Firing a sleep medicine doc...how do YOU do it?

[EricinNC]

Ive seen three sleep medicine doctors. The original guy I go back and forth to, but it seems like whenever I am REALLY having problems that guy is who I end up going to see. But he is not board certified in sleep medicine, he is a pulmonary specialist who does OSA on the side kind of a deal. But I am not real confident in his ability to diagnose and treat other non SBD related sleep disorders like RLS, PLMD, etc. I dont have those, but if I developed them Ive wondered if he'd catch it.

I used a second sleep doc who was board certified in sleep medicine, but was a psychiatrist by his original training. I was not impressed by that guy and I have made it a personal "rule" to not use anymore sleep med docs whose original training is psychiatry as I dont believe they have a background good enough in pulmonary/internal medicine.

I tried a third sleep doc recently and this dude I "terminated" last week. I did it hardcore, was really rough with the guy. He is a pulmonary specialist and head of a hospital ICU. Solo outpatient practicioner. He seemed apathetic and like he could care less. I originally went to him complaining about an OSA flareup, shortness of breath, chest pain, chest tightness...all symptoms I had before I got put on CPAP and came back in recent months. Because of his attitude...I wont go into the details...I told him "you are terminated." Then I sent him a certified letter trashing him, explaining my reasoning and to "lock down" his SBD records of me and to not send them to any other docs. Because frankly, I dont think the dude is worth a cuss.

Anyway, I did it kind of "gestapo" style, really hardcore. Anybody else fired a doctor in that manner before? I honestly got the feeling the guy was just trying to get my insurance money and copay, he did not seem interested in getting my problems resolved at all.

How do you fire a sleep doc? Just leave them? Be nice to them?

Eric

[Janknitz]

I like that you told him, in writing, exactly why you were firing him. Unfortunately, I bet he needs a few dozen more patients like you before he starts to get the message. He sounds like a Charlie Sheen type--thinks he's smarter and better than everyone else, doesn't have to answer to anyone and doesn't have to have a good attitude. Anything more subtle than the "gestapo" style would roll off his back like water off a duck. This probably did too, but hopefully YOU at least feel better.

Sounds like the first doc is a keeper. Don't worry about him not catching things you don't have. You're savvy enough to know when you need more than he can provide.

[Julie]

I think before you pride yourself on being tough with the 'terminated' doctor, you might have tried to sit down and talk to him, really get his attention by being assertive, but not necessarily so aggressive. He might have been tired that day, or just be a quiet person, and your attitude probably wasn't much help (I somehow have an idea you might have been confrontational from the start, though if I'm wrong, so sorry).

I'd rather have a pulmonary (or neuro.) doctor who's not certified in sleep medicine, than some other non-pulmonary one who is. But that's just me.

[mstevens]

I have made it a personal "rule" to not use anymore sleep med docs whose original training is psychiatry as I dont believe they have a background good enough in pulmonary/internal medicine.

I know quite a few psychiatrists who completed Internal Medicine or Neurology training before doing Psychiatry. I even know a few former surgeons and a former anesthesiologist. All psychiatrist have to do primary care training if they do an integrated residency or an internship in Internal Medicine, Family Medicine, or Pediatrics if they don't.

[Mary Z]

I would just not go back. If I wanted the records I would write a release of information for the records to be sent to another doctor.

[EricinNC]

I like that you told him, in writing, exactly why you were firing him. Unfortunately, I bet he needs a few dozen more patients like you before he starts to get the message. He sounds like a Charlie Sheen type--thinks he's smarter and better than everyone else, doesn't have to answer to anyone and doesn't have to have a good attitude. Anything more subtle than the "gestapo" style would roll off his back like water off a duck. This probably did too, but hopefully YOU at least feel better.

Sounds like the first doc is a keeper. Don't worry about him not catching things you don't have. You're savvy enough to know when you need more than he can provide.

Yeah, I think too many people are too nice to their doctors and dont realize a lot of docs could absolutely care less. I brought along a loved one that day with me who told me they were "going to advocate for me" if this sleep doctor gave me the run around, which he did which resulted in me terminating him on the spot. That really upset my loved one and when we left the office, my "advocate" was about ready to cry. It really upset her and I told her, "you told me you were going to speak up for me, why did you not?" She replied, "I became so upset, I almost was crying."

LOL

Too many people are intimidated by doctors, that is half the problem IMO.

Eric

[EricinNC]

I think before you pride yourself on being tough with the 'terminated' doctor, you might have tried to sit down and talk to him, really get his attention by being assertive, but not necessarily so aggressive. He might have been tired that day, or just be a quiet person, and your attitude probably wasn't much help (I somehow have an idea you might have been confrontational from the start, though if I'm wrong, so sorry).

I'd rather have a pulmonary (or neuro.) doctor who's not certified in sleep medicine, than some other non-pulmonary one who is. But that's just me.

No, I was very nice to the guy at first. Not confrontational until he started giving me his lazy spiel and then I did a 180 on him. He did not like it I could tell and I could tell he was not used to it.

