Do you think we'll ever hear from HDSW again?

[WishIKnew]

That was a really interesting thread.  After starting out so "strong",  I've expected to hear from him/her.  Just wondering if you all think we've heard the last or of HDSW if we will have the opportunity to  dialogue....

[PatDowns]

HDSW was not on here to dialogue.  Not even sure if it was a legit thread or a post just to rile up patients. If the latter, mission accomplished.  Odds are this person will not be back.

[Meinuk]

I'm not too worried.  I was great to actually read the post though.  HDSW  put a name and words to all of those who are burnt out, overworked and think of their patients as cast offs.

I've been thinking a lot about that post.  There was a recent article about why we aren't getting many medical students choosing nephrology  http://nephronline.com/news.asp?N_ID=4617. 

My stance has always been that if more than a few patients are not engaged in their care, then it isn't the patient that is wrong, it is the therapy. We need better trained professionals and more of them. We don't need more of HDSW who just wants a job and didn't learn anything about dialysis until s/he was in the job.  Which says to me that s/he just took a job, and it happened to be at a dialysis unit.  It could have been anywhere that was hiring.  HDSW personified that in their post.  They lumped everyone with CKD (IHD members as well) into that "You should be doing more for yourself, I'm busy" attitude.  The system is broken.

I wrote what I wrote because it needed to be said.  I was a bit nasty, yes, but so was HDSW.  Our care providers have to understand that it is their job to care for us.  If HDSW were a teacher and she couldn't teach her entire classroom, parents would be up in arms, (I hope).  In the thread, Kana was very nice in explaining that she had worked in a hospital and understood that there was a certain element that could be stressful.  My point was (and is) that HDSW chose their job, and was the only person in the equation that had that choice.  If they want to complain about their job stress, they should do it with their peers and those who can do something about it. Not making excuses to consumers.  That is unprofessional and wrong.

If HDSW had problems with posts, they would have been a constructive member of the community by replying to the posts and either refuting from the SW side, or offering a best practice scenario.  HDSW was in most terms a troll.  But a useful troll.  When people read that thread, and they will think twice about what a social worker does, and who is out there doing that job (and also that I am probably a wicked B**ch).

I laughed to myself this morning thinking "What would Epoman have written?"

I can guarantee that dialysis Social Workers DO read IHD, and nurses and dieticians (the jury is still out on Nephrlogists  ).  It is an amazing resource.  Some will agree with HDSW, others will think "WOW, that was brave to post".  But to me, the message is clear, the system is broken, our care providers can't do their jobs effectively, and the healthiest patient will always be the one who can empower themselves and take charge of their own care to whatever extent they can.

[monrein]

I don't think you were bitchy Meinuk, I think you were right on the money and HDSW ought to be advocating for her own profession from within, so that she could provide better service for her clients, who just happen to be renal patients.  Social work is a very broad discipline and one that deals with a wide assortment of populations.  To work with  geriatric clients if one has no patience for old people would be a poor match indeed and even if one does find a population that fits well, burnout is always just around the corner.  Good supervision is important and self-awareness is essential.

I was verbally abused many times by my clients (angry adolescents) and on one occasion physically attacked, but blaming the client was not the answer.  Boundaries are important in the job, as they are in so many relationships, but the social worker's job is to understand the meaning of the "static" that clients present and continue to find creative ways to be helpful to the populations they serve.   People on D can be angry, sad, lonely, lost, stressed, broke, broken, but they can also move beyond those states too with good professional help. 

I was hoping that he/she would come back but if HDSW can't debate and discuss what he/she so confidently/condescendingly posted then there is not much hope for learning anything from clients and I hope that a career change is in the cards. 

[jbeany]

Well, I could go off on a whole tangent on how a women pointing out the obvious truth is seen as bitchy, but a man doing the same thing is competent and self-assured....but let's not for now.  (I wasn't going to win any "sweetness and light" awards for my response, either, Meinuk!)

I'm putting my money on HDSW never showing up ever again.

[Sax-O-Trix]

I personally learned so much from the thread...  Aside from HDSW's obvious inexperience with ESRD and her role in a dialysis center, the responses were worth a million dollars.   I now appreciate my transplant SW and all she has tried to do for me...

[Meinuk]

JB, what I loved about your post was that you took the time to go back and compare and contrast HDSW's post with the work of your social worker.  You took the time to dot the I's and cross the T's, which makes you PERFECT for the legal profession!!!

I just let rip.  Which was cathartic for me, because at work, I have to be politick, and well, that isn't easy.

Monrein, if I never said it before, I just have to say that your spirit and ability to patiently see both sides of the issue have always shone through in your posts.  I am more of an ID girl, and the semi-anonymity (let's face it, I am pretty easily identified) of IHD allows me to let fly when needed.

