Hitting a Nerve

Now that everyone in my family has been vaccinated, we’re starting to do more.

Last week we met my mom and some of her (vaccinated) friends for dinner at a local restaurant. Except for picking up takeout, I hadn’t been to one since early March 2020.

During the usual chatting about jobs, music, my kids, and trips we were thinking about, one of her friends suddenly said: “That’s funny.”

I asked him what was funny, and he said: “My left vision suddenly went dark.”

It only takes a fraction of a second to shift into doctor mode. I asked a few pointed questions and did a quick neuroscan for asymmetries, slurred speech, the things that, after 23 years, have become second nature.

It resolved after about 30 seconds. He clearly didn’t think it was anything to be alarmed about. He’s intelligent and well educated, but not a doctor. I wasn’t going to let it go, and quietly spoke to him a short while later. He may not be my patient, but pushing him in the needed direction is the right thing to do.

I’ve gotten him to the right doctors now, and the ball is rolling, but I keep thinking about it. If I hadn’t been there it’s likely nothing would have been done. In fact, he seemed to think it was more amusing than potentially serious.

Medical blogs and doctors’ lounge stories are full of similar anecdotes, where we wonder why people don’t take such things seriously. We tend to view such people as stupid and/or ignorant.

Yet, this gentleman is neither. I’ve known him since childhood. He’s smart, well educated, and well read. He’s not a medical person, though.

In reality, I don’t think doctors or nurses are any better. Many of us excel at blaming our own symptoms, sometimes worrisome, on less-alarming things. I suspect that’s more human nature, which is hard to override regardless of training.

But maybe it’s time to start giving these people, like my family friend, a pass, with the realization that denial and different training are part of being human, and not something to be poked fun at.

Dr. Block has a solo neurology practice in Scottsdale, Ariz.

Now that everyone in my family has been vaccinated, we’re starting to do more.

Last week we met my mom and some of her (vaccinated) friends for dinner at a local restaurant. Except for picking up takeout, I hadn’t been to one since early March 2020.

During the usual chatting about jobs, music, my kids, and trips we were thinking about, one of her friends suddenly said: “That’s funny.”

I asked him what was funny, and he said: “My left vision suddenly went dark.”

It only takes a fraction of a second to shift into doctor mode. I asked a few pointed questions and did a quick neuroscan for asymmetries, slurred speech, the things that, after 23 years, have become second nature.

It resolved after about 30 seconds. He clearly didn’t think it was anything to be alarmed about. He’s intelligent and well educated, but not a doctor. I wasn’t going to let it go, and quietly spoke to him a short while later. He may not be my patient, but pushing him in the needed direction is the right thing to do.

I’ve gotten him to the right doctors now, and the ball is rolling, but I keep thinking about it. If I hadn’t been there it’s likely nothing would have been done. In fact, he seemed to think it was more amusing than potentially serious.

Medical blogs and doctors’ lounge stories are full of similar anecdotes, where we wonder why people don’t take such things seriously. We tend to view such people as stupid and/or ignorant.

Yet, this gentleman is neither. I’ve known him since childhood. He’s smart, well educated, and well read. He’s not a medical person, though.

In reality, I don’t think doctors or nurses are any better. Many of us excel at blaming our own symptoms, sometimes worrisome, on less-alarming things. I suspect that’s more human nature, which is hard to override regardless of training.

But maybe it’s time to start giving these people, like my family friend, a pass, with the realization that denial and different training are part of being human, and not something to be poked fun at.

Dr. Block has a solo neurology practice in Scottsdale, Ariz.

Now that everyone in my family has been vaccinated, we’re starting to do more.

Last week we met my mom and some of her (vaccinated) friends for dinner at a local restaurant. Except for picking up takeout, I hadn’t been to one since early March 2020.

During the usual chatting about jobs, music, my kids, and trips we were thinking about, one of her friends suddenly said: “That’s funny.”

I asked him what was funny, and he said: “My left vision suddenly went dark.”

It only takes a fraction of a second to shift into doctor mode. I asked a few pointed questions and did a quick neuroscan for asymmetries, slurred speech, the things that, after 23 years, have become second nature.

