Pathetic DR visit!!

clenchingtobreathe · Post by **clenchingtobreathe** » Mon Sep 24, 2018 4:53 pm

Many of you will be either nodding your heads or shaking your heads about this.
I had my first Dr. visit since starting CPAP.....close to 3 months now. Not only was he unaware that I had been changing my pressures, he didn't really care. Never asked how I felt. Never offered advice or help for my issues. Was delighted that I had an average AHI of 1.3 and that I was sticking to it. He had NO knowledge of the AirSense 10 for Her (so I explained the algorithm) but he said Medicare wouldn't pay for another machine for 5 years He wrote me a prescription for it in case I want to buy it myself.
And after all that, here's the kicker: I asked him if HE was using CPAP. He said no. He told me that he has tried it but couldn't sleep with it at night. OMG!

This is the same guy who told me CPAP would cure my clenching and need for sleep medication!
I told him he needed to send his apnea patients to this page.
He made my next appt. for a YEAR from now.

And THIS is supposed to be one of Nashville's top pulmonary specialists!

chunkyfrog · Post by **chunkyfrog** » Mon Sep 24, 2018 4:57 pm

. . . "TOP?"
In his own opinion, certainly!

clenchingtobreathe · Post by **clenchingtobreathe** » Mon Sep 24, 2018 5:09 pm

chunkyfrog wrote: ↑
Mon Sep 24, 2018 4:57 pm
. . . "TOP?"
In his own opinion, certainly!

It's a certainty that I'll be doctor shopping before the year is up! I walked out wondering if it would have been different if I had insurance that paid his $465 for 15 minutes....instead of Medicare that only paid $98.

palerider · Post by **palerider** » Mon Sep 24, 2018 6:43 pm

clenchingtobreathe wrote: ↑
Mon Sep 24, 2018 4:53 pm
And THIS is supposed to be one of Nashville's top pulmonary specialists!

Well, as they say, THERE'S your problem!

Lung specialist, not sleep specialist. your problem's further up.

chunkyfrog · Post by **chunkyfrog** » Mon Sep 24, 2018 9:13 pm

My plastic surgeon was paid 30 to 40 cents on the dollar by Medicare.
His reconstruction of my "rack" was a beautiful job, nonetheless.
I think it is more about the doctor than Medicare.
Insurance only pays part. Self-pay patients see the "full price", but many never pay a cent.

Sheriff Buford · Post by **Sheriff Buford** » Tue Sep 25, 2018 3:29 am

I have never seen a sleep doctor. My primary physician wrote my original script and I educated myself here. Do you need to see a sleep doctor? Of course, if I had issues, I'd be the first to see a doctor.

Sheriff

ChicagoGranny · Post by **ChicagoGranny** » Tue Sep 25, 2018 5:51 am

clenchingtobreathe wrote: ↑
Mon Sep 24, 2018 4:53 pm
And THIS is supposed to be one of Nashville's top pulmonary specialists!

You need a doctor who is board certified in sleep medicine. Some pulmonologists are, most are not. The two best sleep doctors I have used were neurologists with board certifications in sleep medicine.

jnk... · Post by **jnk...** » Tue Sep 25, 2018 6:31 am

Just to play doctor's advocate . . .

All I wanted from my sleep doc was a diagnosis and a prescription. After that, I was pretty much done with him. I did speak to him on the phone once after that to ask if he would write something more specific in order to help me deal with a brain-dead DME, but it turned out I didn't have to do go that route.

Docs diagnose and prescribe and sometimes supervise a lab/center, but the therapy itself is something obtained elsewhere and supervised elsewhere, for the most part. The docs that become more involved with the specifics of the therapy are often going above and beyond in order to help patients get the most out of the equipment that is obtained, set up, and supervised elsewhere.

Just sayin' that's the way I understood it back when I got diagnosed. Maybe things have changed.

Midwest_non_sleeper · Post by **Midwest_non_sleeper** » Tue Sep 25, 2018 9:21 am

ChicagoGranny wrote: ↑
Tue Sep 25, 2018 5:51 am

clenchingtobreathe wrote: ↑
Mon Sep 24, 2018 4:53 pm
And THIS is supposed to be one of Nashville's top pulmonary specialists!
You need a doctor who is board certified in sleep medicine. Some pulmonologists are, most are not. The two best sleep doctors I have used were neurologists with board certifications in sleep medicine.

^^^ This.

I deliberately see a neurologist that is certified in sleep medicine. He understands the terminology, the methods, what XPAP does, what it's supposed to do, desired outcomes, etc. When I told him that I was changing my pressure to meet my personal needs based on accumulated data from SH, and the hospital staff who monitors compliance wasn't happy that I was doing that ("It's outside of the prescription"), he simply waved his hand away and said that I was doing well and he was unconcerned with their opinions, afterall, he was the one who wrote the prescription. He then asked me "How do YOU feel with the settings?"

