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Can a higher pressure actually increase CAs?
I DO work in a teaching hospital, and there is never someone who is last in the graduating class. There are several..... Fortunately, most of them either get better or don't make it. Those that do make from that crowd, well, that's what private practice is for Wink
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An expert is someone who's had enough experience to realize he's not really an expert.
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(11-27-2014, 12:59 PM)Sleepster Wrote: ...everyone who works in a field that requires expertise knows that there can be a big difference between someone with 5 years of experience and someone with 20 years of experience...

Sincere congrats to you and others who actually got the point I was trying to make.

The rest of you? Better luck next time. Thanks for playing; now here's your consolation prize:

What I was NOT trying to say is that Gladwell's definition was not a deeper discussion or that we should buy into oversimplification of Gladwell's point, or that there are not a lot of mitigating factors. It is, we shouldn't, and there are.

So rather than going off on a tangent or splitting hairs, and dispensing with the specifics, the obvious point is that someone with more experience and training, all else held equal, is going to make better-informed choices for his patients. Who can disagree with that?

But that raises the important question "how much training and experience do they actually need as opposed to how much they just might not have?" I question whether a high percentage of those licensed to help us actually have the tools and abilities to do that effectively.

The "system" may just really be nothing more than a house of cards. We are supposed to think that two little letters, MD, qualify them as experts. I have always questioned authority, and I question it right now on this subject. I think our expected perception may have a potentially gargantuan and possibly lethal disconnect with the reality.

So that is the other point; for an issue this complex, it is quite possible that there are a lot of diagnoses and recommendations being made by "non-experts" ill-equipped to make informed decisions, all of who still proudly hang framed diplomas on the wall behind their desks so that you can't miss them. We're not talking about being "pretty good" at hanging drywall here; this issue is literally a matter of life and death for many sufferers.

For a complex issue such as this, someone who splits their focus between sleep issues and other issues at a 1 to 20 ratio, all else held equal, will know 1/20th of someone who does it all the time for the same length of time. The odds are highly in favor of that being the case, a high percentage of the time. Again, math does not lie. And for this particular issue, it is very, very tough for someone to even approach expert status if they have not had a very long history of specific training and specific experience. Period. Maybe I am overstating the case; maybe we don't need an expert. Maybe you don't need an expert.

Bottom line, better training for the sleep doc, more emphasis in the practice on sleep issues, are both attributes that are going to serve you better than someone who does not have the specific training and experience when we are talking about a complicated issue. I could probably take my own appendix out just by perusing WebMD, but I think I would rather end up going to the Mayo clinic. Those who's egos refuse to let them see the wisdom there, good luck with that.

And it was also not meant as something carved in stone; of course there are mitigating factors, such as how smart the person is, how well they adapted to the training, how well they learn from what happens in their practice, their personality, bedside manner, communications skills, and so on.

None of that denies the fact that training and experience really matter in a significant way, and that an ENT in the 6th year of his practice that graduated from med school in Guam and did not have specific sleep studies training and does not see a high percentage of sleep patients day to day, just might not be as well-equipped to make an informed decision about what the proper diagnosis and treatment might be, as someone with significant training and experience.

Maybe the 100-year practice figure has a margin of accuracy factor of only 50%. It well could. That still equates to 50 years of practice needed. Or maybe 150. I don't want to belittle the facts by others perceiving this as simply a "shock" statistic, but that might be what is needed for some to actually wake up (no pun) and smell the propane here. Which smells a lot like snake oil.

And it all hinges on what I qualified this with before, which is "with all else held equal". Of course, all else is never quite equal. I know that; we all know that. But thanks, anyway, for pointing that out for us.

The 60-year-old Neurologist with a sleep fellowship and a high number of sleep patients may not reach that "expert" bar either, but he has a much greater probability of being better at making those decisions. Or he could be a dud and the guy just out of residency might be brilliant. Anything is possible. There is a reason they refer to it as a "practice".

I still would play the smart odds, regardless.

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I agree. I would play the smart odds but I would go a step further. At the current state of the "science" of sleep apnea there are a fair number of non-quantified variables effecting the whole situation. I would be looking for a person adept at putting their own knowledge and experience together with the data they can collect and come up with a good working hypothesis. Test the hypothesis safely on the patient and act intelligently on the results of the test.

That is the MD I want for my sleep doctor.

Best Regards,


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