It resolved after about 30 seconds. He clearly didn’t think it was anything to be alarmed about. He’s intelligent and well educated, but not a doctor. I wasn’t going to let it go, and quietly spoke to him a short while later. He may not be my patient, but pushing him in the needed direction is the right thing to do.

I’ve gotten him to the right doctors now, and the ball is rolling, but I keep thinking about it. If I hadn’t been there it’s likely nothing would have been done. In fact, he seemed to think it was more amusing than potentially serious.

Medical blogs and doctors’ lounge stories are full of similar anecdotes, where we wonder why people don’t take such things seriously. We tend to view such people as stupid and/or ignorant.

Yet, this gentleman is neither. I’ve known him since childhood. He’s smart, well educated, and well read. He’s not a medical person, though.

In reality, I don’t think doctors or nurses are any better. Many of us excel at blaming our own symptoms, sometimes worrisome, on less-alarming things. I suspect that’s more human nature, which is hard to override regardless of training.

But maybe it’s time to start giving these people, like my family friend, a pass, with the realization that denial and different training are part of being human, and not something to be poked fun at.

Dr. Block has a solo neurology practice in Scottsdale, Ariz.

As of today, I’m still wearing a mask. And I have no desire to stop.  I’ve been vaccinated. Everyone in my family and social circle has been vaccinated. But I’m still wearing one, at least inside (besides my house).

In my everyday life I see a fair number of patients. Because I’m in a medical office, not a grocery store, I still ask others to wear them.

I believe in the efficacy of the vaccines, but at the same time I know that they have their limitations. Even vaccinated people (including myself) can be unknowing carriers. Five percent of vaccinated people can still develop a COVID-19 infection, with varying degrees of seriousness.

The COVID-19 virus, as viruses do, continues to change with time. This is nothing new. At of the time of this writing the delta variant is the one getting the most press, but there will be others. Sooner or later one will get around the defenses conferred by the vaccine.

Vaccines also can lose benefit over time. If there’s anything we’ve learned during the pandemic it’s that we have a lot to learn. Every year I get a flu vaccine based on anticipated flu strains for the coming year, and there’s no reason to think COVID-19 will be any different.

So, I’m still wearing a mask. It provides some protection for me, and it provides some protection for my patients (many of whom are immunocompromised). No one is saying it’s perfect, but on the scale of things I can do to help keep them safe it’s a pretty minor one.

I still wear a mask in stores, too. I don’t know who around me there has, or hasn’t, been vaccinated. Even if I’m not at risk, many of my patients are, so I don’t want to bring it back to the office.

I’m sure I’ll stop wearing it in the next few months, but I’m not there yet. Maybe I’m just overly cautious. Maybe it’s a good idea for now. But I’d rather give it a bit more time to make sure.

Dr. Block has a solo neurology practice in Scottsdale, Ariz.

As of today, I’m still wearing a mask. And I have no desire to stop.  I’ve been vaccinated. Everyone in my family and social circle has been vaccinated. But I’m still wearing one, at least inside (besides my house).

In my everyday life I see a fair number of patients. Because I’m in a medical office, not a grocery store, I still ask others to wear them.

I believe in the efficacy of the vaccines, but at the same time I know that they have their limitations. Even vaccinated people (including myself) can be unknowing carriers. Five percent of vaccinated people can still develop a COVID-19 infection, with varying degrees of seriousness.

The COVID-19 virus, as viruses do, continues to change with time. This is nothing new. At of the time of this writing the delta variant is the one getting the most press, but there will be others. Sooner or later one will get around the defenses conferred by the vaccine.

Vaccines also can lose benefit over time. If there’s anything we’ve learned during the pandemic it’s that we have a lot to learn. Every year I get a flu vaccine based on anticipated flu strains for the coming year, and there’s no reason to think COVID-19 will be any different.

So, I’m still wearing a mask. It provides some protection for me, and it provides some protection for my patients (many of whom are immunocompromised). No one is saying it’s perfect, but on the scale of things I can do to help keep them safe it’s a pretty minor one.

I still wear a mask in stores, too. I don’t know who around me there has, or hasn’t, been vaccinated. Even if I’m not at risk, many of my patients are, so I don’t want to bring it back to the office.

