Fired my sleep doc & found a new one

[ReadyforRest]

A couple of weeks ago, I had my one year (+ 3 month) check-up. I'm doing great and have no issues, thanks to all the help I've received here. But I've never been completely happy with my sleep doc, sleep clinic, and the way they do things. Lots of things, like impossibly hard beds fitted sideways to the wall with your head at the open end, not at the wall or headboard end (weird). They only deal with select DME's that aren't close by, and if you use an off-the-list DME, they delay and stonewall filling out forms that you need to get your machine. The arrogant and attitudinal male doctor (who runs the clinic) came in after my sleep study spouting stock info that didn't apply to me and basically irritated me right from the start. Then after titration I was seen by a different doc, this one female, who apparently works with him, but I was never told I would be seeing someone different each time. Then in the 3 month follow-up I saw the male doc again, so no consistency at all, etc.

On this fourth visit to my sleep doctor, silly me, I'm expecting to see the big boss man. No, I am seen by the intake nurse? or office worker? ... I frankly don't know who she was, because they don't really explain who this is, but it's how they do things there. She says to me, "Hi, it seems like we just saw you a few months ago!" I'm a bit confused, because I haven't been there in a year. I tell her "No, this is my one year check-up." She replies that she knows (although I'm wondering if she really DOES know, or she's just pretending she does), but she says, "it seems like we just saw you". I can't remember seeing this one at all, ever before, but who knows? They have a whole lot of people working there. Then she went on to talk about everything EXCEPT my appointment, about taking trips and going on cruises and umpteen other things. I'm thinking, is she assessing my responses to see if I'm thinking cognitively and not exhibiting signs of sleep deprivation? Or is this just small talk that is taking up waaaay too much time? Eventually she asked how I'm doing, if I had any problems. I replied that I was having no problems, except some issues with getting to sleep at a normal time. If I put the mask on, can't get to sleep, and am still awake an hour later, I'll get up. Then when I'm really tired, I'll finally go back to bed, because I don't want to lay there awake for an hour attached to the mask & hose. So my times are a bit screwed up, but I will sleep in to compensate. I also tell her I frequent a very good sleep apnea forum where I get help from knowledgeable people to make my treatment better, and that I keep a journal (I pull out both journals), that I'm very involved in my treatment and have software and download stats daily. I know she's not the doc. But she asked. I don't like that I might have to say this twice, once to her and once to the doc. She downloaded my sd card, and did a weigh-in. All of this took about 10 minutes.

Finally the doctor came in. And surprise, surprise ... it was the second doc, the woman (who I actually liked better, because she didn't have attitude, and a year ago she caught the fact that I needed an apap and switched me before I bought one). So this doctor gets a verbal report from the nurse-office worker-girl on what I've just told her ... and then I notice that on the computer screen, the info from my SD card is a synopsis ONLY. They glance at it, say I'm doing well, and all seems fine. 5 minutes of this, and the doc starts writing out a prescription. I said, "What are you doing? This is my one year check-up." The doc says, "Oh, I thought it was your follow-up after your one month machine trial!" Then she rips up the prescript. Needless to say, I am taken aback. I'm running the last 15 minutes through my memory banks, trying to figure out how this appointment got misinterpreted so badly. Did we not make it clear that it was my 1 year check? Is there something I'm missing here? "No," I reply. "This is my one year check, and in fact, you are the doctor who prescribed my autoset a year ago." "Oh," she replies, smiling. Yeah, no worries. It doesn't matter that I don't remember you, and was about to write out a brand new prescription for another machine. No problem that I don't know you from Adam.

And here's the other thing that I realized after I left. Back in April, I went into the clinical settings and changed the low number from 8 to 9 (14/ 9) because I wasn't happy with my readings, and wanted to fine tune them a bit. Since I did that, my stats got progressively better. No one noticed that the number was different than what was prescribed. I had gone in there half in trepidation, expecting to get some kind of reaction, hopefully not a bad one, that I had made this change myself. But they didn't even notice it. I mean, this same doc had set the last setting to 14 / 8, and had supposedly recorded it somewhere in my file or in my online chart. But she didn't notice that it was different than the original???

Well, if she didn't know it was my one year follow-up ... I suppose a little pressure change wasn't important either ...

