Frustration with primary care doc. Anyone else?

[RetPM]

Need to get some frustration out of my system and see if anyone else has run into this scenario with their primary care doc. I called for an appt. with him last Thursday afternoon, after I had seen him for a 3 mo. check only 10 days prior. Got an appt. for late Friday afternoon to have him check out some increased heart palpitations which had developed Monday last week. Now, I have always had these and have always been told that they are harmless, benign extra beats. But the fact that I had gotten into a cycle of having multiple spells of them throughout the day for most of last week was a bit concerning. Last time I had a lengthy bout of these was 3 years ago when I was exhausted and stressed after retiring and moving to another state all at the same time. Had a stress test with dye at that time and all was OK.

Last week they got so annoying that I thought I'd better have them checked out. I figured it could be that my thyroid was a bit out of whack, or that it was stress from hip pain from my arthritic hip, but thought it best to check it out. I also kept wondering if having a bad week with my cpap treatment could have anything to do with precipitating this stretch of them. I started cpap at the end of May, and just when I think I've got it all figured out something new pops up. The past few weeks I had been training myself to sleep on my back because I had been swallowing air when sleeping on my side. My hip seemed better sleeping on my back, so I figured that was the way to go. It was going OK until leaks started waking me up multiple times. My mouth falls open when I sleep and my lower lip is often hanging out below my full face mask when I wake. I had a whole week or so of this before I saw my doc last Friday. I thought perhaps the bad nights and less than optimal treatment had caused my palpitations to flare up. (BTW, I just ordered some new seals for my mask. If this doesn't help I'm thinking about a chin strap. Also back to side sleeping, but on good hip side!)

Well, I found out that he does not want to discuss the particulars of my cpap treatment. When I asked if the bad cpap nights could have caused the palps to flare up, he told me I was overthinking the whole cpap thing--that I didn't HAVE to use it if I couldn't, but that it is much better for my health if I do. He told me not to worry about the stats on the machine--that all he cared about was that wearing the mask for at least four hours a night was better than not wearing it at all...that treatment, I guess no matter how crappy, was better than no mask at all. When I mentioned reading something on the cpap forums, he kiind of made fun of that and told me that I needed to discuss my problems with my DME company--that they are the experts in this and deal with it all the time. Well, so far my calls to them have been less than satisfactory as far as discussing any problems I was having. They are great for wanting to send you supplies though.

I know this makes my doc sound like a real jerk, but he has never been like that before. I am chalking it up to being 4:30 on a Friday and him possibly having had a really bad day. I could tell at the outset of the appt. when he was asking me about the palpitations that he was very impatient and not his usual self. Maybe he lost a patient that day or just had to give one very bad news...I don't know. But I was pretty disappointed that he had that whole attitude about the cpap treatment. Guess I won't talk to him about it again, as all he seemed to want to know was if I was wearing my mask or not. The most help and information I've received is from this forum...and from the lady at the sleep clinic that conducted my home study. I went to pay my bill and got to talking to her and learned a lot! Never did have any communication with the sleep doctor at the clinic though.

If you've made it through my rant, thanks for reading. Has anyone else had this experience with their primary care doc regarding cpap treatment?

[Krelvin]

My current PCP is very into my CPAP therapy, wouldn't want it any other way. She wants to see the reports as well.

[chunkyfrog]

It is not uncommon for doctors to believe DME's to be helpful;
Unless, of course, they use cpap themselves. Opposition to online help?
JUST PLAIN IGNORANT!
I would be looking for another doc if it were my situation.

[MarylandCPAPer]

I am not surprised by your primary care doctor not knowing enough about CPAP treatment to address your concerns. Mine relied upon the recommendations from the sleep lab, which were issued by a sleep specialist who reviewed my sleep study but who I never met. All drs. are asked for is data on how often you use your machine (Hours/night and how many nights in the period of time assessed) to certify that you are in compliance with use of the machine, so the DME can get paid by insurance. If your dr. was a sleep specialist, s/he might have been more interested in hearing the details of your treatment and been able to give you better feedback.