I’m sure I’ll stop wearing it in the next few months, but I’m not there yet. Maybe I’m just overly cautious. Maybe it’s a good idea for now. But I’d rather give it a bit more time to make sure.

Dr. Block has a solo neurology practice in Scottsdale, Ariz.

As of today, I’m still wearing a mask. And I have no desire to stop.  I’ve been vaccinated. Everyone in my family and social circle has been vaccinated. But I’m still wearing one, at least inside (besides my house).

In my everyday life I see a fair number of patients. Because I’m in a medical office, not a grocery store, I still ask others to wear them.

I believe in the efficacy of the vaccines, but at the same time I know that they have their limitations. Even vaccinated people (including myself) can be unknowing carriers. Five percent of vaccinated people can still develop a COVID-19 infection, with varying degrees of seriousness.

The COVID-19 virus, as viruses do, continues to change with time. This is nothing new. At of the time of this writing the delta variant is the one getting the most press, but there will be others. Sooner or later one will get around the defenses conferred by the vaccine.

Vaccines also can lose benefit over time. If there’s anything we’ve learned during the pandemic it’s that we have a lot to learn. Every year I get a flu vaccine based on anticipated flu strains for the coming year, and there’s no reason to think COVID-19 will be any different.

So, I’m still wearing a mask. It provides some protection for me, and it provides some protection for my patients (many of whom are immunocompromised). No one is saying it’s perfect, but on the scale of things I can do to help keep them safe it’s a pretty minor one.

I still wear a mask in stores, too. I don’t know who around me there has, or hasn’t, been vaccinated. Even if I’m not at risk, many of my patients are, so I don’t want to bring it back to the office.

I’m sure I’ll stop wearing it in the next few months, but I’m not there yet. Maybe I’m just overly cautious. Maybe it’s a good idea for now. But I’d rather give it a bit more time to make sure.

Dr. Block has a solo neurology practice in Scottsdale, Ariz.

I’m not an academic. Never will be.

I’m also a crappy statistician. Neither my university nor medical school required statistics classes, so I never really learned them. In medicine you pick up an idea of how to interpret them as part of the job, but I’m certainly not a pro with numbers.

Which brings me to the word of the day, Aduhelm, AKA aducanumab.

A lot of drugs have come and gone in the 30 years since my medical school pharmacology class, but very few with this one’s degree of uncertainty.

Clearly its mechanism works: It removes amyloid from the brain. I don’t think anyone will argue that. But the real question is whether this translates into actual clinical benefit.

The water is murky here, and even its most ardent supporters admit the evidence isn’t exactly overwhelming. To some extent the approval basically puts it in a huge open-label clinical trial, with the Food and Drug Administration saying that it will be withdrawn if success isn’t seen in follow-up studies.

I’m not a statistics person, but I understand that, when numbers are marginal, they can be spun to mean whatever someone wants them to mean. And the stakes here, both medically and financially, are pretty high.

Alzheimer’s disease, unquestionably, is a devastating illness. The best treatments we have for it are modest at best. The demand for new treatments is huge.

But “new” doesn’t mean the same as “effective.” This is where the statistics, and their supporters and detractors, come in.

Patients and their families aren’t (usually) doctors. They want a treatment that’s both effective and reasonably safe, especially for a disease where a tragic prognosis is well established. With this drug (and similar ones in development) we face a balance between uncertain benefits and a clear risk of amyloid-related imaging abnormalities. The best we can do is explain these vagaries to people so they understand the uncertainties involved.

Perhaps more troubling is the possibility lurking in the background: The amyloid comes out, but the prognosis doesn’t improve. This brings us to the possibility (already voiced in journals) that the whole amyloid theory is wrong, and we’ve spent all this time and money chasing the wrong villain. As Morpheus, in The Matrix, implies, our whole reality on this may not be real.

Regrettably, in science (and medicine is a science) the only way to find out what works and what doesn’t is through trial and error. Computer modeling can take us only so far. Whether Aduhelm succeeds or fails will all be in the numbers.

But if it (and similar agents) fail in the general population, then it may be time to accept that we’re chasing the wrong bad guy.

