Wednesday, November 10, 2010

The Dimensions of Dialysis

The Dimensions of Dialysis
by Stephen Z. Fadem, M.D., FASN
A Response to God Help You, You're on Dialysis
Atlantic Magazine, December 2010


God Help You, You’re on Dialysis is an investigative journalism article that appeared in the December 2010, Atlantic Magazine. It tries to explicitly highlight everything that is wrong with dialysis. This dismal picture, however, is strictly one-dimensional.

Dialysis has emerged and progressed since 1972 as a life-saving gift to people who earlier would have died. In 1969, while in medical school, I saw a four-year-old African American child die with uremia because he did not qualify for dialysis. Through the years since then we have honed our skills and greatly expanded the dialysis program. In many countries, there is no government financial support of dialysis therapy, and as a result those patients who cannot afford care succumb to their illness. We now dialyze an older set of patients and have less hospital time. We are identifying outcome measures that simply do not work, and creating plans to identify and strongly support those that do. We are looking at what is best about dialysis in other countries and incorporating that into our efforts to care for patients. At the same time, we are now more focused on the quality of life and on educating patients well before they ever require dialysis. In this fashion many patients can select to preemptively undergo a kidney transplant or choose a home dialysis modality. Other patients with concurrent morbid conditions may elect not to choose dialysis at all. All of this progress is made despite wanton cuts in funding and critical nurse shortages. Sadly, many patients who enter a dialysis program missed an opportunity earlier in their lives to control their lifestyles and eating habits. The results of uncontrolled obesity, cardiovascular disease, diabetes or hypertension are comingled with inexorably progressive kidney failure.

Like the muckrackers of the early 1900s, whose model was to selectively report the sensational negative aspects within an industry, the author of this paper only looks in one direction. The name muckracker was attributed to Theodore Roosevelt. It is memorialized in a speech that is just as timely today as it was 100 years ago.

“... you may recall the description of the Man with the Muck-rake, the man who could look no way but downward with the muck-rake in his hands; Who was offered a celestial crown for his muck-rake, but who would neither look up nor regard the crown he was offered, but continued to rake to himself the filth of the floor.”

The facts are there; there are problems within the dialysis profession. Many patients come to dialysis poorly prepared, having been poorly educated as to what to expect. Alternate therapies have not been explained to them; they do not have an appropriate access placed, and are unaware of their responsibilities toward their care.

The have been cuts in the program; it is an entitlement and thus engenders a negative reaction among those who are trying to create a fiscally responsible government. Worse, the fear of what will happen next, as new cost containment initiatives are rolled out, has been very unsettling.

In dealing with very human issues, mistakes happen. Unfortunately catastrophes occur in a small minority of instances. Our profession at large is very aware that the potential for an accident or an infection is high by the nature of what we do, and we strive hard to meet our task with an abundance of caution. Most instances are “near misses” and lead to quality improvement processes that improve the system. Ineptitude is strongly addressed internally through counseling, retraining and sometimes employee termination. Some instances of negligence lead to unexpected outcomes, and are dealt with in the court system, and sometimes through state or federal sanctions.

Dialysis facility inspections are performed less frequently because of the lack of well-trained surveyors at the state or federal level. However, internal surveys are regularly performed. A survey at any level is very helpful to a dialysis center – we welcome it an important tool in pointing out deficiencies and weaknesses. It serves to enable the team to receive extra help and advice from outside experts. In the majority of instances there is a period of corrective action followed by another survey. During this time the facility retrains its employees and works through process to develop a stronger infrastructure. Many of these facilities go on to become model units. In some situations, they must close because they fail to meet the standards that not just surveyors, but peers and colleagues expect. Mischaracterization of these inspections through the media by investigative reporters is exciting copy, but harms the scope of a process intended to be corrective, not punitive.

Sadly, the author of this article missed an opportunity to look around at all the dimensions of dialysis, and instead chose the path of the muckrakers of the past, just looking downward and raking filth.

16 comments:

  1. I found very useful information from your Blog.Among men, the incidence of lung cancer has been declining, but it continues to increase among women. Doctors may perform a bronchoscopy, which allows them to examine the bronchial passages using an instrument called a bronchoscope.Lung cancer hospital India is here to help you anyway.

