Don't blame RT/DME

[-SWS]

Same crock of feces by another greedy DME/ RT, who claims to be in business for his/her clients, but acts against their best interests.

If you had a track record around here of backing up most of your expert decrees with either evidence or even a semblance of logic, then I'd pay more attention to all your "short concluding" statements. This narrow-scoped rhetorical question is one of many examples I have read in your posts lately:

Why do DMEs come to this board, except to shill for clients? Alleged patient ignorance is bliss for them.

There are many viable social reasons besides economics that RTs and DMEs might come to this board. But shilling? By salaried or hourly employees as the motivational rule rather than the exception?

You must be either an analytical virtuoso or characteristically "short concluding" about your condemnations and decrees. Because with the dialogue in this thread, I can't see where poster rjayrrt is here shilling. Nor can I see where there's only one greedy reason that RTs and DME's---who are cut of the same genetic and behavioral stuff as the rest of our species---might come to a message board.

Yet another stage-grabbing and edgy expert pronouncement from Autopapdude...

[rested gal]

Why do DMEs come to this board

I think quite a few of them genuinely want to see how things look from the "patient"'s point of view, and want to pick up some helpful tips from "patients." Along with ways to make using cpap easier and more comfortable, cpaptalk definitely presents many points of view! Some more strongly expressed than others.

I've never had a problem with the idea of doctors, DME employees, RTs, sleep techs, you-name-it coming to this board and posting. I already know what things are like on the side of the fence of a CPAP user myself. While working on treating myself, I became fascinated enough by the subject of "sleep" and the treatments for sleep disordered breathing that I WELCOME the chance to see how it looks on the other side of the fence -- the perspective of the sleep "professionals."

No, I don't automatically accept their opinions as being "the way", any more than I do the opinions of anyone else on this board -- or out "in the world." Heck, I reserve the right to change my own opinions from time to time!!

rjjayrt says he/she is a CPAP user, as so many of us are. That's reason enough, in my book, to come to this board. Sharing opinions is part of being here too, whether it be an opinion about how often to clean a humidifier or an opinion as to whether it's a good idea for people to tweak CPAP pressure on their own. Suits me fine to hear opinions from all sides. And to express mine, as well.

Oh, and yeah...I'm a tweaker. However, I do understand the reasons why people working in the sleep/DME industry are not allowed to change pressures, or instruct CPAP users in how to do that, without a physician's order. That doesn't apply to me, thank goodness.

[Sleepy Taz]

RG wrote "I think quite a few of them genuinely want to see how things look from the "patient"'s point of view, and want to pick up some helpful tips from "patients." Along with ways to make using cpap easier and more comfortable, cpaptalk definitely presents many points of view! Some more strongly expressed than others. "

I am glad that I waited to respond to autopapdude as Rested Gal and SWS put it in a better way than I would have. We all need to remember that this is an open forum and that even though opinions vary we need to be respectful of each other. From what I have read from the professionals that have posted on this board, they have been courteous and some here like Autopapdude are as rude as they can be. You claim 11 years on the hose makes you an expert, well my 21 years tells you that you have a lot to learn. There are many here with less than 5 years experience that would put us both to shame with their depth of knowledge and they actually are nice people who want to help others, not pick a fight just because they do not agree with or dislike someone because of their profession.

[Sleeprider]

rjayrt, welcome to the forums. Hopefully we all benefit and learn from the exchange. My argument in favor of providing equipment is based on patients like myself who are never titrated through a sleep study (what ever reason, intolerance to the study, failure to sleep etc). Anyway, I have been on a APAP for about 2-years, with the explicit understanding that the MACHINE would do the titration. Knowledge from this forum enabled me to take control of that machine and make it better by interpreting the data and narrowing the APAP range, disabling ramp, adjusting Cflex and even adding a heated hose that no one prescribes, carries or insures.

I think it has been my good fortune to not have to deal with sleep doctors, but rather to work with my primary physician to come up with a flexible solution that works well. I would argue that people empowered to understand and control their own therapy are more motivated and successful (the sleep doctor's word would be "compliant") and obtain more effective therapy. For obvious reasons, there will never be a study that investigates the efficacy of patient involvement in therapy, but there is plenty of anecdotal evidence for it on this forum. If the sleep doctors, DME and RTs worked towards supporting knowledge and engaged patients as partners in decision-making, then the kind of reactions we have seen in this thread would not exist. It is a very natural reaction for people to react to control with resistance, orders with distrust. CPAP is a great opportunity to invite participation and experimentation. There is no danger in adjusting pressures and settings. The best machines are set up to do it automatically, and they can be optimized by certain setting adjustments.

Your participation and insights are a welcome addition to the forum. The limitations of what you can do within the confines of a prescription and your employer's and profession's policies is understandable; however those constraints should not result in withholding information that can help a patient better understand his equipment and treatment. There is a fine line between doing everything within your power for patients, or protecting the perceived business interests of doctors and the DME. It has to be a tough line to walk.

[Uncle_Bob]

We set all the machine's to show AHI and Leak #'s with education on what those numbers mean and what range they should be within.

When you say all machines does that mean you initially give all your patients a data compatibile machine or do they have to request one?

The main problem with the majority of DMEs/RT is they hand out a bare bones dated machine and pocket the maximum amount of cash possible.

[cinco777]

CpapRRT wrote

We set all the machine's to show AHI and Leak #'s with education on what those numbers mean and what range they should be within. RRT/DME provider

Thanks for responding. Please encourage your fellow RRTs in your DME and those from other DMEs that you meet to adopt your laudable practice of turning on AHI and Leak reporting and educating the user on what each means and the good ranges for each. Direct them to CPAPTalk to learn how to get their AHI and Leak numbers to fall within these good ranges.