That’s what data and statistics do.

Dr. Block has a solo neurology practice in Scottsdale, Ariz.

I’m not an academic. Never will be.

I’m also a crappy statistician. Neither my university nor medical school required statistics classes, so I never really learned them. In medicine you pick up an idea of how to interpret them as part of the job, but I’m certainly not a pro with numbers.

Which brings me to the word of the day, Aduhelm, AKA aducanumab.

A lot of drugs have come and gone in the 30 years since my medical school pharmacology class, but very few with this one’s degree of uncertainty.

Clearly its mechanism works: It removes amyloid from the brain. I don’t think anyone will argue that. But the real question is whether this translates into actual clinical benefit.

The water is murky here, and even its most ardent supporters admit the evidence isn’t exactly overwhelming. To some extent the approval basically puts it in a huge open-label clinical trial, with the Food and Drug Administration saying that it will be withdrawn if success isn’t seen in follow-up studies.

I’m not a statistics person, but I understand that, when numbers are marginal, they can be spun to mean whatever someone wants them to mean. And the stakes here, both medically and financially, are pretty high.

Alzheimer’s disease, unquestionably, is a devastating illness. The best treatments we have for it are modest at best. The demand for new treatments is huge.

But “new” doesn’t mean the same as “effective.” This is where the statistics, and their supporters and detractors, come in.

Patients and their families aren’t (usually) doctors. They want a treatment that’s both effective and reasonably safe, especially for a disease where a tragic prognosis is well established. With this drug (and similar ones in development) we face a balance between uncertain benefits and a clear risk of amyloid-related imaging abnormalities. The best we can do is explain these vagaries to people so they understand the uncertainties involved.

Perhaps more troubling is the possibility lurking in the background: The amyloid comes out, but the prognosis doesn’t improve. This brings us to the possibility (already voiced in journals) that the whole amyloid theory is wrong, and we’ve spent all this time and money chasing the wrong villain. As Morpheus, in The Matrix, implies, our whole reality on this may not be real.

Regrettably, in science (and medicine is a science) the only way to find out what works and what doesn’t is through trial and error. Computer modeling can take us only so far. Whether Aduhelm succeeds or fails will all be in the numbers.

But if it (and similar agents) fail in the general population, then it may be time to accept that we’re chasing the wrong bad guy.

That’s what data and statistics do.

Dr. Block has a solo neurology practice in Scottsdale, Ariz.

I’m not an academic. Never will be.

I’m also a crappy statistician. Neither my university nor medical school required statistics classes, so I never really learned them. In medicine you pick up an idea of how to interpret them as part of the job, but I’m certainly not a pro with numbers.

Which brings me to the word of the day, Aduhelm, AKA aducanumab.

A lot of drugs have come and gone in the 30 years since my medical school pharmacology class, but very few with this one’s degree of uncertainty.

Clearly its mechanism works: It removes amyloid from the brain. I don’t think anyone will argue that. But the real question is whether this translates into actual clinical benefit.

The water is murky here, and even its most ardent supporters admit the evidence isn’t exactly overwhelming. To some extent the approval basically puts it in a huge open-label clinical trial, with the Food and Drug Administration saying that it will be withdrawn if success isn’t seen in follow-up studies.

I’m not a statistics person, but I understand that, when numbers are marginal, they can be spun to mean whatever someone wants them to mean. And the stakes here, both medically and financially, are pretty high.

Alzheimer’s disease, unquestionably, is a devastating illness. The best treatments we have for it are modest at best. The demand for new treatments is huge.

But “new” doesn’t mean the same as “effective.” This is where the statistics, and their supporters and detractors, come in.

Patients and their families aren’t (usually) doctors. They want a treatment that’s both effective and reasonably safe, especially for a disease where a tragic prognosis is well established. With this drug (and similar ones in development) we face a balance between uncertain benefits and a clear risk of amyloid-related imaging abnormalities. The best we can do is explain these vagaries to people so they understand the uncertainties involved.

Perhaps more troubling is the possibility lurking in the background: The amyloid comes out, but the prognosis doesn’t improve. This brings us to the possibility (already voiced in journals) that the whole amyloid theory is wrong, and we’ve spent all this time and money chasing the wrong villain. As Morpheus, in The Matrix, implies, our whole reality on this may not be real.

