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Curious as to what it takes to become a certified sleep doc?
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Mosquitobait Offline

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Post: #11
RE: Curious as to what it takes to become a certified sleep doc?
(06-26-2015 05:50 PM)DocWils Wrote:  BTW, here in Switzerland they are generally sub-branches either of pulmonolgy or neurology, and often the two don't mix - there are two different sleep labs in my hospital, for instance, one in each department (and in different buildings a good fifteen to twenty minute walk apart).

They appear to be the same way here as well, although there are some sleep clinics now that have both backgrounds (Mayo Clinic, of course, has both). The director of the clinic I go to has her background in internal medicine.

No matter how much training your doctor has been through, it's not helpful to you, the patient, if they aren't helping you. THAT is the main problem for many who are on this board. You bring your Sleepyhead report in to talk about what problems you have and they are only interested in the AHI and compliance and off you go. Half of patients already stop using their cpap- why ignore the patient who is focused on improvement and USING their cpap?

While I have a small axe to grind with the Sleep Center, it is about their office model rather than their abilities. I don't mind being pawned off to the PA if I could get my questions answered. She couldn't answer them and I'd still be waiting if I didn't already find it out on the internet.

Honestly, I think they need to have classes once a week for folks new to cpap so that they can come in and ask their questions and get the help they need to be successful. That's what they do for folk with blood sugar meters. Help them until they are doing it right. Oh wait, that's what the DMEs are supposed to be doing! Yet another story. But, so far, I am not whining about my DME.

Quote: self diagnosing and coming in to the office with completely wrong ideas around 70% of the time

I completely agree with you. I put off going to the doctor because my problem was part of the many lists on the Internet of things that happen during menopause that are perfectly normal. Finally went and 10 days later was having major surgery for cancer. I was WRONG.
(This post was last modified: 06-26-2015 11:02 PM by Mosquitobait.)
06-26-2015 11:00 PM
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DocWils Offline

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Post: #12
RE: Curious as to what it takes to become a certified sleep doc?
(06-26-2015 07:01 PM)Mark Douglas Wrote:  No disrespect intended but were it not for google I would still be a zombie because the medicos sure as heck weren't helping!

As i said, 70% of the time it doesn't help - that still leaves 30% - you are one of the lucky 30 out of 100.
06-27-2015 04:52 AM
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DocWils Offline

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Post: #13
RE: Curious as to what it takes to become a certified sleep doc?
(06-26-2015 11:00 PM)Mosquitobait Wrote:  
Quote: self diagnosing and coming in to the office with completely wrong ideas around 70% of the time

I completely agree with you. I put off going to the doctor because my problem was part of the many lists on the Internet of things that happen during menopause that are perfectly normal. Finally went and 10 days later was having major surgery for cancer. I was WRONG.

My point precisely. I don't want to guess how many people don't come in when it is something grave, but we recently estimated that that number had increased exponentially since the Internet has started. The number coming in insisting wrongly they have something grave and wasting a ton of money to find out it is something simple we know about, cyberchondria we know about, but those who could have come in and hadn't is a number that remains difficult to asses, and frankly, we are pulling that from late diagnosis and mortality files. In many cases we could have saved them.

But, again, in around 30% of the cases it actually helps, and those lucky percents are glad of Google. So, perhaps it is a wash, but I think about all the people who could have been helped had they come in earlier.
06-27-2015 04:59 AM
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me50 Offline

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Post: #14
RE: Curious as to what it takes to become a certified sleep doc?
and sometimes people have a problem and had the biopsy and flow cytology, etc. and still there is no diagnosis other than all is well. Then, there is a huge change in the same area and what is the diagnosis? stage 4 cancer with chart notes where a specialist recommended a repeat test be done 2 or 3 months after the initial one but that was not relayed to the patient and that test never was redone. There were 3 doctors that missed it. During the biopsy, they even came back for another sample and then said it was negative. A month later, it wasn't negative and I presume wasn't in the earlier test either.

I said all of this to show that we have to be proactive in our own healthcare. If we feel something is wrong, outside of hypochondria, etc., then keep pushing and going to another doc if you aren't being listened to. It just might save your life or get caught early where there are not a lot of damage and loss of some quality of life due to delays in a diagnosis. I have seen it happen at least 3 times now.
06-27-2015 05:58 AM
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OpalRose Offline

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Post: #15
RE: Curious as to what it takes to become a certified sleep doc?
If it weren't for my friend "Google", I would know very little about Sleep Apnea, because, Lord knows, I wasn't getting much direction from doctors, sleep techs, or DME. If it weren't for my friend "Google", I wouldn't have found this forum while searching for information on SA.

