Ok I'm new here. Just had my follow up after my sleep study night and my titration night. I don't trust my doctor and with tricare prime insurance and living 75 miles from the tricare authorized doctor,  changing doctors is a little difficult unless I drive 3 hours down to Los Angeles. I tried to get a copy of my sleep study results and he said I didn't need them and he will send copies to my primary care doctor. No problem then, my Primary Care Dr will give me the results when she gets them. What he did tell me and my husband is that I am backwards, over 55 instances (dr words not mine) per hour on my side compared to 31 on my back and with titration my pressure is at 10cm H2O with my AHI at 31 and my SaO2@ optimal pap at 86% up from 82%.

Is it just me or should I insist they adjust me a little more to get better numbers?  Any opinions greatly appreciated.

It did make me feel better when I told him what equipment I wanted and he asked how I knew so much about what i wanted and I told him friends with apnea which i consider all of you friends.

I'm fighting Tricare Prime now just to get my equipment. Of course the insurance says they will have a determination for me in the next 2 weeks.....Oh YAyyyyyy (sarcasm totally intended)

Thank You

Its going to be tough for you to insist they adjust your settings until you get a hard copy of those documents.

If you are getting massive resistance and you cant switch doctors, then make sure that you get an APAP machine somehow. That way you can get a titration without having to deal with that !@#! sleep lab.

Send a WRITTEN request to this sleep lab for the doctor's dictated results (1-2 pages each) AND the full scored data summary report w/condensed graphs (5+ pages each) for both your sleep evaluation PSG, your titration PSG AND a copy of the equipment order (script) via Certified Mail, Return Receipt Requested. Keep a copy of your written request, the Certified Mail receipts AND the green Return Receipt card as proof of your request. These are part of your medical records and as such you have a LEGAL RIGHT to these copies under HIPAA. If they fail to provide those copies to you or refuse to then you have the proof to file a complaint under HIPAA to force their compliance. Good luck!!


_________________
Some people are like Slinkies... Not really good for anything, but they still bring a smile to your face when you push them down a flight of stairs.
Resmed VPAP Auto. Humidaire 3i, Simplicity mask, ResScan 3.7, S8 ResLink, Embla oximeter.

WOW not a good lab.  

You absolutely have a right to see them, get them.  

You need to know what they did

I know when I had my titration test they kept ajusting until the numbers were very good.

Once you have your records, make sure that if you see a different sleep doctor  he is board certified.  Does anyone know if the forum has a site with board certified sleep doctors in the USA and perhaps other places?


_________________
REMstarplus, M Series with C-flex and heated humidification
C- Pap setting of 10
ResMed Mirage Quatro full face Mask
Sleep study showed 36 events per hour
Location, Nebraska

This is just a harmless question, but one that may spark a huge debate:

Why is there so much love for Board Certified Sleep Physicians? I se this phrase on the this forum daily and I do wonder why that title seems to associate that physician with the inability to make mistakes. It seems like it goes like this... hey these results look odd and is countered with ... change to a board certified physician... Ugh.

A lot of this falls on the technician too. The sleep physician may spend 15 minutes looking over your data (YES even board certified doctors) and if the technician hasnt done a good job, then he is put in a spot to interpret data that may not be showing the complete picture. There are many more poor physicians out there than anyone would want to admit, but just because you are seeing someone who is board certified ... it doesnt mean that your journey will certainly be better. Maybe it reduces the potential for errors to be made, however ive yet to see any proof of that.

Thoughts?

RAM_Sleep wrote:

This is just a harmless question, but one that may spark a huge debate:

Why is there so much love for Board Certified Sleep Physicians? I se this phrase on the this forum daily and I do wonder why that title seems to associate that physician with the inability to make mistakes. It seems like it goes like this... hey these results look odd and is countered with ... change to a board certified physician... Ugh.

