The Knowledge Gradient: Doctor-Patient
In years past we went to the doctors’ in the belief that we would be treated, that is “cured” of our disorder or illness. Societal norms have changed. As our diseases are channelled into specific areas, alas sometimes for the convenience, profit, or administrative benefit, their investigation and treatment become more illusive, inaccessible, specialized or expensive. Many of us have come to realize the need for self-advocacy in health-care. Is this an issue when it comes to sleep problems?
Sleep is not only a case in point but brings with it other complications. Sleep is a relatively new field of investigation, generally poorly understood by doctors who are inadequately trained to deal with the problems they will face in practice. This short-coming presents as an apparent disinterest in an area of medicine which carries a profound affect on other areas of health, both physical and mental.
Most people have, at some time experienced some sleep disorder or another, be it Insomnia, restless legs (RLS), Snoring, Obstructive Sleep Apnea or Jet-lag and/or other circadian rhythm disorders. Most of those will have investigated their problem if recognized. It’s easy to spend a few hours reading books, magazines or on the internet only to realize that a solution is not necessarily as easy to achieve as it seemed.
Many investigations and studies into undergraduate medical syllabuses show teaching and training to provide just a few hours in “sleep medicine”. The reader will notice that the doctor and the patient may often be provided or seek a similar time in the appreciation of sleep disorders and dysfunction. As much as the medical student is provided a structured ‘few hours’, the patient is certainly highly motivated as it is their own problem, or one of a family member and/or someone they care about.
While this “knowledge gradient” is alas not unique, it does encroach on a subject of extreme importance in society and the result is poor recognition, understanding, diagnosis and treatment in society as a whole. The medical fraternity are not in a hurry to go back to school or undertake significant study time, nor are the administrative and financial bodies who seek to simplify and economize. Suddenly finding a disease that affects so many, so greatly and that it was there under our noses for so long does not sit well with any.
What perhaps complicates this further is the views already held for, as Einstein was claimed to have said, ”the greatest hurdle to new learning is old learning’. We have to unlearn what we’ve been taught and believe in order to rebuild the facts as are presently known, accurately - “A paradigm shift” if you will. These views and beliefs may reflect societal and cultural beliefs rather than scientific knowledge. They may also be driven by commercial interest and special interest groups such as pharmaceutical companies and the CPAP industry,
In 2017 alone – an estimated 70 million Americans had insomnia, and 43 million suffered from Obstructive Sleep Apnea (OSA), mostly undiagnosed. As obesity rates remain high, this problem is not likely to decrease. Therefore, there is ample room for future growth of the CPAP device industry - presently worth 4 Billion, sleep studies (4.3 Billion), over-the-counter and prescription medications (1.5 Billion) and other services.These together have been estimated to exceed $28.6 billion in 2017 with the market growing by 3.3%, to 2023, 4.7% average annual growth is forecast which in my opinion is a vast underestimate.
Perhaps the most obvious shortcoming is a lack of reference. “What is good sleep”. The doctor and the patient may have very different ideas and definition of this. Few solid definitions exist as it is clear that within reason an individual’s definition reflects his or her experience (as does that of the doctor). We need a better understanding of the subject in order to provide both general and specific individual care.
A very simple example is “how long does it take to fall asleep?” The majority of those who almost wake themselves up when their head hits the pillow are convinced that’s a good sign, while those that take half an hour often consider themselves insomniacs. Add to that the fact that we usually can’t estimate such things accurately and the need for better guidelines becomes clear. Incidentally 15-30 minutes to fall asleep is still considered both physiologically and commonly usual.
So the above paints a clear picture;
A. We need better awareness and understanding of an aspect of all of our lives (sleep) because it has a profound effect on daytime health and functioning.This is at the Governmental, professional, societal, community, family and individual levels.
B. Peer reviewed studies repeatedly indicate that with an inadequate teaching and training syllabus, the need to accept that our doctors sometimes know little more than we do and some unable to objectively solve our problems is required by us and the profession.
C. We stay ‘healthily sceptical’ about people and clinics who are in (and out) of the medical system as they may have financial or other primary motivators. Equally we must not be refuse care that would be of great benefit to us (“shoot ourselves in the foot”) and go without what we genuinely need based on mild paranoia on our part. We should still seek for honesty and integrity.
Awareness is key – it is the first step toward bettering our health, the health of those we care about and the system itself.
Knowledge, they say, is power.
OAT and CPAP are the commonest prescribed means of managing OSA. Other options such as surgery exist. Optimal treatment by either is improved with a good nasal airway. Adjunctive intervention such as weight loss, positional therapy and other behavioural treatments should be considered to support either therapy.
Ask your doctor, dentist or us, the questions you need answers to:
Do I really need something done ?
Why ? Is my problem affecting my body, my health, my mouth and teeth ?
What happens if I don’t do anything ?
What are my benefits if the problem is resolved ?
What are my choices and how much does therapy cost?
How long does it take before I benefit ?
How long do the benefits last ? Do I have to do anything ?
Does it hurt and are there any associated problems ?
Will it work for me, what happens if it doesn’t ?
We can start to put these questions into an understandable perspective for you. “You need to know what you need to know” - and that’s before you start any kind of Medical or Dental care - this is your right. This way, you can make a choice based on what’s right and best for you.
Assistance, interest in the patient and support increases the success of any therapy.
For more Blogs - please see - www.abettersleep.net - Stephen Bray (2020)