Peripheral medical vision can save lives

Dr. Frank Maddux
Dr. Frank Maddux

Five years ago, my life required saving and I didn’t even know it.

At that time, I was a doctor of 27 years, only 52 years old, a respected voice in my field, healthy by most accounts, lying on an exam table like many before me watching my heart on a monitor. Unlike millions of Americans who get this evaluation every year, I knew with one glance that the obstructed blood vessel on the monitor would require a serious procedure. Soon after, I would undergo heart surgery.

As a practicing kidney doctor and head of medicine for the country’s largest kidney care provider, I have seen thousands of patients. I have explained the risks of “silent” kidney disease that could lead to a life of dialysis to many. But how often had I missed silent cardiac disease like my own?

It made me think of my own peripheral medical vision – the ability to look beyond what was right in front of me – and the ability of the rest of the health care system to do the same.

North Carolina, where I trained and practiced for years, is tied with several states for the second highest percentage of patients on dialysis, with 1,497 per million, according to the National Kidney Foundation. At the same time, the American Heart Association says heart disease is the second highest cause of death in the state.

The body is much greater than the sum of its parts. Yet health professionals often look at things in terms of independent organs or disease processes.

Systemic diseases do not play by those rules. Comorbid conditions, the presence of more than one disease, can appear in as much as 25 percent of the population, according to a 2010 study by the Centers for Disease Control and Prevention.

As medical professionals, we need to improve our ability to view patients’ complete health – otherwise we risk missing a host of interacting disorders.

A prime example is kidney and cardiac disease. A number of studies have shown that cardiac disease is the biggest killer among patients on dialysis, accounting for 20 to 30 percent of deaths.

A recent study by Johns Hopkins University shows that a simple blood and urine test used to identify people with kidney issues is an accurate predictor of increased risk for heart and vascular disease.

The U.S. Preventive Services Task Force should recommend aggressive screening with these simple tests for all adults, something it currently does not mandate. Furthermore, we need to train physicians to spot the links between kidney, heart disease and related chronic conditions, as well as complete further research into these links.

We should not let heart disease sneak up on our patients like it did to me. We need more active surveillance to link systemic conditions. It’s time to take the blinders off and take a clear-eyed look at how we treat patients.

Dr. Franklin W. Maddux is the Chief Medical Officer and Executive Vice President for Clinical and Scientific Affairs at Fresenius Medical Care North America. He also is a Clinical Associate Professor of Medicine at the University of North Carolina School of Medicine.