Ask the Doctor
Questions about kidney disease? Risk factors? Signs and symptoms? Are you concerned about yourself, a friend or family member? Ask Dr. Spry.
As a pre-teen, Chester Fox knew he was destined for a career in medicine. Suffering from a difficult-to-diagnose condition, his pediatrician insisted the illness was all in his head and sent him to the psychologist's couch. After finding another doctor who nailed his diagnosis, Fox was determined to become a doctor himself, if only to save people from guys like his first doctor who was so quick to dismiss his pain. Fox recently won an NKF research award throughÂ which he'll be helping family doctors uncover the mysteries of kidney disease.
Thirty years into a career as a family practitioner, Fox says he "absolutely loves the work. It's a privilege to be a doctor. I cherish the trust that people place in me and the field I chose -family medicineâ€”allows me to develop close, long-term relationships with my patients. I could do a college physical for a kid I delivered myself and sometimes I take care of four generations at onceâ€¦you might say I get the whole picture."
As a recipient of NKF's KDOQI Research grant, he's trying to ensure that his colleagues get the whole picture when it comes to finding and treating kidney disease.
When he was approached about how best to reach primary care physicians (PCPs) about implementing the KDOQI guidelines, he was ashamed to admit he had never heard of them. So his first step was to survey a group of PCPs and see if any of them knew about these evidence-based guidelines. It turned out that most hadn't heard of KDOQI. Nationally, only about 50% of PCPS recognize stage 3 kidney disease, even with the lab results right in front of them. Many don't know about controlling high blood pressure in people with kidney disease or how to recognize when kidney disease is causing anemia.
Fox is determined to change all that with his recently awarded NKF research grant. He is working with 12 practices to provide an enhancement assistant who will spend time in the offices each week to help the doctors collect data from their patient charts and show them how to recognize and treat chronic kidney disease (CKD).
One of the keys to his success, both as a doctor and teacher, is his ability to simplify complex concepts and distill the main points or "takeaway message" for his students and patients.
As part of the grant, Fox has developed a simple one-page clinician guide that boils down key KDOQI treatment recommendations. In keeping with the "less is more" philosophy, he's planning to condense it even further, getting it down to five bullet points before widely disseminating.
Because of this KDOQI research grant, Fox was inspired to submit a proposal to the National Institutes of Health for a grant to do the same kind of work using computer decision support in a larger national network, comprised of 40 practices throughout the U.S. He'll be able to study outcomes of computer decision making and practice facilitation. "I wanted to stimulate other research grants with this initial study and now there'll be lots more PCPs with reminders about CKDâ€¦I can't tell how they'll respond but at least they'll have the reminders in front of them."
Fox pauses, deep in thought about the next research grant, "Do PCP offices need more than computer decision-making reminders in order to react to the information in front of them? What will it take to get them to begin implementing these treatment recommendations?"
Fox is already planning his next big study, but he'll take a well-deserved break this summer to work on his golf game and spend time with his wife, college-age kids and pet dog and cat. After all, he likes to focus on the whole picture--both work and play-- and it's those ongoing, long-lasting relationships in life that he enjoys most.
Click here for info on NKF's research program, from which Fox recently won a grant.