Doctors and The Things They Tell Us

[sleepycarol]

I have a friend at work that has been on a cpap about the same length of time as I have been (Aug of 2007). We were talking yesterday after school and he commented that he was going to ask for another sleep study. Of course being the "non-nosy" person I am asked him why.

Said he was feeling like crud and wasn't getting any sleep. Said when he did sleep he was still exhausted and couldn't figure out why.

A couple of weeks ago he said he made an appointment with his sleep doctor -- since his family doctor wouldn't deal with his sleep apnea.

Said the doctor told him to bring in his machine and they would go "over" his therapy and try to figure out why he was once again feeling so tired (he had been doing fine until this past summer). He said he went and the doctor took his machine to the back room, came back in and told him his machine was set correctly at 12 and everything was working properly. His therapy "results" looked great and there wasn't anything for him to worry about and to keep using his machine nightly.

Well I told him I could look at the data from his machine if he could remember to bring the card to work I would bring my laptop and card reader. He came in this morning and said -- well my machine doesn't have a card or even a place to put one in. I asked him for the name and he said he had written it down and it was a Remstar Plus.

Now he thinks his sleep doctor is great (but is leaning on thinking not so great after their little talk). I looked at him dumbfounded cause I KNOW the doctor doesn't have a clue about his therapy -- only compliance.

Tomorrow (didn't have a chance today) I am going to have a talk with his wife (she teaches in the next room) and explain that his machine doesn't record anything but compliance data and that doctor is full of himself when he tells someone with a Plus machine that their "therapy results look good". He has other health issues and it makes me mad the doctor blew him off like that!!!

When doctors tell their patients that and THEY (the doctors) KNOW they don't know they should be ran out of town!!

[Shellie_p]

Well at least his doctor believes he has sleep apnea in the first place.

I was diagnosed in 1995. And from then till around 2007 I went through 6-7 doctors that blew off my sleep apnea and even a couple that downright refused that it was even a valid medical diagnoses. If you can believe that one.

Now I get to start seeing a Pulmonoligist(SP?) That specializes in sleep. My daughter saw him a few months ago and I was really ANNOYED that they have no means of reading the cards from the machines in the first place, And had NO Interest in seeing the fax that the DME had sent them of my daughters card info. Granted she had the Mplus that only shows compliancy. But to not even want the info.

Now I have to go see him soon (hes the only one in town) and I fear I will be hunting for a new one that my insurance will pay for because he didn't seem to know much at all. So what was med school teaching these people??

[fireman38355]

sounds like somebody needs a new sleep doc. If it were ME, I would go to their office and TELL them why I was finding a new doctor, and EVERYBODY in the clinic would hear me.

[Goofproof]

Two months ago my primary heart doctor, told me I needed to have a defib unit installed, he is my most trusted doctor of six. The problem I had one put in over three years ago, something I really regret as the poorest medical choice I have ever made. I ask him which side to put it on as the bump in my chest would be pretty high if he used the left side, due to the one that's already there. Kind of shakes your faith in Doctors. Jim

BTW: The one I have now has defective leads on it, That they say would be more dangerous to remove that leave in, unless it shorts out and kills me.

[DoriC]

Sleepycarol, Stories like this make me so MAD! "Dr: Your results are great"!! I'm curious about one thing, in 3 years your colleague hasn't been the least interested in knowing how his therapy was going?? Now that makes me SAD! I'll be interested in an update about this if you get "un-nosy" again.

[jonquiljo]

When doctors tell their patients that and THEY (the doctors) KNOW they don't know they should be ran out of town!!

Well I'm afraid that while many doctors should know better - there are a great number who really don't know what they are doing. Getting an MD requires great memorization skills - its the reasoning and thought that they are missing in many cases. I taught med students when I was in grad school in the 70's and I was shocked at how little they wanted to know - they just wanted to remember what they thought they needed to remember. Let's say most of them were "deficient" in one or more types of reasoning skills.

