Don't blame RT/DME

[rjjayrt]

I understand that some DME's or RT's are only in the game for the money, but some us try to do it right. I personally spend as much time as necessary with all my cpap users to ensure they understand why there receiving therapy and how to utilize the equipment. I put them on machines they need, and if they have a request for a particular machine I do what I can to provide it. I don't own the company, I have to abide by what my companies policies are as it relates to equipment rental/purchase and I have to abide by what the insurance company says. As far as changing pressures without the MD's order well thats covered by law. If you look at your machines manuals, somewhere on it it will say for sale upon order of a physician, or something of that sort. I'm bound by my states licensure requirements and FDA. I must abide by the physicians order. I can't change the pressure without it. As far as giving patients the clinicians manual, there may not be a law about that, but it would be improper because I'd be giving the patient the ability to do something that I'm prohibited by law to do. If you have complaints, take it up with the physicians or FDA, they can change it, I can't.

[Kiralynx]

You started off with a good post -- and sound like someone whom one could work for.

Then you got abrasive (in my view) about people changing their pressures and saying we can't have clinical manuals.

You're right: YOU, as an RT or DME employee cannot change a person's pressure without an order from their doctor.

No one yet has been able to cite an actual law which prevents cpap-users from changing their own pressures to optimize their therapy.

I have diabetic friends who are fully trained in calculating how much insulin or other diabetic medications they need to take to handle their condition. Several have software into which they download the results of their blood glucose meters several times a day. Some have physicians who want to see that information -- and woe betide the person who shows up without it.

I see no difference between treating sleep apnea and treating diabetes: in both, patients need all the information they can obtain. They should learn how to handle all manner of issues, including reading the results from their machines with their own software if they so desire, and making educated modifications to their programs if they so desire. Ideally, this would be done in conjunction with their doctors and RTs.

Sadly, many doctors, RTs, and DME employees may feel threatened by having to deal with an informed cpap-user base. This is unfortunate, because a doctor's decisions should be based on data, and the best information about the daily function of a CPAP comes from an informed patient.

[rjjayrt]

your absolutely correct. I can't provide a law which says you can't change your own pressures. I'm pretty sure that there isn't one, but its like I said, You can't expect me to provide information which would allow you to do something that I could not do legally without a physicians order. Secondly, you must be really careful about this notion of changing your own pressures. The numbers you get from a download are only 1 part of the equation as it relates to need to change pressures. There may be other factors involved, theres a reason physicians don't treat themselves. I'm not saying it can't be done, but I'd be more comfortable knowing that the person whos changing the pressure is fully versed in sleep medicine, knows what the unintended affects of the change may cause, and knows how to deal with them. I'm all for patients being as aggressive as possible in there own care, to be perfectly honest it reduces my workload. I'm just not sure that self treatment is prudant.

[DJ_Boxer]

I believe and follow through with this belief that even though I can look at my reports and change my pressure: CPAP/APAP, I would only do it after consulting with my doctor. Also it's hard to believe that it is getting harder to use a machine and get the patient version of the software that works with your machine and computer(my case: Encore Viewer 1 and currently have Vista x64 getting 7 Professional for XP Mode).


DJ

[rjjayrt]

I agree thats a problem. There should be a way a user can get the information concerning there cpap use easily without having to go to the Doctor or DME.

[rickskids]

Information is dangerous. We need to be protected from ourselves. Can you imagine the havock we could cause if we were better informed. It is for our own good that we not know the inner workings of the machine that gives us the breath of life. All we need to know are the basics...how to turn it on, how to shut it off. Let the professionals decide for us what works best. I'm suprised were allowed to see data that we can misrepresent without the know how of an RT or Dr.
Please leave this forum and never come back. In the short time here I have met people with more knowledge and compassion about OSA that any DME could ever hope to compile by reading all the manuals in the world. Now go along and sell somebody something they may or may not need at a 70 + margin.

[rjjayrt]

only a close mined person could find fault with someone whos agreeded with 90% of what he's said just because of his profession.

[Uncle_Bob]

I understand that some DME's or RT's are only in the game for the money, but some us try to do it right. I personally spend as much time as necessary with all my cpap users to ensure they understand why there receiving therapy and how to utilize the equipment. I put them on machines they need, and if they have a request for a particular machine I do what I can to provide it. I don't own the company, I have to abide by what my companies policies are as it relates to equipment rental/purchase and I have to abide by what the insurance company says. As far as changing pressures without the MD's order well thats covered by law. If you look at your machines manuals, somewhere on it it will say for sale upon order of a physician, or something of that sort. I'm bound by my states licensure requirements and FDA. I must abide by the physicians order. I can't change the pressure without it. As far as giving patients the clinicians manual, there may not be a law about that, but it would be improper because I'd be giving the patient the ability to do something that I'm prohibited by law to do. If you have complaints, take it up with the physicians or FDA, they can change it, I can't.

