I Think I'm In Trouble

Komodo wrote:I'M BACK FROM MY DOCTOR! ........and OMG!!!!!!!!!!!!!!!!!!!!!!!!

HE should be paying ME instead of the other way around!

You HAD to be there to see the expressions on his face when I started in with my questions.....priceless!

Since he didn't have any data from my DME, I brought my daily log. When he saw it, his eyes went wide in amazement, first, then the frown came! He asked me how I got the data, and I told him I went into the clinitian menu. He told me I wasn't supposed to go in there!!!! Things kinda went downhill from there! He looks at my data and says it looks like I'm doing pretty good, my AHI averages <8.0. I tell him, it should be <5.0. He says:" Yeah, that's right, but where are you getting your info from?" I tell him about our little forum here! He is NOT happy! I ask him a few simple, intelligent, questions, that he "briskly" answers in as few words as possible. He agrees with ME, that I should raise my pressure from 14 to 16. He tellls me he'll have my DME come out and do the change, I tell him, don't bother, I can do it myself. THAT was the straw that broke the camel's back! He says:"I guess you really don't need me." hands me my paperwork and says:"Make an apointment for next year on your way out." and walks out of the room!!!!!

NOW... what should I make of this? Have I become so well educated from this forum that I really don't NEED a doctor, and be happy?
~OR~
Should I be f'ing p*ssed off at the treatment I received, and go looking for a different doctor???

I choose the latter!


When I've read posts from some of you other folks about the horrible way your doctors have treated you, I couldn't believe it. Until now! WHAT IS WRONG WITH THESE DOCTORS!!!!!!

My opinion (and from my own experience), is that if you have the "garden variety" of OSA (no Centrals or CSDB), and you have a data-capable machine and your prescription.......you don't need an idiot doctor......especially one that can't conduct an intelligent conversation with an informed/enlightened patient.

I cut my doctor loose after my second meeting with him after I started therapy (the first meeting was to go over my sleep study report and get my prescription). I flat-out told mine that I had changed my pressure (from 18 cm. to 10 cm.) almost immediately upon getting my machine (I tried 18 cm. for about an hour). He stammered a bit......asking how I changed my pressure......I informed him that I just went into the machine setup menu and changed it. I also had Encore Pro reports to backup my decision and that I was getting AHI averages of less than 1.5. I'll have to give him a little credit that he didn't chastise me for changing it......but he has had a reputation (locally) of having a poor "bedside manner".

Ya done good!


Den

You live on Longuyland. No shortage of any type of doctor there.

Go find a sleep doc that wants to work with his patients, not lord over them. I have a pretty good one from a practice at a major Philly university hospital. Maybe you should take a look at that kind of practice.

mars wrote:Why Australia should be so much like the US in this respect I do not know. There are good doctors, but my experience is that they are only 1 in 4.

Think that's probably generous! My sleep specialist told me nothing, charged me $240 for 12 minutes, of which only $110 was refunded on Medicare. It'll be a cold day in hell before I step back in there (yes I know, and no, not "Hell" in Norway, where it often freezes over!). I refused to go back, went through the Sleep Centre for the little assistance or feedback I needed, and found this forum. Never went back to either, not nearly as proficient as the folks here.

Komodo wrote:He says:"I guess you really don't need me." hands me my paperwork and says:"Make an apointment for next year on your way out." and walks out of the room!!!!!

And yes, that's turned out to be true! He's obviously small in some area or other, feels inadequate (the ladies on the forum know what I mean)! If he were any kind of decent doctor, he'd be pleased you're taking such positive steps in YOUR therapy.

(Rooster's right as always, "YOUR" therapy. Love reading your posts Rooster, always thought provoking.)

SleepyT wrote:Go, Komodo! Go, Komodo! Go! Go! Go! You did us proud!

I agree! Go you!

It is just appalling that there medical professionals out there in these so called enlightened times that still believe they can treat their patients with disrespect. However, it is up to us, the patients, to do something about it.

If my doctor treated me like that I would be making a complaint to his professional association. I would send a letter describing his behaviour to the most unpleasant tabloid journalist I could identify, and I would be finding another doctor.

Over the years I've met a few of these arrogant people. I leave them in no doubt about what I feel. A perfect example was the surgeon who didn't want to answer any more questions about my recovery and rehabilitation after a sporting injury. I had about 5 questions I wanted him to answer. When he showed reluctance, I just kept asking more questions. I didn't leave till he answered them, and the other 25 or 30 questions that i conjured up to show him the error of his ways. And I sent his outrageous bill to his professional association. They made him reduce it. I paid the reduced rate after 6 months of correspondence.

But all is not so bad. The sleep doctor I consulted is a gem. She referred me for the sleep study, reviewed the results with me and explained what it all meant, then later when I showed her my printed copy of my data, she expressed surprise and pleasure that I was looking at my results, was able to interpret them (thanks to cpaptalk.com) and was managing my own therapy. She gave me an email address so I could ask any questions without making an appointment, and has been responsive and gracious. There must be others like her.

It behoves us all to find the good ones and support them, and shun the bad ones. It is up to us

K

I've had more than a reasonable share of miserable jerks for so-called physicians.

