CPAPtalk.com

Here's my story:

Saw GP on 11/30/2010; complaints about falling asleep, etc. She ordered the sleep study; provided me with Sleep Study contact info. Called, made appointment for what turned out to be a split study. Originally appointment was scheduled the week after Christmas, but they called and moved it up to December 22nd as the doctor was going to be out of the office. When I made the appointment I advised them that I have problems sleeping in new/strange places, and that I had a prescription for a sleep aid for when I do. They said bring it and take it. The whole point is for you to sleep, etc.

A week later, I had a call from the Sleep Doc (don't even remember his name, but could look it up) who gave me my results verbally and said that they would be sent onto my GP. Another week later I still hadn't heard from my GP, so I called and asked for two things; a copy of my results and a copy of my prescription. I finally got them.

The GP's office had just arbitrarily sent the script to Crapria. I told them I will not deal with them and had found a DME that was in-network that I would rather use. (BTW it took Crapria over 4 weeks to call me. I waited until they called to tell them their services weren't needed. Glad I didn't wait!) I had found this forum before getting the results call from the Sleep Doctor. I'm so glad that I did.

I picked up my equipment from my DME on January 10, 2011 with assurances from the Technician there that they would contact me in a couple of weeks to see how I was doing.

Well, I haven't heard from ANYONE since. Except I had my annual physical with my GP in February, she asked a quick question about how I was feeling. To which I answered honestly, that I was feeling much better and no longer falling asleep at work or, more importantly behind the wheel (but didn't say that last part to her). And, of course, since then no one has contacted me to follow up specifically on my sleep apnea, getting used to the machine, etc.

I recently received a reminder card from my DME that it's time to order supplies!

So Well wrote:What are your specific complaints about the "low-rent" firms?

1) I told the first one I need meds to sleep. The doc agreed. But the sleep lab refused to let me take them. So I stayed awake all night.
2) New to SDB and not having a sleep study, I asked for another. Instead, the doc prescribed an apap machine for me not knowing whether I had SDB or not.
3) No follow up, none, zip. "Churn 'em and burn 'em, volume, volume, volume . . ." You choose the cliche.
4) Other complaints too, but I don't want to turn my post into an essay on their incompetence.

You want their name, PM me.

The second sleep lab at least tested me. The study showed I had severe sleep apnea, and they prescribed CPAP at a specific pressure.

So Well wrote:Quite often consumers seek out low-cost ("low-rent") firms in order to save money or in order to get something they can afford. In other words the consumer demands low-cost firms and the market responds.

"Quite often"? Not if the consumer has insurance, which most do. If you have insurance, you look at the clinicians accepting it.

I have GHI PPO. The best and the worst doctors have accepted it. Nothing to do with market responding.

Without granular, accurate information, the market can't make informed decisions. Ask any stock or hedge fund manager.

So Well wrote:Would I dare go to a provider for the first time without a personal recommendation from a close and trusted friend or associate???

My wife was especially good at discussing this with new neighbors and friends

I think you just contradicted yourself.

No matter, "personal recommendation from a close and trusted friend", that's the standard line from the medical community.

Like your close trusted friends have the full panoply of diseases/injuries you might develop. Like they can do little more than identify whether the clinician has a good bedside manner.

OK, your hip hurts and you need a hip replacement.

Ask your wife to ask her new neighbors and friends who are the top ten hip-replacement surgeons in the city where you live.

Who are the mediocre ones? Who are the ones just sliding by?

Again, I don't mean bedside manner. I mean their surgical skills, verifiable by endpoints. Keep in mind, with a bad orthopedic surgeon, you can end up in a wheel chair.

I kinda doubt your friends and neighbors (new and unknown, or old and trusted) will have access to this information.

So Well wrote:Market forces do have a very tough time prevailing in the medical field. This is due to heavy regulation and licensing throughout the field by federal and state governments.

Might it have anything to do with the medical field doing everything it can to avoid published, detailed reports to consumers on their individual outcomes and endpoints?

So Well wrote:time allowing, I could tell you some bad stories about top notch university hospitals

I could do the same. But I'm guessing you mean individual doctors/nurse/techs within those hospitals, not the entire hospital itself.

Lets take Memorial Sloan Kettering, considered one of the best cancer institutions in the world.

My wife has survived breast cancer for 20 years, and in that time we've met some of the best—and worst—doctors/nurse/techs at MSK.

The best ones can save your life. The worst ones often don't know the literature, and can make decision that can kill you.

But "market forces" (cough, hype) drive consumers from around the world to MSK.

If they're lucky, they get one of the good doctors there. If not . . .

