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Permalink Reply by Mike on August 26, 2009 at 1:39pm

fortunately, it isn't just you. but you and your ilk are just a small subsection of the population of folks diagnosed with sleep apnea who take a proactive approach to managing the condition. the newly initiated rarely realize how new and in flux this aspect of medicine truly is, and kind of rely on their doctors to know everything and tell them what to do. then they get crap equipment/service and fall out of "compliance" and off the radar.

i do think the physician should be accountable for keeping abreast on the latest developments with this stuff and conveying it to the patient. sleep deprived patients who haven't yet seen how much these machines can move the needle forward for their well-being don't have the proper motivation/information at the time of diagnosis.

j n k said:

I think that any physician that decides to know about machines and masks is exceptionally motivated to learn outside his realm. My theory is that the techs are supposed to know how to test, the doc is supposed to know to prescribe, and the crutch-salesman is supposed to know how to apply the prescription to machines and help me with masks. I think they should all willingly answer my brief, pre-researched questions, but I consider it my job to keep up with what is going on to make sure I get what I need and to keep them all honest. But that's just me.

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Permalink Reply by Mike on August 26, 2009 at 2:09pm

that might be a winning approach for your doctor to take, but what about the doctor for a newly diagnosed patient who is clueless?

j n k said:

Maybe all sleep-docs should have a bank of computers in the waiting room with links on the desktop to the sleep forums. :-)
I like a doc who stays away from machines so I know he isn't in cahoots with the neighborhood crutch-salesman.
The only exception is when it comes to SV machines. I would expect the doc to know them and perhaps presribe a particular brand, even.

Yeah, I know that is a confusing position to take. I'm not even sure I agree with myself on that one.

:-)

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Permalink Reply by Judy on August 26, 2009 at 9:29pm

Keep in mind that the locals invest af pretty good chunk of change to have a supply of xPAPS and accessories on hand and readily available when a new patient is sent over by the sleep doctor. AND they get reimbursed for that investment in drips and dribbles over a period of 10 to 13 months in most cases. Whilst the online DME suppliers get their money up front BEFORE the equipment is ever shipped.

That being said I happen to believe that the sleep doctors SHOULD KNOW about the various xPAPs available w/a rough idea of their capabilities, at least of the more sophisticated models such as bi-levels and SVs, etc. They have access to the data from the titration they SHOULD be able to use that data to write a pretty specific script for their patients' needs. Sending a generic script for a bi-level of IPAP 10, EPAP 5, heated humidity is pretty darn poor scripting in my book. And "I" am only recently learning that one brands settings aren't necessarily the same as another's and titrating on one doesn't necessarily equate to therapy on another's but the sleep doctors don't seem to realize that yet. I don't expect them to know the finer points and all the comfort options of every brand and model but I do think they are sadly lacking in interest or knowledge of at least the more important ones. And I sure as heck am NOT impressed w/these sleep doctors who totally ignore APAP data or data from any fully data capable CPAP as not reliable, who aren't willing to at least recognize that data's value in exposing trends that at one night PSG just can't.

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Permalink Reply by RockRpsgt on August 31, 2009 at 5:15am

I disagree Judy. i think that the doctor needs to know about sleep, how to fix it, and how it pertains to his individual specialty. It is not the doctors fault that the system is messed up. We scream for PAP independence in one post, but then talk about putting more responsibility in the doctors hands in another. That makes no sense. the doctors should no what kind of buisiness practices the DME he is contracted with is conducting, and he should know that the DME is up to date on the technology.

As far as the machines being different. how can we expect the doctors to know what the manufacturers do not understand.

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Permalink Reply by Judy on August 31, 2009 at 10:32pm

Shucks, Rock Hinkle!!! The sleep doctors in our area are NOT contracted w/the local DME suppliers. The patients' INSURANCE is contracted w/the various local DME suppliers and the sleep doctors just write the script and send it to one of the local DME suppliers your insurance is contracted w/and, at least my sleep lab, ask if I have a preference amongst the 3 locals my insurance was contracted with.

Yeah, I want more independence - BUT - if the doctor isn't willing to give that independence then he should know MORE about the bi-level he is scripting than he does. One or the other, right? We can't have it both ways?

But yeah, yer right, sleep doctors SHOULD know about sleep, how to fix it, and how it pertains to his individual specialty. The key word is SHOULD.

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Permalink Reply by Judy on September 1, 2009 at 12:54am

You know, Rock Hinkle, at one time I would have said I would have no use for a sleep center wherein I didn't have a consult w/the doctor - but - a couple of years experience down the road - I would GLADLY skip seeing the doctor if I'm given my druthers and can see the RPSGT for a consult!!!!! Ooops.You DID say RRT/RPSGT! Both credentials, so much the better!

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