Summary

The author questions the motives behind healthcare providers' persistent recommendation for peritoneal dialysis (PD) despite their preference for traditional dialysis, suspecting financial incentives.

Abstract

The author, who has been documenting their experience with dialysis, expresses skepticism about the healthcare system's push for peritoneal dialysis (PD). Despite thorough research and a firm decision to opt for traditional dialysis, they face repeated suggestions from doctors and counselors to consider PD. The author wonders if these recommendations are influenced by financial gains, such as commissions or bonuses, rather than the patient's well-being. They describe a series of interactions with medical staff, including an unsolicited call from a dialysis center counselor advocating for PD, which leads the author to suspect that the persistence may be due to monetary rewards for healthcare providers who encourage patients to choose PD over more costly in-center hemodialysis. The author's resolve to stick with their choice of dialysis treatment is based on careful consideration and extensive research, and they resist the pressure to switch to PD.

Opinions

The author is skeptical of healthcare providers' motives for pushing peritoneal dialysis, suspecting financial incentives.
Dr. E and his assistant are perceived as overly insistent on peritoneal dialysis despite the patient's clear preference for traditional dialysis.
The author feels that the counselor from the dialysis center used guilt to pressure them into considering PD, which they found manipulative.
There is a belief that insurance companies may be complicit in pushing PD due to lower costs, possibly offering incentives to healthcare providers.
The author is firm in their decision against PD, citing valid reasons and extensive research to back up their choice.
The author appreciates the support of one counselor who respected their decision and offered to cancel an unnecessary appointment about PD.

On Commission? A Fishy Story.

Our dialysis story — chapter 18

Photo by Money Knack, www.moneyknack.com on Unsplash

More and more, I wonder if some of our healthcare providers are paid by commission.

When Dr. E first mentioned dialysis to us, he was confident that peritoneal in-home dialysis was the right option for Ben. He expected us to proceed in that direction with very little information. His assistant, a PD dialysis patient before her kidney transplant, was just as confident.

I wasn’t. I couldn’t go forward without information — lots of information, facts, and opinions — and no one was offering that. So, I Googled and read and watched videos and shared my findings with Ben.

Together, we decided peritoneal dialysis was not for us.

I stated my case and convinced Dr. E’s assistant that traditional dialysis was a better choice for us. Dr. E, however, was not convinced. Even while we were in the emergency room, waiting for Ben to be admitted to have a temporary port installed and to start dialysis, Dr. E came by and said that he was sure Ben would end up doing PD.

Since then, Ben’s had fistula surgery to merge a vein and artery for long-term hemodialysis. I call that a firm commitment to our choice.

Dr. E visited Ben at the dialysis center last week, and again, he brought up peritoneal dialysis. Really?? Again? He told Ben:

You can always choose to switch from hemodialysis to PD.

Ben said he was satisfied with his current dialysis situation. Dr. E smiled and said:

You can always change your mind!

Later that day, while Ben was still at dialysis, I received a call from a counselor at the center. She wanted to make an appointment with me to discuss at-home peritoneal dialysis. I told her what I told the other counselor that called when Ben was in the hospital:

Thank you, but I thoroughly researched PD, and it’s not a good choice for us.

She replied:

Don’t you think it’s worth 15 minutes of your time to hear what I have to say about PD? Surely, you can spare that much time to discuss what’s best for your husband.

She played the guilt card well.

I agreed to give her 15 minutes after I take Ben to dialysis tomorrow. I knew she would not change my mind, but I didn’t have the energy or the time to argue with her over the phone.

When I picked up Ben that day, I told him about the call and my appointment to speak to the counselor. He didn't like it:

Dr. E visited me today and talked about PD again. I’m sure he told the counselor to call you. Why waste your time? Why won’t they leave us alone about this?

It’s okay. I’ll talk to her for a few minutes and present our case. Maybe, they’ll leave us alone after that.

Yesterday, I received a call from the first counselor who spoke to me when Ben was in the hospital. She said:

I understand that you and your husband have changed your minds about PD.

Confused, I replied:

What? No, we haven’t changed our minds. Why do you say that?

Oh, I’m sorry. I was told you have an appointment with S tomorrow to discuss switching to PD.

I explained that I only agreed to a 15-minute appointment to get everyone off our backs about PD. I reiterated what I told her in May.

Yes, I recall the reasons you had for not wanting to do PD, and they were all very valid. PD is not for everyone. I’m really sorry S pressured you into a meeting. If you and your husband are satisfied with hemodialysis, you don’t need to convince S or anyone else of your reasons. We need to respect your research and the decisions the two of you made. After talking to you in May, I knew you were well informed and that you and Ben made a well-thought-out decision. I’ll cancel your appointment with S.

I thanked her.

Ben and I are certain that we haven’t heard the last about PD, which makes me wonder if there are financial incentives for doctors and counselors to push a patient to PD. Do they get paid a commission for PD patients? A bonus? A free vacation in Fiji?

The insurance companies pay less for PD than in-center hemodialysis since the patient and caregiver do all the work. Are they behind these annoying pushes for Ben to switch? Do they give monetary rewards for coercing a patient into PD? Maybe a health providers’ Caribbean cruise?

I don’t know, but . . .

It sure smells fishy to me.