In April, Lynda A. Szczech, MD, MSCE, FASN, became the first woman in the National Kidney Foundation’s 60-year history to be appointed President-elect.
Szczech is currently associate professor of medicine at Duke University Medical Center in the Division of Nephrology. She earned her undergraduate degree from Pennsylvania State University, her medical degree from Jefferson Medical College and an MSCE in Clinical Epidemiology and Biostatistics from the University of Pennsylvania, School of Medicine.
What got you interested in nephrology?
I initially started my internship thinking that I wanted to be an oncologist and a hematologist because I was really fascinated by the abstract nature of cell division and what goes on in the bone marrow. And then I met some of the nephrologists here at Duke. They were the kind of doctors I wanted to be when I grew up, and their love of nephrology was infectious—in a good way. They were just role models for me. Through their eyes I learned to love the kidney, and then subsequently love the patients. They are a hearty bunch who go though a lot and are really to be admired.
It sounds like it offers a different experience for doctors?
It does. The care of the CKD patient is going to this field where so much of the care of the patient is in the subspecialists hands. Most primary care providers are very afraid of dialysis patients. They’re very afraid of people who have creatinine that are out of the two or three range. Nephrologists understand that, and they take on a greater role in these patients. PCPs just don’t feel like they can keep up with everything that they need to with those patients. Nephrology has been dealing with this for a long time. It does offer more than just life as a subspecialist because you have to understand the every day bread-and-butter problems that a person gets just because they’re a person—not because they’re a person with kidney disease.
Is it more of a job of the nephrologist to stay in contact with the PCP?
I think so. This is something that on public policy platform that we’re going to start seeing real changes over the next decade. The last decade has been spent with nephrologists jumping up and down saying, “Hey, remember the kidney. You know what, a creatinine greater than 1.4 doesn’t mean that CKD has started, it started much before that.”
We’ve been jumping up and down, yelling and screaming, trying to get awareness. And I think that’s really started to happen, where people are relying on the eGFRs that they get on the lab, knowing how to interpret them and calling them to the attention of others when they are slightly abnormal. Now, we really have to get into the communication. The public policy things that are changing nationally includes the concept of the patient-centered medical home.
The nephrologist is going to have to take a much greater role in communication than we have in the past because of the epidemic of CKD. The more patients, the less you can do as a silo, an island, the more you really have to act as a consultant and say, “In this situation, I would do the following. Please send back to me when.” That’s something I think we’re going to have to tackle as a subspecialty over the next decade with the increased communication and greater awareness.