Now we have the cost driven medicine. I used to know a lot of MD's - many from my school days - and they all left in the late 90's after the big surge of HMO's and cost based medicine. But before that - and the few remaining in medicine - I heard and hear what goes on and boy - it is frightening!

They get nasty letters over and over again from insurers each time they prescribe a drug or test that the insurance company finds too expensive or doesn't want to do. Insurance companies just rain paper on them constantly with threats and nasty-grams. They are constantly threatened with their "provider status" from major health plans. If BC/BS drops a Dr as a preferred provider because they Rx to many meds or tests they have their patient base drastically reduced. So they are held hostage into following what the insurers want. If not, they can go out of business or at least start to lose money. If they are part of an HMO, they have strict rules on how to practice - and it all pertains to money and cost, not health. They have very little room for real decisions. Of course, this only applies to the ones that can make decisions. The ones that only can memorize just do the same thing over and over. And lots of them hate what they do. They hate their jobs far more than you can ever imagine.

Top that with a group of people who are status and money oriented, arrogant and elitist - I am not surprised at all that a Dr. faked it when he told your friend that his treatment looked good. He probably was not in the mood to Rx yet another sleep test and jeopardize his livelihood. He probably just didn't care any more as it was easier to lie than to even think about your friend as a patient. Of course, it was a no-brainer to Rx your friend a newer data capable machine - oops! There's that old insurance company hammering on the Dr not to do that isn't here? So it's easier for them to sit back and say nothing - or lie - than to fight the system and their income. Of course many of the real gutsy ones - or the real smart ones left medicine years ago - because they hated this way of life.

Our problem is that we trust these people too much. We tend to put our lives in their hands as it scares us when our health fails us. Its human nature to do so. The problem is that these people and the people they report to (the insurance industry) are not to be trusted. Not all Dr's are bad, but there are way too many that are. And most of them follow the mandates of the insurers more than you think. They have no choice.

[Sillyme]

The ones that only can memorize just do the same thing over and over. And lots of them hate what they do. They hate their jobs far more than you can ever imagine.

You might enjoy this episode of "Doctors Unplugged" - titled "Why your doctor is so wierd and what you can do about it". It's a series of videos done by two prestigeous physicians in the style of "Car Talk". Starts off a little chatty but is very informative.
http://www.doctorsunplugged.com/episode ... o_about_it

[Sillyme]

[/quote] They are constantly threatened with their "provider status" from major health plans.[/quote]

My PCP was dropped by BC/BS because he "Spent too much time with his patients". He contested it and showed them statistically that more time listening and educating patients actually saved money, but he was denied. His practice still seems to be doing well. This is the kind of Doc you don't mind paying 'out-of-network' for. Luckily my Aetna still covers him (for now).

[Sillyme]

-- well my machine doesn't have a card or even a place to put one in. I asked him for the name and he said he had written it down and it was a Remstar Plus.

When I asked for a machine with data capability the sleep lab RN (I never actually saw the doctor) kept insisting that the Remstar Plus was the best machine on the market and would give the doctor what he needed. I tried to explain the difference between the Plus and the Pro but she got very irritated. At first I tjhought she was just dim. Now I believe it is a control issue.

[steamfan]

I had been seen regularly by a fairly large clinic/hospital system, and the persistent and nagging feeling that they were ONLY interested in the most superficial diagnosis and treatment that would get me billed and out the door. In frustration, I called the Mayo Clinic, said "I feel like hell and nobody is helping me. Can you see me?"

My first appointment was with a Pulmonologist with a couple of Ph.D.s besides his M.D. and he spent 90 minutes with me. I was stunned. "Won't this get you in trouble with the Clinic or the insurance company?" He laughed, and said, "I'm paid the same whether I see one patient or one hundred. And the Mayo Clinic encourages us to spend as much time as necessary with our patients, in order to achieve a good result"

They use a team approach, pulmonologist, sleep doc, cardiologist, neurologist and came up with a great set of answers that I would NEVER have gotten at my former clinic. They also gave me their cell phone #'s and said "Call if you have any issues, okay?"