    ReplyDelete
  2. Thanks for the interesting thought.I love you page and think of you often.Here is Become Certified Personal Trainer

    ReplyDelete
  3. Such a inspirable and good post . I got new knowledge able while reading this . Keep sharing this type of post.production services company

    ReplyDelete
  4. Such a inspirable and good post . I got new knowledge able while reading this . Keep sharing this type of post.
    astrologers

    ReplyDelete
  5. Welldone, very interesting blog.I praised your forum for giving such a useful information.keep it up.astrologers

    ReplyDelete
  6. We are urgently in need of kidney donors in Kokilaben Hospital India for the sum of $450,000,00,For more info
    Email: kokilabendhirubhaihospital@gmail.com
    WhatsApp +91 7795833215

    ReplyDelete
  7. We are urgently in need of kidney donors in Kokilaben Hospital India for the sum of $500,000,00,( 3 CRORE INDIA RUPEES) All donors are to reply via Email only: hospitalcarecenter@gmail.com or Email: kokilabendhirubhaihospital@gmail.com
    WhatsApp +91 7795833215

    ReplyDelete




  8. sell your k i d n e y for money, we are looking for k i d n e y d0n0rs with the sum of $500,000.00 USD,apply now via email: (hospitalcarecenter@gmail.com)
    WhatsApp +91 7795833215

    ReplyDelete



  9. sell your k i d n e y for money, we are looking for k i d n e y d0n0rs with the sum of $500,000.00 USD,apply now via email: (sk500968@gmail.com)
    WhatsApp +91 7795833215

    ReplyDelete

  10. We are urgently in need of kidney donors in wockhardt hospital India for the sum of $500,000,00,( 3 CRORE INDIA RUPEES) All donors are to reply via Email: wockhardthospital7@gmail.com

    ReplyDelete
  11. We are looking for serious kdney donors for sum of 3 crore,For more info Email: healthc976@ gmailcom
    Call or whatsapp +91 994 531 7569

    ReplyDelete
  12. Urgent need female for egg donation with the sum of $500,000.00 3 crore,Email: jainhospitalcare@gmail.com


    ReplyDelete

  13. We are urgently in need of Organs Donors, Kidney donors,Female Eggs
    Kidney donors Amount: $600.000.00 Dollars
    Female Eggs Amount: $500,000.00 Dollars
    Email: jainhospitalcare@gmail.com
    Whats App: +91 8754313748
    Please share this post.


    We are urgently in need of Organs Donors, Kidney donors,Female Eggs
    Kidney donors Amount: $600.000.00 Dollars
    Female Eggs Amount: $500,000.00 Dollars
    Email: jainhospitalcare@gmail.com
    Whats App: +91 8754313748
    Please share this post.



    We are urgently in need of Organs Donors, Kidney donors,Female Eggs
    Kidney donors Amount: $600.000.00 Dollars
    Female Eggs Amount: $500,000.00 Dollars
    Email: jainhospitalcare@gmail.com
    Whats App: +91 8754313748
    Please share this post.



    We are urgently in need of Organs Donors, Kidney donors,Female Eggs
    Kidney donors Amount: $600.000.00 Dollars
    Female Eggs Amount: $500,000.00 Dollars
    Email: jainhospitalcare@gmail.com
    Whats App: +91 8754313748
    Please share this post.

    ReplyDelete
  14. You want to Sell your kidney for money $800,000, 4.CR
    Email: columbiaasiahospital48@gmail.com
    Website: https://www.columbiaasia.com/india/hospitals/
    Dr Anderson
    Telephone no: +919740648251

    ReplyDelete
  15. We are urgently in need of Organs Donors, Kidney donors,Female Eggs,
    Kidney donors Amount: $600.000.00 Dollars
    Female Eggs Amount: $500,000.00 Dollars

    WHATSAP: +91 91082 56518
    Email: : jainhospitalcare@gmail.com

    We are urgently in need of Organs Donors, Kidney donors,Female Eggs,
    Kidney donors Amount: $600.000.00 Dollars
    Female Eggs Amount: $500,000.00 Dollars

