NephMadness 2016: The Case for Conservative Care
Jane Schell, MD, is an assistant professor in nephrology and palliative care at the University of Pittsburgh Medical Center, PA. She completed her residency in internal medicine at Johns Hopkins. She went on to complete a fellowship in Hospice and Palliative Medicine at Duke University Medical Center. She has developed and published a communication curriculum, NephroTalk, for nephrology fellows addressing treatment decision-making and end of life care in patients with kidney disease.
“The only important statistic is the final score”
As many NephMadness fans know – anything can happen in the last minutes of a game. Many teams become flustered by the ticking clock and often change strategy to win at all costs – be aggressive, play hard, and take chances. Faced with a race toward the end, this strategy change often leads to setbacks – offensive fouls, desperate shots, and missed opportunities. These players who push toward a win despite having the odds stacked against them tend to suffer the most.
The conservative care team in ESRD offers a different, slower strategy. Rather than pushing ahead, these players focus on defense and preparation. With the strategy of the tortoise, they maintain a steady level of function and independence on the court until the end of the game. Conservative care in ESRD team has become a favorite for certain matchups. Older patients with advanced kidney disease, especially those over 80 years, may fair better with a team whose philosophy is focused on quality of life and preparation for the future.
Behind every successful team is a thoughtful coach who looks beyond the statistics and takes the time to learn what matters most and what players hope to gain from the game. Patents who elect conservative care tend to focus on the quality of life rather than pursuing strategies to prolong survival. My pick for NephMadness 2016 is conservative care in ESRD. These players tend to spend the bulk of their time on the court enjoying the game rather than warming the bench.
Go Conservative Care! You can do it and beat those Atypical HUS-ers. I know this team goes against the prevailing strategy, but sometimes you have to look at problems with a new lens and find new ways to solve old problems.