Rested Gal - got what you advised (doc poked fun @ internet)

krousseau · Post by **krousseau** » Tue Aug 08, 2006 1:46 pm

To me, the whole point of things is so that the doctor can focus on medicine, and the equipment providers to focus on knowing the equipment. Equipment providers don't need to know all the underlying medicine behind why a person has OSA and the doctor doesn't need to know about all the bells and whistles on every CPAP machine.

It would be great if it worked that way without regard to what the machine cost and if insurance kept its nose out until a good sleep doc and a good DME applied their expertise to the diagnosis and treatment of each client. Insurance insures that the knowledgeable DME cannot use his/her knowledge to recommend the best machine for the patient. A doc who may not know all the bells & whistles of the equipment still has to write the script-The DME does not usually get to exercise any judgement based on his/her knowledge of the best machine for you. Usually their judgement is based on the least expensive machine that meets the parameters set in the RX because insurance in't going to give full reimbursement. Insurance reimbursements rates assure that the DME doesn't hire knowledgeable people who are more costly to hire.

S/he needs to know as much about the equipment as we expect him/her to know about drug interaction when s/he writes a prescription.

We can expect that but there are many physicians that write Rx's for drugs that they have little knowledge of. It is a part of the problem medical care has with the large number of people who have serious adverse side effects, overdoses, and harmful drug interactions. I am an advocate of having some drugs that require a specialist or consultation to prescribe. That would mean not every doc could just write scripts for potent cardiac meds, or psychiatric meds, potent antibiotics, meds that have dangerous side effects and require close monitoring, or drugs that interact with many others. Some hospitals do have some rules in place like this-only psychiatry can write initial RX's for certain psyc drugs. Only an infectious disease doc can write for certain antibiotics. I once threw an expensive RX down the toilet after reading the side effects-the risk was not worth it for the relatively minor condition I had. The drug was taken off the market soon after because of the high rate of serious side effects. Learned to read before filling an Rx for a drug I didn't know.

REMmaster · Post by **REMmaster** » Wed Aug 09, 2006 1:10 pm

The doctor cant prescribe you the provider manual. As far as the FDA is concerned, that would be the same as handing you his prescription pad and letting you prescribe yourself whatever you want.

People need to get it out of their heads that it's some vast conspiracy to make you tired. Medical professionals have to follow regulations that you might not like. Or should he risk being screwed by the FDA just so you can act like you're a sleep professional?

I understand wanting to be involved in your own treatment, but people need to understand that they ARE NOT clinicians or physicians and that a prescription device carries with it a whole bunch of regulations.

Artwood · Post by **Artwood** » Wed Aug 09, 2006 7:30 pm

Just because you have a doctor's license doesn't mean you know JACK about CPAP equipment.

I gurantee you that there are people on this forum who are more knowledgeable about CPAP equipment than 90% of the MD who though they may be professionals in medicine are definitely clueless in CPAP equipment.

When is tyhe world going to figure out that much that a physician does doesn't take a rocket scientist and that they are not gods?

_________________

CPAPopedia Keywords Contained In This Post (Click For Definition): CPAP

jeepdoctor · Post by **jeepdoctor** » Wed Aug 09, 2006 8:16 pm

Remaster said, "I understand wanting to be involved in your own treatment, but people need to understand that they ARE NOT clinicians or physicians and that a prescription device carries with it a whole bunch of regulations."

This may be the crux of the issue. Why should a CPAP machine require a prescription. Could it be to keep the medical mafia alive, well, financially well-off and driving a new Cadillac every year?

rested gal · Post by **rested gal** » Wed Aug 09, 2006 9:30 pm

REMmaster wrote:The doctor cant prescribe you the provider manual. As far as the FDA is concerned, that would be the same as handing you his prescription pad and letting you prescribe yourself whatever you want.

I don't see that as being the same thing at all. If a doctor thinks his patient is capable of making pressure adjustment decisions, and the doctor WANTS his patient to be able to have that kind of control of his/her treatment, and the doctor WANTS his patient to have the manual that describes how to do that, it makes perfect sense for the doctor to tell the DME to give the setup instructions booklet to the patient. How would that be any different from an Rx for a med that stated on the Rx, "take as needed"?

REMmaster wrote:a prescription device carries with it a whole bunch of regulations.

Of course it does.

Would you be kind enough to point us toward the FDA regulation governing CPAP machines that forbids a doctor from allowing his patient to make pressure changes and forbids the doctor from making sure the patient is given the exact instructions written by the manufacturer of that machine for how to do that?

krousseau · Post by **krousseau** » Wed Aug 09, 2006 10:51 pm

Many diabetics get insulin prescriptions and test their blood glucose levels frequently-initially they are given guidelines as to how much insulin to take at certain glucose levels. Those diabetics that want to have better control learn to adjust their insulin dose outside the set guidelines. They learn to adjust their food/exercise/insulin balance, they learn what to do when they are sick. There are classes in diabetes self management and a magazine for diabetes self management. The patient who learns to self manage his/her diabetes is the "dream" patient for most health care providers. IMO insulin is more dangerous than a CPAP.

What's with the reluctance to have people adjusting their CPAPs--the things already have a min & max pressure.
Would't it be great to go to a workshop on interpreting Encore Pro and adjusting your pressures. And having a Hosehead magazine come to your home with articles on mouthleaks, rainout, strange noises from the mask, new products, vaseline overdose and a report on the latest outbreak of plague traced back to a humidifier (sorry I couldn't help myself).