||Offering Options for Dialysis: 'We Need to Do a Better Job'
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Berns on Nephrology video blog from Medscape Nephrology.
"I queried the audience at the talk I gave at the Spring Clinical Meeting, and absolutely no one indicated that they would be willing to do 3-times-weekly, in-center hemodialysis as their own initial dialysis modality.
There is clearly a tremendous disconnect between what we as nephrologists would opt to do if we needed renal replacement therapy and what our patients end up doing. This is troubling and disconcerting."
Editor's comment: Unfortunately, the kind of medicine that nephrologists want to practice is not the kind of medicine that dialysis patients need. Nephrologists, being gods of internal medicine alchemy, disdain dealing with patients' psychosocial needs. Nephrology much prefers a formulaic/alchemical approach to medicine and has successfully avoided a whole-patient approach to dialysis care for forty years.
Adding to the problem, business leaders and the government have assisted them in creating systems that enable and richly reward nephrologists for practicing a perverse form of medicine... and for being lousy physicians. By design, these systems don't respond to patients' needs, they ignore them. As a result, after forty years we have the wrong machines, wrong clinics, wrong care teams, wrong quality measures, and wrong reimbursement incentives, as well as no significant employment or rehabilitation programs.
While I commend Dr. Berns for speaking out, I don't believe he — or any other prominent nephrologist — has come close to understanding the depth and true nature of the problems. Nephrology has huge blind spots and misconceptions as to its roles in poor patient outcomes. As a start, we should no longer allow nephrology to hide behind its alchemical knowledge and command of statistics. Nephrologists need to evolve into being better physicians.
Nephrology needs to embrace approaches to dialysis care that continually balance the patients' preferences, their psychosocial needs, and their medical needs. After 40 years, we should be restoring a large percentage of dialysis patients to health who are also living as normal lives as possible.
That's what nephrologists would do for themselves. What are we paying them for?