    WHATSAP: +91 91082 56518
    Email: : jainhospitalcare@gmail.com



    We are urgently in need of Organs Donors, Kidney donors,Female Eggs,
    Kidney donors Amount: $600.000.00 Dollars
    Female Eggs Amount: $500,000.00 Dollars

    WHATSAP: +91 91082 56518
    Email: : jainhospitalcare@gmail.com




    We are urgently in need of Organs Donors, Kidney donors,Female Eggs,
    Kidney donors Amount: $600.000.00 Dollars
    Female Eggs Amount: $500,000.00 Dollars

    WHATSAP: +91 91082 56518
    Email: : jainhospitalcare@gmail.com



    We are urgently in need of Organs Donors, Kidney donors,Female Eggs,
    Kidney donors Amount: $600.000.00 Dollars
    Female Eggs Amount: $500,000.00 Dollars

    WHATSAP: +91 91082 56518
    Email: : jainhospitalcare@gmail.com

    We are urgently in need of Organs Donors, Kidney donors,Female Eggs,
    Kidney donors Amount: $600.000.00 Dollars
    Female Eggs Amount: $500,000.00 Dollars

    WHATSAP: +91 91082 56518
    Email: : jainhospitalcare@gmail.com

    ReplyDelete
  16. We are urgently in need of Organs Donors, Kidney donors,Female Eggs,Kidney donors Amount: $500.000.00 Dollars
    Female Eggs Amount: $500,000.00 Dollars
    WHATSAP: +91 91082 56518
    Email: jainhospitalcare@gmail.com
    Please share this post.

    We are urgently in need of Organs Donors, Kidney donors,Female Eggs,Kidney donors Amount: $500.000.00 Dollars
    Female Eggs Amount: $500,000.00 Dollars
    WHATSAP: +91 91082 56518
    Email: jainhospitalcare@gmail.com
    Please share this post.

    We are urgently in need of Organs Donors, Kidney donors,Female Eggs,Kidney donors Amount: $500.000.00 Dollars
    Female Eggs Amount: $500,000.00 Dollars
    WHATSAP: +91 91082 56518
    Email: jainhospitalcare@gmail.com
    Please share this post.

    We are urgently in need of Organs Donors, Kidney donors,Female Eggs,Kidney donors Amount: $500.000.00 Dollars
    Female Eggs Amount: $500,000.00 Dollars
    WHATSAP: +91 91082 56518
    Email: jainhospitalcare@gmail.com
    Please share this post.

    We are urgently in need of Organs Donors, Kidney donors,Female Eggs,Kidney donors Amount: $500.000.00 Dollars
    Female Eggs Amount: $500,000.00 Dollars
    WHATSAP: +91 91082 56518
    Email: jainhospitalcare@gmail.com
    Please share this post.

    We are urgently in need of Organs Donors, Kidney donors,Female Eggs,Kidney donors Amount: $500.000.00 Dollars
    Female Eggs Amount: $500,000.00 Dollars
    WHATSAP: +91 91082 56518
    Email: jainhospitalcare@gmail.com
    Please share this post.



    We are urgently in need of Organs Donors, Kidney donors,Female Eggs,Kidney donors Amount: $500.000.00 Dollars
    Female Eggs Amount: $500,000.00 Dollars
    WHATSAP: +91 91082 56518
    Email: jainhospitalcare@gmail.com
    Please share this post.

    We are urgently in need of Organs Donors, Kidney donors,Female Eggs,Kidney donors Amount: $500.000.00 Dollars
    Female Eggs Amount: $500,000.00 Dollars
    WHATSAP: +91 91082 56518
    Email: jainhospitalcare@gmail.com
    Please share this post.

    We are urgently in need of Organs Donors, Kidney donors,Female Eggs,Kidney donors Amount: $500.000.00 Dollars
    Female Eggs Amount: $500,000.00 Dollars
    WHATSAP: +91 91082 56518
    Email: jainhospitalcare@gmail.com
    Please share this post.

    ReplyDelete