Rested Gal - got what you advised (doc poked fun @ internet)

[episodic]

In another thread, you had recommended my prescription be amended to say this below before I went to the DME:


Auto-titrating cpap - Respironics REMstar Auto with C-Flex and integrated heated humidifier
pressure: 7 - 15 cm H20
c-flex setting: 2
ramp: off
mask - patient's choice
The patient is to be given the therapy setup instructions card/booklet in addition to the User manual.

----------------------

The doc looked at me and said "Who gave this to you?" I just said I did some research. He said, "You got this off that interweb stuff didn't you?" - I sheepishly said, yea. He said I guess all this makes sense. What is this cflex stuff? I said that it relexes the pressure as I exhale.

He queried me about the clinician's manual. THat is the only part he would not do. The rest is on my prescription now.

Now I need to get the the DME.

[Snoredog]

no big deal on the manual, it is only a 5-6 page stapled photocopy flyer. it doesn't really give you much in the way of information anyway, most of the text is taken up with symbols and cautions. Programming the machine is just a matter of flip-flopping settings and been posted here a million times. They now put all those instructions on a single card with the M series machines.

Once you do it once you never look at it again.

[RedThunder94]

i have the entire clinical manual for the remstar pro2 and the remstar auto in a pdf format file if you want it i could send it in an email, lmk.

[NightHawkeye]

The doc looked at me and said "Who gave this to you?" I just said I did some research. He said, "You got this off that interweb stuff didn't you?" - I sheepishly said, yea. He said I guess all this makes sense. What is this cflex stuff? I said that it relexes the pressure as I exhale.

He queried me about the clinician's manual. THat is the only part he would not do. The rest is on my prescription now.

The audacity of physicians is truly amazing! Another all-knowlegeable gatekeeper refusing to empower patients, because only he is knowledgeable enough to write sleep apnea machine prescriptions, and yet this clown has no clue what C-flex is. Sigh . . . .

Good work episodic!

Regards,
Bill (thinking most physicians refuse to accept the fact that many of their patients know more about treating their own disorders than their physicians do)

[inacpapfog]

Yup, lots of people maintain strong opinions on narrow views!
That includes some doctors and DMEs !

[rested gal]

Good job, episodic.

[Guest]

[quote="episodic"]In another thread, you had recommended my prescription be amended to say this below before I went to the DME:


Auto-titrating cpap - Respironics REMstar Auto with C-Flex and integrated heated humidifier
pressure: 7 - 15 cm H20
c-flex setting: 2
ramp: off
mask - patient's choice
The patient is to be given the therapy setup instructions card/booklet in addition to the User manual.

----------------------

The doc looked at me and said "Who gave this to you?" I just said I did some research. He said, "You got this off that interweb stuff didn't you?" - I sheepishly said, yea. He said I guess all this makes sense. What is this cflex stuff? I said that it relexes the pressure as I exhale.

He queried me about the clinician's manual. THat is the only part he would not do. The rest is on my prescription now.

Now I need to get the the DME.

[snoregirl]

It is amazing how this doc thinks you can't/won't get ahold of the manual anyway. Free from people sharing here, or $5 on ebay. Plus there are those of us who would "play" with our machines until we figured it out anyway. Which is more dangerous to messing things up, having a manual that tells you which button to push (easier than programming a VCR) or messing around pushing every button and combination of buttons until we find it? Your doc (and a lot of others) need a does of reality.

[jeepdoctor]

The doc said, "What is this cflex stuff?" Episodic responded, "...it relexes the pressure as I exhale."

The doc has lots of company. The Lincare respiratory therapist in our fair city told me that Cflex is the pressure ramp-up function. She also told me that only she could set the Cflex setting.

As far as docs go, to the good docs, M. D. means medical doctor. To the others it appears that they think it means medical diety.

[Guest]

[quote="jeepdoctor"]The doc said, "What is this cflex stuff?" Episodic responded, "...it relexes the pressure as I exhale."

The doc has lots of company. The Lincare respiratory therapist in our fair city told me that Cflex is the pressure ramp-up function. She also told me that only she could set the Cflex setting.

As far as docs go, to the good docs, M. D. means medical doctor. To the others it appears that they think it means medical diety.

[Guest]

Why should the doctor know everything about a CPAP machine? That makes no sense to me.

That's the reason there are various partners working together in various parts of the system. It's the same reason a dermatologist isn't going to know everything about spinal surgery. Are you calling the dermatologist a fraud and call for him to lose his practice because he doesn't know about it?

To me, the whole point of things is so that the doctor can focus on medicine, and the equipment providers to focus on knowing the equipment. Equipment providers don't need to know all the underlying medicine behind why a person has OSA and the doctor doesn't need to know about all the bells and whistles on every CPAP machine.

If the doctor was a board certified sleep specialist and not just a PCP or a pulmonologist, I might feel a little differently - since he has chosen to specialize in sleep medicine he/she should be more likely to know some basic cpap functions. Even still I wouldn't say it's a big deal.