Today I went back to my old sleep doc, who is not really even a sleep doc but a pulmonary guy who refers people to sleep clinics on the side. He took the bull by the horns today and gave me an EKG...heart checked out OK and then without me asking for it...ordered a new split night sleep study. Ive never had a split night study before. Hopefully this hell Ive been undergoing for a while will be over soon after I get retitrated.


Eric

[EricinNC]

I have made it a personal "rule" to not use anymore sleep med docs whose original training is psychiatry as I dont believe they have a background good enough in pulmonary/internal medicine.

I know quite a few psychiatrists who completed Internal Medicine or Neurology training before doing Psychiatry. I even know a few former surgeons and a former anesthesiologist. All psychiatrist have to do primary care training if they do an integrated residency or an internship in Internal Medicine, Family Medicine, or Pediatrics if they don't.

I would not trust a psychiatrist to follow my pulmonary functioning (SBD) for anything. I take an SSRI and the whole psychiatry mindset I have found is dismissive of the patient and their complaints. I dont trust shrinks. I want my sleep doc to have a pulmonary/internal medicine or at least a Neurology background, in addition to the sleep medicine stuff.

Eric

[SleepingUgly]

In my opinion, a psychiatrist who is (ideally) board certified in sleep can be the perfect doc for certain types of conditions/problems, and for certain people. For example, if a person does take psychotropic medication, I would expect a sleep doc who is also a psychiatrist to understand the implications of that better than the average pulmonologist. Someone who has a comorbid psychiatric diagnosis would especially benefit from someone with that kind of training. Also, some psychiatrists are just better at negotiating human relations and being empathic than the average doctor (and some suck...). Also a psychiatrist may be better at the behavioral medicine piece of this.

I have never had the opportunity to see a psychiatrist who was a sleep doc because when I was about to see one that I heard great things about, he moved away (story of my life with the good sleep docs--I move or they move). The best sleep doc I ever had happened to be a pulmonologist, but what was great about her was that she was very empathic and very thorough.

[Bons]

My current sleep doc is a psychiatrist. He's also head of the department for a major teaching hospital, so I figure he knows what he's doing.

I terminated the last one by going to the office, cancelling my appointment and requesting a referral. The form asked for a reason for termination, and I wrote that I did not like the doctor's arrogance and temper tantrums (called me a control freak when I asked him why my AHI was still above 5 and questioned why he wanted me to take klonopin when the summary report for my sleep study had the standard advisory against klonopin and other drugs).

[Slinky]

I've generally either cancelled an appointment and requested my records. Or I refused to make an appointment and requested my records. BUT I DID encounter one sheister who "weakened my inhibitions" and I shared my thoughts quite vehemently w/him before requesting my records and marching out the door. Hey, my family doctor had died on me during a heath "crisis" and I was doctor shopping and I was getting darn tired of doctor shopping .... I needed HELP and wasn't getting it or even being taken seriously by some. The wrong doctor picked the wrong time to display a pissy attitude to me. What can I say? I was too angry to even be embarrassed by my behavior.

Welllllllll, there was one other time, fairly recently, where I could have handled the situation better .....

[cotech50]

I have never met a real sleep doc. My sleep study was ordered by an ENT I was seeing when I chose to ask about my symptoms. The sleep study was done in a hospital room which was not conducive to sleep at all. The 45 min of data was interpreted by a pumonologist which I guess I would call him the sleep doc in my case maybe. I believe in the last 5 years more facilities and people have dove into the sleep industry because there is money to be made off of it which has complicated in many cases of seeing someone that really cares about you and your diagnosis and treatment. Maybe if he is smart he will realize and learn from this experience, if not he may get more. These people are not GODS and some of them I believe are in it for $$$$$$$ and those are the ones that need to be weeded out.

[mstevens]

Folks this is easy. I'm a physician. I just "fired" my own doctor, who is a colleague I see several times per week in meetings yet can't seem to get an appointment with. I called went to her office and signed a release to forward my records to a different doctor. No drama necessary.

[Wulfman]

Six years ago I had a pulmonologist masquerading as a sleep doctor. He was the ONLY one in a 160 mile radius area that I had to choose from......and his reputation preceded him. He's supposedly board-certified in SOME areas, but he's not certified in "sleep medicine". I had one meeting with him before the sleep study and two following the sleep study......the first to get my prescription and the next for a follow-up to review the therapy. I was actually supposed to have had another appointment with him but I canceled that one (and made a verbal complaint about him to the receptionist who took my call).......and (obviously) haven't been back to him (or any other ones) since. I have data-capable machines that tell me how my therapy is working. In my opinion, finding "good" doctors is a real crap-shoot.


Den

[SleepingUgly]

Folks this is easy. I'm a physician. I just "fired" my own doctor, who is a colleague I see several times per week in meetings yet can't seem to get an appointment with. I called went to her office and signed a release to forward my records to a different doctor. No drama necessary.

You couldn't get an appointment with her via her secretary, or you couldn't get an appointment with her by asking her directly for one? (and I assume you mean that you can't get an appointment as soon as you want one, not that you can't get one ever.) I have a hard time believing that a physician who knows you personally would not get you in for an appointment. Fair or not, a physician patient that is willing to use his/her "I'm a physician" card can no doubt get better service from another physician than the average non-physician patient.