Giselle Kohler, MD, has long felt a strong obligation to ensure that patient and families fully understand the ramifications of medical care and long-term treatment. As a nephrologist in private practice in Springfield, Mo., the 2015 alum of the Nephrology Fellowship Program at Washington University School of Medicine takes care of patients in the region stretching from southern Missouri to northern Arkansas.
“I’m amazed at the diversity and level of pathology I see daily,” she says. “It has been an outstanding experience.”
Kohler has been interested in the physiology of the kidney since high school. One of the reasons she pursued a medical career in nephrology was that she would be able to enjoy the “critical thinking that comes from analyzing complex acid base cases.” With dialysis patients, though, the appeal of nephrology is that Kohler is able to develop close and longterm relationships with patients. It was during her fellowship that she realized some of her most memorable experiences with patients involved helping them manage difficult situations.
“In internal medicine, and even more so in nephrology, patients present with complex and often chronic medical illnesses with significant morbidity and mortality,” explains Kohler. “I wanted to better understand my role in complex medical cases where critical illness and end of life intersect, so I decided to seek additional training in bioethics.”
Kohler earned an online certificate in bioethics from Loyola University in Chicago. She subsequently joined the Washington University Ethics consultation team, a multidisciplinary team that assessesand evaluates ethicalconcerns and offers recommendations on approach to medical care. “It really enabled me to put into practice the ethical concepts I learned in my certificate program,” she says.
Recently, Kohler returned to the Division to lecture on A Practical Approach to Ethics in Nephrology, in which she discussed shared decision-making and four key themes that influence care decisions: medical indications, patient preferences, quality of life, and contextual settings such as social, financial or other concerns.
Reminiscing about her time as a fellow, Kohler says the hours were longand the work was demanding. “But we were all supportive and helpful to one another,” she is quick to add. “I really enjoyed spending a whole conference discussing the nuances of a single case and hearing the different perspectives of faculty. The program was outstanding and the teaching and mentorship were excellent.”