Question, Would you refer your patients to this forum ?

[rjjayrt]

Absolutely, I will and have many times.

[Kiralynx]

your absolutely correct. I can't provide a law which says you can't change your own pressures. I'm pretty sure that there isn't one, but its like I said, You can't expect me to provide information which would allow you to do something that I could not do legally without a physicians order. Secondly, you must be really careful about this notion of changing your own pressures. The numbers you get from a download are only 1 part of the equation as it relates to need to change pressures. There may be other factors involved, theres a reason physicians don't treat themselves. I'm not saying it can't be done, but I'd be more comfortable knowing that the person whos changing the pressure is fully versed in sleep medicine, knows what the unintended affects of the change may cause, and knows how to deal with them. I'm all for patients being as aggressive as possible in there own care, to be perfectly honest it reduces my workload. I'm just not sure that self treatment is prudant.

Hmm... so, a nurse practitioner cannot change a diabetic's dosage without the doctor's permission, but the diabetic is supposed to allow himself or herself to repeatedly go hypoglycemic or hyperglycemic because the nurse practitioner refuses to provide the information they need to make modifications to their daily routine?

If that happened to a diabetic, they would be within their rights to sue the practitioner. And in fact, I know of one practitioner who tried to patronize a diabetic patient whom the doctor knew well, and when the doctor received the patient's report on the practitioner, the practitioner was told to straighten up, or she would not have a job. Unknown to the practitioner (who was new), the doctor had asked several of his oldest and most trusted patients to have appointments with this practitioner to evaluate her suitability to continue working for his practice. The practitioner failed her on-the-job test. She assumed she was the expert, and the patients were too stupid to understand. She failed to grasp that ignorance is a lack of education, while stupidity is a failure to understand that education is lacking.

Just so you know where I'm coming from: I bought the card reader and software, and monitored my therapy. I discussed the results with the RT. (My doctor's probable reaction to being called for permission was that I likely knew more about my situation than she did at this point.) However, we went through all the forms, and my prescription was officially changed. Then the RT (who does not come to my house; I suspect she is afraid of my dogs) phoned me and walked me through changing the settings.

You do not have the right to judge what information I can and cannot have about my health. You are not a doctor. That is why there is a limitation on what you are permitted to do. But expanding that to say that I am not allowed to make decisions about my health is unacceptable.

I used to have a PCP with that attitude. That PCP missed diagnosing my gall bladder disease, my IBS, my sleep apnea, and my uterine cancer. That is why that PCP is my former PCP.

I have said this before and I will say it again: I live in my body. No one knows it better than I do. I may consult a medical practitioner for advice, but no one, and I do mean NO ONE tells me what I can or cannot do.

The doctor who diagnosed my apnea thinks my participation in this Forum is great. My current PCP pointed out that most patients aren't as motivated as I am to educate myself, but when I pointed out that uneducated diabetics might be similarly unmotivated, she looked very thoughtful. It's common knowledge that there's a huge drop-out rate in CPAP therapy. This seems to indicate that the common method -- your method -- of denying cpap users adequate education and participation in their therapy is a flawed method at best.

You are against self-treatment. You are also against educated patients participating in their own therapy, since you consider it in their best interest that you deny them information they are entitled to.

This raises the question of why you posted in a peer-to-peer Forum in the first place.

[DoriC]

You have stated your position very well and I know you are bound by the law and your employer. My questions are simple ones. As an RT are you at least very well qualified to dispense the best machines possible and explain in detail how they work, and select the best masks for each individual patient, know how to fit them correctly, help with leaks, understand the struggles we face and suggest good inside tips to help us achieve success, always accept our phone calls when we're asking for assistance, and also take the initiative by calling the prescribing Dr to ask if you can adjust settings based on your direct observations of our complaints and if you can interpret the data you see? These things and more were lacking in our relationship with our DME and we would have failed miserably without the experts on this forum.

[rickskids]

Please go away! I feel my space being violated by you. Go and speak to your colleagues about your professions transgretions against your clients and how you as an industry will fix them. When you have your house in order then and only then come back and report.

[millich]

Here we go again....

[BlackSpinner]

Lack of education and control by patients => more patient visits => bigger profits

[DJ_Boxer]

rickskids: please say who you are talking to when you reply, because just because we as a group are not face to face does not mean normal common courtesy should be thrown out the window.

DJ