JB, as far as assertive women and the names ascribed to them, well, I think that I am reconciled to owning that label.  I grew up with a Valley of the Dolls mother who died when I was 13, I am one of four sisters:  a radical feminist sister, a sister who was a nun and a sister who is a lesbian (no joke).  Somehow, I ended up the occasionally moderate one.  I am assertive, because that was baseline at our Sunday Dinner table if I wanted to get a word in edgewise. As Einstein said, "everything is relative"!  But the joke is, that as a girlfriend, I just want to go with the flow and be happy. At 44, I have become reconciled to those diametrically opposed sides of my personality, and I am more than ok with it.  I can be a B in one aspect, but I am also the woman who hands him the wine bottle and says "be a man and open this please?" (I do balk at fluttering my eyelashes though)

I am always up for a fight, but I learned that if it won't matter in five years, let it go.  I thought that calling HDSW out was the right thing to do, and the more I thought about it, the more I thought to yell at them about.  I would love to have them debate more here on IHD.  I would welcome that.  But I agree with Pat Downs.  HDSW wasn't here to join in the conversation.  HDSW got their feelings hurt when they realized that patients know the difference between right and wrong. In my eyes, the best defense is no offense, and HDSW was seriously offensive.

Sax, I learn something from almost every post I read here on IHD (umm, maybe not the three word story thread  .)  That is why I love IHD so much.  I don't post a lot, but I read obsessively.  I bug Karol every once in a while, and I have come to feel emotionally attached to so many people that I only know as a "nickname" on an internet message board.  This whole internet thing is amazing, I hope it catches on  .

I kinda wish more renal care professionals would come here and have a rant.  When they anonymously read IHD, they see some of the inner thoughts of their patients, but we don't often get to read theirs.  We are all people first, and then we are assigned/earn different labels.  I just wish that we could create a place where everyone's needs are met (at least in the dialysis unit).

For the fun of it, we should link to the original thread: "Defending Dialysis Social Workers" http://ihatedialysis.com/forum/index.php?topic=22961.0

[rsudock]

    oh no did I miss some drama?! Where is that thread!!! That's what I get for going on vacay!

[jbeany]

Meinuk put the link in her post right above yours, rsudock.  Come join the fun....er, discussion. 

[okarol]

I liked all the responses - I was so mad when I read the social workers post that I could not put together two coherent words.

Jenna was not given a social worker the first 3 years at children's hospital (age 15 to 18.) She dropped through the cracks because she is not low income or English as a second language. We were struggling to find out what to do. Later I find out, she should have had help all along.

The social worker at dialysis was friendly and stopped by once in awhile. She rarely could answer a question regarding jury duty, disabled parking passes, the transplant evaluation, or Medicare, or support groups. She did not seem to have any resources available to her, and most of what we ended up learning was via the internet.

The transplant team's social worker was focused on evaluating Jenna's qualifications to be wait listed, so her role did not offer much in the way of assistance.

Maybe I am jaded. I don't know how someone could take that job and be content being ignorant.

[Meinuk]

Karol, I say this so much that I should put it in my signature line.  The system is broken.

As I cut and pasted into my final post in the original thread, CMS (Medicare) asks facilities for the MINIMUM requirements to certify for payment. The majority of dialysis units are certified in the United States because after 33 months, Medicare is normally the primary payor for dialysis no matter what (unless your employer had less than 100 employees, and then medicare can be primary earlier). 

Of course, many providers feel that the not only just have to give minimum care, they scrimp and hire part time Social Workers (and dietitians), so that they can do a walk by, note it in the chart, maybe hang up a poster or two and then do the other things in a unit that there isn't enough staff to do.  Like sending forms to Medicare. I really do understand the problems at work that HDSW is having.  S/he is just a symptom of a broken system, and lashed out at the wrong people, and well, s/he ticked me off.

Dialysis units need to be not only fully staffed to provide good care (and that means more than just hiring someone to simply update 106 charts, and add their professional MSW to the signature line, then  feel that they have fulfilled their MINIMUM requirement - like HDSW seems to think), providers need to re-think their staffing, and see that they are CARE FACILITIES, that should be multidisciplinary to treat the whole patient.  Not blood sucking and cleaning factories that simply shuffle red-eyed listless bodies in and out of chairs every 3.5 hours, who treat their employees like non-union factory workers. 