A lot of this falls on the technician too. The sleep physician may spend 15 minutes looking over your data (YES even board certified doctors) and if the technician hasnt done a good job, then he is put in a spot to interpret data that may not be showing the complete picture. There are many more poor physicians out there than anyone would want to admit, but just because you are seeing someone who is board certified ... it doesnt mean that your journey will certainly be better. Maybe it reduces the potential for errors to be made, however ive yet to see any proof of that.

Thoughts?

You are exactly right, but your last sentence says it.  What is wrong with reducing the potential for error as much as possible.


_________________
REMstarplus, M Series with C-flex and heated humidification
C- Pap setting of 10
ResMed Mirage Quatro full face Mask
Sleep study showed 36 events per hour
Location, Nebraska

Something new wrote:

RAM_Sleep wrote:

This is just a harmless question, but one that may spark a huge debate:

Why is there so much love for Board Certified Sleep Physicians? I se this phrase on the this forum daily and I do wonder why that title seems to associate that physician with the inability to make mistakes. It seems like it goes like this... hey these results look odd and is countered with ... change to a board certified physician... Ugh.

A lot of this falls on the technician too. The sleep physician may spend 15 minutes looking over your data (YES even board certified doctors) and if the technician hasnt done a good job, then he is put in a spot to interpret data that may not be showing the complete picture. There are many more poor physicians out there than anyone would want to admit, but just because you are seeing someone who is board certified ... it doesnt mean that your journey will certainly be better. Maybe it reduces the potential for errors to be made, however ive yet to see any proof of that.

Thoughts?

You are exactly right, but your last sentence says it.  What is wrong with reducing the potential for error as much as possible.

Nothing at all, but the reality is that (for the most part) it is a coin toss (with a bit of weight). If you are really set on reducing errors as much as possible, then youd think that a lot of people would be making very long plans to go to the elite labs in the nation, right?

I didnt mean anything personal, if people happened to take it that way. I just find that a lot of people jump on the ship to go to a board certified physician. Beginning very soon, most if not all labs are going to have to be accredited with board certified physicians. Is it likely that labs who have invested in hundreds of thousands of dollars worth of equipment will just bow out? Nope. Those same "!@#!" physicians that people are flocking away from are going to get board certified and be able to maintain their labs. Much lilke anything else, Board Certified is a title that isnt worth anything unless that physician has the willingness to take your care seriously.

The whole reason we encourage people to use a physician accredited in sleep medicine is because accredited physicians have much more extensive education in that area and additionally, they are required to maintain continuing education to maintain their accreditation.  I can feel an argument brewing as to the training required so I have an email in to the American Board of Medical Specialties to find out exactly what that is.  But I promise you, it is much more than a weekend seminar.  You can find who is accredited in you area here at www.abms.org as well.

It just makes sense to us that you want someone on your team that has the most formal education, and keeps current, in the field.  Do we say anywhere that they don't make mistakes, NO.  Do we say anywhere that all physicians who are not accredited are any less knowledgable, NO.

But here, our goal is to try to ensure that OSA patients get the best possible care and as an Internet forum, the best way we can do that is to direct people to physicians accredited in sleep medicine.  We do not have the resources to check out everyone who practices sleep medicine.

If someone has a physician they are using who is not accredited in sleep medicine and they love them, them that is great, carry on!  But our goal here is not to practice medicine but direct people to those that are the most likely to be better educated in the field.  What would be your suggestions to people RAM_Sleep?

Vicki


_________________
Being defeated is often a temporary condition. Giving up is what makes it permanent.
Marilyn Von Savant

That which does not kill you makes you stronger-Friedrich Nietzsche
Friedrich must of had apnea.

Also,

I know you are a sleep tech RAM_Sleep and may only look at things from the sleep lab point of view (per the post above about accrediting sleep labs) but many people (if not the majority) are referred to the sleep lab only for the study and then the follow-up occurs with their PCP.  Especially in those cases is it important that they have continued follow-up with someone who specializes in sleep medicine and is preferably accredited in it.

