Does your MD allow you to change your machine?

Slinky · Post by **Slinky** » Fri Oct 12, 2007 6:38 pm

I still say that this doctor had every reason to believe that you just chose to ignore his response in his letter to you. He had no way of knowing that you didn't receive it and deserves the benefit of the doubt. If anything all he knows is that you didn't take your machine in to the DME as he suggested.

I didn't say to lie about changing your pressure. I said I wouldn't even mention it unless HE brings it up. And then if he does you explain WHY just as you did in your original post starting this thread.

He has no defense against your being left high and dry w/no assistance. BUT when you DID get thru to him w/your letter he had every reason to believe you had received his response. You didn't take the machine in to the DME to be checked out (w/good reason, you had no way to know he wanted you to do so) so he had every reason to believe that you didn't intend to follow thru w/him and thus he didn't order the overnight oximetry.

I think you would be making a mistake to not follow thru one more time and keep the 25 Oct appointment before deciding whether to continue w/him or not. I stand by my suggestions given earlier. Not keeping that appointment "could" be cutting your nose off to spite your face.

stevoreno · Post by **stevoreno** » Fri Oct 12, 2007 6:39 pm

No.

Stevoreno
Biloxi, Mississippi
10/12/07

Slinky · Post by **Slinky** » Fri Oct 12, 2007 6:55 pm

Ha! I had forgotten about the actual subject of your original post!

Actually, does he know? Yes. Does he "allow" me to?? Ha! As if I care one way or the other. I know HOW to change it and if my stats support a change and "I" opt to do so, I do so. I keep him informed by dropping off my smart card for an hour after at least a week's data if the change is an improvement. If it isn't, I don't bother.

However, I had a bad experience after being Dx'd, Rx'd and just turned loose w/CPAP and an ill-fitting mask and sheister DME supplier about 10 years ago so when I went in for this sleep study last year I didn't pull any punches about what I'd been thru prior and what I expected, including I "would" have a fully data capable CPAP and I "would" buy the software and reader and I "would NOT" be kept in the dark! I "would" be given the full summary reports from my evaluation and titrations, I "would NOT" accept ANY equipment w/o our discussing it and coming to an AGREEMENT on what equipment he would order. I was exhausted, I was cranky.

Fortunately, the sleep lab manager and I had spent a day together way back when and I'm sure she helped to make my abrasive personality more palatable and bearable for him. He may or may not be one of the best sleep pulmos around but he is a great guy and the entire lab staff as well as the sleep lab manager are GREAT and a pleasure to work with.

I wish I had been more diplomatic at my first appointment w/him prior to my sleep evaluation and I'm sure grateful the sleep lab manager was able to smooth over the rough spots because its been a good relationship w/this entire sleep lab as well as my sleep pulmo!!!

dllfo · Post by **dllfo** » Fri Oct 12, 2007 7:55 pm

Yes...I have taken responsibility. I gave a written waiver to Apria and my Pulmonologist. He tossed it in the trash can and said let's work on it together.
He is VERY supportive and seems genuinely interested in the SV unit.

cflame1 · Post by **cflame1** » Sat Oct 13, 2007 10:23 am

My initial DME... they got irriated with me so I fired them

My current DME... doesn't care what I set it at, they've never asked to see a report, but they are there if I have questions or need something (I like them)

My GP... sent me for the original study, but I know more about my machine, and how it works than she does (she never wants to see anything).

My sleep doc... he doesn't care what I set it to, wants to see the reports when I see him (once a year unless I have a problem). If I have issues I call or stop in.

Shutchis1951 · Post by **Shutchis1951** » Sat Oct 13, 2007 10:29 am

What is Jim's software you refered to in the first post and will it work with my machine?

Slinky · Post by **Slinky** » Sat Oct 13, 2007 12:15 pm

Nope. James' software is his brilliant EncoreProAnalyzer, and it was formulated for Respironics' EncorePro software. It is not compatible w/our Resmed AutoScan and ResScan software.

DreamDiver · Post by **DreamDiver** » Sat Oct 13, 2007 1:54 pm

I'm on the insurance route. Until I actually have to pay something out of pocket, I'm going to let the DME make changes. It really is a case-by-case basis though. I'm fine jumping the hoops for now, but that may change in the future.

The DME doesn't ask about pressure settings, just the compliance data.

KansasRT · Post by **KansasRT** » Mon Oct 15, 2007 8:51 am

I don't want to ruffle feathers, just repeat what I have said before. The people here are EXCEPTIONS! Most patients could care less what there machine is set at, or what sleep apnea is and how their settings affect their treatment. It is sad, but like with most things it is a all or nothing system. If your DR told you is was OK to change your settings, and then told someone else it was not OK and you somehow talked, the other person would be insulted. MOST CPAP patients that we see should NOT change their settings. I am OK with people who can desribe sleep apnea and can present an understanding of how the settings and results can be changed by settings. But the reality is that most cannot. If you have googled Sleep Apnea on the internet you are way ahead of most. I have a hard time getting some patients to pay attention for more than 20 minutes to go over a set up. It is sad that some are being punished for others unwillingness to understand.

msheda · Post by **msheda** » Mon Oct 15, 2007 9:04 am

Huh, what were we discussing?

