What is PsychoNephrology? Interview with Kidney MD . . .

Had the opportunity to meet a kidney doctor, named Dr. Gavril Hercz. He is a staff nephrologist at Humber River Hospital. An Associate Professor at the University of Toronto. And a member of the Canadian Psychoanalytic Society.

He’s part of a new wave of kidney disease medicine that looks at more than just treating the physical disease. This new way of approaching kidney disease is called, psychonephrology.

I’m interested in this broader approach because I believe it will better address the overall concerns of patients living with chronic kidney disease. I believe if our concerns are better addressed then our lives will be better and our outcomes will be better too.

ACA Health Care Coordination

I chose this photo because it suggests dealing with illness from a wider perspective than just medical needs. With everyone at the table, a wider perspective will be addressed. A wider perspective will lead to better understanding of the person living with the illness and lead to a healthier and more happy patient.

I was able to ask Dr. Hercz a few questions about psychonephrology. His answers are a little long but worth the read.

The most important thing he said was . . .

“The hope is that further interest in psychonephrology will lead to widespread acceptance of the equal importance of caring and curing as applied to kidney health.”

1. What is psychonephrology?

Psychonephrology concerns itself with psychosocial topics and aims to create a common language, which would enhance communication between patients, families and clinicians.

Beyond communication, it fosters ongoing research in psychosocial areas, which would positively influence current and new ways of delivery medicine to patients.

Although this was an important topic during the early days of dialysis therapy, i.e. from the 1960s to the 1980s,  psychosocial caring approach was superseded by more technological and pharmacological concerns of nephrology therapy. Recently, however, there has been a growing interest on the emotional aspects of nephrology care, especially with the emerging focus on patient centered care.

Part of this is the realization that fostering more empathetic communication can result in improved adherence to therapy, less intercurrent illness and reduced staff burnout.

2. Why do you think this approach is important?

For patients coping with kidney disease, too often the focus is on issues concerning blood test results, blood pressure readings or machinery problems. Although these are vital for good health, there are other equally important topics, often unspoken, which have a huge impact on one’s coping abilities. We tend to  ignore powerful emotional disturbances, which may affect us, our families and our medical caregivers.

These changes cover a spectrum of emotional responses, such as anxiety, depression, sleep disturbances, inability to concentrate, inability to work with nephrology staff, inattentiveness to treatment procedures, etc. All these reactions are part of the normal response to dealing with a chronic illness. Unfortunately these reactions may be little understood by the staff or our families. The misunderstanding may make the situation worse, both for patients and the health care team.

3. What do you think this means for kidney patients? (Dr. Hercz chose an example to answer this question.)

We realized that the transition to dialysis can be a very anxiety provoking time for patients and families. As a result, we have devised a dialysis transition unit, with an increased emphasis on emotional support, self-management and education. This has resulted in greater numbers of patients adopting home dialysis modality as their chosen modality of treatment. We are currently exploring new forms of peer support to help with this process even more.

determinants_piechart250

This is just a graph that I found online but looking at the suggested percentages, Clinical Care accounts for a small percentage of the “bigger picture” when health is being considered.

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