physicians

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physicians

Postby ang » Wed Apr 09, 2003 11:52 am

I'm just curious..... how often does it happen that you think you have found the ideal CPAP pressure, and yet when the physician interprets the study he/she orders a different pressure? This used to happen to me a little more often than it does now, until I actually talked to the physicians (keep in mind that the physicians who interpret in our lab are not certified in sleep, but are experienced). When I showed them that sometimes I am increasing for snore arousals, which wouldn't reflect a change in the AH index, or that I had to increase due to events in REM, they seemed to pay more attention to my patient summary, and understood why I did what i did. Just wondering......
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Postby NYsleepyhead » Wed Apr 09, 2003 10:06 pm

It varies greatly depending on how the physician is reading the study. By this I mean is the doc reading the data summary report (RDI for each pressure, etc), the techs report or the raw data. I have various docs reading my studies. One doesn't review raw data at all so the highest pressure gotten to by the tech, or the one I recommend in my tech preliminary report is the pressure that gets written. Another physician may look at the preliminary report, see if the data summary concurs and then writes that script. I have another doc who doesn't look at the data summary report or the tech prelim and just looks at raw data and flow curves and makes up their own mind based on thier interpretation (I prefer this approach!).
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Md's interpret

Postby respbarb » Wed Apr 09, 2003 10:36 pm

We have one Doc, a pulmonologist, certified in sleep, who reviews all data, and makes up his own mind. I too prefer this approach.
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Postby ang » Sat Apr 12, 2003 9:00 pm

Of course I want the physician to look at all of the data. But I think that I observe things that may not be reflected in the report- at least in ours. For example, someone may have the same RDI on a cpap of 9 and 10, but on 9 they had a ton of snore arousals. Or an RDI may appear lower on a lowever level of cpap, but they weren't in REM on that level (this data is in our report). I guess since the physicians I work with aren't certified in sleep, this was an issue.
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Postby RPSGT88 » Sun Apr 13, 2003 7:16 pm

I've long held the belief that physicians interpreting a sleep study must review raw data to truly understand the patinet's physiology as well as confirm scoring accuracy. An interpreting physician must be competent enough to know when the final pressure is not the best and gives critical weight to tech notes describing the study moment by moment.

Not all reading physicians possess the skill to adequately interpret sleep studies, much less titration studies. We as techs can help advance the reading skills of our physicians by being highly educated ourselves, and finding the time to "read" with them whenever possible.

Unfortunately there are many physicians who dictate from a scored report and never see raw data. The process is no different than having an X-ray interpreted by a Rad. Tech who writes a report which is then "interpreted" days later by a physician reading the report. That's bad business and the AASM discourages it.
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Postby ang » Thu Apr 17, 2003 7:11 am

I guess I am afraid that one of our physicians who reads isn't looking at the raw data- at least not a lot of it. I think he bases most of his decision on the final report. Now if I lived in a perfect world....... :lol:
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Postby Rick » Thu Apr 17, 2003 5:35 pm

Okay, I am sorta confused here.
Just what is the expectation y'all have of the interpreting physician?
Should they score each study and then compare what they have with what you got to get the answer?
My impression is that most physicians use the reports from scoring a study as a map and go through it to see if they agree with what was noted in the reports. You know, like, the stage changes and a representative few apneic events.
My old center had two physicians, a pulmonologist and a neurologist. The pulmonologist would go through events looking for phase shifts in the effort channels before scored events and the neurologist would look closer at the raw data of the heart rate and the details of stage changes. Both had respect for the night tech and if they had to give an answer quickly after a nCPAP Trial(patient going out of the country soon or whatever) they would order nCPAP straight from the tech notes before any reports were produced. They would still do what they did for their interpretation but when it came down to it they trusted the technical staff and their impressions.
My 2 hundredths of a dollar.
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Postby RPSGT88 » Fri Apr 18, 2003 1:53 am

Rick, I expect average quality interpreting physicians to look through raw data to confirm accuracy of the scored report, to use their superior education and expertise in picking up on anything the sleep tech missed and to make the all important judgement calls on the best way to treat patients.

These last ten years I've become spoiled by working for several ABSM diplomates trained at Duke University. Those physicians develop the ability to keep an accurate running mental count of # of apneas, PLMS, arousals, staging and so forth while paging though a record during interpretation. After Lights On they take pleasure in comparing their mental note of events/arousals/staging with the scored report. And not too often their mental notes are just as if not more accurate than the report (which is scored to the highest standards.) When I first saw them do this I was in disbelief but after watching them day after day I became a believer. I realize those physicians are not the norm. Fortunately I work for one of them at this time and the quality of interpretations from our lab is way over the top.

My opinion is that if a physician does not send a record back to be re-scored once in a while, the physician is not performing his or her job as the final element in quality control. I used to work for a physician who would occasionally send a record back to be re-scored and not say what was wrong with it. That makes you look really hard at scoring skills! Physicans like that extract the best work from their techs who develop superior skills as a result.

I could not bear to work in a lab where the physicians did not care about fine detail. Perhaps I am obsessive. I'm a sleep tech.
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Postby sleepguy » Fri Apr 18, 2003 3:41 pm

In our Center, after the tech scores the study and prints the report the doc is required to review the actual study. Any changes they make get in a seperate score file which is used to generate the final report. I can then have the various parameters dumped into an Excel template to compare the numbers. The Medical Director also reviews the other docs interps and data and signs off on those as well. I'll also take a random record, remove all identifiers and set up seperate score files for each tech and doc. The Medical Director is the Alpha and all scores are compared to his.

It doesn't matter how good your scoring techs are (and mine are great), the docs absolutely, positively, no exceptions, have to review the actual tracing. I won't process their fee tickets for interps until they sign off that they've review the study and dictated their report.
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