Oh, yeah.. apnea bad...

DreamDiver · Post by **DreamDiver** » Mon Oct 15, 2007 9:17 am

Kansas RT,

What you say makes sense. Most patients don't know and don't care about anything but results. Each case is a little different. I understand the reasoning behind CPAP therapy and have done a little research, but have not done enough research to feel comfortable changing any settings. I'm paying a professional to know what they're doing about my prescription. I should let them do their job if I have confidence in them, and I do. It seems to be getting results.

Once I've gotten to a place where I'm comfortable, and my data shows something that looks like it needs changing, I'll probably approach the sleep doc for interpretation and suggestions and go from there.

I'm curious. Do patients usually talk to the sleep doc or the RT about pressure setting changes? What's the normal course of events for this kind of thing?

extremeliver · Post by **extremeliver** » Mon Oct 15, 2007 9:36 am

Restless1 wrote:Does your doctor allow you to change your machine?

Actually, I haven't told him. Maybe I should clue him in on my new machine too. hmmm

msheda · Post by **msheda** » Mon Oct 15, 2007 9:37 am

A. I have never talked to "my sleep doc". He is just a name on a report. (he isn't even the one that wrote the script, my GP did that).

B. I haven't talked with my GP, someone shoved a filled out script under his nose and he signed it. Its says: AUTO BI-PAP Needed.

C. My sleep study was ordered by my Nurse Practioner, not my doc.

D. Unless you scream at this people to do stuff it doesn't get done.
(ie: Sleep study was done on 8/10 it was a split, I knew my pressure when I left... script was written 3 weeks later after much follow up on my part)

E. My health, my cash, my machine, my settings. But that is only me, I tend to be curious about things, and understand cause and effect. If my numbers weren't what I wanted, I would make a change, then give it a week to settle in. Still not right? Move a little more. Got worse, move the other way.

F. Based on the response I've had from the "Professionals" (and boy are they professional, based on the definition that professional means they got paid, they all got paid quite well), I would still be waiting on a DME to get in touch with me to set me up for a machine. Actually, come to think of it, I am. I still haven't been contacted by the "REAL DME" to get me a machine. I'm sure any day now they will be in touch with me.

(ok.. yeah.. this falls under DONT GET ME STARTED)

DreamDiver · Post by **DreamDiver** » Mon Oct 15, 2007 10:03 am

msheda wrote:A. I have never talked to "my sleep doc". He is just a name on a report. (he isn't even the one that wrote the script, my GP did that).

B. I haven't talked with my GP, someone shoved a filled out script under his nose and he signed it. Its says: AUTO BI-PAP Needed.

C. My sleep study was ordered by my Nurse Practioner, not my doc.

D. Unless you scream at this people to do stuff it doesn't get done.
(ie: Sleep study was done on 8/10 it was a split, I knew my pressure when I left... script was written 3 weeks later after much follow up on my part)

E. My health, my cash, my machine, my settings. But that is only me, I tend to be curious about things, and understand cause and effect. If my numbers weren't what I wanted, I would make a change, then give it a week to settle in. Still not right? Move a little more. Got worse, move the other way.

F. Based on the response I've had from the "Professionals" (and boy are they professional, based on the definition that professional means they got paid, they all got paid quite well), I would still be waiting on a DME to get in touch with me to set me up for a machine. Actually, come to think of it, I am. I still haven't been contacted by the "REAL DME" to get me a machine. I'm sure any day now they will be in touch with me.

(ok.. yeah.. this falls under DONT GET ME STARTED)

Wow. I've had a slightly different experience. My GP referred me to a sleep doc. I watched her hand write the referral. My sleep doc spent a good half hour with me. The sleep techs let me try on about seven different masks. I must admit though, I did shepherd everything through. I researched what masks were available before the sleep testing, so I knew what I wanted to try, and they were happy to oblige. I also researched which DME might best serve my needs out of about five my insurance would pay for.

I approached my DME before they got the script. I even asked specifically for the M-series pro model after reading about it here. When they balked and told me I should get the plus, I whined about how my insurance was "so slow and that it would probably be another month, and thanks for being a shoulder to vent on, heck, I'll just go online and buy it there," they suddenly had one available. I was a hose head two days later.

There are quite a number of roads for people to get to CPAP Land.

mindy · Post by **mindy** » Mon Oct 15, 2007 10:05 am

I think that the issue of whether or not to change settings and what to tell sleep doc is a case-by-case issue.

When I went for my sleep doc first follow-up appointment, I brought in the printed reports since my Smartcard had been goofy and I'd had to erase it. In addition to the EncorePro reports, I brought in a few of the EPA graphs. Doc was wowed by them. The pressure changes showed and I brought it up ... said my AHI had been rising and from looking at the reports, decided to make some *small* changes. We discussed where to go from that point and I listened to sleep doc's suggestions. No negative reaction to my changes.

They also checked my mask for leaks and I wanted to try a FF mask so they fitted me for one of those.

No complaints! Guess I'm lucky!!

Mindy

Does your MD allow you to change your machine?

DME's and Docs

No feathers ruffled here

Re: Does your MD allow you to change your machine?