Dialysis Pits Patients' Desires Against Clinicians' Goals
Berns on Nephrology video blog posting via Medscape Nephrology.
Editor's note: Dialysis patients want to live as normal lives as possible. Patients will accept, and even pursue, longer dialysis treatments as long as they can maintain the most important and meaningful activities of their lives. Look to Tassin (France) or the long-time home hemodialysis patients in the Nordic countries for examples.
The title of this article illustrates U.S. nephrology's long-term failure to consider both the medical and psychosocial needs of dialysis patients. Patients want to dialyze to live, not live to dialyze. With most U.S. nephrologists financially invested in maximizing dialysis clinic profits, nephrology has little interest in tailoring dialysis treatments or equipment to meet patients' psychosocial needs. Nephrologists would tailor dialysis treatments, times, and schedules for themselves and their own family members. Why should patients comply with a(n economic) system of care that is designed to fail them?
The economic foundation of U.S. dialysis care is not unlike the antebellum South. The professional community's thinking is insular and specious. Until U.S. nephrology develops a code of ethics that treats their patients as equals and includes the necessity of emphasizing patients' goals -- or until dialysis patients develop a universal declaration of their human rights and needs and then fight for its enforcement -- the economic system of U.S. dialysis care will continue to discount and ignore the meaning and purpose of patients' lives.