un-ethical?

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un-ethical?

Postby TexasSleepguy » Sun Jul 06, 2003 4:04 am

Have you ever--while scoring gave the patient an apnea because he was boarderline with a hypopnea and really needed the CPAP, so you called an almost hypopnea an Obs? just curious
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Postby NYsleepyhead » Sun Jul 06, 2003 5:36 pm

I think a lot of people tend to overscore because they feel the patient "needs it." I have a real problem with doing this. Remember, it is the physician's duty to diagnose and treat the patient, not the scorer. The scorer's duty is to score events per the physicians scoring rules or the current accepted criterion. If the patient has mild disease let the physician describe it that way and justify it in their dictation, that is what the physician is supposed to be there for, to advocate for the patients treatment.
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Docs

Postby TexasSleepguy » Sun Jul 06, 2003 11:40 pm

yes they should...but, Some of the M.D.s I have worked for have said "you are the sleep expert" "you make it so" but you are right its ther job.
Wish I could work for a board certified sleep Doc!
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Postby Mandy » Mon Jul 07, 2003 12:06 am

I know exactly what you're saying, TexasSleepguy. Yes, it should be the physicians responsibility but not all of them see it this way. I had one medical director say to me "that's what you get paid the big bucks for." I get paid the big bucks? Yeah, right. He never even looked at the raw data nor did he want to.

This brings up another issue I've often wondered about. Is the interpreting physician obligated to recommend treatment options? In other words, when interpreting a study, should they simply dictate the results and let the referring physician decide what to do or should they recommend treatment options? I've seen it done both ways.
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Postby Bobzzz » Mon Jul 07, 2003 4:37 am

In other words, when interpreting a study, should they simply dictate the results and let the referring physician decide what to do or should they recommend treatment options?


I simply don't understand how these referring docs think they know how to treat Sleep Disorders when most of them have no background in the field. To me it's like going to a Dermatologist for a Cardiology problem. When I started in this biz, Sleep docs were the only ones allowed to diagnose & treat Sleep Pts. That's how it is in our lab. The GP's, ENT's, Cardiologists and all the rest refer Sleep Pts. to the Sleep docs.
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Postby NYsleepyhead » Mon Jul 07, 2003 1:46 pm

I agree, a course of treatment should be indicated by the sleep physician who is reading the study. This NEEDS to be a board certified sleep doc, otherwise, whats the point of having the study read. The whole point in that the doc reading the study (and billing several hundred dollars for it) is that he will understand the results better and know what the indications and likely success of various treatment options are better than a primary care (or otherwise oriented) doc who wouldn't know what to do with the raw data. I wouldn't let my primary care doc get within ten feet of treating my sleep disorder, they get absolutely zero training in the field (I speak from experience as my fiance is a 3rd year medical student and the only sleep med info she has picked up in medical school so far is from me!).
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treatment recommendations- yes or no?

Postby Mandy » Mon Jul 07, 2003 4:44 pm

I also agree that treatment recommendations should be made. The interpreting physician that I work with does this but I've seen reports from other sleep centers where there isn't any recommendations. On another note, the neurologist that interprets the EEG's where I work never makes any recommendations. I've often wondered how the referring docs would know what to do with abnormal EEG results. Are physicians trained more in this area of medicine?
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Postby Rick » Tue Jul 08, 2003 4:40 pm

How about the GP Referring but not wanting the Sleep Doc to treat because of the fear of "losing" their patient to the Sleep Doc?

I have had a physician say to me "I have the results of your test, let me look up and study how to treat you then I'll get back to you." Truth and she ain't my physician anymore.

There is a reason they call it "Practicing" Medicine...
:wink:
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Postby NYsleepyhead » Tue Jul 08, 2003 5:36 pm

I would get rid of that physician, what do they have to worry about? The sleep doc isn't going to take their patient, they are just going to follow their sleep disorder. I haven't met many sleep docs that want to or have time to take patients away from GPs. Most sleep docs don't even want to treat sleep apnea patients for too long because they are "boring" (not my words) what would they do with people coming into their office with sniffles and hemorhoids.
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Postby Rick » Tue Jul 08, 2003 6:46 pm

For some doctors it comes down to money. They see less money if their patient has to see another physician for referral. They see things differently, they ARE doctors so some feel they can do what any other doctor can do, why should they loose out on getting money?

I know there are good and bad doctors, they are a subset of humanity so that means there are also small minded, bigoted, stupid doctors out there. At least it seems that people don't treat them as if they are God anymore. Off the soapbox and back to the grind.
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