Regrettably, in science (and medicine is a science) the only way to find out what works and what doesn’t is through trial and error. Computer modeling can take us only so far. Whether Aduhelm succeeds or fails will all be in the numbers.

But if it (and similar agents) fail in the general population, then it may be time to accept that we’re chasing the wrong bad guy.

That’s what data and statistics do.

Dr. Block has a solo neurology practice in Scottsdale, Ariz.

Music has to be one of humanity’s most unique traits, and, at the same time, one of neurology’s greatest mysteries.

Where did it come from, and why? Rhythmic sounds are part of the universe, from heartbeats to spinning pulsars. Somehow, though, they became ingrained into the very structure of our brains to where having music around is part of our existence.

When it started, we can only guess. The first known musical instrument is a flute carved from bear bone, made 67,000 years ago, but music is certainly older. The first instruments were probably clapped hands, then rocks and sticks.

Tens of thousands of cultures have developed over the course of human history. And, to date, not a single one is known that didn’t have music.

It takes energy to create music, too: to make and play instruments, think of songs, sing ... So at some point having music became an evolutionary advantage of some sort (one can imagine Bill and Ted saying “Dude, chicks dig it”) or it wouldn’t have lasted. Then, as people spread out, music forms got mixed and matched among cultures. Always changing, never leaving, and now somehow woven into the DNA of our brains.

The physics principles behind music are limited and simple: percussion, a vibrating string, air movement in a tube ... But from such simple things the human brain has adapted thousands of natural, and now synthetic, objects, to create an endless variety of unique sounds.

There are plenty of articles out there about how music can be relaxing or stimulating, capable of distracting you or helping you concentrate. Music can help you forget a bad day or remember a good one. They talk about PET scans and cortical activation and many other interesting things that show the effect of music on the remarkable human brain.

But at some level it doesn’t matter to me. I don’t try to understand music any more than I try to understand my dogs. I just know I couldn’t live without either. I’m not alone. Look around you: How many people on the train, or plane, or in the gym have earbuds on?

I have iTunes on my office computer, with roughly 5,000 songs covering the majority of genres from classical to rock. It’s the first program I switch on early each morning when I start the day. It gets me focused on the work at hand, and adds an enjoyable element to the day.

I’m not a musician. I took a few guitar lessons as a kid, but never really learned it. I used to joke that the only instrument I could play was the stereo (now I guess it’s iTunes). Coming from a maternal line of excellent musicians, it’s embarrassing to admit my lack of talent. But my inability to perform it myself doesn’t keep me from enjoying it.

There is no better example of the remarkable human memory than its ability to instantly recall the lyrics of songs you haven’t heard for 20, 30, 40, or more years. A few notes and it’s like you heard them yesterday. At this point, almost 30 years since my medical school graduation, I’ve likely forgotten a large portion of what I learned there. But 70s or 80s pop from my youth? Still there, and immediately recalled.

We process music everywhere – at stores, in elevators, in the car – without realizing it, like driving down the street and automatically reading signs as we pass them. But no matter where it is in our level of realization at the time, it’s a key part of our everyday lives.

Another marvel of the remarkable human brain.

Dr. Block has a solo neurology practice in Scottsdale, Ariz.

Music has to be one of humanity’s most unique traits, and, at the same time, one of neurology’s greatest mysteries.

Where did it come from, and why? Rhythmic sounds are part of the universe, from heartbeats to spinning pulsars. Somehow, though, they became ingrained into the very structure of our brains to where having music around is part of our existence.

When it started, we can only guess. The first known musical instrument is a flute carved from bear bone, made 67,000 years ago, but music is certainly older. The first instruments were probably clapped hands, then rocks and sticks.

Tens of thousands of cultures have developed over the course of human history. And, to date, not a single one is known that didn’t have music.

It takes energy to create music, too: to make and play instruments, think of songs, sing ... So at some point having music became an evolutionary advantage of some sort (one can imagine Bill and Ted saying “Dude, chicks dig it”) or it wouldn’t have lasted. Then, as people spread out, music forms got mixed and matched among cultures. Always changing, never leaving, and now somehow woven into the DNA of our brains.

