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Sorry Curt. i am at work and just had time to read what you had said. thank you for the insight. i agree that the information is not dangerous to the majority of the people out there. I had a patient not to long ago with severe anxiety and obsessive compulsive disorder. This pt showed up 3 hours early for her study. i came in early to help her. She made me check her blood pressure every half hour until i put her to bed. During the hook up she diagnosed herself with CHF, COPD, and neurmuscular disease. All of this because she had read about apnea. whichh she ended up having a very mild case of. There is no way that you could convince me that this patient would benefit from knowing how to change her pressures. it is not something that everyone needs to know. That is my opinion anyway.
Mr. Hinkle,
I take a total exception to your statement here.
If the doctor says it will get better if you walk off the cliff, you’re not going to question his order?
You, and every other person in the medical profession had better be questioning everything, unequivocally. If you don't question everything, and the doctor has erred, because you followed his directive knowing it to be flawed, in addition to getting sued, you’re criminally negligent - period. (I know you don’t like the idea, but I suggest you educate yourself to the criminal laws to which you can be subjected to in relation to your job duties and responsibilities.)
To question him openly, whether in front of a patient or not, may save a persons life and it is your duty, whether you like it or not, to protect the patient's well being contrary to your fear of hurting the poor physician's feelings.
Rock Hinkle said:As medical professionals we have to assume that the doc knows best. We are after all extensions of him/her empowered to do only what they give us permission to do. Questioning a doctor's decision in front of a patient is bad form. Any questions your RT had should have been asked prior to delivering you your machine. I believe it to be naive to believe that we are smarter than our physicians. Yes I have met my share of docs with no common sense, or street smarts. very few, if any, have been intellectually slower than me.
Judy said:Nope, jnk. The RT didn't question it at all, just set it 4-20 as scripted.
"the RT in Judy's situation should have had the knowledge to know what to do in this situation. He was an RT for godsake. How could he not be educated in COPD. This to me is individual negligence." >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> Indeed, it is right to ask this & other questions. "He was an RT for godsake"......... Now that 'He' has been identified as a "negligent" RT, who is going to blow the whistle on this "negligent RT" and sort him out? I assume because he is a "RT (registered therapist?) he is registered or licensed or has some sort of American recognized credentials. Perhaps he also has to be a bona fide member of some American RT members Assoc. or Professional group. Because he is an official RT, the public is entitled to assume he is competent, knowledgeable and trained enough by whatever "registering" agency certify s you folks. Who or what Professional Health Care "college or group" is now going to go into bat for the public patient and either sort this fellow out, censor him, de-register him or just hold a closed door members only disciplinary hearing & privately and secretly "self regulate" this 'negligent' professional member of their own self regulating society? It is human nature for all so called professional societies to wish to keep every negative aspect of their members conduct "covered up", "kept in house" and to never wash their dirty laundry in public. That is in all social groups and whether right or wrong, the wagons circle & the shutters come down, "in the interest of professional confidentiality".................... Not bagging your RT certification(s) / training, but as you say, "how could he not be trained in COPD?" Here in Oz, the Health Care Professional that will "treat, advise, fit and then sell" you your CPAP machine, if vended from a participating ResMed "authorized" Chemist / Drug store, will probably have been one of the permanent chemist shop staff who was that stores best "Homy Ped" health shoe salesman or perfume / beauty products 'consultant', etc....... He / she will have probably attended the ResMed sales reps one day 'official ResMed RT' intensive training course, given in the chemist shops lunch room. A "certificate of completion" / "attendance" (suitable for framing) will then almost certainly be presented to each successful newly 'trained' Resp. Therapist. That former health shoe salesman is then turned loose on the paying public who believes they are being treated / advised by a comprehensively trained health care professional. The names / places may change with different manufacturers, retailers or Chemist chain store policy, but that will cover most newly emerging "sleep wellness centres" that are opening up here in Australia all over. Not the best way to get the CPAPs into the hands / bedrooms of the thousands of Australians that suffer from some form of sleep dis order(s), but at least it is "educating" the public about the insidious health danger / risks of un treated sleep apnea etc..... Because the amounts of money this sleep wellness industry generates, it will, of course attract every sort of scammer, shyster, huckster, fraudster, unscrupulous dodgy sort of low life money grubbers into its ever expanding "profession". The 'negligent' professionally licensed / registered professional will also be in amongst this lot. After a long amount of time and the public outcry / exposure by the TV media 'muck rakers', the Australian govt. will step in & take over the management of this 'industry' by introducing public safety bureaucratic regulations and of course figure out some way of taxing the industry. In Oz, we need a doctors prescription to purchase / order / rent / lease a CPAP