Further, can you blame a doctor for not wanting to actually prescribe the settings manual? He's now putting his licensce on the line stating on paper that he wants the person to be able to adjust thier own machine and also that he feels they are fully able to do so without any harm. If something bad happens, guess who the very first one to be held accountable for it is? The doctor whose name is on that prescription.
Without having a great deal more information - I know I wouldn't sign it if I was a doctor.

[jeepdoctor]

Guest said, "Why should the doctor know everything about a CPAP machine? That makes no sense to me."

Speaking as an engineer, and as a patient, I feel that the doc should know and understand the equipment s/he is writing a prescription for. S/he needs to know as much about the equipment as we expect him/her to know about drug interaction when s/he writes a prescription.

The doc writes the prescription which then goes to, usually, a DME. The DME has no financial incentive to provide a higher-cost machine with auto and Cflex capabilities. If the doc doesn't put it on the prescription, it probably won't happen. Therefore, the doc needs to know the capabilities of the equipment and prescribe accordingly.

Guest further stated, "If the doctor was a board certified sleep specialist and not just a PCP or a pulmonologist, I might feel a little differently - since he has chosen to specialize in sleep medicine he/she should be more likely to know some basic cpap functions. Even still I wouldn't say it's a big deal." Guest, you are full of crap.

[Guest]

Guest further stated, "If the doctor was a board certified sleep specialist and not just a PCP or a pulmonologist, I might feel a little differently - since he has chosen to specialize in sleep medicine he/she should be more likely to know some basic cpap functions. Even still I wouldn't say it's a big deal." Guest, you are full of crap.

Well no - I'm not full of crap but thank you all the same.

[Another Guest]

He's now putting his licensce [sic] on the line stating on paper that he wants the person to be able to adjust thier [sic] own machine and also that he feels they are fully able to do so without any harm.

Harmed by cpap? I can't recall an instance where anyone has been harmed by cpap... whether they adjusted it themselves or had it adjusted by a DME.

The head of Resmed had this to say:

CPAP is as dangerous as a bowl of cereal. The only way you can get hurt by one is if someone picks the damn thing off the nightstand and hits you over the head with it.
-Peter Farrell, CEO, ResMed

Inappropriate CPAP is harmless. Untreated sleep apnea kills.

-Dr. Barbara Phillips, MD, MSPH, FCCP
Professor, Division of Pulmonary Critical Care and Sleep Medicine
Director of the Samaritan Sleep Center
Department of Internal Medicine
University of KY College of Medicine
Lexington, KY

Cpap therapy is about as benign as you can get. You can hang your head out the car window while driving down the road and get the same effect.

The harm that does occur is when cpap isn't used.

Why should the doctor know everything about a CPAP machine? That makes no sense to me.

You don't think a doctor should know about the drugs and equipment (s)he prescribes for a patient? You don't think a doctor should be current on the newest drugs and equipment so (s)he can make an informed decision as to what is the most appropriate drug or equipment to prescribe for the patient? You don't think it is incumbent upon the prescribing physician to know the features and benefits of what he is prescribing? Really?? I suppose there are a handful of lazy disreputable doctors out there who would agree with you; we can only hope they are vocal in their opinion so they will immediately lose their license to practice medicine.

[rested gal]

Why should the doctor know everything about a CPAP machine? That makes no sense to me.
---
To me, the whole point of things is so that the doctor can focus on medicine, and the equipment providers to focus on knowing the equipment. Equipment providers don't need to know all the underlying medicine behind why a person has OSA and the doctor doesn't need to know about all the bells and whistles on every CPAP machine.

I think the Guest makes a good point.

If the doctor was a board certified sleep specialist and not just a PCP or a pulmonologist, I might feel a little differently - since he has chosen to specialize in sleep medicine he/she should be more likely to know some basic cpap functions. Even still I wouldn't say it's a big deal.

Another good point.

Further, can you blame a doctor for not wanting to actually prescribe the settings manual? He's now putting his licensce on the line stating on paper that he wants the person to be able to adjust thier own machine and also that he feels they are fully able to do so without any harm. If something bad happens, guess who the very first one to be held accountable for it is? The doctor whose name is on that prescription.
Without having a great deal more information - I know I wouldn't sign it if I was a doctor.

Yes, in this litigious society, I can see how a GP who doesn't know much about cpap treatment or the machines would hesitate to turn the keys over to a patient, even if he thought the patient is a reasonably intelligent, informed person capable of handling his/her own treatment decisions.

Some doctors are quite comfortable with letting a well-informed patient have control over a benign (as a couple of other guests rightly pointed out) kind of therapy.

It was worth a try, to try to get that on the script. I think the GP did fine, to cooperate with the specific requests as far as he did. Especially since cpap treatment and all the stuff that goes with it isn't completely familiar to him.

Better that than a GP who won't even consider changing a single thing and who relies absolutely, totally, completely on what equipment is recommended on the study report, despite anything a patient who has obviously been researching this stuff might bring up.

This GP was openminded imho, and willing to consider what his patient said. Wasn't a knee-jerk "NO" type to anything the patient might suggest. Sounded like a good doctor to me.