Don't blame RT/DME

"You can't expect me to provide information which would allow you to do something that I could not do legally without a physicians order" - do you fully comprehend what you're saying? What YOU can do without a doctor's order is one thing, but what WE choose to do is none of your business! You are not a soldier guarding classified information, you are just a purveyor of goods who is told that YOU cannot change the pressures without a doctor's order. No one said anything about your passing on information that we MAY or may not use to change our own pressures. At least learn to interpret the wording properly.

deadhead77 wrote:On the assumption that there is no user qualification requirement involved it would seem ridiculous to present someone with a diagnosis of sleep apnea, provide them with the equipment that will ease this affliction and then, allow them to fiddle with it!

Why so ridiculous? i paid for my study and I paid for the machine. Its my equipment and its my therapy, i will educate myself and fiddle all I like.

user requirement My user requirement is to save my own life

Granted there will be people who would prefer to hold the doctors hand all the way, that's their choice.

I wonder where my therapy would be now had i left the doctor/DME with my bare bones CPAP set at a pressure that does not work for me? I would have been making changes on 6 month check ups and would maybe complaint in another 10 years

I'm glad i fiddled

deadhead77 wrote: NO, for the vast majority I think that the whole delivery of information should be graduated into various levels of competence that is monitored and rubber stamped by professionals.

Kinda like a driving license for CPAP

I think this whole debate emphasizes a general distrust of 'professionals' now that we can investigate stuff online.

I would hate to be a good doctor right now, so much distrust and cynicism over ethics etc.

We must all be very careful we don't go too far with our opinions based on a little knowledge gained in a few hours on the net.

If, you can prove you know what you are doing and are prepared to legally take responsibility for your health, then you should be able to take over those aspects of your treatment you have proven you are capable of. Other than that absolute, you should do as you are advised/told by the person deemed fit to administer your treatment and who is qualified and liable if they get things wrong.

Again, I think there needs to be a definitive procedure laying out the progression of treatment from day one that the patient can absorb gradually. There should be mention of the possibility of being able to take personal charge subject to...


I think it would make everyone sharpen up!.

Thanks for starting this thread, I hope you care as much as you seem to. Sorry about the poster with arse apnea sounds like he could do with a good kip.

Uncle_Bob wrote:

deadhead77 wrote: NO, for the vast majority I think that the whole delivery of information should be graduated into various levels of competence that is monitored and rubber stamped by professionals.

Kinda like a driving license for CPAP

Exactly, good analogy.

How long were you on cpap before you got confident enough to change settings etc.

Uncle_Bob wrote:

deadhead77 wrote:On the assumption that there is no user qualification requirement involved it would seem ridiculous to present someone with a diagnosis of sleep apnea, provide them with the equipment that will ease this affliction and then, allow them to fiddle with it!

Why so ridiculous? i paid for my study and I paid for the machine. Its my equipment and its my therapy, i will educate myself and fiddle all I like.

user requirement My user requirement is to save my own life

Granted there will be people who would prefer to hold the doctors hand all the way, that's their choice.

I wonder where my therapy would be now had i left the doctor/DME with my bare bones CPAP set at a pressure that does not work for me? I would have been making changes on 6 month check ups and would maybe complaint in another 10 years

I'm glad i fiddled

Right on, Uncle Bob! If I'd waited on my 'certificate of competence' I'd STILL be suffocating! I'm almost 6 months into my therapy and am doing fine...just fine fiddling around on my own with the help of these fine folks.

rjjayrt wrote:first of all I am an RT and part of my daily job is to setup and educate patients on/for cpap. I am also a user of cpap. I'm currently on 14cm, on an M seriers pro with cflex and I use a flexifit 431A full face mask. As far as what I offer my patients, its really simple, I would not give a patient something I would not use. I take all phone calls. I;m usually on call every other week 24/7 for after hours calls. I've routinely changed masks on patients when necessary or just because they'd like to try something different. Not all DME's are bad. As I said earlier, I educate until the patient is comfortable with what there doing and why there doing it. I don't use cheap equipment, only machines which are fully therapy/compliance downloadable and just about every mask made (not really, but most). Most importantly I have OSA and as a user I think I retain a unique perspective on cpap. I'm on this forum to educate myself, help educate others who may want help and to help myself on new tips and tricks. Thats all. I just have a different perspective as it relates to DME and sometimes need to defend those of us who I think are trying to do it right.

oh, and by the way, please fill out your equipment profile...so we can help you with your therapy! And WELCOME!

deadhead77 wrote:I think this whole debate emphasizes a general distrust of 'professionals' now that we can investigate stuff online.

