What Drs?

Hi Folks

Can a urologists be your renal Dr?

Thanks
Bob Obrien

Hi Bob,

A urologist specializes in the urinary tracts (both genders) and the reproductive tract in men. While the urinary tract does include the kidneys, I’d have to know a lot about the training of a urologist before I’d want one to be my kidney doctor, if I were you. Kidneys have so many functions beyond just “plumbing” that the specialty of nephrology arose solely to deal with how complex they are. And, even most nephrologists don’t know very much about dialysis–how much do you suppose a urologist would know?

Hi Folks

Hey Dori

First in a lot of searches I’ve done both fields of study keep coming up. So I searched to see if a urologist could be a dialysis dr? no answers. So where I do turn ,here , it seems like when I want hard facts on the subject you folks (both Dori and Beth and all the people who put into this site) seem to have the answers .

The Dr I have in mind is my Dr of 35 yrs, who knows me like a book, in both the physical sense and my mental sense. Just to recall I was born Spina Bifda with no control of function waste down.

Thanks
Bob OBrien

[QUOTE=Dori Schatell;15469]Hi Bob,

A urologist specializes in the urinary tracts (both genders) and the reproductive tract in men. While the urinary tract does include the kidneys, I’d have to know a lot about the training of a urologist before I’d want one to be my kidney doctor, if I were you. Kidneys have so many functions beyond just “plumbing” that the specialty of nephrology arose solely to deal with how complex they are. And, even most nephrologists don’t know very much about dialysis–how much do you suppose a urologist would know?[/QUOTE]

Hi Bob,

Wow, thanks for the vote of confidence. :smiley: I’ve never heard of a urologist being someone’s kidney doctor, but suppose that doesn’t mean it isn’t possible, especially if yours knows you as well as it sounds like he does. Or, you could certainly keep your doctor as your primary and he could always consult with a nephrologist if there was something he didn’t fully understand himself.

Hi Folks

Hi Dori

What I really want to know is law. Can a urologist be a dialysis Dr?

thanks
Bob OBrien

Here’s a Wikipedia article that describes a nephrologist’s training and areas of expertise. This article also mentions urologists as being surgeons:

The current ESRD regulation that governs dialysis facilities has these qualifications for the physician director of the dialysis clinic. It doesn’t have requirements for other doctors. The Secretary referred to in this section is the Secretary of the Department of Health & Human Services.

I Physician-director. A physician who:
(1) Is board eligible or board certified in internal medicine or pediatrics by a professional board, and has had at least 12 months of experience or training in the care of patients at ESRD facilities;
or
(2) During the 5-year period prior to September 1, 1976, served for at least 12 months as director of a dialysis or transplantation program;
(3) In those areas where a physician who meets the definition in paragraph (1) or (2) of this definition is not available to direct a participating dialysis facility, another physician may direct the facility, subject to the approval of the Secretary.[/I]

Even though this doesn’t require that all physicians treating patients with ESRD be nephrologists, in the nearly 30 years I’ve been working in ESRD, I’ve never heard of someone on dialysis being followed by anyone other than a nephrologist (some are DOs, most are MDs). I suspect this is because the medical director is ultimately responsible for the care provided by all doctors who see that clinic’s dialysis patients. Therefore it would be important to find out from your nephrologist if he/she would feel comfortable assuming that responsibility for your urologist’s care considering that he has probably not had the specialized training that a nephrologist receives.

Hi Folks

Hey Beth

My Urologist is a surgeon and has worked on me for 35 yrs. I’m not of all the areas he has worked in since it just now has come up , I tried hard to find someone in the dialysis world who could instill a sense of trust I have in my urologist.
It just that reading some of posts here (see Jane’s on Drs and Dietitians) and now myself being on dialysis for two yrs. I’m left with no confidence with my home team . I think that they do there best, but I want someone who knows me physically and mentally. Plus right now the unit I go to seems to be backing off. instead of calling them , we first have to call the main hospital and leave message.

That why I turn here since everything I found left me wondering.
thanks
bob obrien

[QUOTE=Beth Witten MSW ACSW;15506]Here’s a Wikipedia article that describes a nephrologist’s training and areas of expertise. This article also mentions urologists as being surgeons:

The current ESRD regulation that governs dialysis facilities has these qualifications for the physician director of the dialysis clinic. It doesn’t have requirements for other doctors. The Secretary referred to in this section is the Secretary of the Department of Health & Human Services.

