The hemodialysis patient: object of diagnosis or part of the treatment team?

Through multidisciplinary diagnosis, the end-stage renal disease (ESRD) treatment team defines the patients's problems and sets goals to reach positive outcomes. Each of the team members has a voice in recommending strategies to reach these goals, because each has been trained in appropriate treatment objectives. Patient noncompliance (nonadherence) with team recommendations can be a major, ongoing problem for the team. The untrained, unhealthy, and often unconsulted amateur member of the team is the patient who is asked to carry out the team plan. Where is the patient's place on the team? There is no doubt that the patient can enhance the planning and development of the treatment objectives. But is the patient's presence seen as a hindrance to planning? More consideration needs to be given to this ongoing issue in an effort to achieve successful patient-oriented outcomes.