machine. If you do not wish to trouble your overworked GP or overburdened public funded hospital "sleep clinic", the manufacturer will provide a doctor issued script for you. No waiting / appointment necessary. You will probably not even be in the same state as the prescribing doctor, nor will you ever physically ever see / contact / consult with the scripting doctor ( nor will you ever be allowed to see the issued script or know who the Dr. was that Rx'ed it)........... Again, not the best system, but it got me tested, diagnosed and most importantly, allowed me to place a world class machine on me and my wife's' bedside table(s). >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> As far as Michael Jackson goes. I do not care. He got what he deserves. How much money do you think he paid for the treatment that killed him? < I have no idea how many US greenbacks went into the local Doctor(s) & providing Pharmacists bank accounts, but the true amounts will never ever be known. Whether Michael Jackson "got what he deserves", depends on your moral / ethical / religious / personal beliefs etc. He bought the drugs he craved by "buying" the integrity & honesty of the health care professional Doctors, pharmacists & I would not know who else. Any industry or profession that self regulates itself is set up to fail from the very start. Govt. oversight / regulation becomes a bloated bureaucratic monster and most members of the consuming public are too apathetic, dis interested or frankly, too stupid, to care about what sort of service(s) are provided to them, as long as the govt., HMO, insurance company, employer or what ever Mr. Obama's' national health care scheme (taxpayer funded, of course) picks up the tab. I personally think most of the famous celebrities / rich folks / politicians hardly ever get what they deserve. Perhaps in Michaels case, the chickens came home to roost a bit before he & his camp followers were ready.............. < Curt, there is no way that you could convince me that this patient would benefit from knowing how to change her pressures. it is not something that everyone needs to know. That is my opinion anyway. >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> I acknowledge exactly the scenario you described happens far too often in all branches of any service providing industry / service. Why would I even consider "trying to convince" you that your patient would benefit from knowing how to change her pressures ? I absolutely agree that " it is not something that everyone needs to know. That is my opinion anyway." Who could believe these sorts of folks could or need to have access to these sorts of info etc ? But, in my own personal family situation, I now believe my wife & I both know more about sleep disorders & the scope of therapy available using the ResMed brand of CPAP machine - therapy. The re-treaded shoe salesman / RT was so nervous & self conscious during her "break in" initial 'consultations' with my wife & I, WE were encouraging her & leading her through the fitting & 'counseling' session. The chemist, though, oversees & monitors the shops trainee RT's so I don't think the risk or any "fatal negligence" will occur there. The patient is given the machine & mask to take home and the pressure settings are the "infamous" 6-20 cent. of H2o minimum / maximum settings. After one week, you come back in and download the weeks data & the "RT" adjusts the settings (titration?) according to the ResMed furnished handbook and you go home for another week of trials. The perfect set up? Probably not, but as I said before, it gets folks at least to recognize they may have a life threatening condition & gets the ball rolling as far as available non hospital provided advice / treatment. The waiting list for getting a (free) govt. funded o'night sleep study is way over 12 months & that time lapse is growing even as I type. I jumped the que by funding my own private sleep study & funding my wife & my treatment / machine(s). Those that can't do that or afford it, are probably doomed to years of sleep disturbance before the "free" govt. system gets to them. No qwik fix or "right answer" for every situation / scenario. Good luck to all that are afflicted with these & other health problems......................... YMMV, Curt Hakl
Duane McDade ... I don't condemn the RRT or the sleep doctor because the sleep doctor ordered 4-20cm and the RRT set the APAP at 4-20cm BECAUSE I have no idea if 4-20 cms WAS what the doctor ordered or if he didn't order any particular pressure at all OR if he ordered a more logical pressure range and the RRT took it upon herself to set it 4-20 cms. I don't KNOW what the scenario behind the scenes was. What I DO know is that I don't have a particular amount of respect for either of them. The RRT has proven to be either less than truthful or not at all knowledgeable on other matters and the sleep doctor wasn't interested in ANY data except how are you feeling and a cursory look at ONLY the summary data page - I got the impression only to verify I was telling the truth that I was 100% compliant - once we got the fiasco of no humidifier ordered or provided and I was able to obtain a stand alone heated humidifier FROM A FRIEND, not a professional. Needless to say I left the "care" of those two "professionals".
And, frankly, so far the only "sleep professionals" that I've come to admire and respect are the PSGTs. Not to say there aren't some "bad" PSGTs out there too. Just that my PERSONAL experience has been BEST w/the PSGTs and considerably less so w/the RRTs and MDs/DOs on the whole. I'm fortunate now to have a helpful RRT and a decent DO. But that wasn't always the case. I think many of us CAN agree that the sleep profession has some serious growing pains to work thru.
Meanwhile - fully data capable CPAPs and APAPs are EXCELLENT trend verifiers between good in-lab PSGs as indicated and needed - or in defense of poor quality or unobtainable sleep professionals..
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