Vicki



Last edited by Vicki on Fri Oct 23, 2009 2:35 am; edited 1 time in total
_________________
Being defeated is often a temporary condition. Giving up is what makes it permanent.
Marilyn Von Savant

That which does not kill you makes you stronger-Friedrich Nietzsche
Friedrich must of had apnea.

Vicki wrote:

Aso,

I know you are a sleep tech RAM_Sleep and may only look at things from the sleep lab point of view (per the post above about accrediting sleep labs) but many people (if not the majority) are referred to the sleep lab only for the study and then the follow-up occurs with their PCP.  Especially in those cases is it important that they have continued follow-up with someone who specializes in sleep medicine and is preferably accredited in it.

Vicki

It is becoming mandatory to follow up with the sleep physician and if that is not fully practiced, then it is going to be soon. I do try to look at things from both points of view and I will always have the same thoughts on the issue. Board Certified is a title that may not mean anything and will not mean anything if that physician isnt overly concerned with the patients care. I know plenty of board certified physicians that spend a total of 5 minutes dictating results. They dont look at prior history and they certainly do not view the study. They look at the data provided by the technician and plug in numbers to a template. Its that easy...and not the best for the patient, obviously. So can anyone tell me that they would refer their friends to THAT physician as opposed to the non-board certified sleep physician that takes 30-60 minutes to look over the actual study and results?

Thats all that I am saying. Dont get too hung up on a physician being board certified. It IS just a title for some.

Ram, sadly we (the lay person) have no way of knowing WHICH doc takes the time.  Having been in medicine BC (before children) many years ago, I know first hand, what you speak of.

I would cringe when someone would say they had an appointment with certain docs but honestly we can't really say much. If asked directly my opinion I would share with others in a politically correct way who they should seek out BUT never would I discourage someone from seeing a particular doctor, unless they were  a close friend.  I knew who to see and who not to see and that was comforting...until my husband's job took us to another state, where it was nearly impossible to glean that insider knowledge from the medical community.  I eventually befriended people who felt comfortable sharing but until then it was a name in the phone book and that as you know is quite scary.

So while I truly do understand where you are coming from, until someone has the inside knowledge of where to go and who to trust we are all left with the only measurable standards out there and board certification for now is about the best barometer we have.


_________________
~ElleMarie~ One day at a time......are you kidding me?.....sometimes it's just one minute at a time.

Jun 2007 AHI 100.7 started cpap at 9** Oct 2007-11** April 2009 Bipap-15/10
Respironics auto M w/ Optilife nasal pillows

How well I know of experts being much less than perfect.  My daughter's orthopedic doc. recently missed a broken foot and dismissed her pain.  At least he ordered an MRI to rule out soft tissue injury and he caught it then.  We're switching docs.  Problems with her eyes have similarly been dismissed by "experts" and I finally recently stumbled onto someone who could help her.  It is very, very frustrating and difficult to fight with physicians to get properly diagnosed and treated.  

A friend saw a highly regarded GI doc who told her to go to someone else because she asked questions.  She gladly complied.

I also taught medical students and I have plenty of stories to tell.  But I also know that the majority of physicians are in it because they truly care about people and want to help them.  I imagine that is why most physicians who are serious about sleep medicine get accredited.

I have been fortunate to have great sleep docs who I have had strong partnerships with in my care, including asking me to follow my data and trusting my judgment about my therapy as long as I keep them in the loop.  I stand by my rant that everyone should do their best to find someone that they find competent and receptive to questions and partnerships in their care.  And I am sorry that there are some bad apples out there, as there are in any field.

Vicki


_________________
Being defeated is often a temporary condition. Giving up is what makes it permanent.
Marilyn Von Savant

That which does not kill you makes you stronger-Friedrich Nietzsche
Friedrich must of had apnea.