Some doctors do not appreciate patients doing independent research and getting advice from Internet forums, while others are glad we are proactive in our treatment. Yours obviously is the first type. Most of what most of us here learned about using CPAP came from online sources and this forum, not from our doctors or DMEs.

In your situation, I think a referral to a cardiologist may be in order. No matter whether your heart palpitations are being caused by CPAP or by something else, your possible heart problems need to be addressed by a cardiologist. Cardiologists are not necessarily familiar with the specifics of CPAP treatment either, but tests of your heart function ordered by a cardiologist should help find out what is going on and how it should be treated. I just underwent a series of such tests myself and the cardiologist's review was reassuring and helpful. My GP's interpretation of the same tests was different from the cardiologist's interpretation.

I hope you find a doctor soon who can help you figure out what is going on and how to treat it.

[LSAT]

I'm really lucky...My PCP has a mother that is on CPAP and my Cardiologist also uses CPAP. Both are relatively familiar with the potential CPAP problems.

[Bill44133]

You went to the doctor to complain of increased heart palpitations. Since he believes you are over thinking the cpap thing; then what did he say what could be the issue? Did he address your concerns at all? Was he just ringing the cash register one more time before calling it a day on Friday?

With what you have posted I would be afraid to go back to this doctor..

[Janknitz]

Most doctors who are not sleep specialists know very little about CPAP other than it's a good treatment for apnea. Beyond that most don't get into the minutiae of types of CPAP treatment, masks, hoses, machines, and settings. I'm impressed that some PCP's do seem to know more!

Your doctor sounds like he is a little intimidated by your knowledge in this area. He is also woefully uninformed if he thinks that use of the CPAP is optional and/or that 4 hours a night is adequate treatment. He is mixing up the Medicare compliance requirements with optimal treatment.

I would have way more respect for a doctor who 1) admits his lack of in-depth knowledge ("I don't know much about the day to day use of CPAP, would you like me to refer you to someone who can help you?") and 2) praises your commitment and knowledge toward optimizing your own health. This doctor did neither, he belittled your efforts, and pretended he knew more than he did. He is taking a cavalier attitude toward YOUR health. This is not a doctor I could trust or feel comfortable with--he would be my former doctor after an appointment like that.

[RetPM]

I am not surprised by your primary care doctor not knowing enough about CPAP treatment to address your concerns. Mine relied upon the recommendations from the sleep lab, which were issued by a sleep specialist who reviewed my sleep study but who I never met. All drs. are asked for is data on how often you use your machine (Hours/night and how many nights in the period of time assessed) to certify that you are in compliance with use of the machine, so the DME can get paid by insurance. If your dr. was a sleep specialist, s/he might have been more interested in hearing the details of your treatment and been able to give you better feedback.

Some doctors do not appreciate patients doing independent research and getting advice from Internet forums, while others are glad we are proactive in our treatment. Yours obviously is the first type. Most of what most of us here learned about using CPAP came from online sources and this forum, not from our doctors or DMEs.

In your situation, I think a referral to a cardiologist may be in order. No matter whether your heart palpitations are being caused by CPAP or by something else, your possible heart problems need to be addressed by a cardiologist. Cardiologists are not necessarily familiar with the specifics of CPAP treatment either, but tests of your heart function ordered by a cardiologist should help find out what is going on and how it should be treated. I just underwent a series of such tests myself and the cardiologist's review was reassuring and helpful. My GP's interpretation of the same tests was different from the cardiologist's interpretation.

I hope you find a doctor soon who can help you figure out what is going on and how to treat it.

Thanks for replying--your situation with diagnosis after sleep study sounds like my experience. The lady at the sleep lab told me that many PCPs just hand off a newly diagnosed apnea patient to a DME, simply because they aren't that well versed on CPAP. She wasn't at all surprised that it was the DME who called to tell me I needed to set up an appointment for a CPAP machine--hadn't heard a word from my PCP's office. She indicated that is not at all unusual. BTW, my PCP is an internal medicine specialist, not a sleep doctor at all.

