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October 06, 2009


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Brian Steele-Sierk

Love it.
Also, as a diabetic and a dialysis patient, there is one thing that needs to happen in renal care that happened about twenty years ago in diabetes care:
Providers need to stop congratulating themselves on a low quality of life for the patient and start having high expectations of a patients ability to care for them selves, and have high expectations in terms of outcomes. I had a brief conversation with Irl Hirch, from UW where he stated that diabetics diagnosed today will not have the complications every other generation has had.

We need caregivers who are willing to have the same attitude about dialysis shaping the culture of renal care.

Christopher Blagg

Great! More than 40 years ago when we started our home hemodialysis program in Seattle Dr. Scribner said:
“The adjustment and rehabilitation of patients with any chronic disease are improved by giving them a full explanation of their disease and its treatment and as much responsibility for their treatment as they can accept.”

He said he first learned this from a diabetic specialist when he was a fellow at the Mayo Clinic.

Jason Hwang

We're in complete agreement, Bill. Our book goes much further than the Atlantic piece in describing what needs to happen, and, as you astutely suggested, we indeed advocated the use of patient networks to change how we manage chronic disease care. We also discussed the use of health savings accounts to create appropriate incentives for patients' health care decisions and even provided a timeframe for widespread HSA adoption. Finally, of particular interest to you and your readers, we included a case study of home hemodialysis to illustrate how the payment system has stalled health care innovation in the U.S.

Bill Peckham

Interesting Jason. The Innovator's Prescription: A Disruptive Solution for Health Care is available from Amazon.com and looks like a good read.

I am not sure how relevant health savings accounts are for those with CKD or in general for those with a chronic condition. In the special example of people treating CKD with dialysis they are largely covered under Medicare. Hence my advocacy for deductions on Medicare premiums.

Bill Peckham

Chris I am always cheered when I am echoing Scrib. It seems to me Scrib had optimal dialysis all figured out by about 1965 - the rest of us are just catching up.

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