However, I do think times may be changing... and I think that informed patients are helping make those changes. I just got rid of the PCP I'd had for around 20 years because he decided to play psychological games with me over my cancer issues. "Boogah, boogah, you must have this test because clearly your cancer is coming back..." when I was by myself, but when my husband was with me, the test was "a routine procedure, and he didn't really expect to find anything..." There's enough stress involved with getting to where I can be declared cancer free without the doctor who missed the initial symptoms of the disease in the first place using it as a bludgeon.

OTOH, the gynecologist and oncologist who are handling the cancer treatment (surgery and afterwards) have been absolutely top mark. Accommodating, and helping me to have my special diet while in hospital and everything else.

The pain management doctor was the one who spotted my apnea. She was a bit abrupt, but I liked her -- and she was right on the mark.

And, my NEW primary care physician keeps her appointments on time. (With the old one, you arrived for your appointment, and then sat for 2-3 hours, watching an endless parade of pharmaceutical representatives take precedence over you, the paying patient.) She appears to be interested and helpful -- and doesn't hesitate to say if something is out of her league.

Yes, I think change is possible. But it isn't going to be easy.

Komodo wrote:I have my first visit with my sleep doc today since I started cpap therapy.
I called them up yesterday to ask if they wanted me to bring my smart card, or if I had to bring my entire machine, so they could get the data, and go over the results with me.

I was told neither. My DME is supposed to fax my data to them. Not a problem, EXCEPT, they never asked me to send them my smart card! My doc's office calls my DME and chews them out. They call me, apoligize, and tell me to send in the smart card (not that it's going to do any good now)
While I have my DME on the phone, I ask them about turning on my "auto-start" function. I tell them, that when I go into the menu to turn it on, I don't have that option. They ask HOW can I get to that portion of the menu, since THEY never tell their customers how to! I tell them I got the clinitians menu on-line. They are NOT happy with me!!! They say they're going to "call my doctor" and inform him. ( Shame on me! ) So now my DME is mad at me.

While I was on the phone with my doc's office, I was amazed that a Sleep Doctor didn't have the software to read smart cards! Told the young lady on the phone with me that I had been keeping a daily log, and she said to bring that along with me, that the doc could use that data. I tell her that it's not complete data, only what shows up on the LED. Now SHE want's to know how I got that info! I tell her about this forum, and she is VERY impressed!!! I gave her the addy, and hopefully, she'll become a member as well.

Now here's where the trouble comes in. First, my DME is mad at me, and I have no idea how much trouble they can cause with my insurance company.
Second, and more importantly, I'm starting to have some SERIOUS concern with my Sleep Doctor. WHY doesn't he have all the software & hardware to gather data from his patients??? IF, he's going to rely on the DME to gather data, why isn't he on top of it making SURE the data is there before the patient has an appointment???

Is this the same type of sub-standard treatment the rest of you get from your doctors?

I have a lot, I mean a LOT of questions I'll be asking my doc today. I'll post up his replies tomorrow if any of you are interested. That is of course if he doesn't have me arrested in his office for beating him over the head with my data notebook!

I have had a lot of trouble with my DME also. My family doctor put me on an oxygen concentrator while I sleep until I got my cpap. I called the DME for two weeks trying to get someone to call me back about the cost and if my insurance would cover it. Then after I got the machine I called twice about questions regarding changing the hoses and no one there could tell me when or how! I had to look it up on the internet. The the next set of nasal prongs they sent had the wrong ends on them and would not fit on the hose. When I called they again said they had no idea what I needed. They I came home from work one
day and there was a note on my door that I had missed my appointment. I called and asked what appointment and they said to fill my oxygen tanks. I said I don't have any oxygen tanks and they said they must have me confused with someone else! Well, that was it. I called the next day (I have one week until my cpap machine fitting) and told them to come pick up their equipment I didn't need it anymore. The lady asked if the patient was deceased! I said no I am the patient. She said only my doctor could order the equipment to be picked up. I asked her if the doctor was paying for it. So I had to call my doctor who then asked ME for a number to fax the order to!! I was thinking maybe the sleep doctor will be better but after reading your post I am thinking not so. I think it is the staff the doctors hire. They don't realize they are morons.

jnk wrote:I think it is important for us to understand how many doctors view things. There are exceptions to the rule, but I believe, as has been stated, that most sleep docs view treatment questions and machine questions as something they leave to the tech/therapists.

When a doc starts getting involved in the nuts and bolts of machines, he is crossing a line and stepping on toes. Docs diagnose and prescribe. That's what they do. They don't fill the prescription and they try not to get in the tech/therapists way....

jeff

I believe Jeff has the right perspective on the Sleep Docs. T'will save us all a lot of wasted energy on anger if we appropriately lower our expectations. You can walk up to a long brick wall and shout at it, kick it, punch it, cuss it, bang your head against it....but it probably still will not yield or look any differently after all that. You're still up against the brick wall.

