to address from a PAX taxpayer's point of view, like there's a huge financial gain for us to have like a behavioral health dialysis clinic.

SPEAKER_02 15:07

Right.

SPEAKER_00 15:08

But who's gonna do it?