What is a Dialysis Physician-on-Duty
A Dialysis physician-on-duty is a licensed medical practitioner who monitors and helps facilitate dialysis among patients with kidney disease. They go on duty for a certain number of hours per day in a free-standing center or hospital-based center involved in dialysis. They can monitor hemodialysis/ peritoneal dialysis etc. based on skill and training.
How to Become a Physician on Duty
Step 1: Get a Medical License by passing the PLE
Step 2: Undergo training in hemodialysis
Option 1: undergo residency training in internal medicine
Option 2: undergo Philippine Society of Nephrology (PSN) hemodialysis post-graduate training and certification
Option 3: undergo fellowship training in Nephrology
Step 3: Get you Basic and Advance Life Support License
should be updated every 1-2 years depending of accrediting institute
Proper training for the job will ensure patient safety and work place safety. It will also benefit the well being of the patients more. You must know what your are doing!
Duties and Responsibilities of a POD
1. A POD is not a Nephrologist
A POD is the representative of the medical director and attending nephrologist in the unit. They are not nephrologists. They takes orders and guidance form the kidney specialists to facilitate the dialysis.
They should not order whether a patient should be dialyzed. Orders for HD initiation must come from a nephrologist.
In times when the attending nephrologist is not able to make rounds, it is the task of the POD to relay pertinent patient complaints and physical exam that may affect the dialysis treatment.
2. POD must do patient evaluation
Being a POD is not merely being at the center. Though at times the workload is light, it does not justify the claim that HD Duty is time for video watching/ sleeping/ roaming around nearby malls. A POD must assess the patient BEFORE, DURING and AFTER hemodialysis.
All complaints, complications and outcomes must be relayed to the attending nephrologist during treatment sessions
A POD must use their medical judgement and act as a triage whether a patient is fit to undergo hemodialysis or should be sent to an emergency room or be admitted to a hospital. This is very important for free standing units.
A POD must be ready to coordinate transfer to hospitals and issue needed referral documents
They must know the capacity of the unit and its staff to handle the current status of the dialysis patient
They must also evaluate the potential risk a patient may bring to a unit. Example: patients with active PTB, Covid -19 must be provided proper isolation precautions. HEPA B, C positive patients must also be properly assigned to exclusive machines to avoid cross contamination.
During dialysis, the POD must do intermittent rounds to check the patients’ status
After dialysis, the POD must evaluate the status of the patient and check if there are any additional new complaints/ improvement of symptoms seen pre-dialysis.
3. A POD must work hand in hand with nurses and technicians
The POD must have proper knowledge of the dialysis orders as well as protocols during HD. They should check that the execution of orders is properly done by the staff
Example: check proper heparinization, UF setting, time of treatment and administration of medications
A POD must not rely on nurses in making medical decisions. He is the alter ego of the nephrologist and must be properly trained to handle the treatments
4. A POD must communicate with attending nephrologist regarding adjustments of medications and HD settings
A POD must be aware of recent lab results of patients and check trends. The maintenance meds should also be reviewed. Should adjustments be made, POD must inform the attending nephrologist and confirm suggestions/plans.
IV drug infusions must also be monitored and checked for correct dosage administration
The HD settings are not set in stone. Should special situations occur like pulmonary congestion, excessive water retention, desaturations, acute MI, stroke, surgery etc., the POD must inform the nephrologist and adjust the settings accordingly.
5. A POD must be able to counsel patients regarding dialysis access care
This usually is the job of the nurses, but a POD must be able to recognize access problems like thrombosis, infection, dislodgement etc. They must also tract the establishment of permanent safe access for patient
POD must always check patency and integrity of dialysis access and refer to vascular service for further management
Unless under special situations like war/lockdowns/ disasters, a POD must not attempt to suture or unnecessarily adjust the positioning of dialysis access without proper coordination with the attending vascular surgeon and nephrologist
6. A POD must monitor laboratory examinations of patients
Routine monthly /quarterly/annual labs must be monitored by POD. Hepatitis profile monitoring must also be vigilantly enforced.
A POD must always counsel patients regarding importance of compliance to lab test.
7. A POD must monitor important vaccinations
Counselling regarding flu, pneumonia, covid-19, hepatitis, tetanus vaccination must be done by the POD
8. A POD must complete needed paper works
Completion of medical records and documentation of physician orders must be done by the POD.
Issuing of medical prescriptions should be done by POD and not be left to the nurses.
9. A POD must be ready during disaster evacuation
Benefits of Being a POD
Forced relationships are rewarding
Due to the routine and long term nature of the work, you tend to develop deep and trusting relationships with patient and their families. The unit becomes a “2nd home”.
It gives a sense of satisfaction working alongside patients for their recovery/ transplant or even until their death. It is a rewarding job if you take it seriously.
It is a routine job, you get to be used to it easily
Most of the problems encountered are similar and the process is usually routine. Hence, no need for so much adjustment once you get to understand your role.
You will develop more medical and paramedical acquaintances
The nephrology world is relative small, and you tend to develop lots of connections along the way.
You will have a normal sleep wake cycle
Early to bed and early to rise is the lifestyle a POD. It avoids long duty hours without sleep.
You have a chance to study or do other things during duties
Should you finish your evaluation early, you can do some other things in between treatments - unless you are always toxic * wink *
Always remember, do not leave the unit during duty hours, because dialysis patients are “very unstable”, sudden deterioration and complications may occur.
You develop a special medical skill
It takes a special skill to handle dialysis. It is not taught thoroughly in medical school.
Food is never a problem
If you are kind, compassionate and caring to your patients, they are generous to help you with your meals. But of course, don’t expect or demand.
Risks of Being a POD
You become attached
Sometimes it is hard to draw a line between your emotions and professionalism. You might be affected by a patient’s death. Sometimes you will be compelled to shell out financial aid.
Due to the nature of Filipino culture being very close, sometimes patient tend to overstep boundaries. Hence, there is a need to maintain professionalism.
Low salary
The payment of a POD is usually an hourly rate. Rates vary across regions in the country. Relative to a hospital/ industrial /pharmaceutical based work, the salary is relatively low.
Contractual nature of the job
In the Philippines, it is seldom that centers employ POD. No additional benefits are given except for hazard pay. Hence, there is a need to be really careful in selecting work places.
Exposure to infectious communicable diseases
Most Dialysis patients are immunocompromised, hence there is a wide array of infectious pathogens that they may acquire like PTB, pneumonia, blood stream infections, Hepatitis B. Hence, a POD must observe proper PPE in handling patients.
What to Bring on Your Duty
Your medical tools: Stethoscope, pen light, tape measure
PPE
Calculator
Heart ready to serve
Lots of patience – dialysis patients are very stubborn
We hope you learned a lot from this post written by our very own, Dr. Meridette Sales! Feel free to share it with your colleagues! See you on our next blog post!
Comments