Don't lose sight of the big picture in health care

I went to the Okavango Delta this summer. We were supposed to be hearing a discussion about the indigenous grasses of South Africa. Somehow I just couldn't focus. This photo typifies health care in the USA. We are all trying to follow an agenda, which is at best a blur when one gets sight of the big picture. We complain about the high costs of the transition to dialysis, yet...

• 82 percent of patients start dialysis with a catheter instead of a permanent access.
• SOURCE: USRDS
• Dialysis is the end stage of a disease that all too often with proper nutrition, medications and care could have been avoided.
• Qais Al-Awqati's KI Editorial 2006 Kidney International 69:1707-1708, 2006
• Tufts - Sweetening the Pot GDAE Policy Brief No. 09 - 01 February 2009
• Some elderly patients do not do well with dialysis because of multiple comorbid conditions. Starting patients too early does not help
• Dialysis or not? A comparative survival study of patients over 75 years with chronic kidney disease stage 5 Nephrol. Dial. Transplant. (2007) 22 (7): 1955-1962.
• Predialysis nephrology care of older patients approaching end-stage renal disease. Arch Intern Med. 2011 Aug 8;171(15):1371-8.
• We have a shortage of nurses, yet are not doing well in promoting home care or self care for our patients
• SOURCE: USRDS
• American Association of Colleges of Nursing Nursing Shortage
• We fail to adequately correct for volume in dialysis patients
• Dick Glassock's CJASN article CJASN December 2009 vol. 4 no. Supplement 1 S79-S91