Laws about Respiratory Therapists

BrianRT · Post by **BrianRT** » Fri Jun 15, 2007 6:45 pm

Judy,
I wasn't really serious about the consulting service for data interpretation. IMHO, that could be done for free by a number of PAP knowledgable people on this forum. I would think that knowing your AHI's and leak rates and 90th percentile, etc. isn't rocket science, just a little education on what to look for.

"I am sorry, but an RPSGT will be much better qualified to work with OSA patients, patients with multiple sleep problems such as OSA and insomnia or PLMS than an RT" --DP

Dan,
The last thing I want to do is get in a pissing contest about RT vs. RPSGT. Granted, PLMS and insomnia is a little out of my scope of practice, but saying that an RT is much less qualified (the inverse of 'much better' as you stated) to work with an OSA patient is a little presumptous. Managing a patient with OSA and multiple medical/pulmonary problems such as COPD, CHF, Pulmonary Fibrosis, Pulmonary Hypertension and others could be a little problematic for a non-RT (physician nonwithstanding). A good understanding of the entire ventilatory picture (PaCO2/acid base balances, mean airway and intrathoracic pressures, alveolar respiration and pressure release ventilation just to scratch the surface) is definately indicated in patients presenting with these co-morbidities.

But hey, we're all in this together, right? No need to be mutually self-exclusive

_________________

CPAPopedia Keywords Contained In This Post (Click For Definition): AHI

Slinky · Post by **Slinky** » Fri Jun 15, 2007 7:07 pm

DEN!!!! For crying out loud! The frumpy ditz RT at my CPAP DME supplier's makes at least THAT much a year???? She isn't worth the powder to blow her to h*ll for crying out loud!!! What a rip off SHE is!!! She isn't worth what her schooling for her credentials cost!

Now, the RTs and RPSGTs that take the time to stop in here and help us out sure should be getting the 95th percentile as a BASE salary!! God bless them. (And, Brian and DP, don't you go getting swelled heads!) We appreciate those of you who take the time and interest.

Babette · Post by **Babette** » Fri Jun 15, 2007 7:23 pm

Brian, are you telling me if I hired a competent RT I wouldn't have to ALSO HIRE an ENT and a Pulmonary specialist?

I'm laughing, because right now my TEAM consists of: The techs at the sleep lab, the Neurologist who is my "sleep do", my primary, of course, the pulmonologist who was already treating my allergies and asthma, and now I need to go find an ENT to talk to me about my tonsils and whatever else they can think of.

Oh, and I need to hire an RT to make reports to the Neurologist.

Good lord, how did I get this old? I watched my grandmother do this. What was I THINKING letting myself get into this bad a shape??? Sigh...

Well, it's not a good day to die today. Maybe tomorrow night, after I give my seminar on historic head coverings and hairstyles for the fashionable 1855 babe.

LOL,
B.

Guest · Post by **Guest** » Fri Jun 15, 2007 8:19 pm

Babs,

For what it's worth, my RT (and Sleep doc) looked at my printouts and got a blank look in their over-paid eyes. I found myself educating THEM!

Save your time & money. You're obviously an intelligent lady who's done her research. How do you think they can help you?

Babette · Post by **Babette** » Fri Jun 15, 2007 9:34 pm

Well, if I find that I'm having trouble, and I need to make a change of some sort, I will need assistance. For example, what if I lose weight, and decide I need to change my pressure? I could probably handle that, but if for some reason I need the doctor to write me a scrip for something, she will want to see what the RT has to say about my readouts. See?

I guess I don't need an RT right this very minute. Though I'm sure I'll need some help setting up the new APAP and getting it tweaked just right. But I'm looking forward to the future, and life without the current B&M DME and how to make the current system work for me.

The doctor only knows how to do HER part - she's used to having info fed her by Techs and RT's. So, I'm just pondering how to make that work. Not a huge immediate crisis, just gathering knowledge for anticipated future need.

Cheers,
B.

BrianRT · Post by **BrianRT** » Fri Jun 15, 2007 9:59 pm

1855 babes?
Hmmm....those ankle length dresses really turn me on ROFL!

Interesting that you don't see a lot of ENT docs in sleep medicine though

As always sweetheart, I'm available to assist in whatever capacity I can manage.

And my fee is paid in full with altruistic currency.

Babette · Post by **Babette** » Fri Jun 15, 2007 10:48 pm

How dare you look at my pure virgin ankles, sir!

You just wait until I get these split crotch drawers finished, then we'll see who's sexy... And YES, they are historically authentic! You think taking a piddle in 10 starched petticoats is EASY? Split crotch is MANDATORY! Heck, it may be MEDICALLY NECESSARY!

Thank you so much, Brian! (Blows Kisses)

LOL,
B.

DP · Post by DP » Sat Jun 16, 2007 6:16 am

BrianRT wrote:The last thing I want to do is get in a pissing contest about RT vs. RPSGT. Granted, PLMS and insomnia is a little out of my scope of practice, but saying that an RT is much less qualified (the inverse of 'much better' as you stated) to work with an OSA patient is a little presumptous. Managing a patient with OSA and multiple medical/pulmonary problems such as COPD, CHF, Pulmonary Fibrosis, Pulmonary Hypertension and others could be a little problematic for a non-RT (physician nonwithstanding). A good understanding of the entire ventilatory picture (PaCO2/acid base balances, mean airway and intrathoracic pressures, alveolar respiration and pressure release ventilation just to scratch the surface) is definately indicated in patients presenting with these co-morbidities.

