Replies to This Discussion

Permalink Reply by Rock Conner RRT on August 24, 2009 at 11:02am

Jeff's is a reasoned view.

j n k said:

Rock,

I often see merit in approaches that aren't my approach of choice.

And yes, I have argued against the home-study model more than I've argued for it.

But the present system is less than perfect as it now operates, and in my opinion the people who 'don't have time' are the ones with severe obstructive sleep apnea but have no idea what is killing them. Speed versus quality of care is often the fine line to walk in choosing overall approaches in medicine. Or, so I hear.

Since it doesn't make sense to give the whole world an NPSG, concerned people can't be blamed for brain-storming ways of getting at the undiagnosed more quickly and more cheaply. When the treatment that is likely to help by far the majority of the SDB sufferes is so much cheaper than the tests and associated office visits for getting to the treatment, one approach is simply to see if a patient responds to the treatment so that the treatment itself becomes part of the diagnostic process. Docs do that all the time with drugs much more dangerous than pressurized air. And many highly-respected sleep docs already do that with pressurized air by having a patient sleep with an auto for a month or so when the titration is inconclusive.

So if the choice is between a diagnostic process that runs up into the thousands of dollars versus a diagnostic process of just handing the patient a $600 full-data machine to see if that helps, the arguments against the $600 option had better be awfully clear to the bean-counters.

I think the proponents for the home-test model (of which, again, I am not one, yet) admit that certain patients do not fit that option and, further, that some getting the home test and a machine would need to be sent for a PSG if daytime sleepiness or fatigue continues, or if the estimated AHI reported by the home machine remains high, indicating possible central complications. So it isn't an all-or-nothing proposition, Rock.

But it could still potentially mean less business for the labs/centers years down the road. And surgeons and dentists would probably get cut out of the loop (if you'll pardon the expression) completely. Once enough primary care docs see what those machines can do, they might bypass the specialists completely and do so with the full blessing of insurance.

That thought scares me, personally, just as it does you. But I still see the potential for it happening. And the arguments against it are getting harder and harder to make, in my opinion.

Maybe the writing on that wall is part of why some bodies have given up on educating techs. :-)

jeff

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Permalink Reply by RockRpsgt on August 24, 2009 at 5:20pm

You guys are really good at this! I concede.

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Permalink Reply by Banyon on August 24, 2009 at 7:07pm

Cindy Brown said:

If it's the cost involved why not just send home a video camera and taping system that could tape folks while they sleep. The video tape of someone with untreated severe sleep apnea can be a powerful diagnostic tool. Especially for those people in denial. We all know that one of the biggest hurdles to diagnosis is getting the patients to even acknowledge they have a problem.

Having said that, our sleep docs have been using auto titraters for patients the suspect have sleep apnea. They have also been sending auto titraters home with patients that have been diagnosed in the lab and with a home study. They also have been sending their patients that have been diagnosed in the lab back to the lab to be titrated. Our medical director says that we have much better results with the patients that come back into the lab for their titrations. Is that because it's one more opportunity to educate the patient on sleep apnea and on therapy? Is it because the human touch (being the eyes and the ears) is so much better than any machine can do? I don't know what the answer is. But I do know that Jeff is right that the system as it stands now doesn't consistently work well.

Cindy

Refreshing thoughts Cindy!

I see the professionals here fretting and crying over and over about the people mean old Banyon would leave untreated.

Is it not your profession that is telling me that 90% of the cases are not even diagnosed yet? Maybe I should be doing the fretting and crying?

Checkout the history of all defunct industries. Most did not see it coming because they were entrenched.

In a way, I am like the professionals in this thread. I am an entrenched patient using what works for me. I am handicapped to my way of thinking just like you professionals are handicapped by your certifications, acryonyms, and ways of thinking.

People from outside the current sleep profession and patient base will have to build the new way of doing it. I don’t even think it will be drive-thru clinics. It will be something none of us have imagined yet. (If we can keep the government out of the way.)

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Permalink Reply by RockRpsgt on August 25, 2009 at 1:59am

Guys women just talk sleep i am easy. Banyon I am guessing that in a past relationship someone from the medical industry really hurt you. Get back on that horse again little buddy.

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Permalink Reply by RockRpsgt on August 25, 2009 at 2:22am

Crying about and defending are 2 completely different things banyon. We were actually debating a very big issue when you came in crying about the way the medical community has treated you. i do agree that the system is flawed. hell i see it every day ( well 3 times a week anyway). not all of the blame can be put on the medical community. it is not my fault you are sick or is it your doctors. maybe you should talk to your insurance company. if they will not listen you can always move to Canada. Your plan does not solve the problem. it creates more. the solution has to be one that you( the pt), me (the medical community), and the insurance companies ( the man) can all agree on.