This might be interesting, (or not): http://www.aasmnet.org/Resources/PDF/BSMGuidelines.pdf
If I read it correctly, a person having an MD credential can be certified as a sleep specialist MD by simply passing an exam. The "alternate track" seems to actually involve training and supervision. (Did I get that right?) Hmmm......I bet I spent a thousand more hours of study on this forum over my first 3 months of cpap therapy, than an MD would spend with study materials to pass that exam.

Many moons ago when one of my youngest (now 25) was a baby and very, very ill, the GP sent me to a paediatrician. Apparently a lovely guy, the woman just LOVE him.

He was a good looking chap, must admit, very smooth manner. But when he advised my son had tachycardia, and would need to be watched as he grew up, I needed to know more. I'm very non-intuitive - love the facts, not the guessing game. He replied that I was a smart woman, I'd figure it out, and I could get nothing more from him.

Voted with my feet, and went to another specialist who was, to be kind, not good looking. But gave me the info I needed. GP was shocked, no one ever leaves him! Told the GP he was condescending, but apparently not many see through the smooth exterior. If I'd been older, I'd have probably taken him to task, but was young & inexperienced, as well as unconfident!

(Turned out there was not a lot they could tell me, it was a guessing game, but at least the new doctor put this to me and explained the why and hows of it!)

I think Jeff has given us the best advice we could get regarding what we can expect from most sleep doctors. We expecct our sleep doctors to know all things regarding sleep therapy. While in reality we are frustrated when most of us get the type of doc Jeff describes:

wrote:jnk wrote:
I think it is important for us to understand how many doctors view things. There are exceptions to the rule, but I believe, as has been stated, that most sleep docs view treatment questions and machine questions as something they leave to the tech/therapists.
When a doc starts getting involved in the nuts and bolts of machines, he is crossing a line and stepping on toes. Docs diagnose and prescribe. That's what they do. They don't fill the prescription and they try not to get in the tech/therapists way....

Apparently in Australia is isn't much different to quote Mars and Grandmma:

mars wrote:
Why Australia should be so much like the US in this respect I do not know. There are good doctors, but my experience is that they are only 1 in 4.

grandmma wrote:Think that's probably generous! My sleep specialist told me nothing, charged me $240 for 12 minutes, of which only $110 was refunded on Medicare. It'll be a cold day in hell before I step back in there (yes I know, and no, not "Hell" in Norway, where it often freezes over!). I refused to go back, went through the Sleep Centre for the little assistance or feedback I needed, and found this forum. Never went back to either, not nearly as proficient as the folks here.

Here on cpaptalk.com, we have Rested Gal, Ozji, Slinky, Den, Kathy, SWS, Muffy, Jeff, DreamDiver, just to name of few of the resident whizzes. Who among us has not received more help and instruction in sleep apnea therapy from this site than we have ever received from our sleep doctor. Realization of these facts, can end a lot of our frustration.


Just one question Jeff, After our Sleep Doctor orders a sleep study, reviews it and writes the final report . . . then gives his patients a prescription for their equipment, are they good for anything else?

Jan

Help out your fellow citizens by posting your experiences with your doctor. There are a number of forums for this, including the following: (no particular order)

http://www.ratemds.com/social/
http://www.ratemymd.ca/ <<<< For Canadians
http://www.ratemydoctor.net/

SaltLakeJan wrote: . . . Just one question Jeff, After our Sleep Doctor orders a sleep study, reviews it and writes the final report . . . then gives his patients a prescription for their equipment, are they good for anything else? . . .

Sometimes. It depends on the doc, your insurance situation, and how successful you are at managing your therapy.

I was very pleased with my sleep doc. He gave me very good information about me and about sleep medicine in general at the first visit. He has been willing to return phone calls same day to answer questions. At one point, when I was dealing with a brain-dead DME employee, he said, "Look, Jeff, you tell me what you need me to write out as a prescription, and I'll get it faxed to that DME today." What more can one ask for in a doc?

A good sleep doc will look over the raw data of a sleep study to see if there is anything only a doc would recognize in all that info. I also think that it is the doc who has to be the one to say that you are being successfully treated and are compliant in order for insurance, and sometimes the law, to be happy. And a good sleep doc should be there for you if you have indications your therapy isn't successful anymore.

Other than that, the big problem in how it all works, in my opinion, is the DME situation moreso than the sleep-doc situation. There is no real competition among DMEs, so there is nothing to drive any improvement in services. Some are good just because they want to be, but they aren't rewarded financially for it. The crooks are the ones raking in the moolah. And it seems to me it is often, not always, but often, the least-talented RTs that end up sitting on their butts at the DME getting paid for doing nothing. Just my opinion, that.

When I go to a doc with my complaint, I want him to write the prescription for what will solve the problem. I will get back to him if it doesn't. If he checks on me later, that is bonus. But I don't think my sleep doc went to school to understand blowers and masks. And if I needed something like an auto-SV one day, it would be more important to me, I think, that I have a good working relationship with the techs/RTs than that I got along well with the doc. I want the doc to oversee the direction my treatment goes in, but I have to trust the people who can be hands-on with the treatment to walk me through the rest.

Again, I am NOT trying to let the docs off the hook. They should earn their money just like everyone else. I just think the bigger problem is the DME problem for most of us. I could be wrong on that. But that's how I see it.

jeff