Who's Better? ENT or Pulmonologist?

Which one makes a better sleep doc?

Both can be good. Depends more on the individual doctor than the specialty. Ask around for referrals from OSA patients if you need a good physician.

I'd go for either a pulmonologist or neurologist... to me an ENT is sort of like a doctor for treating symptoms, rather than someone who's more likely to really understand the source of the problems.

Most referrals to sleep labs actually come from ENT doctors, as they can see if you have physical abnormalities that might cause OSA, such as a short jaw line and thick neck/small throat. Depends on how concerned and caring the doctor is, whatever his/her specialty. Lots of referrals come from IM or Family Practice as well.

Don't want to seem cynical, but I bet most of those referrals from ENT's are based (as you said) on they're wanting some physical obstruction to show up that they can then operate on.

Sleep specialists can come from several medical disciplines such as pulmonology, ENT, psychiatry, neurology, etc.

While most of us would agree that other issues are more important than specialty, if you are starting only with a list of possible doctors, specialty is one thing you can find (sometimes the only thing since my insurance web site does not list sleep as a specialty).

Ideally, if you know where your problem comes from or have any related symptoms it might make a difference. For instance, I have a periodic limb movement problem which is neurology, so I picked a neurologist from an insurance list initially. Even if it is unrelated, you might want a doctor who knows about your other conditions. If you have other lung problems, that might argue for one who knows about lung problems.

There may be a case for avoiding doctors who also own equipment companies or labs since it creates a financial conflict of interest. It has been documented in several studies that in general doctors who have a financial interest in a test are more likely to order it. If they own a lab, they are more likely to request a sleep study.

Much discussion here has dealt with the problems arising from durable equipment suppliers wishing to supply the cheapest item they can, with the usual solution being to ask your doctor to prescribe just what you want. A doctor who benefits financially from your equipment purchases may be less likely to support you in requesting expensive items.

It is also well documented that doctors tend to prescribe the treatments they can do themselves (and get paid for). I suspect on who can do surgical procedures would be more likely to push you to have one.

As I read the data on surgery, it may be over used. Apparently, if frequently improves the problem. However, the patient usually still has a problem afterwards and still needs a CPAP machine. If you are going to be on a machine regardless, the case for the surgery (and risks , cost,and pain) is often weak. A doctor who has no financial interest may be a better source of advice.

Don't want to seem cynical, but I bet most of those referrals from ENT's are based (as you said) on they're wanting some physical obstruction to show up that they can then operate on.

In my situation it was not the case. The doctor had no interest in operating or generating more business for his specialty, as he was extremely well established. He said "I think you have sleep Apnea and should go for a sleep study."

newname wrote:Which one makes a better sleep doc?

It depends on the training the doc has. My ENT told me to switch from a full face mask to a nasal one for the benefit of my sinuses even though I am a mouth breather because of them. He was only concerned with that tiny part of my anatomy, not with the overall effect or quality of the treatment. My pulmonologist was concerned about my number of events and couldn't care less how I achieved them as long as I used the machine and mask that worked for me. He is not associated with any DME and the only lab he is associated with is the one in the hospital that does the free (to me) tests. I was referred to a hospital and specialists that handles OSA by my GP.

In my earlier studies, the OSA did not show up yet, just the PLMD. I have lung issues, and it was my pulmonologist, I think maybe with a subspecialty in sleep, who sent me for the tests expecting to find OSA, and put me on meds for the PLMD. Three years later went to a neurologist for my neck, and they switched my med for the PLMD, saying what I was on was no longer the usual first line of treatment any more. For this reason, I would have at that time said a neurologist is best to manage PLMD, though she wasn't dealing with a dual diagnosis. It was a referral from my internist to a sleep doctor at a sleep clinic who diagnosed OSA and initiated CPAP treatment, and to me he was the least helpful in achieving successful therapy (I'm being kind). In recent years, a new sleep doctor (pulmonoligist) is managing both my OSA and PLMD, and I've been very impressed with her handling of both aspects of my difficult case.

Guess I said all this to show why I agree that it depends entirely on the doctor, not their specialty. A quality physician will refer a patient to the one who can best help them, instead of insisting on the mode of treatment of their practice. Someone on here a few months ago said their ENT told them CPAP was their best option. Just don't know how a newbie can evaluate a doctor unless by referrals. Sometimes it's after the fact that we know.

Kathy

If you have simple OSA, a pneumatic engineer would be the best choice. He would want to solve the problem quickly, effectively, and efficiently and you would not have any arrogant doctor's bedside manner issues to deal with.

rooster wrote:If you have simple OSA, a pneumatic engineer would be the best choice. He would want to solve the problem quickly, effectively, and efficiently and you would not have any arrogant doctor's bedside manner issues to deal with.

Only from Rooster...

tattooyu wrote: One night does NOT a trend make!

It does if one of you gets pregnant.

tattooyu wrote:
One night does NOT a trend make!


It does if one of you gets pregnant.

Or if you have Herpes.

Autopapdude wrote:
Or if you have Herpes.

A politician picked up a lady and took her to his motel room.

They had you-know-what and then relaxed in bed.

The lady said, "Do you have aids?"

The politician said, "No!! Why do you ask???"

The lady said, "Oh, that's good. I wouldn't want to catch it again."

I agree that it depends on the doctor. My doc is an ENT and I pushed for surgery, thinking I could eliminate the apnea without any long-term commitment on my part to use CPAP. His reply was, "believe me, I'm a surgeon, and if I thought surgery would help, I would recommend it." But it wasn't for me. And, after i did my research and went in to the office armed with information on the type of new machine I wanted, after a few questions, he wrote a prescription for it immediately, and commented that he wished all his patients were as informed and proactive as I was. I depends on the doctor, the person, the character, etc.