Why Kidney Disease Treatment Fails: Understanding Barriers

At the end of every video, I often leave you with a brief message and a small request: to share your experience. This isn’t just for my benefit—it helps other patients and the wider audience learn from your insights. More importantly, it significantly enhances my own learning. I strive to learn something new every day, and I believe no doctor can truly grow without learning from their patients, the local sociopolitical environment, and the happenings in their community.

In today’s episode, I want to discuss the significant lessons I’ve learned over the past two years since I returned to Pakistan. There are some major challenges that kidney patients face in their journey towards better health. These challenges not only hinder their recovery but also complicate their overall management.

My Journey Back to Pakistan and the Healthcare Reality

When I returned to Pakistan in 2021, I was initially impressed by the advancements in healthcare. Large hospitals had been established, and there were many highly qualified doctors and professors. The healthcare system had also seen a great deal of modernization. However, when I started seeing patients, I was deeply saddened. Most of the kidney patients I encountered were already in the late stages of kidney disease, often Stage 4 or 5, and many were on the verge of needing dialysis.

Instead of following the traditional approach, where we lament the unfortunate state of affairs and express sorrow, I decided to step outside and educate the public. In Pakistan, there are millions of people suffering from kidney disease who are unaware of their condition. It became clear to me that these individuals need to be educated about how they can recognize kidney disease early and how they can manage it better.

As more early-stage kidney patients began to visit me, I started to identify the major obstacles that prevent effective diagnosis and management of kidney disease. Unfortunately, these obstacles do more harm than good, acting as barriers rather than helping patients improve their health.

The Root Cause: Ignorance

The most significant barrier to kidney disease management in Pakistan is ignorance. I consider ignorance the greatest challenge because it is not just a lack of education; even those who are educated can sometimes display ignorance. An educated person, even without a formal degree, who reads newspapers, books, and engages in logical discussions, can bring significant improvement to their life. Such a person is capable of learning from others and adapting to new information.

However, when someone is ignorant, they become stubbornly attached to their own views, refusing to listen to others or consider alternative perspectives. This ignorance can be found in people of all education levels, from those with PhDs to those who are completely illiterate. The problem in Pakistan is not just a lack of education but a refusal to step out of this bubble of ignorance.

This ignorance manifests itself in many ways, the most significant of which is a refusal to listen to others. People are often unwilling to improve themselves or consider new information. I firmly believe that this collective ignorance—among patients, the general public, and even some doctors—is the biggest hurdle in managing kidney disease effectively.

Poverty: The Next Major Challenge

The second major obstacle is poverty. I humbly acknowledge that many patients in Pakistan are unable to seek treatment simply because they cannot afford it. It’s not just about affording the treatment; many cannot even afford the diagnostic tests needed to understand their condition. Some patients I see can afford to get tests done regularly, while others, despite me waiving my consultation fee, cannot afford even a single test. They have to think twice before buying medication because they do not have the means to pay for it.

This is a heartbreaking situation. In any civilized society, in any developed or even decent society, basic medications should be available to all patients. If not free, then at least at a subsidized rate that makes treatment accessible. Poverty is a significant barrier to understanding, diagnosing, and treating kidney disease effectively.

Fear and Despair: A Psychological Barrier

The third major obstacle at the patient level is fear and despair. The moment a diagnosis is made, especially when it involves a serious condition like kidney disease, patients often become overwhelmed with fear. They panic, thinking their condition is much worse than it is. This fear is often exacerbated by misinformation or misunderstanding.

You can see this in the comments on YouTube videos or in messages sent to doctors—patients frequently say, "Doctor, I'm very worried." This worry often does not correlate with the severity of their condition. A patient might have a mild proteinuria, but after watching a few videos and misunderstanding their content, they start believing their condition is life-threatening, even though it might not be.

Instead of using social media as a tool for enlightenment, patients sometimes fall into the trap of unnecessary worry. This worry then leads to a cycle of stress and psychological distress, which can be more harmful than the kidney disease itself. It’s essential for patients to use social media to better understand their condition and to approach it with a calm and informed mindset.

I plan to dedicate an entire episode to discussing the psychological stress and anxiety that comes with kidney disease. For now, I urge you to accept your condition, educate yourself about it through reliable sources, and use social media as a tool for reassurance rather than panic. If you suspect your condition is life-threatening, seek medical attention immediately. However, if the information suggests that your condition is not critical, take the time to understand it fully before panicking.

The Healthcare System: A Sacred Cow?

Now, let’s move on to the more sensitive issue of the barriers within our healthcare system. It’s often considered taboo to criticize our institutions, and healthcare is no exception. Patients may complain all they want, but it’s often brushed off because it doesn’t make a difference. However, when healthcare professionals critique the system, it’s taken very seriously, and people tend to take offense. But constructive criticism is necessary to improve the system, and we must continue to voice it.

One of the things that saddens me most is the role of doctors, especially nephrologists, in the awareness and management of kidney disease. Despite holding large conferences in prestigious hotels and beautiful locations, I don’t see these gatherings having a real impact on patients' lives. If anyone benefits from these events, it seems to be the pharmaceutical companies, who often foot the bill.

The second major issue within our healthcare system is incentivization. Our healthcare system is heavily influenced by the sale of medications rather than focusing on patient education and prevention.