bad primary care doctor...

[bellab]

Your doctor's sleep apnea knowledge aside, any PCP should be your partner and advocate. My PCP does not have any particular expertise in sleep disordered breathing, but he supports what I need so I don't need to see a specialist. Yesterday I gave him two Encore trend reports (2-pages each) showing compliance and efficacy for the past 3-months, and one from 2014. I also provided a 1-paragraph summary of my sleep study, history, and a comparison of APAP and BPAP efficacy and "his" recommendation to continue BPAP treatment at x, y, z pressure. That all goes into my medical record, and supports prescriptions.

I really like my doctor. You should find one like that.

I agree, I do need to find a doctor like that. This doctor wasn't interested in hearing my concerns or opinions, she was just interested in hitting up my insurance for an office visit. I mean really, she charges my insurance what? $200 just to tell me "No I won't write a prescription" rather than telling me that over the phone?

I understand that they can't know everything, but at least make sure the answers you give are accurate. Giving me a non-answer is better than giving me a false answer.

[BlackSpinner]

My doctor didn't know anything about sleep apnea either when I told her to refer my to a sleep study. But she didn't pretend, she looked things up. She was always happy to learn about something new. (Of course she herself had been through the medical mills trying to get diagnosed for thyroid problems). My current one is of the "Let me look into that" type too. In the last few years her office has gotten automated and the first thing she does is go online and look at your entire medical history, if I go to another specialist, clinic or urgent care it is all there. If she is presented with something new, it is there on the province's medical database (the province is working on building a telemedicine model for outlying communities) Plus she can do it in 3 languages. I am very happy with her (now if only her office staffs' faxing of prescriptions could be as good....)

[oncomingspork]

I wish you could see my doctor. Anything she doesn't know, she gets me a referral for, and asks me how it was afterwards.

[jonny515]

My PCP diagnosed me. I had no idea I had sleep apnea and don't have the usual symptoms. She's also a PA (probably best doctor I have ever seen).

[Hang Fire]

I mean really, she charges my insurance what? $200

lol You are as ignorant of insurance as your doctor is of sleep apnea. But I give you credit for the question mark.

[bellab]

I mean really, she charges my insurance what? $200

lol You are as ignorant of insurance as your doctor is of sleep apnea. But I give you credit for the question mark.

Actually, I regularly look at my health insurance claims, and she generally charges between $150-$250 for office visits. I'll be calling my insurance about this one because I don't think she should get to charge for wasting my time.

[ChicagoGranny]

she generally charges between $150-$250 for office visits

That's the so-called "list price". Your insurance company probably allows something in the range of $80. So you pay a copay of maybe $50 and the insurance company pays $30.

[bellab]

she generally charges between $150-$250 for office visits

That's the so-called "list price". Your insurance company probably allows something in the range of $80. So you pay a copay of maybe $50 and the insurance company pays $30.

Yeah, I just took a quick look through my benefit summaries, actual amount paid for this doctor ranges between $90-$150. Thankfully my copay is only $15

The biggest two issues for me rather than the money is the time lost from work and the misinformation.

[Janknitz]

Not that apnea isn't serious, but how could you trust a doctor like that if something REALLY serious came up and you didn't have time (or ability) to research it to make sure she really knew what she was talking about??? That's why you can't stay with that doctor, and why she needs to be told (even if she doesn't listen) that her interaction with you was unacceptable.

I know you're upset about the time and money wasted, but the real crux of the matter is that you need a physician you can rely on to understand her limitations and always tell you the truth. "I don't know" is a perfectly valid answer. Making up shit so that she can save face is horrible.

[ChicagoGranny]

Yeah, I just took a quick look through my benefit summaries, actual amount paid for this doctor ranges between $90-$150.

You might want to look at the detail instead of the summaries. The insurance company has a standard amount they will pay for a doctor visit - it won't vary from one visit to the next. The variation you report may be because you are looking at the doctor's fee plus lab fees. Lab fees will vary depending on what tests are conducted.

[chunkyfrog]

I left one doctor because he appeared to be senile.
I had the impression that his staff was "helping" him a lot because, frankly, he was likable.

[Mudrock63]

I'm sort of kind of amazed at the lack of knowledge about sleep apnea among the medical professionals I have dealt with. Honestly, this is the place to come for information. And I am so thankful it is here, and for the folks that help everyone out every day.

Don't be amazed. It's not that unusual. I tell the doctors and DME what I want and I get it. Shouldn't have to do that.... should be the other way around. I get an average of .2 AHI, no leaks, happy with my mask and most of all.... I feel much better during the day. Oh well.

Sheriff

I hear you. I've been told by the professional that anything under 6.0 AHI is GREAT. Uh, it's only GREAT, IMO, if I feel amazingly better. Which I don't. So I learned here that what I probably really need is Bipap treatment. Fortunately, I believe my doctor will follow my lead when I pull the trigger and ask for a different machine. We'll see.

[oncomingspork]

I'm sort of kind of amazed at the lack of knowledge about sleep apnea among the medical professionals I have dealt with. Honestly, this is the place to come for information. And I am so thankful it is here, and for the folks that help everyone out every day.

