By Bill Peckham
Kevin MD has a post up on a New York Times article, Treating an Illness Is One Thing. What About a Patient With Many? that points to the lack of practice guidelines for those with multiple health problems - those with multimorbidity. The article and the 2005 paper it links to do not include chronic kidney disease among the conditions studied but the conclusions are just as applicable to people with CKD.
In the article, Fred Powledge who has multimorbidity says clearly what many dialyzors would say:
Fred sounds like he is pretty far along the learning curve, and I'd say informed self management is ideal, however, many with multimorbidity are not going to be able to learn to self manage (in a timely way) particularly if the onset is sudden. Not to mention the trouble we all have trying to stay up to speed.
As the article notes there is no advocacy group or national institute for those with multimorbidity. In dialysis no one has looked at how dose of dialysis effects the management of those with additional health problems. There are case mix adjusters for reimbursement but where are the "treatment adjusters"?