The role of the nephrologist in patient rehabilitation.

The justification for the enactment of the End-Stage Renal Disease (ESRD) Program in 1972 was to provide the lifesaving potential of dialysis and transplant to patients with terminal renal failure. Implied as a return on cost was that many of those whose lives were prolonged would contribute to society through work and taxes. It is not surprising at a time of growing concern about health-care costs that vocational rehabilitation for patients undergoing dialysis and transplant has again come to the attention of Congress and others. The nephrologist, the leader of the health-care team caring for patients on dialysis and outpatients with transplants, plays a crucial role if an increasing number of patients are to be rehabilitated. The attitudes of the nephrologist can establish the belief in staff and suitable patients for or against the possibility of attending school, retraining, or working. Identification of medical problems as impediments to rehabilitation and their resolution, where possible, is an essential function of the nephrologist and other team members. Any process that seems at first glance to be difficult requires an evangelist if success is to come. The nephrologist must be the primary motivator. There are a number of extrinsic barriers to rehabilitative success including employer health insurance, disability regulations, and attitudes toward people with disabilities. The nephrologist, as a respected figure and patient advocate, must be willing to deal aggressively with these barriers whenever the occasion arises.(ABSTRACT TRUNCATED AT 250 WORDS)