Nephrologists between power and vulnerability in times of technology

Abstract

The doctor-patient relationship is often discussed from the perspective of patient vulnerability. Little attention is given to the vulnerability of nephrologists in their professional practice, a reality often affected by profound cultural transformation arising from technological development. Nephrology is based on research and procedure instrumentalization, both permeated with technology. In addition, the relationship between nephrologists and institutions is governed by market rules. Recent data showed a shortage of new nephrologists and the need to improve the technical training of new professionals, foster the establishment of interventional nephrology, and attract more graduating physicians to this medical specialty. Bioethics offers a different perspective on the issue, since it takes the subjective concerns of medical doctors and the social environments they participate in into consideration in order to enhance their ethical autonomy. These ideas may be discussed as part of undergraduate or specialization programs, thus reinforcing the acknowledgement of vulnerability as a condition and of the relevance of adopting a reflective attitude toward the events of everyday life that interact with the morality of nephrologists, so that risks are adequately faced having bioethical parameters as a reference.

Toma de decisiones en la retirada del tratamiento renal sustitutivo: aspectos éticos

“…el riesgo de burnout, fatiga por compasión, problemas morales y vulnerabilidad. Esto ocurre especialmente si carecen de conciencia de sí mismos y de un entorno de trabajo adecuado 57 , por lo que es necesario que desarrollen una conciencia crítica de su situación 39 . En España, el índice del 11-23% de burnout en personal sanitario general aumenta a un 27-39% en nefrología 1 .…”

“…Los diferentes tipos de TRS, especialmente la HD, tienen un gran coste económico 39 . Esto tiene repercusiones en los servicios de salud de los países que la subvencionan y en cómo se reparten sus recursos.…”

Nephrologists and patients: between vulnerability and equity

“…In this context, Obregón et al's 2 paper is quite original, since it reverses the traditional viewpoint, concentrating not on the vulnerability of the patient, but rather on nephrologists themselves, regarding the technological, economic and professional contingencies that affect their field of work, their medical fees and their labor ties. 2 A recent paper produced by our group sought to expand the view on vulnerability in the developing countries that make up the BRICS (Brazil, Russia, India, China and South Africa). 3 These countries account for 40% of the world population, 25% of the World's Gross Product and 40% of the Global Burden of Disease.…”

The Brazilian Society of Nephrology Code of Conduct: a bioethical analysis

“…Nephrology was one of the medical specialties most affected by ethical dilemmas resulting from the accelerated scientific-technological development in the post-war period, with nephrologists often exposed to difficult ethical decisions, especially in a context of scarcity of resources 5 , 6 . It is no coincidence that most Nephrology Societies were created during this period, such as the Brazilian Society of Nephrology (SBN), founded in 1960 7 .…”