Thread by @arvindcanchi

This is a Thread about the Indian caregiver.
Most #CKD & #Dialysis pts come with their relatives as caregivers when they come for an OP consult. Usually it is the spouse & sometimes, the children. I make it a point to enquire about their health even though they are not my pts 1/n

I will tell you why I do that with a couple of real-life events. My 55 yr old #CKD Pt came without her husband for a consult which was unusual. When I asked her, she started bawling out in distress, saying that he'd died of a heart attack the previous month. 2/n

He was 60 years of age and hypertensive, but it appears that he never bothered to go for his regular BP check or for that matter an annual cardiac check. I didn't know of this & wondered at the time, should I have asked him how he was during his many visits to my OP chambers? 3/n

Another of my pts who has been on my follow-up for DKD for 18 yrs asked my if I remembered his son who'd accompanied him to his OP visits more than 10 yrs ago, but lived elsewhere now. I said yes I do & he said "oh, he has some mild leg swelling, that may be nothing I guess?" 4/n

I advised a couple of tests and it turned out that the son had DKD with proteinuria and a Screat of 1.3 mg. Out of sight is out of mind, people say. Should I have asked my diabetic Pt to get his son screened earlier?
(The Bangalore Hospital HD pts demographic data👇) 5/n

I've made it a point for some years now to ask every caregiver relative how they are doing. Any doubts that they may have about the Pt or about themselves. It is sometimes difficult to do that in a conversation inside an OP consult room when you are not talking to a patient. 6/n

We tend to gloss over "family and family history" sometimes, due to our workload. But I feel, that we need to give this more importance. Currently I tell all my pts to get their relatives screened for hypertension and diabetes & complications if they are above 35 yrs of age. 7/n

In the broader sense, screening for such diseases should be a public-private partnership? Should there be govt policy in India that mandates health checks on joining a job & 5 yrly therafter, on joining govt enterprises such as the armed forces and PSUs, & Private Companies? 8/n