RE: Contec RS01 "apnea" monitor
You are right, we are busy as all heck all the time, and in the US it is far worse for those under HMO systems, which, IMHO degrades the quality of care given by putting strict time pressures on the physician and keeps them from really getting to know their patients. Canada's social medicine system is similarly plagued by setting quotas for how many patients a doc must see per hour.
Also, a GP simply isn't sufficiently trained to recognize in detail the way an apnoea diagnosis works or the correct procedures to diagnose it (or the hints and clues needed). This, while not being rocket science by a long shot, is still a specialist area, here in Switzerland either under Pneumology or Neurology, depending on the type of apnoea, and specialists in those disciplines are trained in diagnosis and testing, as are sleep specialists, which generally are in the Neurological department (except, for some reason, at the Unispital, which has its sleep lab in the Pneumology department, perhaps in recognition that the overwhelming majority of sleep related disorders are often simple oxygen deprivation problems, or perhaps it has another simple historical reason - the first doctor to agitate for one was in the Pneumology department).
What GPs can do is see a set of symptoms and put two plus two together and hazard a guess that apnoea is at the heart of a problem (giveaways are complaints of snoring, rises in weight, being tired all day, and elevated blood pressure, plus a larger neck size - these almost always, when presented in combination, will trigger that guess, but sleep medicine is not normally part of their rotation through all the departments during their training) - GPs are prone, by the nature of their job, to take time to come to such a conclusion, by virtue of knowing a patient for a while, and observing the rash of complaints they bring in, and by experience. In the US, fewer and fewer people get to stick with one GP for any length of time, often being shared out between several in an HMO, and this makes it harder to jump to a diagnosis like apnoea. Heck, I AM a doctor, and have been for a very long time, and even knowing my symptoms, it took me a few years to come to the conclusion that I might have apnoea and ask for a referral and testing.
I knew I felt dragged out by 4 p.m. and had no energy, and fell asleep watching the evening news, but I put it down to ageing. My wife moving into the den to sleep due to my snoring wasn't enough to trigger the warning. Instead I looked for, and found, a deviated septum and had it fixed. To no avail, in terms of the snoring. It took my GP and me together, trying to trace down what I thought was a dickey heart to sort of hazard the guess that I might need to hit the sleep lab. Once there, the single test was enough to confirm. But my GP knew me for years, and neither of us had hit on apnoea as a first diagnosis. We are both pretty competent, believe me, and it still eluded us for a long time.
It isn't that 80% of the practitioners are less than fully competent, but that medicine is heavily compartmentalised and even most GPs are specialists (usually Inner Medicine), so, not all possible answers will be at their mental fingertips. In the US, just as here, we are heavily and continuously educated, and cannot maintain a license to practice without that continual education. But in General Medicine, there is a LOT to cover, way more than specialists have to cover, and sleep medicine is one tiny corner, one which most GPs may not get around to while trying to keep up on the myriad of illnesses they must learn about and stay on top of new technology and medical procedures. In fact, I have yet to see a session on sleep medicine on the compulsory continuing education list we must cover each year, and that is something I intend to bring up with the authorities. True, not every GP in the US has their FACP any more than every GP here has their FMH, and trust me, these are tough to get, but in order to remain licensed, they still have to pass a certain number of tests and education elements every year, and it is a whole lot. Plus the mass of paperwork, the dealing with a myriad of insurance companies, the record keeping, the patient reports and diagnostic reports from the specialists, well, it is a lot, to say the least. And it can breed a certain resistance to take certain efforts in a given direction, particularly when they know it is a cost that may turn out to be for nothing. Even here we have a resistance to that - we don't gladly get patients to spend money at all. And apnoea is still not in the forefront of a general practitioner's mind, unless he has encountered it a few times already. A fat person to us means we look at the heart and other organs way before we tackle the idea of apnoea, although almost every fat person has it (opera singers tend not to, for some odd reason. I have a soprano as a patient and by all indications from her body size, she should have it severely, but not at all is the answer for her - I even had her tested at my cost, out of sheer curiosity- I guess all that singing really does keep her throat opened and toned enough to counteract the fat) and we should have it in the forefront of our thoughts. Maybe with time that will be the case, but right now, it still isn't.
Heck, this is a disease that was barely even known about thirty-odd years ago, and now we have "smart shirts" to diagnose it, and of course, CPAP to treat it. I would call that lighting fast growth in learning and recognition of the problem, at least in this profession.