I would hate to be a good doctor right now, so much distrust and cynicism over ethics etc.

We must all be very careful we don't go too far with our opinions based on a little knowledge gained in a few hours on the net.

If, you can prove you know what you are doing and are prepared to legally take responsibility for your health, then you should be able to take over those aspects of your treatment you have proven you are capable of. Other than that absolute, you should do as you are advised/told by the person deemed fit to administer your treatment and who is qualified and liable if they get things wrong.

Again, I think there needs to be a definitive procedure laying out the progression of treatment from day one that the patient can absorb gradually. There should be mention of the possibility of being able to take personal charge subject to...


I think it would make everyone sharpen up!.

Thanks for starting this thread, I hope you care as much as you seem to. Sorry about the poster with arse apnea sounds like he could do with a good kip.

I'm glad i have arse apnea otherwise I would be farting all the time, i would prefer not to I don't know about you

Why not take all of your ideas to your socialized National Health service in the UK. In my experience they would rather throw million of pounds into management and procedures than in the end does nothing for end patient care. I know several in the UK diagnosed with sleep apnea but still waiting for a machine. Let alone getting chance to fiddle with one

In America people tend to work with their doctor and they have a lot more choice and control with their health care. You would love to be a good doctor right now in America as your practice would be likely be doing a good business.

Your seem to like to control and to speak for the majority. Seriously look at the amount of "you should" type statements statements in your post.

deadhead would you have taken the advice of Dr Harold Shipman without question? http://en.wikipedia.org/wiki/Dr_Harold_Shipman

deadhead77 wrote:

Uncle_Bob wrote:

deadhead77 wrote: NO, for the vast majority I think that the whole delivery of information should be graduated into various levels of competence that is monitored and rubber stamped by professionals.

Kinda like a driving license for CPAP

Exactly, good analogy.

How long were you on cpap before you got confident enough to change settings etc.

After about 1 nights sleep, a couple of hours on the net (cpaptalk.com) and a chat with my RT

deadhead77 wrote:

Uncle_Bob wrote:

deadhead77 wrote: NO, for the vast majority I think that the whole delivery of information should be graduated into various levels of competence that is monitored and rubber stamped by professionals.

Kinda like a driving license for CPAP

Exactly, good analogy.

How long were you on cpap before you got confident enough to change settings etc.

I have to strongly disagree with requiring a "certificate" to be able to manage ones own therapy. In my opinion, such certificates end up just being a money maker for the company/group that issues them. I just see so many problems with such an idea. Who would dictate the content (DMEs? machine manufacturers? CPAPtalk members?)? Who would manage updates? Would continuing education be required? What would the scope of the content be? (too large and it isn't specific enough to be of any real use or too confusing for many, too small and many users would be left wanting) How much would it cost the patient? Would RT's even let it happen or would they (rightfully) consider it a threat to their usefulness?

Personally, I wouldn't know 1/2 of what I do now if I had been required to learn it through some sort of structured certificate program. I have learned what I have needed or been curious about...I'm smart enough to evaluate information sources, read journal articles and most of all, know when I don't know enough to make a judgement other than to call in a "professional." But even when I call in a professional I will present my case, ask educated and pointed questions and be prepared with articles from reputable journals

Doctor's aren't "Gods" that posess some superhuman ability to understand medical issues. They are human, and like the rest of us faliable and unable to know everything about every subject or even every disease/condition they might ever come accross. Yes, an individual patient is more likely to think zebras than horses when they hear hoofbeats, but sometimes that out of the box thinking is what picks up that unusual (or not so) diagnosis.

