Fisher & Paykel Icon Premo (comments?)

[Ugly]

Reality what a concept? Someone released an album by that name.
Robin Williams I think, although it could have been Steve Martin or George Carlin.

Nuts. It was bugging me so I looked it up. Robin Williams.

On the supplier side, no such pressure exists, but the profit motive does and since sales people are given payment partly based on sales (and I am sure kickbacks) and told what to move, they can try to give you the runaround.

But if that's the case then wouldn't it be in their best interest to push a superior machine? I would think that they'd be glad to dump an AutoSet onto me rather than the Escape.

I haven't made that call to leave a message but I'll do it.
I want to make sure there are no more goof-ups.

[archangle]

Just a few weeks ago I caught crackling in the lower left quad of a patient's lung that two younger doctors hadn't caught. Ultrasound revealed some congestion and a big clump of something or other (I try not to x-ray if I don't have to, and the ultrasound machine was right at hand) that showed up quite nicely (normally this is a job for x-rays over ultrasound, but sometimes, especially with the newer machines, you get something useful), so Prednisone, Makatusin and Mucofluid for six days and now the patient has nice clear lungs and no cough (wish I could claim the same for me - horrible cough and nothing budges it). So, despite the untrustworthiness of the suppliers in Ontario and Quebec, I am still grateful for my scope. It saves lives still. And fits my ears without pressing or biting. And it cost $7.00 CDN in 1977.

No matter how good the tools are, you still need a working human brain at the end of the process. A low tech "test" like home CPAP machine data with a smart medical person looking at the data can often be better than a high tech in lab PSG with a dummy reviewing the data who's just going through the motions.

While we berate the doctors and DMEs for pushing the wrong things on the patient, we need to realize that they often have to push hard to get the patients do the right things, too. Lots of people really have to be pushed hard to get them to do CPAP and many other things they really DO need. I think sometimes they get a little too used to pushing the patients around and pushing past their objections.

Unfortunately, they sometimes don't discriminate in the urgency and certainty of what their saying. There's a difference between "You really need to use your CPAP" and "The ResMed Quattro full face mask is the best mask for all patients."

[DocWils]

True, Archangel, true. The hardest thing is to get compliance out of a patient, and sometimes we just say things very baldly and leave it at that, not realising that it may have the wrong effect or interpretation. Added to that the time pressure everyone is under in the med profession (and I know very few who have an easy day of it, even the lab tech who spends his days reviewing columns of numbers and needs to spot patterns through the haze), and of course, getting patient compliance is actually hell. We have to assume that you are adults and want to get better, but often have to push like mad (and in this sense, doctors make the worst patients - compliance amongst doctors with illness is worse than in the general populace - so much for knowing better) and because of time pressure can be quite blunt about it. Doctors are no longer trained in the art of talking to patients (we were still in my day, shortly after it was dropped, along with Latin and Greek, all still necessary, I think) and suppliers never have been (the exception is the LungenLiga, who's "advisers" are trained in counselling patients, to a lesser extent), so it all gets rather messed up.

And one more thing - we're human, and mess up like anyone else. Hopefully. no one gets seriously hurt by our mess ups, but it happens - overwork, fatigue, emotional exhaustion, they take their toll - I have a friend who is an Obi-Gyn surgeon - she holds twelve hours at her own clinic, plus surgery at the local hospital plus is on call at three others. She has no private life whatsoever, sleeps maybe five hours a night, and is seriously on the near edge of burn out - she's been doing this for 15 years and is considered one of the best cervical and breast cancer surgeons in her area and still has to fit in time to look after her mother, who suffers from dementia. A lot of us finally convinced her to take up golf once every few weeks to help her get her mind out of her practice and give her a chance for some normalcy (that's why we play golf, btw - it is therapy for us). So far she's managed to remain in top form, but she'll be tired or cranky some day, and ooops! And that is how it happens, folks. So don't ride us too hard, and if we say take your medicine, take it and don't make us have to chase you. We won't, you know. We have no time for it.

[Sleepster]

[...] and of course, getting patient compliance is actually hell. We have to assume that you are adults and want to get better, but often have to push like mad (and in this sense, doctors make the worst patients - compliance amongst doctors with illness is worse than in the general populace - so much for knowing better) and because of time pressure can be quite blunt about it.

You can't push a string.