So I went home and stewed for a few days, feeling like I'm just another body on the conveyer belt over there. That they have no idea who I am, no interest in my treatment in their assembly-line practice. Then I went online, found another local sleep clinic that was recommended to me a year ago and called them up. They were VERY nice. We talked at length about how they operate. I liked everything they had to say. I went in last Friday for a tour of the place. Liked the sleep clinic set-up better, beds feel like real beds, comfortable, with real headboards and night tables, looking like real bedrooms. I talked at length with the tech who runs the sleep studies. Liked how much knowledge she had, how informed she is. Discussed with the office girl (one of two, not four at the other place) the way they do things, the doctors, their approach. You have one doctor all the time, and are not switched around. They prefer patients who are proactive and are involved in their own treatment. They have many patients who have software and download their info to look at their detailed stats. I also have the option that if I don't like the doctor I first choose to go to (there are 3 respirologists on staff), I can change to another who suits me better, and then always see that one.

I saw my family doctor yesterday. I told him I wanted to change sleep doctors (he'd referred me to this one) and explained why. I brought him info on this sleep clinic, plus business cards for all 3 doctors there, told him I took a tour of the place. He was happy to get it all, and said it's good to get feedback and recommendations from patients on other places to refer to. He was very willing to sign the referral form. He faxed them all the sleep test data that he had in his file, my original sleep test, titration, and all follow-up info.

So I now have an appointment in mid-December for a consult with the new sleep doc. Hope it's better than the last one!

[LSAT]

Simple comment...If you went through a year without any problems...Why do you need a sleep doctor? I, like many on this board have not seen a sleep doctor since my original titration. If I need an updated prescription, I get it from my primary care doctor at my annual physical.

[ReadyforRest]

That's how it's done here. There are prescribed time frames under OHIP (Ontario Health Insurance Plan) when to do follow-up appointments. After the one year check up, you don't have to go back for two years, if you aren't having any problems. But if you do want to be seen earlier, then no problem, just call and go in. Our system is different than yours, I guess.

If they say they want me to come in to see how things are going, I'm fine with that. I'd rather that than they ignore me and I get lost in the shuffle. From a doctor's standpoint, someone who is getting regular follow-ups is more likely to be compliant and stick with their therapy than someone who is not getting periodic monitoring.

[StuUnderPressure]

Simple comment...If you went through a year without any problems...Why do you need a sleep doctor? I, like many on this board have not seen a sleep doctor since my original titration. If I need an updated prescription, I get it from my primary care doctor at my annual physical.

NOT trying to change your procedure as it seems to work for you.
And I do agree that constantly going to the Sleep Doctor is a waste of time.

But, I find in my city that DMEs listen more to & will follow more closely RXs written by Sleep Doctors instead of a GP, etc. - especially the Sleep Center I frequent which is owned & run by a large regional hospital. That Sleep Center does probably 80% or more of the Sleep Studies in my city even though there are at least 3 others that I know of. When I had my 1 & only Sleep Study done 16 years ago, they were the only game in town.

So, I try to keep them on "retainer".
They are bad about wanting to reschedule appointments, so I use that to my advantage. When they call to reschedule, I tell them I don't have my schedule in front of me & will have to call them back. And then, I just don't call them back & I "fall through the cracks" & no one is the wiser. Once, they had to go find my file in storage because it had been so long since I had been there.

If "they" don't try to reschedule an appointment I may have, I call & cancel the appointment with the same excuse that I will call them back later to reschedule.

When it comes time for a new machine, I just find that dealing with them is so much easier. After all, it took me 16 years to train them to the point where they say something, I object, & then they relent & do what I wanted done in the 1st place.

Although they are far from being "good", I just don't want to have to train somebody else.

[Todzo]

Thanks for the good example!

[johnthomasmacdonald]

My doctor is really Pugsy, the other one just gets all the money from the insurance company and signs the prescriptions ( as recommended by Pugsy of course)

[squid13]

I may be wrong but if your on Medicare they require you to see a sleep Doctor every year. When I order my parts on the phone they ask when my last visit was and when my next appointment is and who the Doctor is. I'm on Medicare and they supply my supplies.

[bwexler]

My doctor is really Pugsy, the other one just gets all the money from the insurance company and signs the prescriptions ( as recommended by Pugsy of course)

Even though this may be true for many of us we shouldn't say so publicly, it could get her in trouble, practicing without a license.

[StuUnderPressure]

I may be wrong but if your on Medicare they require you to see a sleep Doctor every year. When I order my parts on the phone they ask when my last visit was and when my next appointment is and who the Doctor is. I'm on Medicare and they supply my supplies.

If Medicare does require a yearly visit to the Sleep Doctor, I just might have to reschedule the appointment I cancelled since Medicare is now my primary insurer.

But, before I do that, I will have to get confirmation of that requirement from someone else than a DME or even my Sleep Doctor. Guess I have some research to do in my future.

