As practicing clinicians in the United States, we generally feel privileged, with access to a highly developed and pioneering medical care system along with an advanced and cutting-edge technology in the world’s largest economy.
In the past several years, however, we have noticed the staggering development of the so-called emerging economies, including those of some Asian-Pacific countries, which now challenge the economic superiority of the United States and the rest of the western world. Each time I fly to the modern Asian airports in Seoul, Taipei, Dubai, and Singapore, I feel the urgent need for long-overdue modernization of our once-to-be-proud-of airports LAX and JFK.
Similarly, during my visits to hospitals and dialysis clinics in Asian countries, I see another rapidly deepening contrast: the patient care practice differences between the United States and Asia. The technology and resources used in the United States that are considered conventional medicine are falling behind the cutting-edge technology and clinical machinery in such less-affluent countries as Thailand and Malaysia, not to mention the highly modern state-of-the-art medicine in Japan and Singapore.
I also see enormous differences in the nephrology practice between us and them. In the United States, we are proud of starting dialysis treatment early and fast, but our Taiwanese colleagues start dialysis therapy with an average eGFR below 5 mL/min/1.73m2.
While we are proud of using ACE inhibitors and angiotensin receptor blockers to slow the rate of chronic kidney disease progression, Taiwanese nephrologists implement half a dozen more interventions to this end, including low-protein diet reinforcement and monitoring, keto-analogues of amino acids, and charcoal derivatives to modulate uremic toxins.
On the dialysis front, too, other countries appear to be ahead of us. In this country most of us have no clear idea what so-called “on-line hemofiltration” is, whereas in many other countries it has been practiced routinely in outpatient dialysis clinics for years. Our dialysis machines are outdated compared with those of some other nations. We do not allow our patients to eat during dialysis treatment, whereas meals are served routinely in many outpatient dialysis centers in other countries.
We appear to be disconnected from the rest of the world and uninterested in knowing why other nephrology communities are moving forward faster than we are. In terms of income, we feel that we are paid relatively well in this country, yet we do not realize that even Canadian nephrologists, on average, earn 20% to 40% higher income than their counterparts here.
On the bright side, however, the rest of the world still looks up to us and our guidelines. Yet we should not take our leadership position for granted but to cherish it and to try hard to preserve and reinforce it.
Dr. Kalantar-Zadeh is Medical Director, Nephrology, for Renal & Urology News.