Doctor's aren't very forthcoming with information about patient concerns, so what choice is there but to do research yourself.

No disrespect to you Doc Wills, I can tell you are a caring physician and you take the time to come here and explain your point of view. It is much appreciated to see a Doctor get involved, but I suspect you are in the minority.

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06-27-2015 07:46 AM
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49er Offline

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Post: #16
RE: Curious as to what it takes to become a certified sleep doc?
(06-27-2015 07:46 AM)OpalRose Wrote:  If it weren't for my friend "Google", I would know very little about Sleep Apnea, because, Lord knows, I wasn't getting much direction from doctors, sleep techs, or DME. If it weren't for my friend "Google", I wouldn't have found this forum while searching for information on SA.

Doctor's aren't very forthcoming with information about patient concerns, so what choice is there but to do research yourself.

No disrespect to you Doc Wills, I can tell you are a caring physician and you take the time to come here and explain your point of view. It is much appreciated to see a Doctor get involved, but I suspect you are in the minority.

Well said OpalRose as that is my exact situation. I would love to have a sleep doctor whom I respected to manage my case but so far, I haven't found that person. I am not asking for perfection but at least show me that you have some idea about my situation and what I am dealing with which hasn't been the case with any of the sleep doctors I have seen.

Everything I have learned about sleep apnea and pap therapy has been through this board and the other one. Pretty sad although I am grateful they exist big time.

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06-27-2015 08:34 AM
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PaulaO2 Offline
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Post: #17
RE: Curious as to what it takes to become a certified sleep doc?
One can be certified out the wahzoo but if they don't use the tools available, they might as well be the guy on the street corner.

We're not asking that they look at our data monthly. We're asking they ensure we get data capable machines so the data is there when needed. I went through a plethora of scary heart tests, my blood pressure so high they thought I would have a stroke. But it was "just" my sleep apnea not being adequately controlled. My sleep doc acted all "pfft" about it. Did a single night with an oximeter, increased the pressure by 2, and said I didn't need to do a follow up. A data capable machine and an educated patient would have eliminated a lot of expensive tests and worry.

Papers on the wall are expensive but worthless art if the doctor refuses to use what he/she has learned.

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06-27-2015 10:17 AM
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Mark Douglas Offline

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Post: #18
RE: Curious as to what it takes to become a certified sleep doc?
(06-27-2015 04:52 AM)DocWils Wrote:  
(06-26-2015 07:01 PM)Mark Douglas Wrote:  No disrespect intended but were it not for google I would still be a zombie because the medicos sure as heck weren't helping!

As i said, 70% of the time it doesn't help - that still leaves 30% - you are one of the lucky 30 out of 100.

From my viewpoint your 30% is my 100%
and that makes a world of difference would't you agree?
.
This goes to my long term complaint. I am not a number and please look at my symptoms. Please treat ME not my "numbers". If my TSH is "normal" but I have every classic symptom of hypothyroidism don't tell me I'm depressed and give me an anti-depressant and send me out the door. Investigate further!
I asked one MD to forget the TSH - in view of my symptoms and family history can you not run a full panel. His response was "insurance won't pay for it" at which point I exploded I don't give a Dxxxxx about that I'll pay for it! I decided at that point I needed a thinking human doctor not a robot..,,
Professor Kingsfield would be very disappointed in him.
Current Doc B listened to my recitation of woes, looked at my skin, asked do I have trouble swallowing, and sent me for an ultrasound. After results tells me I have had Hashimoto's and have had for a minimum of 20 yrs and quite possibly 30 yrs. About how long I had been wandering in the desert of incompetent health care...
.
If a doc calls me to his office and says the AC isn't working and I run all the tests and tell him there is nothing wrong with the AC it is all in your head take an anti-depressant I wonder how that would fly?

Rant Off.

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06-27-2015 03:49 PM
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PaytonA Offline
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Post: #19
RE: Curious as to what it takes to become a certified sleep doc?
I must say that I have had few problems with my doctors other than the fact that I was prescribed my VPAP by my PCP who was a family medicine practitioner and that was the end of it. I think that it may have been the medical group that he was in that caused no referral to a sleep specialist. I was just left with the DME for support. The DME is Apria so we all know how well that went!! Since I have had this forum's help figuring things out, I no longer need to get information that I need from the DME, although I do enjoy talking to someone who knows their business. That happens very seldom with Apria.