[squid13]

Here's a thread back in October were they discussed some of this. viewtopic/t93341/Medicares-New-Law.html

[Pugsy]

Here's a thread back in October were they discussed some of this. viewtopic/t93341/Medicares-New-Law.html

I have heard a lot of rumors but haven't seen it in print.
Anyone actually seen the regulations and not taking the word of DME (though I know they NEVER lie) or someone in the office that probably hasn't seen any rules either??

Only thing I have seen in print is regarding new users and compliance and the face to face interview prior to 90 days usage.
I haven't seen anything in print from Medicare regarding follow ups needed for getting replacement equipment within the allowed schedule.

[StuUnderPressure]

Here's a thread back in October were they discussed some of this. viewtopic/t93341/Medicares-New-Law.html

I have heard a lot of rumors but haven't seen it in print.
Anyone actually seen the regulations and not taking the word of DME (though I know they NEVER lie) or someone in the office that probably hasn't seen any rules either??

Only thing I have seen in print is regarding new users and compliance and the face to face interview prior to 90 days usage.
I haven't seen anything in print from Medicare regarding follow ups needed for getting replacement equipment within the allowed schedule.

The one requirement you note above that you have seen in print is dead on.
Surprise, Surprise, Pugsy is right!

While helping someone in Feb 2013 get her 1st machine paid by Medicare soon after she qualified for Medicare, I did some research to weed out the rumors from the facts. I did see that particular item (amongst others) in actual print.

But, I don't remember seeing anything about yearly visits to the Sleep Doctor just to continue to get supplies. I know that I can't fill drug RXs that are more than a year old (I am NOT on Medicare for drug RXs), but to buy a mask or hose, etc. seems a bit extreme.

[LSAT]

What is the definition of a "sleep doctor". You can consider your primary care doctor as your sleep doctor and use your annual physical as your yearly visit.
Just discuss your CPAP and how you are doing at that visit.

[angcor580]

Good for you ReadyforRest! So important to be proactive! I am thankful that I had a good experience with my sleep specialist and I am able to message her at any time with a quick response. However I am not fond of my DME supplier but luckily my sleep specialist make it works. I would never go see my primary care physician for prescription on my CPAP titration... as that not her specialty. If I need to make any changes to my CPAP script or need medicine I have to see the doctor within that year. I just now switched to yearly check in with my doctor since I am doing well. I know the body changes over time so I will always plan to see the sleep specialist once a year just in case.

[ReadyforRest]

Thank you, angcor580. What bothered me most about my sleep doctor was that they didn't know who I was, or which appointment I was coming in for. Why would I go to someone who can't even get that straight? It didn't give me confidence in them being on top of my treatment at all. I don't want to be some anonymous patient in their assembly line operation. That's how they made me feel.

Here's a link to our sleep medicine Clinical Standards put out by The College of Physicians and Surgeons of Ontario. http://www.cpso.on.ca/uploadedFiles/pol ... S-2013.pdf

It's what all sleep study facilities here have to follow. Very interesting reading. If you scroll down to page 89, it gives you a breakdown of sleep terminology and how they score apneas, hypopneas, RERA's, etc. There's a lot of good information on sleep disorders in children and how they treat them, also.

I couldn't find any specific information about when follow-up appointments should be scheduled. Only this, on page 40:

"Follow-up:
Sleep Physicians who provide medical consultations, diagnostic polysonography or initiate treatment
(either separately or together) for patients with sleep disorders, are expected to provide appropriate
and timely clinical follow-up to review test results and monitor clinical outcomes.

Specifically, in relation to patients with sleep-disordered breathing, if the sleep physician initiates
(recommends or prescribes) any form of positive airway pressure treatment (for example, CPAP,
BiLevel PAP, ASV, NIV), he/she is expected to review with rare exception, the patient within 3 months
of commencing the treatment to verify efficacy, adherence, and clinical response to the treatment. If
these outcome measures are unsatisfactory within the first 3 months of treatment, the sleep specialist
should continue to follow the patient until the sleep problems are resolved. When satisfactory clinical
outcomes have been achieved, or a suitable compromise reached in the event that it is not possible to
achieve an optimal outcome, the sleep physician should make suitable arrangements for long-term follow-up.
Long-term follow-up may be undertaken by the sleep physician, or the referring or family
physician, but there must be clear communication in writing with documentation in the patient’s chart
from the sleep physician, who will be responsible for further follow-up of the patient.
There may be rare circumstances (for example, a patient being flown in from northern Ontario for a
sleep study) where it is not feasible to provide regular on-going medical follow-up, and where there is
no alternative facility that can provide this follow-up – in such circumstances, there must be clear
communication in writing documented in the patient’s chart with the referring physician and an
agreed-upon shared plan of care for the patient."