Banyon said:

Cindy Brown said:

If it's the cost involved why not just send home a video camera and taping system that could tape folks while they sleep. The video tape of someone with untreated severe sleep apnea can be a powerful diagnostic tool. Especially for those people in denial. We all know that one of the biggest hurdles to diagnosis is getting the patients to even acknowledge they have a problem.

Having said that, our sleep docs have been using auto titraters for patients the suspect have sleep apnea. They have also been sending auto titraters home with patients that have been diagnosed in the lab and with a home study. They also have been sending their patients that have been diagnosed in the lab back to the lab to be titrated. Our medical director says that we have much better results with the patients that come back into the lab for their titrations. Is that because it's one more opportunity to educate the patient on sleep apnea and on therapy? Is it because the human touch (being the eyes and the ears) is so much better than any machine can do? I don't know what the answer is. But I do know that Jeff is right that the system as it stands now doesn't consistently work well.

Cindy

Refreshing thoughts Cindy!

I see the professionals here fretting and crying over and over about the people mean old Banyon would leave untreated.

Is it not your profession that is telling me that 90% of the cases are not even diagnosed yet? Maybe I should be doing the fretting and crying?

Checkout the history of all defunct industries. Most did not see it coming because they were entrenched.

In a way, I am like the professionals in this thread. I am an entrenched patient using what works for me. I am handicapped to my way of thinking just like you professionals are handicapped by your certifications, acryonyms, and ways of thinking.

People from outside the current sleep profession and patient base will have to build the new way of doing it. I don’t even think it will be drive-thru clinics. It will be something none of us have imagined yet. (If we can keep the government out of the way.)

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Permalink Reply by Banyon on August 25, 2009 at 7:19am

Rock Hinkle said:

.......... We were actually debating a very big issue when you came in crying about the way the medical community has treated you. ...........

You invented that and attributed it to me. Others can check the thread - there is nothing like that in this thread.

Good-bye.

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Permalink Reply by RockRpsgt on August 25, 2009 at 8:20am

Ok maybe that is not the way it happened banyon. You did come in and start attacking the acronyms. Which by the way I do not have yet. In return I attacked you. I think that this post has developed into an us against them thing. I apologize for my part in it.

So what is the answer? How do we fix? What is the compromise that makes everyone happy? Where do you and I compromise Banyon?

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Permalink Reply by Duane McDade on August 25, 2009 at 8:35am

This is the nicest thing you have ever said, wow there's still hope for you! Mollette
Mollete said:

Banyon said:

nothing




nothing

mollete

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Permalink Reply by Banyon on August 25, 2009 at 9:42am

Rock Hinkle said:

Ok maybe that is not the way it happened banyon. You did come in and start attacking the acronyms. Which by the way I do not have yet. In return I attacked you. I think that this post has developed into an us against them thing. I apologize for my part in it.

So what is the answer? How do we fix? What is the compromise that makes everyone happy? Where do you and I compromise Banyon?

I'm out Rock. There have been no hard feelings from my side. It's only an internet forum.

My outlook is very different from yours.

Good luck in your profession. I like your enthusiasm and your openness.

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Permalink Reply by RockRpsgt on August 25, 2009 at 9:51am

Thanks

Banyon said:

Rock Hinkle said:

Ok maybe that is not the way it happened banyon. You did come in and start attacking the acronyms. Which by the way I do not have yet. In return I attacked you. I think that this post has developed into an us against them thing. I apologize for my part in it.

So what is the answer? How do we fix? What is the compromise that makes everyone happy? Where do you and I compromise Banyon?

I'm out Rock. There have been no hard feelings from my side. It's only an internet forum.

My outlook is very different from yours.

Good luck in your profession. I like your enthusiasm and your openness.

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Permalink Reply by RockRpsgt on August 25, 2009 at 11:02am

I think Duane is pretty dam funny. Mollete brings a very strong view to the table. Cindy, jnk, Judy, banyon, susan, Bee everyone brings something good to the table. Even when I do not like it. This is the best show running right now. Hell I tuned to read about Lala's burps and Flo's rash! LOL

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Permalink Reply by Rock Conner RRT on August 25, 2009 at 11:30am

most assuredly!

Cindy Brown said:

Gee Jeff I don't even rate an honorable mention?

Cindy

j n k said:

I think you are both very passionate about the need for people with SDB to get the help they so desperately need. Personally, I see that as the exact same outlook, myself. The rest is just details as discussed in forums in learning from other points of view.

Rock H. has said in the past that he is here specifically to learn from patients.

Banyon knows his stuff and has seen more than enough to have plenty to say, even if it shocks some people.

Oh, sure, Duane and Mollette can get a little mean sometimes, but I think they mean well too. Well, most of the time. Or at least, I have made the choice that I would like to believe they do. :-)

I hope Rock Conner is still finding this all entertaining. I know I am.

jeff

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