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.