That's all I needed to hear to know that he gets it.

jnk... · Post by **jnk...** » Tue Sep 25, 2018 9:44 am

It doesn't matter which specialty (neuro/pulmo/psych/fam/) accompanies the sub-specialty of sleep, IMO.

Certification in sleep seems to be most often sought and obtained by lung docs ( http://www.absm.org/byname.aspx ), and they are more likely to tend to have an interest/understanding of the forms of treatment machines and the settings, IMO.

That said, if I were primarily having trouble with central sleep apnea, I might feel most comfortable with a neuro or cardio doc, depending.

Re: Pathetic DR visit!!

And for the record, my friends who have visited the Dominican Republic have all had a great time there!

Sheffey · Post by **Sheffey** » Tue Sep 25, 2018 10:31 am

Midwest_non_sleeper wrote: ↑
Tue Sep 25, 2018 9:21 am
I deliberately see a neurologist that is certified in sleep medicine.

I prefer the same. Neurologists certified in sleep seem to have a better understanding of sleep apnea associated comorbidities. My biggest problem is RLS and PLMD - neurological related. The two neurologists I see started a weight-loss program because so many of their apnea patients are overweight.

Arlene1963 · Post by **Arlene1963** » Tue Sep 25, 2018 11:32 am

My sleep doctor had a speciality in Respirology. (MD, MSc, FRCPC, Respirology)

At my appointment with her after my sleep study to discuss my diagnosis and treatment plan, she focused almost entirely on my mean sleep oxygen saturation reported in the sleep study, saying it was just fine. She asked if I experience daytime sleepiness. When I told her I don't she seemed a bit ambivalent about prescribing CPAP for me even though my PSG indicated an AHI of 16 (moderate OSA).

In her report to my nurse practitioner she wrote that weight loss is the best way to control obstructive sleep apnea long term. Considering my BMI was 25 (and this was also on the report) this rang a bit hollow and I must admit I lost faith in her.

I got the distinct impression that had I shown any reluctance to use CPAP I would have been sent away without a prescription, and told to concentrate on lifestyle modifications. (diet, exercise,, etc). I asked for a prescription for CPAP however, and she wrote one up for me and told me I don't have to see her again.

She was very pleasant and certainly was never rude or abrupt, but just didn't seem particularly useful to me.

Anyway, I am no longer a patient of hers and I self treat.

clenchingtobreathe · Post by **clenchingtobreathe** » Tue Sep 25, 2018 11:44 am

Thanks you all! I have pretty much decided to just take care of myself. If, after 2.5 months, the doc doesn't want to see me again for a year....I guess that's what he expects me to do anyway. I guess I just expected/wanted someone (and he is bd certified in sleep disorders) to CARE a little more......after all, he's the one who told me that untreated apnea can damage the major internal organs! But I can get that from my primary doc who is a gem! And he'll write prescriptions for whatever equipment I need in the future....

jnk... · Post by **jnk...** » Tue Sep 25, 2018 12:14 pm

For me, a doc these days is a lot like a waiter at a breakfast diner. I don't need a hug. I just want efficiency, accuracy, competence, and trustworthiness. I want him to care about his job and humanity in general. I don't need him to do the work of the cook, the owner, the busboy, or to feed me each bite. I may need some answers to my questions about the options on the menu so he can accurately write down the order I agree to. But if someone gets that order to me, I've mostly got it from there. If not, I'll catch his attention myself if there's something off. It's OK with me if the busboy, the owner, or the cashier fills my coffee cup or hands me the ketchup if the waiter is busy taking other orders. I'll still leave a tip.

A good doc can make all the difference. But he is still just a glorified middleman in a much larger operation, all things considered, the way modern medicine is having to be practiced.

SewTired · Post by **SewTired** » Tue Sep 25, 2018 4:14 pm

clenchingtobreathe wrote: ↑
Tue Sep 25, 2018 11:44 am
Thanks you all! I have pretty much decided to just take care of myself. If, after 2.5 months, the doc doesn't want to see me again for a year....I guess that's what he expects me to do anyway. I guess I just expected/wanted someone (and he is bd certified in sleep disorders) to CARE a little more......after all, he's the one who told me that untreated apnea can damage the major internal organs! But I can get that from my primary doc who is a gem! And he'll write prescriptions for whatever equipment I need in the future....

While we all have our disgust about sleep doctors, there's no reason to handhold you if he isn't going to do anything else. He (or a staff PA or NP) MUST see you to give you a new annual prescription. If you have problems, you call and make an appointment (and good luck with that - typically 1-2 months). I just get mad that they don't even look at the graphs - my AHI barely qualified for a machine. It's my HEART that did. Yet, no questions on that.