A Patient Directs His Own Care

This story originally appeared in the 2012 IHI Annual Report.


Christian Farman was diagnosed with renal failure at age 25. An athletic man in good shape, he recalls, “It was a big shock for me to get into dialysis.” When he started treatments, Farman quickly experienced side effects such as nausea, edema, and extreme thirst. “It was horrific,” he remembers.





“You have to help me treat myself. I need to have control in my life.”

 Christian Farman




Farman received a kidney transplant, but in 2005 he was back on dialysis. On the first day of treatment, he spoke with Britt-Mari Banck, a nurse in the Ryhov County Hospital hemodialysis clinic in Jönköping, Sweden. Farman said to her, “You have to help me treat myself. I need to have control in my life.” He had researched self dialysis and became convinced that if he could manage his own treatment, the side effects would disappear.

In many dialysis centers, the story would have ended there. But Farman’s unusual request was met with an unusual response. “I said, ‘Yes, how shall we start?’” recalls Banck, now acting head nurse for the hospital’s self-care dialysis unit.

Banck showed Farman how to use the dialysis machine, read and interpret lab results, and document his care in his chart. Within five weeks, Farman was managing his dialysis independently. He discovered that self-dialysis resulted in fewer side effects.

Before long, Banck was training other renal patients to manage their own treatment. As more patients performed their own dialysis, and had dialysis more often because it was a less burdensome process, infection rates fell. “We were a community,” Farman says, “and we didn’t feel we were sick anymore, because the treatment was so good.”

Today, nearly 60 percent of the hospital’s peritoneal dialysis and hemodialysis patients are managing their own treatments. The hospital aims to increase that number to 75 percent. Banck says, “It’s a very joyful thing.”

As for Farman, he left his job with Saab Avitronics and went to nursing school. He’s now a registered nurse in Ryhov County Hospital’s ear, nose, and throat clinic. “I have a big advantage, because I see the patient as a resource,” he says.

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