I now see a sleep specialist but I sometimes wonder if it is necessary. Generally, He looks at my last month's statistics from ResScan and asks me how I am doing and we are done. He has helped me with a few things along the way but it just makes me wonder sometimes.

Best Regards,

PaytonA
06-27-2015 05:30 PM
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DocWils Offline

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Post: #20
RE: Curious as to what it takes to become a certified sleep doc?
Mark, did you read what I said in the next post? Yes, lucky 30%, but what of all the people who didn't come in because they googled their symptoms and, misunderstanding how to do a proper symptomology (around 90% of the non medical world, sorry, but it is so) did not ask the right questions, did not understand what they were reading, did not seek treatment and died. Those numbers haunt me, and will forever haunt me, and for those lives I mourn. There is nothing on Google to separate the wheat from the chaff, and far too much much bad advice being given by unqualified people, and that of course bothers me immensely. And a lot of the self help forums peddle dangerous notions in the guise of helpful advice, advice that costs the thoughtless person who peddled their particular ignorance nothing, and then left my people to mop up the mess, often too late. We are reverting to the era of snake oil peddling. So, yes, it does bother me, and worry me.

That said, when it is helpful, as it often is here, for instance, then it is very helpful indeed. But when it is not, it is harmful, and at times very harmful.

I am sorry you had a bad run in with a doc, so have I, more than once, it happens, we aren't gods and we don't catch everything, but you were smart enough to seek a second opinion, and that got you out of the woods, and btw is what we always say, get a second opinion. I certainly don't have ego enough to be bothered if a patient seeks a second opinion, so long as it is from a qualified source, I see it every day - today I had one, at my own advice, and did a second opinion for someone else after 4 ops did not help the poor bugger. And since I could not see where the problem was, I sent him on for a third opinion (the problem wasn't the surgery, IMHO, but the massive damage to the foot already before anything had been done - the cutter was fighting a rear guard action in a way, but I sent the patient on to a colleague who has been doing wonderful things in metatarsal reconstruction anyway in the hope he could see a way the original doc could not).

And yes, we do tell patients that the insurance won't pay for something - we are obliged to, in fact, by law - they are in the US too, so far as I know (not allowed to sucker you into expensive procedures that you are left holding the can for, without your express consent). And yes, some docs can't see past the test numbers, but most are better than that.

Out of curiosity, would you have come up with Hashimoto's by Googling it? I actually doubt it - it is a tough diagnose and one where all the symptoms would have to line up, and you would not likely have focussed on the symptoms that would have found you the syndrome via google. The tip - the skin pallor and the trouble swallowing were probably things you would not have seen and put in. Heck, a lot of GPs miss it. The fact the TSH and Free t3 and T4 levels were good would certainly have thrown a lot of docs off the scent. As you know (or not) I run, as part of my job, a special diagnostic team for difficult cases, full of talented and laterally thinking physicians and students, to train them how to think medically. In the last year we were turfed two patients with mystery illnesses that turned out to be Whipple's, something most city doctor's will never see in their entire practice, and something we use to trip up med students. But there they were. Two in a year. The first I pegged inside of a ten minute read of the symptoms and a look a the lifestyle of the patient, and it helped that when I was younger I used to work on a horse farm (race horses, in fact), the second took a week of digging by the entire team before it was agreed upon. Hashimoto's is an easy miss unless you know what to look for - the symptom list mirrors a ton of other things, including depression and half dozen other illnesses, and it is the puffy or pallid face and trouble swallowing that would be the tip off in your case, something you might only see in the right light, and when the thyroid got enlarged enough to impinge on the throat, since the other tip off, the anti-thyroid peroxidase antibodies, were not present in the previous doc's testing. Your second doc got lucky or had a well lit surgery, your first didn't and didn't think to look at you hard. To his eternal shame, I might add. But it was an easy miss, frankly, unless you are very experienced in that field, given that you were seronegative in all previous testing, and that is a rare thing. Count yourself lucky. To use your AC analogy (and forgive me but I know nothing of ACs) it is as if the AC looked perfect in all ways according to normal testing, but the clue lay outside in the window ledge because the AC was tilted just wrongly but subtly. Would you have seen that from in the office? You got really lucky in your second opinion, and I am really happy that you did.
06-27-2015 05:42 PM
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