It was an amazing experience. And I'm getting better. Who knew?

[NotMuffy]

Said he was feeling like crud and wasn't getting any sleep.

Did you try selling him some BretzCrap?

[williamco]

When doctors tell their patients that and THEY (the doctors) KNOW they don't know they should be ran out of town!!

Actually I believe doctors don't know that they don't know. till today there is no mandatory requirement for a doctor to be a "sleep doctor". This is relatively a new field (yes, 20 years is new in medicine), and also patient don't know what to check in a doctor to have him/her as a sleep doctor

The label "Sleep doctor" is till today a self acclaimed title not an earned title based on accredited training

Sleep medicine is not a speciality till now, not like internal medicine, cardiology,ENT..etc
till now sleep medicine is piggybacked on another specialities

[bailachel]

I saw my sleep doctor yesterday and came away a little disappointed. I have been satisfied with him up until now and in fact considered myself lucky to have a doctor who is himself a CPAP user.

This is the first time I have seen him since I switched (myself) from CPAP to Auto. My CPAP pressure was 10. After some tweaking I am now using Auto with a range of 10-15. My 90% is usually around 10.7 but it goes up to 12 every night and sometimes even 13 or 14.

He wasn't upset that I had changed it and he did see that my numbers had improved but while we were discussing this he said that he never recommends auto to his patients and doesn't use it himself because he feels it takes too long to get to the higher pressures in the range so they were better off with a set pressure. This doesn't make sense to me since my pressure is never lower than he prescribed and only goes higher as needed. (I originally set the range from 9.5-14.5 but I had more events between 9.5 and 10)

One of us is missing something in our understanding of how this works. Is it me or the doctor?

[Wulfman]

I saw my sleep doctor yesterday and came away a little disappointed. I have been satisfied with him up until now and in fact considered myself lucky to have a doctor who is himself a CPAP user.

This is the first time I have seen him since I switched (myself) from CPAP to Auto. My CPAP pressure was 10. After some tweaking I am now using Auto with a range of 10-15. My 90% is usually around 10.7 but it goes up to 12 every night and sometimes even 13 or 14.

He wasn't upset that I had changed it and he did see that my numbers had improved but while we were discussing this he said that he never recommends auto to his patients and doesn't use it himself because he feels it takes too long to get to the higher pressures in the range so they were better off with a set pressure. This doesn't make sense to me since my pressure is never lower than he prescribed and only goes higher as needed. (I originally set the range from 9.5-14.5 but I had more events between 9.5 and 10)

One of us is missing something in our understanding of how this works. Is it me or the doctor?

I'm in your doctor's corner on this one. Depending on the pressure settings, he's right. If using an APAP with a range of pressures, TO BE EFFECTIVE, the user needs to get the minimum pressure high enough to eliminate almost all the events. Once that pressure is determined, what few events that MAY occur which would require higher pressures, are usually not worth chasing and may occur anyway before the machine can respond. For many people, the changing pressures disturb the user's sleep and they never feel well rested.


Den

[roster]

Tomorrow (didn't have a chance today) I am going to have a talk with his wife (she teaches in the next room) and explain that his machine doesn't record anything but compliance data and that doctor is full of himself when he tells someone with a Plus machine that their "therapy results look good". He has other health issues and it makes me mad the doctor blew him off like that!!!

Here is one thing I found by experience that really helps get the recalcitrant interested in data!

I take them a color copy of one of my "Daily Details" reports. I take a report that shows a bad period of apneas or leaks and explain to them that using the report I was able to troubleshoot the problem and make an adjustment to prevent apneas the next night. Then I show them a great looking report from the next night. I tell them after the first night I felt like s*** the whole next day and after the second night I felt good the next day.

"A picture is worth a thousand bonks on the head."