I Physician-director. A physician who:
(1) Is board eligible or board certified in internal medicine or pediatrics by a professional board, and has had at least 12 months of experience or training in the care of patients at ESRD facilities;
or
(2) During the 5-year period prior to September 1, 1976, served for at least 12 months as director of a dialysis or transplantation program;
(3) In those areas where a physician who meets the definition in paragraph (1) or (2) of this definition is not available to direct a participating dialysis facility, another physician may direct the facility, subject to the approval of the Secretary.[/I]

Even though this doesn’t require that all physicians treating patients with ESRD be nephrologists, in the nearly 30 years I’ve been working in ESRD, I’ve never heard of someone on dialysis being followed by anyone other than a nephrologist (some are DOs, most are MDs). I suspect this is because the medical director is ultimately responsible for the care provided by all doctors who see that clinic’s dialysis patients. Therefore it would be important to find out from your nephrologist if he/she would feel comfortable assuming that responsibility for your urologist’s care considering that he has probably not had the specialized training that a nephrologist receives.[/QUOTE]

If you’ve known your urologist for 35 years, I’m sure you have a lot of trust in him. Did that trust develop overnight or even in a couple of years? I suspect it took time to develop that trust. Has your urologist said anything about the care you’re getting at your dialysis clinic? Has your urologist given you any indication that he would like to take over the care for your kidney failure? This care would include prescribing your dialysis treatment so the company that ships your equipment and supplies can send you what you need (and what your dialysis clinic is contracted to provide), monitoring your diet, reviewing your labs, adjusting your medications, etc.? A dialysis patient must be affiliated with a dialysis clinic so even if the medical director of the dialysis clinic allowed your urologist to direct your care, the dialysis clinic would still need to see you regularly because Medicare requires the nurse, social worker, and dietitian to document assessments, care plans, and ongoing communication with all patients. When the facility is surveyed by the state for Medicare, the surveyor checks charts to make sure that home patients are offered the same care as in-center patients.

It’s unusual for a dialysis program to require someone to call somewhere else and leave a message rather than having patients call the home training nurse directly. Do all the patients have to call the hospital first or are you the only one? Are you supposed to call the hospital for questions/help at night or during the day too? Does the home training nurse work at the hospital as well as at the dialysis clinic or does your nurse ask you to call the hospital because he/she knows you have no confidence in him/her or the dialysis clinic? When you’re to call the hospital, who are you supposed to talk with or leave a message for? Does your nephrologist know you’re supposed to call the hospital and leave a message instead of calling the dialysis clinic?

Hi Folks

Hi Beth
The reason I have the judgement I do is due to my yrs in the medical world. It doesn’t take a brain sugeon to see that things are not right in the dialysis world as a whole. When I read post from some of the folks on this site and others. I read what really good centers are like and I read what not so good centers are like. I 'm sure you will not deny that the dialysis world ,like the rest of all of our country has both good and bad in it from the top to the most local .

As to my center and calls all I know is when I started there it was call the nurse direct or beeper #, that was 04of 07. Now it is call the main hosiptal , the center is not at or on the grounds of the hosiptal. It is maybe 5 miles west of center.
bob obrien

[QUOTE=Beth Witten MSW ACSW;15522]If you’ve known your urologist for 35 years, I’m sure you have a lot of trust in him. Did that trust develop overnight or even in a couple of years? I suspect it took time to develop that trust. Has your urologist said anything about the care you’re getting at your dialysis clinic? Has your urologist given you any indication that he would like to take over the care for your kidney failure? This care would include prescribing your dialysis treatment so the company that ships your equipment and supplies can send you what you need (and what your dialysis clinic is contracted to provide), monitoring your diet, reviewing your labs, adjusting your medications, etc.? A dialysis patient must be affiliated with a dialysis clinic so even if the medical director of the dialysis clinic allowed your urologist to direct your care, the dialysis clinic would still need to see you regularly because Medicare requires the nurse, social worker, and dietitian to document assessments, care plans, and ongoing communication with all patients. When the facility is surveyed by the state for Medicare, the surveyor checks charts to make sure that home patients are offered the same care as in-center patients.

It’s unusual for a dialysis program to require someone to call somewhere else and leave a message rather than having patients call the home training nurse directly. Do all the patients have to call the hospital first or are you the only one? Are you supposed to call the hospital for questions/help at night or during the day too? Does the home training nurse work at the hospital as well as at the dialysis clinic or does your nurse ask you to call the hospital because he/she knows you have no confidence in him/her or the dialysis clinic? When you’re to call the hospital, who are you supposed to talk with or leave a message for? Does your nephrologist know you’re supposed to call the hospital and leave a message instead of calling the dialysis clinic?[/QUOTE]

If you don’t feel like you’re getting the quality of care that you need, you have the right to report your clinic to the ESRD Network and state survey agency. Federal regulations require that home dialysis patients receive support services from qualified and experienced staff (RN, RD, and MSW) employed or contracted by the dialysis clinic as stated below.