Which is why I said an RPSGT/RT would be the best of both worlds. In any event you are correct, we are all on the same team.

Vasily · Post by **Vasily** » Sat Jun 16, 2007 2:22 pm

We also do not charge for card reading/report printing. If a patient brings in a card to be read, it is read, printed, faxed to their sleep doc, and a copy given to the patient. I ALWAYS ask the patient if they want me to leave the data on their card or want me too erase it.

However due to State laws and hospital policies I am unable to interpret/give advice regarding the printout. This is due to the fact that I work on the DME side of the house, disregarding the fact the I have 15 years under my belt and am a licensed RCP in 5 different states, RRT, CRT, N/P cert, RPFT, RPSGT, B.A, B.S. (I better consult with Slinky's RT to see if I got all that right huh Brian? LOL). Regardless, the ONLY ones I put on my charts or business cards is RRT/RPSGT, these are the only ones that matter to my patients.

Also in many states if you asked the RT "From my report where do you think my pressure should be?" and he tells you "I think it should be at XXcmh2o". This IS legal medical advice, and if you follow that advice and an unfortunate event occurs, that RT can (and has been in some cases) be sued. So it is worth it some regards to checkout your states laws regarding the advice that RT's can give. In my state they have not outlined these sort of laws clearly yet in regards to sleep. However there are similar situations outlined in the RCP laws, due to those I tell my patients, "Sorry by law I can not interpret/give advice regarding that report, you will have to consult your Dr." I'm sure some of them think that I am just making an excuse because I'm really an incompetent ass who is baffled by what he is looking at. Nothing could be farther from the truth since I myself am a CPAP user and do my own downloads at home.

Anyway, Babs my advice to you is too get the software, do your own downloads, print the reports and take them to your ENT. If he/she cannot look at them an do the interp, I would look for another Sleep Doc!!

Here is a good place to start looking:
http://www.absm.org/Diplomates/listing.htm

I spent 6 years as an RT at the tall hospital across I5 from you btw.

BrianRT · Post by **BrianRT** » Sat Jun 16, 2007 8:15 pm

To tidy up the paper trail, we always get a doc's order to set the pressure to whatever the report says. That way there is no inferring that it might be an RT only thing. Ironically, that is where the situations come up where I'm the one explaining it to the doc LOL.

Babs, so is THAT where the modern lingerie concept of crotchless panties came from? I learn so much on this forum ROFL.

BrianRT · Post by **BrianRT** » Sat Jun 16, 2007 8:16 pm

Dan,
No doubt that RRT/RPSGT trumps both hands. It's always good to have a Full House.

Guest · Post by **Guest** » Sat Jun 16, 2007 8:30 pm

I'm curious as to IF or how often you RTs may see an order from a doctor that "defies reason" (expecially for those of you that ARE hoseheads).

Or.....is EVERYTHING "reasonable" when it comes from a doctor?

If you do see these, how do you deal with it?

Den

DeltaSeeker · Post by **DeltaSeeker** » Sat Jun 16, 2007 8:54 pm

Brian and Dan,

The two of YO U are priceless IMHO. It's just too bad all OA professionals aren't as caring and knowledgable as you two. I "STILL" have yet to be contacted by EITHER DME or sleep lab regarding complaince, card reeding, cleaning/understanding check or anything. Dan, it was only through your telling us what your practice does for follow-ups that I found out what it SHOULD be like. And Brian, you're the one who let me know there was a 30 day return policy from the major mask manufacturers! My DME made it seem like they were doing me A HUGE favor by exchanging masks that didn't work for me (either because of comfort or leaks, etc.) My RT absolutely hates me. But I could give a darn! I was finally able to exchange my medium UMFF for the small (MUCH better fit!)

Unfortunately the leak rates on both the UMFFs and the 431 are pretty high. At least I got 2 zero AHI nights so far (yay me!). Dan, tried the Swift at full humidification and still mouth breathed. Tried again this afternoon since dummy me didn't have her data card in her M-auto last night to find out how it performed AHI-wise. But tied a scarf around my head to try to keep my mouth shut. Have yet to DL the data.

RG, I'd pay you anything anytime! You're one heck of a Gal

Babs, good luck with your crotchless undergarments Gotta love someone who really gets into the authenticity of it all! I'm more of a Ren faire wanna-be. I love to get dressed up in costume! Have fun and come back to report (I'm sure you will)

Linda

DeltaSeeker · Post by **DeltaSeeker** » Sat Jun 16, 2007 8:56 pm

Geez, must be getting tired - forgot to spell check that last one. Yuck! I hate typos!!!!! Now THAT's MY profession! Presentations and proofing. Oh well, blame it on SDB

BrianRT · Post by **BrianRT** » Sun Jun 17, 2007 12:43 pm

Deltaseeker,
A most sincere thank you. It's people like you that inspire my tagline (the Emerson quote)

Wulfman,
Unreasonable orders?? O HELL YEAH! In every capacity I've worked in (Long term care, Critical care, DME, etc.)

If it's something really unreasonable, then we bring it to the physician's attention in the most tactful way of course. The best way is to trick them into thinking they are the one changing the order LOL.

Never would I put someone's health in jeopardy because I was too timid to bring it up. This is the 21st century. The days of thinking doctors are gods (No, MD does NOT stand for Minor Deity) are over.

As a funny, my most hilarious order I've ever seen was on a patient who had a tracheostomy. The order was "Naso-tracheal suction, every 2 hrs"
I'm like...WTF???
I thought once about calling the doc and saying "You know, I tried to nasally suction, but the catheter just can't get past that gosh darn trach tube!!"