I should have mentioned that I had and EKG at my PCP's office before I left and it was OK. He also ordered blood work and a 24 hr. Holter monitor, which I am currently wearing. So he did not blow off my symptoms and is having it checked out. As I said, I have dealt with this off and on throughout the years, have been to the ER, worn Holter monitors before, had the stress test with dye, and have always been told that what I have is harmless--just uncomfortable and annoying at times. I know it is also stress related, but was mainly curious to see if he thought this time it could be related to the CPAP problems. I think you are right that all a lot of docs are concerned with is the compliance reporting, and that is as far as their interest in the details of CPAP goes. They leave all of that to the DMEs, sad to say.

[RetPM]

You went to the doctor to complain of increased heart palpitations. Since he believes you are over thinking the cpap thing; then what did he say what could be the issue? Did he address your concerns at all? Was he just ringing the cash register one more time before calling it a day on Friday?

With what you have posted I would be afraid to go back to this doctor..

Thanks for your reply and concerns. Please see my reply to MarylandCPAPer above.

[RetPM]

Most doctors who are not sleep specialists know very little about CPAP other than it's a good treatment for apnea. Beyond that most don't get into the minutiae of types of CPAP treatment, masks, hoses, machines, and settings. I'm impressed that some PCP's do seem to know more!

Your doctor sounds like he is a little intimidated by your knowledge in this area. He is also woefully uninformed if he thinks that use of the CPAP is optional and/or that 4 hours a night is adequate treatment. He is mixing up the Medicare compliance requirements with optimal treatment.

I would have way more respect for a doctor who 1) admits his lack of in-depth knowledge ("I don't know much about the day to day use of CPAP, would you like me to refer you to someone who can help you?") and 2) praises your commitment and knowledge toward optimizing your own health. This doctor did neither, he belittled your efforts, and pretended he knew more than he did. He is taking a cavalier attitude toward YOUR health. This is not a doctor I could trust or feel comfortable with--he would be my former doctor after an appointment like that.

Thanks for your reply, and I agree with you in some respects. At this point I am chalking up this bad appt. to him having a bad day and relying on the DME companies to handle the minutiae of CPAP treatment and problems. I have never before felt that he took a cavalier attitude toward my health or blew off my concerns, and he did order tests for the palpitations. But if I feel in the future that he is belittling me or being cavalier about my health, believe me--I will be finding another PCP!

[RetPM]

My current PCP is very into my CPAP therapy, wouldn't want it any other way. She wants to see the reports as well.

Sounds as if you are one of the lucky ones.

[RetPM]

I'm really lucky...My PCP has a mother that is on CPAP and my Cardiologist also uses CPAP. Both are relatively familiar with the potential CPAP problems.

Bingo!! Very fortunate, indeed!

[pettyfan45]

My first primary care doc told to just lose weight after my first sleep study in December just because even though my AHI was 14 my apnea was still considered "mild" and I after losing almost 30 ponds since March with no change in my symptoms and changing to a nurse practitioner I have another sleep study in mid October and hopefully finally get on CPAP and not feel so tired all the time.

[MagsterMile]

My primary doctor, who basically is good, sometimes dismisses things I mention. For instance, last time I was in, horrible pain in left knee, the nurse weighed me on a digital scale. She must have transposed a number and added 10 pds to my weight. When I tried to tell him that it was wrong, he told me that digital scales do not lie. End of discussion. How do you argue with someone like that! I feel vindicated since the primary doc referred me to Ortho Dr. and that office weighed me on a digital scale and it was the number I knew it should be. It was written correctly on my report.

[Kam23]

Just a couple of thoughts.
You might consider using a pulmaolgist who specializes in sleep disorders. My PCP is fantastic but does not manage my OSA.

As new users we all tended to over think sleep, data, leaks etc. you will get to the point were you just get into bed, put your mask on, turn on the machine and go to sleep. The obsessing decreases.

Has your PCP told you what kind of palpitations you are experiencing. I am guessing from your description they are PVCs. You can have thousands a day and still be considered to be normal. When you start having symptoms that is when you should be concerned.

Good luck