A Conflict of Interest???

After being diagnosed with severe OSA, I had a follow-up phone call from my sleep doc. I don't think he was ready for me

He started out by saying what I already knew; I had OSA. He then said I would need a CPAP, and proceeded to tell what a CPAP was.

After he was done with his elementary explanation of CPAP's I asked him "how much say do I have in the choice of my machine?" There was a pregnant pause, then he kind of mumbles, "well, a lot."

I say good, because I already know what I want, and proceeded to tell him I want an APAP. He begins to balk at this saying most people don't need one yada yada yada.... I cut him off and ask how important is patient comfort? He replies "very". I say good, I want the most comfortable machine available, and I know he can write a prescription for me that indicates a specific machine.

He then starts in on how there's Federal regulations preventing over-prescribing....and, again, I cut him off in mid-sentence with "don't even go there"!

Needless to say, he couldn't wait to get me off the line. (they don't call me Rabid1 for nothin!)

Today I called the sleep center to schedule my titration study. During my conversation with the receptionist I learned the sleep center is also a DME!!! Now it all makes sense to ol' Rick why this doc is so adamant about prescribing a cheapo machine for me. More profit for him!

I gotta say, I'm pretty upset about this, and a little confused about how to handle it.

I should mention that I've already purchased, and for the last week, have been using a RemStar APAP with C-Flex (from Yahoo Auctions). I'm very unwilling to participate in this Sleep Center's little scam.

That being said, I still want to be titrated, and have the prescription for new gear. (Rested Gal now has me thinking about the new Respironics BiPAP with Bi-Flex).

Please offer some advice on how to proceed.

That "cozy" little relationship you just described has come up many times on the forums.

If I were in your place, I would go as far as getting the prescription (in hand) and then not feed their little "system" any more.
Unless you have some specific breathing problems or high pressure requirements, I wouldn't fork out the price for a Bi-PAP when an Auto CPAP would do just fine.

Best wishes,

Den

I don't think you should be overly surprised by this event; good on you, however, for advocating for yourself so well.

If you have the health care coverage to cover the cost of the titration study and/or if you are prepared to pay for this out of pocket, I'd go ahead and have the study. The study could give more info than just the recommended pressure.

Just because this guy is in business trying to make the biggest buck he can (can you say: capitalism?) does not necessarily mean that the Dr. runs a bad clinic or does sloppy work.

If you think that the clinic is a good one, and you can afford it, go for it.

[quote="Wulfman"]That "cozy" little relationship you just described has come up many times on the forums.

If I were in your place, I would go as far as getting the prescription (in hand) and then not feed their little "system" any more.
Unless you have some specific breathing problems or high pressure requirements, I wouldn't fork out the price for a Bi-PAP when an Auto CPAP would do just fine.

Best wishes,

Den

[quote="WillSucceed"]I don't think you should be overly surprised by this event; good on you, however, for advocating for yourself so well.

If you have the health care coverage to cover the cost of the titration study and/or if you are prepared to pay for this out of pocket, I'd go ahead and have the study. The study could give more info than just the recommended pressure.

Just because this guy is in business trying to make the biggest buck he can (can you say: capitalism?) does not necessarily mean that the Dr. runs a bad clinic or does sloppy work.

If you think that the clinic is a good one, and you can afford it, go for it.

Just remember......the doctor works for YOU.
Ask him who's paying for his services.

He's already finding out he's dealing with an informed patient.

Good luck.

Den

Why bother with the confrontation? He will only continue to see himself as "in business" and have little to no concern about conflict of interest. My hunch would be that he would tell you that he prescribes the best machine relative to the patient's needs.

I'd be inclined to think that your strongest position is that of knowledge. Continue to advocate for yourself to get the machine that will give you best treatment and most choices. If you find yourself able to accept that your Dr. is in business AND has to answer to his patients (that would be YOU) you can put his feet to the fire as needed in a very subtle way; just keep yourself well informed and advocate, advocate, advocate for yourself.

As an aside, I always keep good notes of every conversation that I have with anyone who provides service to me. Take notes WHILE YOU ARE TALKING to whoever it is that is providing service; let them see you with your pen and notebook. This act alone delivers a clear message to the service provider that you are actively seeking their advice and counsel and, want to make sure that you follow their instructions as given. It also delivers a subtle message that you are keeping track of what they are saying and will have the documentation needed to hold them accountable if necessary.

This same logic applies when you don't have an ongoing relationship with a service provider. I ALWAYS get the full name of anyone I deal with over the phone, asking for their name at the very beginning of the call. In general, this tends to make the service provider take note that you, the consumer, knows who they are. This makes the interaction significantly more personal -->personal interactions tend to be more inclusive and satisfactory.

Good luck with this.

