Friday, February 20, 2009

"Is twice a week enough?"

"Of course its not!"

An acquaintance came home recently with his son. His wife was diagnosed recently with kidney disease and was put on dialysis. The nephrologist suggested thrice a week dialysis. They started off. Gradually, probably after talking to equally uninformed folks outside the unit, they reduced it to twice a week.

They knew I was on dialysis from a long time. So, they came home to discuss this with me and also wanted my opinion on Peritoneal Dialysis. I told them about my experience with PD and recommended it (provided of course, the neph was ok with it). On the subject of frequency of dialysis, I explained why more was better.

They did not seem convinced.

They argued that she was quite comfortable with twice a week sessions. She did not have any problems till the morning of the treatment. Why, then should they do thrice a week sessions rather than twice a week?

I could not argue too much.

In India, there are additional factors that come into play in the whole "adequate versus optimal" equation. Most people pay for their own treatments. This is a major, major factor. Arogyasree covers the cost of only two treatments per week. I am not sure if these people were availing of Arogyasree.

When the patient was 'comfortable' with twice a week sessions, why do thrice a week? How do you answer this? Dialysis treatments, by themselves, performed in the 'usual' setting at a hospital can be quite traumatic. Add the cost factor and you have a cogent case for 'less is better'. Atleast for the uninformed.

That is why education is so important. If people were educated enough about the long term effects of kidney disease, the comorbidities involved and the risks of being underdialyzed, atleast a part of the dialysis populace would make an attempt at getting better dialysis. Doctors fall woefully short here. The mandatory advice, given without attempting to explain the benefits in a convincing manner will never work.

The entire system needs an urgent overhaul. Bringing in counsellors who talk to the patients and understand their fears and concerns will really help. These counsellors need to be specially trained to handle people on dialysis whose set of problems is entirely different.

As I wrote earlier, there are undeniable mental aspects to a physical illness.

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