I Standard: Self-dialysis support services. The renal dialysis facility or center furnishing self-dialysis training upon completion of the patient’s training, furnishes (either directly, under agreement or by arrangement with another ESRD facility) the following services:
(1) Surveillance of the patient’s home adaptation, including provisions for visits to the home or the facility;
(2) Consultation for the patient with a qualified social worker and a qualified dietitian;
(3) A recordkeeping system which assures continuity of care;
(4) Installation and maintenance of eqipment;
(5) Testing and appropriate treatment of the water; and
(6) Ordering of supplies on an ongoing basis.[/I]

[QUOTE=Beth Witten MSW ACSW;15538]If you don’t feel like you’re getting the quality of care that you need, you have the right to report your clinic to the ESRD Network and state survey agency. Federal regulations require that home dialysis patients receive support services from qualified and experienced staff (RN, RD, and MSW) employed or contracted by the dialysis clinic as stated below.

I Standard: Self-dialysis support services. The renal dialysis facility or center furnishing self-dialysis training upon completion of the patient’s training, furnishes (either directly, under agreement or by arrangement with another ESRD facility) the following services:
(1) Surveillance of the patient’s home adaptation, including provisions for visits to the home or the facility;
(2) Consultation for the patient with a qualified social worker and a qualified dietitian;
(3) A recordkeeping system which assures continuity of care;
(4) Installation and maintenance of eqipment;
(5) Testing and appropriate treatment of the water; and
(6) Ordering of supplies on an ongoing basis.[/I][/QUOTE]

Always remember Beth, we have the right to report the lack of quality of care to the Network, but too often the Network sides with the clinic and where are we supposed to get dialysis if the clinic has a monopoly or there are no other clinics in our city that are any better? Patients do not have the back-up of a neutral advocacy group so our lives are one of walking on eggshells until a better door opens to us.

Since I have been on home txs, I am feeling much better because I remove toxins and fluid 6x instead of 3x, but it is like a full-time job dealing with the dialysis professionals, the machine co. and the supplier as you would not believe how often they are lacking in dialysis expertise and how many errors they make. Re errors, understandably they are busy ppl, but one can not afford their errors when it comes to our health and lives. And re dialysis expertise, that is even more serious. I feel like the nephs and most of the dialysis nurses I’ve encountered are below where they should be in their dialysis knowledge. They are not up to date by any means. I often bring info to them, first, that they have not even heard of. I have spoken to a few dialysis professionals who are experts and they are inspiring. But they are the exception to the rule. The bottom line is, many patients don’t have top clinics and making a switch is not an option at the time.

Now that I’ve become a home patient, I have actually taken on the role of machine tech. The better I understand the machine’s operation and how to troubleshoot, the less problems I have. And I have come to the conclusion that I must find other souces for dialysis info, because if my team is not enthusiastic or otherwise can’t answer my questions so often, I’ve got to find my answers elsewhere. Sometimes that is from another more experienced home patient. Sometimes it’s from someone else on the net. I don’t believe anything by blind faith, check it out carefully and always run it by my team. But for me and many other patients, the team falls short very often.

I am even wondering about looking into what other medical specialties or alternative medicine can provide as the dialysis professionals most frequent answer is “dunno”. I dunno either, but it seems to me that there is so much more that could be offered in terms of education, diet info., exercise. I checked out the DaVita video that Bill P. posted as far as what the job of a renal dietitian entails and I never laughed so hard in all my life- it’s a fairy tale, propaganda! There may be some renal dietitians that are cheery and deliver all the types education as depicted on that video, but if my experience is typical, it’s not the norm. I have had 1/2 doz. dietitians and none of them had any enthusiam. The nephs seem to know nothing at all about nutrition.

I read where Dori said that most patients don’t realize they can switch clinics. In some cases that’s an option, but much of the time it’s not. It can solve a whole lot if one has a good clinic available to him and makes the switch. But I think that those who care about improvement in dialysis need to come up with some “real” solutions. I know there are those who do care. The system as it is has failed a lot of patients. Even in 2008’ patients are still walking on eggshells in clinics. As a home patient now, I am removed from the usual clinic problems, thank God, but it’s like I have a whole new set of problems, because not only do I need to deal with the clinic here and there, but I have to deal with the machine co. and supplier too. That’s a whole lotta ppl. that make errors and can’t answer basic dialysis questions. Still, I’m happier and healthier at home. It’s just pretty surprising and frustrating to me that those who are entrusted with the care of patients so often fall short. I try to always look to fresh solutions for my dialysis care.