Just When We Thought We Understood

I don’t want to have Chronic Kidney Disease.  I have no emotional need to be a patient. But when I read the following blog by England’s Dr. Dan Brett yesterday, all I kept thinking is, “I don’t want to be that part of that 1%.” If only there were a way to predict who would be, I’d have to agree with him.  BUT there isn’t, so I don’t (although I did find his thoughts comforting).

                Offal treatment

                                           Primary Care Blues
                   Dan Brett

21 July 2011

DanBrettblog21july2011.jpgPrior  to 2006, a gentle upward drift in creatinine, as patients grew older,
was considered to be a part of natural ageing. It wasn’t as if my
patients were regularly popping their clogs due to end stage renal
failure, leaving me berating myself for not checking their eGFR or urine
protein / creatinine ratio. Notes might have been annotated with a
‘mild renal impairment’ code by the most diligent of us, but kidneys, on
the whole, were strictly foodstuff or organs for connoisseurs and
specialists.

Then ‘chronic kidney disease’, with all it’s [sic] stages, was invented – and added to QoF [e.g. I had to look that one up: Quality and Outcomes Framework]. With money attached, it immediately became ‘important’. Literally hundreds of unsuspecting, asymptomatic patients – mainly elderly, have been dragged in to be given their bad news – cluttering up my waiting room, having umpteen blood tests and urine tests.

Doctor: “You’ve got stage 3 Chronic Kidney Disease, Mrs Miggins, requiring that we mount an immediate renin-angiotensin blockade, get you on a statin…”

Mrs Miggins: “Oh dear – stage 3 already you say! How long have I got…?”

Patients have been scared witless – terrified that a transplant / dialysis /
imminent death awaits them. [Me again. This is exactly why I wrote the book.] Renal referrals have rocketed and what exactly has been achieved? After four years of industrious GP QoFing, where is the evidence that managing chronic kidney disease is of benefit? According to published studies, only 1% of patients with the stage 3 chronic kidney disease label will progress to end stage renal failure in the next eight years. With these small percentages we need to treat thousands of patients each year to potentially make any difference at all! But doesn’t managing chronic kidney disease reduce deaths from ischaemic heart disease, I hear you say? Nope – kidding
yourself again – evidence is distinctly lacking.

Hoerr’s Law rightly asserts that – ‘It is difficult to make an asymptomatic patient feel better.’

Or put another way, in the words of our godfather – Hippocrates – ‘To do nothing is also a good remedy’.

Here’s the URL for the blog: http://www.onmedica.com/BlogView.aspx?blogid=a9b19411-c226-42aa-bec3-6304dfa3616c&postid=d3de890d-dcd8-4bbc-b681-90c149300609

I have no intention of stopping my treatment, but whenever that panic starts to creep into my heart, I’ll have this blog to quell it immediately.  I’m pretty good about being rational concerning my Chronic Kidney Disease but I’m also human and those what-ifs can make the teeniest little bit of headway when I’m feeling low. Maybe you can use it, too.

Have a terrific weekend and

keep living your life! P.S. Please like our What Is It And How Did I Get It? Early Stage Chronic Kidney Disease page on Facebook, so we can keep spreading the word.

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Published in: on July 22, 2011 at 9:43 am  Leave a Comment  

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