Introduction : In Japan, there are over 300,000 hemodialysis (HD) patients and 6,000 new patients are introduced yearly, a figure which is increasing. It is estimated that 12,000 specialists are needed to provide care for these patients, but there are currently only 4,000 to 7,000 such specialists. There is very little literature regarding the role of generalists in the care of HD patients. In our facility, family physicians provide care for HD patients including managing end stage renal disease (ESRD) with backup support from nephrologists.
Aims : To explore the possibility of expanding the generalist's role in the care of HD patients by critically reviewing our care using several quality indicators and demographics compared with available literature data.
Methods : Retrospective chart review.
Outcome measures : patient demographics, quality indicators including Kt/Vdp, hemoglobin, serum albumin, serum calculated calcium, serum phosphorus, intact-PTH, rates of hospitalization, transfer of care, and death.
Results : Fifty-two patients were cared for in 2011. The average target achievement rate was 80.0% for Kt/Vdp, 69.9% for hemoglobin, 63.7% for serum albumin, 85.4% for corrected serum calcium, 78.3% for serum phosphorus, and 56.8% for intact-PTH.
Conclusion : Generalists can contribute to the care of HD/ESRD patients by utilizing appropriate quality assurance training and support, and in turn reduce the work burden of specialists without compromising quality of care.

Introduction: The learning and practice of bereavement care by Japanese family practitioners has largely been unexplored. The purpose of this study was to clarify what family doctors thought they learned by providing care for bereaved families and how they changed because of it.Methods: Semi-structured interviews were conducted with seven family practitioners working in bereaved family outpatient care at the researcher's hospital. A modified grounded theory approach was used for the analysis.Results: The analysis identified five thematic categories: 1) the doctor's feelings and thoughts before learning about bereavement care, 2) things they learned from providing bereavement care, 3) things they learned by interacting with the families and things they learned upon reflections afterward, 4) changes in themselves, and 5) changes in their feelings after learning about bereavement care.Conclusion: The doctors learned to provide bereavement care by directly interacting with families and by reflecting on those experiences; for example, they learned to listen and be empathetic, and to understand individuals' personal responses to grief. As a result, they may have gained the ability to have a more rounded view of life and death and of their role in helping families adjust to the death of a family member.