At a Glance
- Title: Associate Professor; Medical Director, UVA Dialysis Staunton
- Fellowship: University of Virginia
- Residency: Brody School of Medicine/Vidant Medical Center
Nephrologist Daphne H. Knicely, MD, MEHP, specializes in caring for patients with a wide range of kidney conditions, including: acute kidney injury, chronic kidney disease, electrolyte disorders and kidney stones. Her clinical focus is acute and chronic dialysis in all forms, particularly home hemodialysis and peritoneal dialysis, diabetic kidney disease and solitary kidneys. Learn more about her and her approach to patient care in the Q&A below.
Get to Know: Daphne H. Knicely, MD, MEHP
Describe your role as medical director of UVA Dialysis Staunton.
All dialysis facilities have a medical director who oversees staff and makes sure we follow all federal regulations and maintain the quality of dialysis. UVA Dialysis Staunton is a chronic outpatient dialysis unit, so as part of that role, I oversee the quality of care for about 60 patients. I personally care for about three-fourths of the patients. My colleague has direct care over the remainder. I also make sure the unit is following appropriate guidelines and our quality of dialysis is good, such as water treatment, meeting lab standards and dialysis adequacy.
How do you help patients overcome some of the challenges of ongoing dialysis treatment?
There’s a bit of a bereavement period, a sense of loss of your former self when you realize you have to start dialysis. I help patients understand that dialysis is not who they are now; it’s just something they have to do. I reassure them that we want to work dialysis into their lifestyle and not change who they are.
So part of my job is helping patients first realize what kind of dialysis is best for them.
One is not better than the other; it’s not like you pick one and you live longer. It’s about figuring out which one best suits your life at this point.
Hemodialysis is what people typically think of when they think of dialysis. There are two ways to receive this. You can do it at home or you can come to a center like our unit three times a week and allow a nurse to take care of your dialysis. Home dialysis is where you learn how to do the hemodialysis with a partner on a more simplified dialysis machine similar to coming to a center.
The other way of doing dialysis is peritoneal dialysis, which can only be done at home. This is where you have a catheter placed in your abdomen. We use dialysis fluid and the capillaries in the abdomen to help filter your blood. You do this every day, either at night or throughout the day if it’s easier for you.
Once folks figure out what works best for their lifestyle, it helps them adapt to it.
You completed your fellowship training at UVA. What were some of your key takeaways from this early experience that made you want to return?
One thing I admire about our staff and about UVA is they don’t look at this as just a job. They truly care about the patients. They worry about them when they don’t show up, when they’re in the hospital and when they don’t do well on dialysis. Our team tries to make dialysis as enjoyable as possible. For example, one initiative we’re doing at the unit is to get people moving, doing exercise on dialysis using exercise bands or pedaling a bike. And once a month, they do a dance party during dialysis. They’ll play music and get patients to move around in their seat. They don’t have to do this. Exercise is not part of our quality measures, but it’s something that our staff took on to help patients and try to improve their time at the dialysis unit. I always admired this about UVA staff as a fellow and I appreciate it more now that I’ve come back as faculty.
How did your mom’s experience on peritoneal dialysis influence you and your approach to patient care?
My mom was an uncontrolled diabetic with high blood pressure, heart disease and high cholesterol who never tried to control her disease. She ended up being diagnosed with kidney failure when I was 16 years old.
Her nephrologist was fantastic. He is the reason I’m a physician. He took the time to talk with her and us, and that was really important. Making the transition to needing dialysis is not something that just happens to the patient. It’s life-changing for the entire family. He realized that and he took the time to talk to us about how we were adjusting. He took the time to know us. I try to implement that into all interactions with my patients. I try to get to know the person – not just the disease.
I see my dialysis patients one to four times a month. That’s more than their primary care doctor. So I really get to know them and get to know their family. Some patients may be noncompliant. But sometimes, if you take the time to understand why they’re having trouble getting to dialysis or taking their medications, you can help them strategize and be their best self with their medical disease if you just take the time.
It wasn’t until I was in my internal residency that I realized I wanted to do nephrology. The nephrologists I worked with were phenomenal. They knew their patients inside and out, those little idiosyncrasies that most people don’t learn. I liked knowing patients like that and being part of their lives. I never saw that in other specialties. I know there are times that happens, but I really noticed it with nephrology and that’s why I chose this field.
Education is also a key part of your approach to patient care. Can you explain how you incorporate education into your patient interactions and why you feel it’s so important to do so?
I’m a big believer that the more information a patient has, the more empowered they are to take control of their disease. I believe it helps with outcomes. The data on outcomes is mixed, but if you look at it on an individual level, educated patients do make an extra effort to try to take ownership of what’s going on so they can be healthier.
I incorporate education into my patient interactions by explaining things as much in layman’s terms as I can. Sometimes that’s hard; when you start using words like creatinine, it bumps up to another level. But I try to explain to patients why I think they have kidney disease and what we can do to manage it. I tell them what the kidneys do and help them understand why I look at everything in their bloodwork, all the things I’m trying to manage to make sure their kidneys are still functioning. I give them information to help them make lifestyle changes if the disease progresses. If they have advanced kidney disease, I give as much education as possible on treatments available in different formats, from handouts and videos to talking with them in clinic and teaching them one-on-one about the types of dialysis.
I completed a Masters of Education for Health Professionals degree when I was at Johns Hopkins, and it really helps because the focus was on how to teach adult learners. Not everybody learns the same way. How you learned in elementary school and how you learn as an adult are completely different. You need to see how what you’re doing is going to affect you immediately. You might learn through reading, teaching others, watching videos or hands-on teaching with models — this is how many adult learners learn. So I incorporate different modes of learning because there are different types of learners.
My main focus at UVA will be patient education and community outreach. I’d like to try to partner with some nonprofit organizations to help with community outreach in the future.
What would you like referring providers to know about your practice?
I think it’s important for them to know that when patients come to UVA, we aren’t just going to treat the disease. We’re going to treat the person. Kidney disease in one person is different than in another person. They both might have diabetic kidney disease, but how we address it with them might be a little different. Maybe it’s just educating them on what they can do better. Maybe it’s adding medicines. But it’s not blanketly putting people on medicines and washing our hands of it. We take the time to know the person and provide individualized medical care so that they can live life to the fullest.
Personally, I try to make sure all of my referring doctors know what I’m doing, if I’m making changes to something, why I’m making changes and the reasons for it. I communicate it to them. If a doctor doesn’t get my note, then we probably have the wrong address.
Communication is important because the primary care doctor is the coordinator of that patient’s healthcare. They need to know what all the pieces are doing and if they don’t have information to help manage their patient, that’s a problem. So if a doctor ever does not get something from me, they can call me and I’ll take care of it.
To refer a patient to UVA Nephrology, call UVA Physician Direct at 800.552.3723.