How is the quality of sleep medicine in the US?

[NoddingHacker]

I live in Israel, and have been under the care of 4 sleep doctors. One of them was private practice, other 3 were under my insurance provider. In the last month I have decided to give telemedicine (online doctor visit) a shot, being that all sleep clinics are still closed down in Israel due to covid19 lockdown. 

The level of professionalism, competence and care I have been given was unprecedented for me. And I don't skimp on my health. Lately I have been going to private doctors for almost anything cause public healthcare is so awful. But that US doctor made all my previous private doctors look like interns. He listens to my and doesn't shout prescriptions. Maintains eye contact. When I question whatever he tells me, he explains and makes me an active participant in my own therapy. Most doctors get defensive when you get technical, as if I am questioning their competence or authority.

Have I just got lucky by generally picking the right doctor, or is it just that the quality of sleep medicine (and maybe medicine in general) is better in the US? Cause physicians in Israel are not only inattentive - they routinely make severe ethical mistakes. I was told by 2 physicians that my sleep apnea was caused by being overweight (it wasn't). I was told I had "very light form of sleep apnea, at 7.4 AHI" when in reality its an aggregate which contains 27.5 RDI and 13.2 AHI for REM sleep. 2 months ago an Israeli sleep physician saw me after I had lost 25lbs, and told me I "got rid of my sleep apnea" in full confidence without even bothering to send me to another test!

So now I am wondering if I should "outsource" more of my healthcare needs to the US, or any other countries with higher standards of medicine. I am looking to get feedback by Americans, or non-Americans that tried out American medicine. Mind you that this is not a discussion about the affordability or accessibility of healthcare in America - that's another can of worms.

[Melman]

You've been lucky. My sleep specialist doesn't know one end of a CPAP machine from the other. Always seems bored when I see him and rubber stamps my prescriptions. I do have a general practice doctor who is much better. If you spend much time on this forum you will see that many members don't have a high opinion of their sleep specialists.

[NoddingHacker]

You've been lucky. My sleep specialist doesn't know one end of a CPAP machine from the other. Always seems bored when I see him and rubber stamps my prescriptions. I do have a  general practice doctor who is much better. If you spend much time on this forum you will see that many members don't have a high opinion of their sleep specialists.

A couple questions:

1. When people say sleep specialists, they mean a technician which handles the machines or a board certified physician?
2. How much help is your general practitioner in terms of sleep? Outside of dedicated sleep medicine, only 2 academic hours are given to sleep in med school so most physicians are terribly incompetent in that domain. I once remarked about suffering from jet lag (it's not a word in Hebrew) to my GP and he asked me "what's jet lag?"
3. Have you had any experience with private practice in the US? I know most Americans use job insurance rather than a fancy private insurance. I don't have the luxury of having US insurance, so I just went to private practice and paid out of pocket. Maybe it made the difference?

I do have to mention that US doctor is FAASM (fellow associate) so that may help to explain his level of service.

[ger365]

You've been lucky. My sleep specialist doesn't know one end of a CPAP machine from the other. Always seems bored when I see him and rubber stamps my prescriptions. I do have a  general practice doctor who is much better. If you spend much time on this forum you will see that many members don't have a high opinion of their sleep specialists.

You are soooo lucky, as others have said most quacks er ah...doctors don't know much about cpap. I don't blame them because they are trained to throw drugs at us ans the systems are so broad and complex they can't do it all. 
Si I PO'd a few professionals correcting them politely....rofl
Now a couple of them have learned to listen and not just swag it...
Shalom...

[SarcasticDave94]

I would almost say the same answer as Melman, except my newer sleep doctor does actually listen to what I say about CPAP items.

[Melman]

A couple questions:

1. When people say sleep specialists, they mean a technician which handles the machines or a board certified physician?

In my experience both

2. How much help is your general practitioner in terms of sleep?

Very little but that's because I see a specialist. I think she may be better and I will probably transfer my apnea thrapy to her and drop the pecialist.

Outside of dedicated sleep medicine, only 2 academic hours are given to sleep in med school so most physicians are terribly incompetent in that domain. I once remarked about suffering from jet lag (it's not a word in Hebrew) to my GP and he asked me "what's jet lag?"
3. Have you had any experience with private practice in the US? I know most Americans use job insurance rather than a fancy private insurance. I don't have the luxury of having US insurance, so I just went to private practice and paid out of pocket. Maybe it made the difference?
All my experience is with private practice and my insurance doesn't limit me to a network of doctors. As you probably know, the US does not have a natonal health service.
I do have to mention that US doctor is FAASM (fellow associate) so that may help to explain his level of service.

[Sleeprider]

Based on working with many members on this forum, my opinion is that sleep specialists are among the most detached, uninformed and arrogant specimens in the medical profession, and it is not limited to the U.S. but is pervasive all over the world. I think they get into it because it's easy, low risk and their patients sleep. It seems many never meet a patient in person, but work remotely and review technician's reports, write prescriptions and rely on respiratory therapists and physician assistants to do any hands-on work. It gets worse when they sell equipment, refuse to release records and prescriptions and treat all patients with one-size-fits-all solutions for obstructive sleep apnea and place any blame for therapy failures on the patent. The exceptional physicians are indeed the ones that listen and empower their patients and work wth an open mind to solve their problems.

I have used my regular physician to manage all of my sleep disordered breathing therapy management. He is an "Internist" and that philosophy towards medicine works very well for me https://www.acponline.org/about-acp/abou...l-medicine Much like your telemedicine doctor, mine listens, respects my input and is available for questons of any kind. Your telemedicine sleep specialist may well be an Internist with the sleep medicine accreditation. In my opinion there is nothing keeping the sleep profession from being great other than the idiots it has seemingly attracted. You found a good one, and that's good enough.