[CpapRRT]

We set all the machine's to show AHI and Leak #'s with education on what those numbers mean and what range they should be within.

When you say all machines does that mean you initially give all your patients a data compatibile machine or do they have to request one?

The main problem with the majority of DMEs/RT is they hand out a bare bones dated machine and pocket the maximum amount of cash possible.

At our facility we only use machines that are fully data compatibile, the main machines we use as of today are the PR System One and the Resmed Autoset II. Sure, there are plenty of bare bones dated machines, but we have no use for them at our facility.

We do our own downloads at the 2 week mark, then the 1 month mark and every month for the first year, then on to a 6 month download schedule for lifetime. We do however work under a medical director with a standing pressure change protocol based on our download data and patient comfort, so we have plenty of wiggle room to help our patient's with their needs pressue change wise.

[JimIllinois]

I sure don't have a problem with RT/DME's living within their rules and regulations.

There's a nod-and-wink relationship here, where the professionals have to do what they do, and we do what we do, and the mostly unwritten rules are bent.

As a practice, it's probably not good for novices to mess with their prescriptions. But an adjustment of a cpap is not life threatening over the short term, and with good advice should end up as a positive result in the long term. Most prescriptions are not as forgiving. And the rules have to be written to cover the wide variety of prescription types out there, so they are black and white.

I say, smile and nod when we're told we shouldn't be adjusting our settings, but then make the best decision for ourselves. We don't need to get ulcers over what we're told is the "regulatorily" correct way to live. At least, I don't care to get ulcers over it.

[plr66]

NO, for the vast majority I think that the whole delivery of information should be graduated into various levels of competence that is monitored and rubber stamped by professionals.

Kinda like a driving license for CPAP

Exactly, good analogy.
How long were you on cpap before you got confident enough to change settings etc.

I searched for the past hour, but cannot yet find a couple of links I posted months ago about the pathetically few number of "hours" required for Board certification of Sleep Doc's. I guarantee you that I had put in 2-3X that number of hours of focused study on this forum before I ever got my first machine 15 months ago!! And yes, with continued consultation here, I felt absolutely confident enough from the first week to manage my treatment. Do we need a certificate to operate and adjust our gas burning fireplaces?

[Uncle_Bob]

At our facility we only use machines that are fully data compatibile, the main machines we use as of today are the PR System One and the Resmed Autoset II. Sure, there are plenty of bare bones dated machines, but we have no use for them at our facility.

Wow that sounds like one good DME I wish i went to your DME

[rickskids]

Very early in this thread I stated my opinion that a DME/RT looking to pass the blame to others should stay away. I should have done a better job explaining my position. One person in particular took it upon himself to call me ignorant! I've been called a lot of things in my 45 years on this earth and ignorant is definitely one that boils my Irish blood. Twenty-four of those forty-five years I have spent serving my country, giving all americans the right to express their opinions without fear of repercussions. Five of the last eight years of my life I spent in the mountians of Afgahnistan. Id probably still be there but in my ignorance I drove right by an ID and blew off my left leg from the knee down. Iim lucky I have enough of my leg left to be fitted with a prostatic that will move with my knee, my passenger was not so lucky he died slowly, it seemed like hours while our brothers had to fight through the ambush that was waiting for them and the medics. That day we lost five good men because of my ignorance. So I'm not going to name names but if you have to pass the buck because your chosen profession is filled with profiteers looking to make a dollar I say go elsewhere. And if your an apologist for someone who feels the need to pass the blame you should go with him too. .

[cinco777]

How long were you on cpap before you got confident enough to change settings etc.

10 nights of AutoCPAP usage. On the 10th night, after 10s of hours of reading and research on CPAPTalk, I changed the pressure range from its "delivered" setting of 4 - 20 to a setting of 7 to 10.

The next pressure change that I made was on the 18th day when I changed my pressure range to 4 - 10. On the 26th day, I changed to straight CPAP with a fixed pressure of 8 cmH2O. I have made a few pressure changes since then to see if I can further improve my sleep #s (I am still trying to lower my FL # just out of scientific curiosity - no success so far as it isn't budging).

With software monitoring and thoughtful analysis of the outcomes from a change, I don't see a problem with changing my pressure. Some people do but I don't.

[GaryG]

My pet peeve with my DME is they didn't show me ANYTHING about my machine, especially the mask fitting feature which I use nightly now to reduce leaks. I would hope this is an isolated case of a mistake. Yeah, this info is hidden in the manual, but it should be mandatory to have a DME show the patient how to do this. I mean, I was told to replace my filter in 3 months, but nothing about the fitting feature.

[-SWS]

Rickskids-- thank you for your sacrifice. Man, what a heart wrenching story to read. Heroes can also feel survivor's guilt. Again, please accept my gratitude.

That the DME industry is burdened with corporate profiteering is evident. That the overall sleep industry is riddled with a myriad of challenging issues is apparent as well. But that either can be vilified with wide sweeping and universally condemning brush strokes is remiss. I still don't read the original poster's views as passing the buck. Rather, I see some rationale for views and actions---some of which I don't happen to agree with.

However, despite that original poster presenting some views that I don't happen to agree with, I also saw a professional's attempt to simply reach out and connect with us. The problem with chasing away contrasting but sincere views is that the opportunity for mutual learning and cooperation gets chased away as well.

The problem with vilifying an entire industry is that the ordinary people in any industry---the 95% to 98% of our human population who are not sociopaths---get vilified as well by such broad sweeping brush strokes of universal condemnation...

[Kiralynx]

Just for my own curiosity, I did a search on "Sleep doctor hours of accreditation."

http://www.aasmnet.org/Articles.aspx?id=1428

http://www.aasmnet.org/BoardReview.aspx

both have some interesting information. There's apparently a board there, as well.... although it is not an open board, like this one.