______________________________________________________________________________

When I was young, I used to be a pure libertarian. But over the years I opened a couple of businesses. Some were successful, some not.

I discovered that in the real world, businessmen (and doctors are very much businessmen) often do everything they can to avoid market forces, and keep the market rigged.

A little Ayn Rand goes a long way. Then, inevitably, it collides with reality.

Mike

Mike6977 wrote:

So Well wrote:Would I dare go to a provider for the first time without a personal recommendation from a close and trusted friend or associate???

My wife was especially good at discussing this with new neighbors and friends

I think you just contradicted yourself.

Nope, that is not a contradiction. My wife is very good at networking and I am sure she could have discussions with 30 people in two days about hip surgeons and find the right one.

She did pick out all of our kids' pediatricians, dentists, oral surgeons, and orthodontists and we and the kids have been well pleased. When I was struggling with undiagnosed sleep apnea, she suggested a doctor change and that worked out great.

Mike6977 wrote:
I discovered that in the real world, businessmen (and doctors are very much businessmen) often do everything they can to avoid market forces, and keep the market rigged.

Well there is one thing in your post I agree with. Yes, many business men are not in favor of free markets. Why should they be? Free markets give power to the consumer and take it away from the business man who does not work very hard at making the consumer happy.

Business men love to suck up to government and form those crony relationships to protect themselves from the free market.

BTW, contrary to the stereotype you seem to hold, I have never been a fan of Ayn Rand.

Was your decision process in choosing your first sleep lab a sound process? What did you do different in picking the second one? (All complex decisions made by humans are based on information that is not complete and not totally accurate, hedge fund or otherwise.)

What do you propose in place of a market-based medical care system?

Let me add, IMO, it is a good thing to come here and complain about your doctor, the sleep lab, the tech, the DME, etc. Its some therapeutic venting for the complainer. And it is a warning to newbies making provider decisions, that the government-issued medical license on the doctor's wall means only that the doctor has a government-issued license.

My next door neighbor had a large unhealthy oak removed from his backyard. He spent weeks interviewing tree removal services, reading the internet, talking to neighbors and work associates who had trees removed, and even talked to his home insurance company and the local Chamber before choosing a contractor.

Then on the other hand, people will choose a doctor because they drive by their clinic every day or because their practice is in a nice building. Oh that they would learn to shop for a doctor to remove a tumor like my neighbor shopped for tree removal.

I have a trusted GP who is active in several medical associations and keeps up with what is going on and who is who in a two-county metropolitan area. If I ever have an emergency I will get his recommendation but use any available time to do some verification. For elective procedures I will do my homework before selecting a provider.

Medical care is a market, though not as unencumbered as I would like it to be, and everyone needs to learn to be a good consumer.

So Well wrote:Well there is one thing in your post I agree with.

Business men love to suck up to government and form those crony relationships

Good, I'm glad we agree on that.

But many businesses and industries — around the world — manipulate free markets without ever resorting to the government.

It's much cheaper (and fun!) than shelling out million of dollars to a lobbyist.

It was done to me, when my brother, Lev, and I owned a successful minerals business.


Sorry if I disillusion you, So Well, but in the real world, truly free markets are an illusion.

So Well wrote:What do you propose in place of a market-based medical care system?

One where a doctors or hospitals detailed performance data is open for everyone to see. Not suppressed, like it is now.

So Well wrote:I have never been a fan of Ayn Rand.

Ann Coulter, perhaps?

Sorry, that was too easy to resist. I'd guess . . . Nick Gillespie.

_________________________________________________________________

OK, now to where we disagree:

So Well wrote:(I accept recommendations ONLY from). . . a close and trusted friend or associate.

(But, contradicting what I just wrote, I ALSO accept recommendations from). . . new neighbors and friends.

Nope, that is not a contradiction

I'm a afraid it is a contradiction. I've capped and italicized the words "only" and "also" in your post to help you see it.

No problem, I contradict myself plenty. Just ask my wife.

So Well wrote: My wife is very good at networking and I am sure she could have discussions with 30 people in two days about hip surgeons and find the right one

How would she know if, due to this surgeons skills, his patients averaged 15 years on a new hip (before needing a new one) . . . or only 10 years?.

Your wife could network herself till she's blue in the face, and never get that critical information.

----------------------------

So Well, I'm afraid you've missed my basic point.

For the free market to actually function successfully in medicine, patients MUST HAVE access to detailed data on their doctor's performance.

No problem that you missed my point, I often miss the point myself. Yup, just ask my wife.

Cheers,

Mike