Dr. Graham A Glass, MD

I selected Peak Neurology & Sleep Center specifically because I have a medically complex history and believed a neurology-based practice would be especially well qualified to evaluate my circumstances in their entirety. My medical history includes a previous diagnosis of severe obstructive sleep apnea, prolonged untreated sleep apnea, documented nocturnal oxygen desaturation, a history of being prescribed supplemental oxygen 24 hours a day, seven days a week, a carbon monoxide poisoning that resulted in a traumatic brain injury, and ongoing functional cardiac impairment. Because of these overlapping neurological, pulmonary, and cardiovascular issues, I expected my care to be individualized rather than based solely upon a standardized treatment algorithm. Although I never had the opportunity to speak directly with Dr. Graham Glass after my sleep study, I was told that he interpreted the study. I had been advised that the physician would contact me to discuss the results, but that… discussion never occurred. Consequently, my understanding of the recommendations came through the clinic rather than through a direct physician consultation. Despite the fact that my study documented a nadir oxygen saturation of 83% and that my oxygen saturation remained below 89% for approximately 13 cumulative minutes during only 4 hours and 42 minutes of recorded sleep, my request to consider supplemental oxygen in conjunction with APAP therapy was declined. The explanation I ultimately received was that supplemental oxygen was not prescribed under the practice’s “protocols”. What concerns me is not simply that my request was denied. Physicians are certainly entitled to exercise their clinical judgment, and reasonable professionals may reach different conclusions. Rather, my concern is that the decision appeared to rely primarily upon “protocol” without meaningful consideration of my unique medical history. Prior to my carbon monoxide poisoning and severe TBI, I had already been treated with 24/7 continuous supplemental oxygen because of COPD. Following that diagnosis I sustained a traumatic brain injury that required hyperbaric oxygen therapy in an effort to improve neurological function. My ongoing cardiac condition further underscores why I believed an individualized discussion regarding nocturnal oxygen supplementation was and is medically appropriate. Whether or not supplemental oxygen was ultimately recommended, I expected those factors to receive careful clinical analysis and direct discussion. Since that appointment, I have spoken with both my primary care physician and Medicare. My understanding from those conversations is that there is no Medicare limit on repeating a sleep study when medically appropriate, and my primary care physician recommended repeating mine because the original study was significantly disrupted by repeated awakenings from noise outside my room by staff, limiting the opportunity for an accurate evaluation and preventing completion of a split-night titration. Medicine is fundamentally the practice of applying evidence to the individual patient. Standardized protocols undoubtedly serve an important purpose, but they should not replace individualized clinical judgment when a patient’s history is unusually complex. My experience left me with the impression that Dr. Glass and his “protocol” carried greater weight than the totality of my medical circumstances. Because I never had the opportunity to discuss these concerns directly with Dr. Glass, and because I did not feel that my neurological history, prior oxygen dependence, brain injury, cardiac condition, and documented nocturnal hypoxemia were meaningfully integrated into my treatment plan, I have chosen to seek care elsewhere. I hope this feedback encourages Peak Neurology & Sleep Center to place greater emphasis on individualized physician-patient communication and comprehensive clinical decision-making, particularly for patients whose medical histories exten

excellent provider, good listener, gives clear advice with alternatives, provides adequate time for appointments.Highly recommend