We have a lot of best practice scenarios out there (mostly in the non-profit sector like what we have seen at the Northwest Kidney Centers) BUT, it is easier for people like Kent Thiry @ DaVita (Colorado's HIGHEST PAID CEO) to simply say 106 patients to one social worker will let them just fill in the charts, and the Medicare money will still keep rolling in, and then he will be able to sell some more stock and buy that island in the Caribbean that he had his eyes on or, run for public office because that is what he seem to be thinking of.  Shudder, would Senator Thiry be even more dangerous?  Or would it be better to get him out of dialysis and trimming the public fat?  DaVita is GREAT at lobbying, and has its tentacles all through DC, hey, they founded Dialysis Patient Citizens (THAT is great PR! This is all discussion for the political thread though).   Well, the US Senate has always been called the Millionaires Club, he certainly qualifies.  He cashed in 11 million dollars in stock last Nov, Dec, Jan). http://ihatedialysis.com/forum/index.php?topic=22976.0 

Thiry could be the Medicare Funded Senator from Colorado. If he does it, people will have bled and died for him to be a Senator. DaVita certainly is a tightly run ship. They pay attention to the bottom dollar at any cost, and according to the press in Colorado (his home state/Constituency) his new constituents are being told that patients appreciate the care they get at for profit dialysis.  http://ihatedialysis.com/forum/index.php?topic=22954.0

What are the chances that HDSW works at DaVita?

Getting Techs certified was just the beginning.  We need people to get better quality dialysis (In-center Nocturnal, Home Dialysis) and we need to change staffing ratios in the clinics.  Management needs to stop making the Social Workers be Data Manager and let them be social workers.  Stop hiring anyone off the street who has an MSW and comes cheap, and well, maybe then our death rate will decrease, patients will be better informed (and able to do Google searches on their own), and well, my world would be a better place.

Coffee now.

Next week... Nurses...

[Meinuk]

After coffee and some more thought...

HDSW was so far off with her "Unrealistic Expectations" comment, that I wanted to poke her/him in the eye.  It is the culture of under-staffing that has made the providers start to BELIEVE that we are asking too much when we ask for help with dealing with Insurance/Medicare/ Basic Social Services that are overwhelming due to the nature of our disease.  Helping us cope is why Social Workers are employees in the first place.  By telling us that we have "unrealistic expectations",  we are being told to suck it, and deal with it on our own.

I would love to have a SW post what their job description and responsibilities are, and where the disconnect is. And I'll tell you, posting to IHD is posting to the most able of the dialysis population.  Think of it this way, there are almost 400,000 people on dialysis in the US.  We have 5,880 members, now, I am being generous with these next numbers...  possibly 100-125 active (75-90 are actually ON dialysis others are family members/caretakers - BTW we love you even more for doing this) and of that the majority are Americans. We are a very small group.  But, we can read, write and sit at a computer that we have access to.  That makes us the educated ones, who are able to find out information on their own.

The best part about IHD is that our posts are public and just a Google search away (that is how HDSW found us).  People with questions can find us, and can read our questions/answers/ups/downs/finds/rants and laughs.  This is an amazing resource for the whole world of Renal Care.  We are advocating for better care with every keystroke.  (Again, the jury is still out on the "write a story three words at a time" thread  )

Smacking some sense into HDSW was also a smack to the industry to wake up an smell the coffee (I am obsessed with coffee this morning).  As has been asked by the lobby for "optimum dialysis" folks, "Would you be happy with this standard of care?"  Social Workers should ask themselves that question every once in a while.  The answer may surprise them.

Now I am going to post in the three words at a time thread since I have slammed it twice in the past week...

[Bill Peckham]

I think the for profit issue is a big part of it. Northwest Kidney Centers supports their social workers by having a dedicated financial councilors and transportation coordinators. A lot of renal SWs spend their time organizing transportation and insurance. Having those tasks handled by specialists frees up the SW to do social work.

[KarenInWA]

I think the for profit issue is a big part of it. Northwest Kidney Centers supports their social workers by having a dedicated financial councilors and transportation coordinators. A lot of renal SWs spend their time organizing transportation and insurance. Having those tasks handled by specialists frees up the SW to do social work.

I know Puget Sound Kidney Centers has financial counselors as well.  Not too sure about the transportation issue, as I haven't had to use that.

3 Cheers for our Western WA Kidney Centers!!!     

KarenInWA

[brandi1leigh]

The stories I've read on IHD have always made me very appreciative of my center...that's not to say that things couldn't be improved, but for the most part I truly believe my center is trying to do what's best for the patients. Having said that, the social worker is definitely one of the places I think needs improvement. I like my social worker. She's very sweet. I know that she works for at least one other center, maybe two. She's clearly overworked. I also think that because I am relatively young compared to other patients, she doesn't quite know what I need or how to help me (I feel the same way about the dietitian and the financial coordinator). And I'm still learning what I need. I'm not shy about asking questions or doing my own research, but I don't always know what to ask or what to search for. There has also been absolutely NO emotional support. She's never once asked me how I'm adjusting to everything. That just seems out of her comfort zone. Overall, I'm not sure what she does, other than have me sign a form once a month. I think my biggest problem is that I can imagine how helpful that position could be.