All that being said, I have never adjusted my pressure. I am currently blessed by AHI's of <1 but I am curious if I could do just as well at a lower pressure. However, my titration study showed some centrals so based on what I have learned HERE I have chosen not to mess with my pressure even though I am aware that I may no longer have centrals since I am now used to the pressure. MAYBE one day I'll pick up an auto and run it in a tight range just to satisfy my curiosity, but I'm in no rush at this point. However, I am extremely glad that I have that option, should I ever need it.

I understand that my attitude isn't for everyone and that many people prefer not to deviate from doctors' orders. That is their choice....just like it is mine to be more involved in the management of my health. The ability of the individual to choose the path best for them is what I think is most important.

I understand that some DME's or RT's are only in the game for the money, but some us try to do it right. I personally spend as much time as necessary with all my cpap users to ensure they understand why there receiving therapy and how to utilize the equipment. I put them on machines they need, and if they have a request for a particular machine I do what I can to provide it. I don't own the company, I have to abide by what my companies policies are as it relates to equipment rental/purchase and I have to abide by what the insurance company says. As far as changing pressures without the MD's order well thats covered by law. If you look at your machines manuals, somewhere on it it will say for sale upon order of a physician, or something of that sort. I'm bound by my states licensure requirements and FDA. I must abide by the physicians order. I can't change the pressure without it. As far as giving patients the clinicians manual, there may not be a law about that, but it would be improper because I'd be giving the patient the ability to do something that I'm prohibited by law to do. If you have complaints, take it up with the physicians or FDA, they can change it, I can't.

Same crock of feces by another greedy DME/ RT, who claims to be in business for his/her clients, but acts against their best interests. Why do DMEs come to this board, except to shill for clients? Alleged patient ignorance is bliss for them.

you seem to know alot about me. I suppose I can make the same generalities about you. That all other users on this site are rude , thoughtless and ignorant. I suppose I can make that assumption because you certainly are so the others must be as well. Well I choose not to make that assumption, most users on this site are informed, polite and certainly better able to discuss rationally a topic than you. Thankfully there are not many like you.

As far as giving patients the clinicians manual, there may not be a law about that, but it would be improper because I'd be giving the patient the ability to do something that I'm prohibited by law to do. If you have complaints, take it up with the physicians or FDA, they can change it, I can't.

A Question to all DME employees, professional or otherwise, that espouse the above reason for not providing the Clinician Manual:

How many of you set/enable the user/patient's machine (one that, by design, records AHI, Leak, ..) to show AHI & Leak #s on the machine's LCD? And if you don't, why not? Thanks.

As a worker for a DME company, with all do respect, we care far more about taking care of the doctor's and refferals than giving the patient the ability to change their pressure. Where I work, 100% of the sleep doctors do not want the info in the hands of the patients. At the risk of speaking on behalf of all DME companies, the last thing we want to do is bite the hand that feeds us. I suggest that if you have this big of an issue with not knowing how to change your pressure than take it up with the doctor.

cinco777 wrote:

As far as giving patients the clinicians manual, there may not be a law about that, but it would be improper because I'd be giving the patient the ability to do something that I'm prohibited by law to do. If you have complaints, take it up with the physicians or FDA, they can change it, I can't.

A Question to all DME employees, professional or otherwise, that espouse the above reason for not providing the Clinician Manual:

How many of you set/enable the user/patient's machine (one that, by design, records AHI, Leak, ..) to show AHI & Leak #s on the machine's LCD? And if you don't, why not? Thanks.

We have been advised by all the manufacturers that we work with to remove the clinicians manual from the machine before we give it to the patient.

In Respironics own words, "IMPORTANT! Remove this guide before giving the device to the patient. Only medical professionals should adjust pressure settings", on the front page of their clinical guide.

Therefore we remove it. I have nothing against patients or patient driven therapy, as a licensed medical professional, i abide by the manufacturers recommendations for their equipment.

We set all the machine's to show AHI and Leak #'s with education on what those numbers mean and what range they should be within.