# Dr. Carl Kjellstrand /AKF **URL:** \ **Category:** HD For Professionals\ **Created:** [February 21, 2006, 7:50am UTC](https://forums.homedialysis.org/t/dr-carl-kjellstrand-akf/675 "2006-02-21T07:50:03Z")\ **Posts on this page:** 3\ **Page:** 1
**Author:** ![Jfwag](https://forumcdn.homedialysis.org/letter_avatar_proxy/v4/letter/j/3e96dc/32.png) [@Jfwag](https://forums.homedialysis.org/u/Jfwag)\ **Post date:** [February 21, 2006, 7:50am UTC](https://forums.homedialysis.org/t/dr-carl-kjellstrand-akf/675/1 "2006-02-21T07:50:03Z")
I am so happy that HDC has posted in their update that the American Kidney Fund is to bestow its highest honor on Dr. Carl Kjellstrand. I will never forget when I read one of his “statements” so early on in my dialysis career. Below is what was read and to me at least it was very profound. That’s not to mention what the AKF did for my spouse and me at one of the lowest points in our lives. The AKF is a great resource. Below is something that I find very influential and moving when “debating” home dialysis at the time. He made a difference. Dr. Carl Kjellstrand DIALYSIS IN THE USA In recent medical studies, it has come to light that people receiving dialysis treatment for kidney failure in Europe experience, on average, better health with fewer complications and longer life expectancy than do their American counterparts. There are a number of possible reasons for this discrepancy, such as differences in patient populations and in treatment procedures, but the most significant seems to be the difference in the respective goals of treatment. In Europe, the goal of dialysis is rehabilitation. Patients are expected to do well and to return to normal lives, and their doctors are not satisfied until they do. In the United States, however, the goal often seems to be merely to keep patients alive, without any serious ongoing attention to rehabilitation or quality of life. Might this great difference in intentions and expectations be the deciding factor in the difference in outcomes? Bernie Seigel, M.D., Deepak Chopra, M.D., and others, have written about the influence that expectations of doctors and medical staff have on patient outcomes. Their thesis is that since patients tend to conform with their doctor’s expectations, performing up to, or down to, those expectations, it is a doctor’s solemn responsibility to convey as positive and hopeful an outlook as possible to assure the most beneficial outcome. A recent study in Clinical Psychology Review on the ‘placebo syndrome’ clearly shows that belief in a particular outcome can be as strong a determinant as any medication. Indeed, is it really any surprise that low expectations lead to less than optimal outcomes? Dialysis in the USA has become by default a kind of limbo, and the experience of patients, while fraught with difficulty, is rarely allowed full expression or resolution. Instead, patients are expected to be ‘nice’ while being treated as little more than items on an assembly line. The prevailing attitude of doctors and staff at many clinics is that of denial: that the situation is so bad that it must not be dealt with. The corporate owners, usually far removed from the clinics, tend to make treatment decisions based on short-term profitability, often to the short-term and long-term detriment of their customers well-being. Although patients become inured to the idea of having to dialyze, and would be more than happy to get on with worthwhile lives, they are held back by a system that regards them as permanent invalids with one foot in the grave. It seems that aversion to the idea of dialysis is the stumbling block preventing further investigation of solutions to dialysis-related problems. The common perception is that dialysis is an awful burden which it is impossible to do anything about. Great pains are taken to impose this view on the patients, with regular negative reinforcement: in combination with the treatment, it is an effective form of brainwashing. This defeatism inevitably colors treatment decisions, and leads to a poorer quality of life for all concerned. I don’t think that kind of mentality is appropriate in any medical situation. There may be no cure per se for kidney failure, nor is there a cure for blindness, amputation, paralysis, or brain damage. However, the general trend in all these other cases is to overcome the disability and return the person to a full and worthwhile life, regardless of the obstacles. What makes dialysis so different? Is it the machine? Is it the blood? What is it? I think it is a self-fulfilling prophecy. The time is overdue to re-examine our priorities and re-establish the dialysis program on a solid basis of the optimization of the quality of life of each individual dialysis patient. When that becomes the standard of care, we will also see the optimization of outcomes: patient satisfaction, rehabilitation, and longer, healthier, more productive lives. That is what the system was intended to produce, and that is what we are paying for. Let’s do what it takes to make it so. April 15, 1994 ---
**Author:** ![system](https://d16rlmixcfjfyh.cloudfront.net/original/1X/5d85dacb7e76ee0f7b162785afa5f129bc0805ad.png) [@system](https://forums.homedialysis.org/u/system)\ **Post date:** [March 1, 2006, 5:50pm UTC](https://forums.homedialysis.org/t/dr-carl-kjellstrand-akf/675/2 "2006-03-01T17:50:12Z")
> [@Jfwag](#): > > …He made a difference. … Thanks for the post. IMO, there is no higher accolade. Making things better, making a difference, should be the goal for all of us. ---
**Author:** ![Beth\_Witten\_MSW](https://forumcdn.homedialysis.org/user_avatar/forums.homedialysis.org/beth_witten_msw/32/541_2.png) [@Beth\_Witten\_MSW](https://forums.homedialysis.org/u/Beth_Witten_MSW)\ **Post date:** [March 1, 2006, 6:11pm UTC](https://forums.homedialysis.org/t/dr-carl-kjellstrand-akf/675/3 "2006-03-01T18:11:00Z")
And he is continuing to make a difference, by the way. He is truly a terrific advocate for quality care for patients. He is one of the rare people who speaks his mind even if what he says is not “politically correct” or exactly what everyone else in the renal community is saying. He is an “outside the box” thinker. In my opinion, we need more people like him in healthcare today. I am one of his many fans.