Whoa! While it is not widespread, there are affiliated sleep lab/DMEs full service sleep labs?). Some hospitals provide sleep study services as well as durable medical equipment including xPAP. Just because they do doesn't make them suspect for poor titration or sleep studies by any means. Nor does it make them any different than any other DME in wanting to protect and enhance their bottom line by providing the lowest featured but adequate equipment that will do the job that is necessary to treat our OSA.

I would just plain continue to be frank and upfront w/this doctor and ask him point-blank, will you or won't you give me a script for the specific PAP equipment I want. If he says he won't or can't then have your titration study done elsewhere. If you were satisfied w/your sleep study there's no reason to expect their titration study will be of any lesser quality so if the doctor will cooperate w/you and agrees to script the equipment you want, why go elsewhere? That still doesn't force you to purchase from their DME "wing". And it will probably save you some time in getting your titration study done and script in hand.

You might also clarify w/this sleep doctor ahead of time that you will want a copy of your sleep study and titration study data as well as the dictated reports and will want the script in hand rather than FAXed or sent to the DME. If he's not agreeable to that you can exercise your option to go elsewhere for your titration study. Meanwhile the sleep study is a part of your medical records and therefore, at least in the USA, you have a LEGAL RIGHT to a copy of the data and report. He can stall, but he can't refuse to provide it.

Slinky wrote:

Whoa!

So what you have said is essentially no different from what others have said...

Just because this guy is in business trying to make the biggest buck he can (can you say: capitalism?) does not necessarily mean that the Dr. runs a bad clinic or does sloppy work.

So what is the "whoa" about?

You catch more flies with sugar than vinegar (but who wants flies?)... Avoid a confrontation.

That said, I would go ahead with the titration study, get a copy of the results, and if the pressure is under 10, I would "settle" for an Auto with cflex prescription.

Also, check with billmyinsurance.com to see if they handle your insurance. If so, go through billmyinsurance and bypass your doctor/DME if you are uncomfortable with them.

I wouldn't worry too much about getting the titration study, until:
1) You have a copy of the sleep study (at least the summary), and the doctor's summary of it.
2) A copy of a CPAP script from the sleep doctor.

You should be able to schedule a follow-up visit with the doctor, RT, or NP,
connected with the lab that did the study. Then if problems other than OSA
showed up on the PSG, you need to know about them.

If no problems other than OSA were indicated, titrate yourself, every night
with the APAP for a while,then do the lab titration only if you are having problems.

Of course, I'm not a medical professional, just an APAP user.

Will,

That idea of taking notes just might be the best advice I've heard in a long while!!

I'll do it.

gearhead,

I agree with your thinking, however, the doc won't write a script until I get titrated.

Linda,

As a former police officer, and the chief hostage negotiator for a metro PD, I can assure you I have some negotiating skills. I won't engage the doc more than neccessary, neither will I back down.

The biggest obstacle I face is this is the only sleep center in a 125 mile radius. I can't (easily) go somewhere else.

I said "Whoa!" because things were sounding very confrontational and there doesn't necessarily need to be a confrontation. As Linda said: "You catch more flies with sugar than vinegar." Tact can go a long way to getting you what you want.

Slinky wrote:I said "Whoa!" because things were sounding very confrontational and there doesn't necessarily need to be a confrontation. As Linda said: "You catch more flies with sugar than vinegar." Tact can go a long way to getting you what you want.

Slink,

I'm not advocating a confrontation...unless the doc forces it.

I am simply unwilling to let his business interests to override my health interests.

If he thinks I'll just roll-over and accept an outdated CPAP just because he says so, well, his young egotisical butt is gonna get a little more than he bargained for

Slinky:
I'm not suggesting in any way that one's manner should be confrontational. In fact, my first comment was

Why bother with the confrontation?

There are lots of subtle ways to convey a message that is not confrontational but very clear and direct. Every time that we demonstrate that we are attending fully to the conversation ->knowing the name of the person to whom we are speaking, taking clear notes, asking good questions and recording the answer, we are making good use of time and resource. We are also creating a contiguous record that will be of great help later if the person you are dealing with screws up or "changes" their mind regarding service at a later date.

Slinky, for what it is worth, I spend my day working in the critical care unit of Canada's largest children's hospital, helping parents advocate for themselves when they are dealing with the daunting task of learning all that they can about their child's illness. These parents almost always feel overwhelmed by knowing essentially nothing about a complex health-care facility and really need to learn skills that help them cope and get all of their needs met.

The point of this story is that the skills I've suggested to Rabid1 are skills that I teach to every family I work with. The goal is NOT confrontation, rather it is avoidance of confrontation through clarity that starts in the first interaction. This clarity helps the provider to know the patient's needs and, hopefully, deliver best service right out of the gate. This clarity also helps the patient to feel "heard" and fully involved in his/her health care. It fosters TWO-WAY INTERACTION between the patient and health-care provider rather than that of patient feeling ignored or detached from his/her healthcare.

Linda3032's comment about catching more flies with sugar than vinegar is absolutely correct; delivery is crucial; just as crucial as being clear and direct right from the get-go.