Don't be amazed. It's not that unusual. I tell the doctors and DME what I want and I get it. Shouldn't have to do that.... should be the other way around. I get an average of .2 AHI, no leaks, happy with my mask and most of all.... I feel much better during the day. Oh well.

Sheriff

I hear you. I've been told by the professional that anything under 6.0 AHI is GREAT. Uh, it's only GREAT, IMO, if I feel amazingly better. Which I don't. So I learned here that what I probably really need is Bipap treatment. Fortunately, I believe my doctor will follow my lead when I pull the trigger and ask for a different machine. We'll see.

Yeah...the numbers are just the rough estimate. I had the same experience with a doctor dealing with my thyroid issues. He thought a TSH as high as 5 was "normal." Because the testing labs put normal range at .5 to 5, even though many patients start showing symptoms at 3...

But I didn't feel remotely well till I was at 1 or less. He told me one day he was going to lower my dose because at 1, I was "at risk of becoming hyperthyroid." I don't have a thyroid, never have had, so how could I become hypo? He's no longer my doctor, and my current one is fine with me at .82 (and so am I!)

The AHI cutoff of 5-6 should not be interpreted as "fixed now!" It's a cutoff for diagnostic purposes, for the sake of saying "yes you absolutely have apnea." But they already know that, and they should be trying to get your AHI as low as possible since you've been suffering from abnormally high AHI for so long. Those dumbasses.

[red_roni]

I am not happy with my pcp either. I have told my doctor several times that I felt bad and did not sleep well. She would tell me that people just feel bad when they get old. I am only 54. She told me to get out and exercise and lose weight and I would feel better. She told me that I had to work at feeling better. Now that I have been using the CPAP machine, I am feeling somewhat better. I sleep 7 to 8 hours a night. I am actually doing some organizing around my house. I am also thinking about doing my cross stitch which I haven't done in years. In the past, I just didn't really want to go to bed because I didn't feel like I rested well. I would wake up and really didn't feel any better. I finally was referred to a Sleep Specialist by my cardiologist. I have Moderate OSA and my AHI was 7.8 during my sleep study. I don't have any Apnea episodes, but a lot of Hypopnea episodes. I just feel like my pcp didn't really try to help me. She should have listened to me and tried to actually help me feel better 2 years ago. Sometimes I feel like when you are overweight and have depression, they blame everything on those problems. At this time, I need to find a new doctor but I am worried that I will run into the same thing again. It is so frustrating. I think I am going to ask my sleep doctor if he knows of a good doctor to refer me too.

On the other side of this, I am so excited to be feeling a little better. Now I am motivated to get out and exercise and trying to eat better also. Those things are important also.

[MrGrumpy]

Most primary care doctors know nothing about treating sleep apnea. If they know anything about it, they know you should be referred to a sleep medicine specialist. Losing weight can help some, maybe reduce your pressures a little but it rarely gets rid of all sleep apnea. Many doctors are obsessed with this delusional relationship they have had hammered into them by the health insurance industry "that if the sleep apnea patient would just lose a bunch of weight, most of this apnea stuff would go away on its own." Many PCP docs and even many sleep docs (especially the pulmonary based sleep docs) seem to buy the obesity/OSA relationship link hook, line and sinker. Sometimes there is a strong relationship between obesity....but most of the time, sleep apnea is an illness all unto itself.

I think it may be time for a new doctor -__-'


So I took my home sleep study two weeks ago, and after my sleep study I was told that I wouldn't be able to be seen for a follow up for a month- that's now two weeks from now. I was falling asleep at the wheel and overall not functioning. I called my primary care doctor to ask if they could write a prescription based on the results of my sleep study- they set up an appointment for me to come in, which was today...

I took off work to go to this appointment, and all they did was tell me that they couldn't write me a prescription and that I should wait for my appointment with the sleep center. Rather than, oh I don't know...telling me that over the phone when I asked?


The bigger issue was all of the mistruths and that she said. At this point, I know more about sleep apnea and what my results indicate than she does. She kept telling me things that were untrue. I played dumb and pointed to my results "oh, it's just that it says here..." to no avail. For example, she said she couldn't write my a prescription for an automatic machine because I have "very severe" sleep apnea, not just mild apnea....I pointed out that my AHI was an 8, putting me in the mild apnea range. She pointed to a line that said "A CPAP tiration study is indicated, given the severity of sleep related breathing disturbances....alternatively, the patient may be outfitted with an auto-titrating CPAP unit minimum 6cm maximum 15 cm with nasal interface"

She pointed to the word "severity" and stated that I had severe sleep apnea, even though I told her my AHI was in the mild range.

She told me that an automatic machine would make my sleep apnea worse, putting me at risk for cardiovascular issues.

She also told me that weight loss would improve my sleep apnea

Finally, she stated that I have Type 3 sleep apnea

She got this because my report says "HST- Type III" Uh lady, that refers to the type of sleep study I took...there is no type 3 sleep apnea


So, according to my doctor...I have type 3 sleep apnea in the severe range, an apap will cause me to have issues with my heart, and I can fix all of this by losing weight.




Unbeknownst to her, I got an apap off craigslist, and in the couple of days I've been using it my blood pressure had dropped 10 points, I've lost two pounds (when previously I was gaining uncontrollably despite diet and exercise) and I'm actually able to drive and go to work without falling asleep at my desk or at the wheel.