The physics principles behind music are limited and simple: percussion, a vibrating string, air movement in a tube ... But from such simple things the human brain has adapted thousands of natural, and now synthetic, objects, to create an endless variety of unique sounds.

There are plenty of articles out there about how music can be relaxing or stimulating, capable of distracting you or helping you concentrate. Music can help you forget a bad day or remember a good one. They talk about PET scans and cortical activation and many other interesting things that show the effect of music on the remarkable human brain.

But at some level it doesn’t matter to me. I don’t try to understand music any more than I try to understand my dogs. I just know I couldn’t live without either. I’m not alone. Look around you: How many people on the train, or plane, or in the gym have earbuds on?

I have iTunes on my office computer, with roughly 5,000 songs covering the majority of genres from classical to rock. It’s the first program I switch on early each morning when I start the day. It gets me focused on the work at hand, and adds an enjoyable element to the day.

I’m not a musician. I took a few guitar lessons as a kid, but never really learned it. I used to joke that the only instrument I could play was the stereo (now I guess it’s iTunes). Coming from a maternal line of excellent musicians, it’s embarrassing to admit my lack of talent. But my inability to perform it myself doesn’t keep me from enjoying it.

There is no better example of the remarkable human memory than its ability to instantly recall the lyrics of songs you haven’t heard for 20, 30, 40, or more years. A few notes and it’s like you heard them yesterday. At this point, almost 30 years since my medical school graduation, I’ve likely forgotten a large portion of what I learned there. But 70s or 80s pop from my youth? Still there, and immediately recalled.

We process music everywhere – at stores, in elevators, in the car – without realizing it, like driving down the street and automatically reading signs as we pass them. But no matter where it is in our level of realization at the time, it’s a key part of our everyday lives.

Another marvel of the remarkable human brain.

Dr. Block has a solo neurology practice in Scottsdale, Ariz.

Music has to be one of humanity’s most unique traits, and, at the same time, one of neurology’s greatest mysteries.

Where did it come from, and why? Rhythmic sounds are part of the universe, from heartbeats to spinning pulsars. Somehow, though, they became ingrained into the very structure of our brains to where having music around is part of our existence.

When it started, we can only guess. The first known musical instrument is a flute carved from bear bone, made 67,000 years ago, but music is certainly older. The first instruments were probably clapped hands, then rocks and sticks.

Tens of thousands of cultures have developed over the course of human history. And, to date, not a single one is known that didn’t have music.

It takes energy to create music, too: to make and play instruments, think of songs, sing ... So at some point having music became an evolutionary advantage of some sort (one can imagine Bill and Ted saying “Dude, chicks dig it”) or it wouldn’t have lasted. Then, as people spread out, music forms got mixed and matched among cultures. Always changing, never leaving, and now somehow woven into the DNA of our brains.

The physics principles behind music are limited and simple: percussion, a vibrating string, air movement in a tube ... But from such simple things the human brain has adapted thousands of natural, and now synthetic, objects, to create an endless variety of unique sounds.

There are plenty of articles out there about how music can be relaxing or stimulating, capable of distracting you or helping you concentrate. Music can help you forget a bad day or remember a good one. They talk about PET scans and cortical activation and many other interesting things that show the effect of music on the remarkable human brain.

But at some level it doesn’t matter to me. I don’t try to understand music any more than I try to understand my dogs. I just know I couldn’t live without either. I’m not alone. Look around you: How many people on the train, or plane, or in the gym have earbuds on?

I have iTunes on my office computer, with roughly 5,000 songs covering the majority of genres from classical to rock. It’s the first program I switch on early each morning when I start the day. It gets me focused on the work at hand, and adds an enjoyable element to the day.

I’m not a musician. I took a few guitar lessons as a kid, but never really learned it. I used to joke that the only instrument I could play was the stereo (now I guess it’s iTunes). Coming from a maternal line of excellent musicians, it’s embarrassing to admit my lack of talent. But my inability to perform it myself doesn’t keep me from enjoying it.

There is no better example of the remarkable human memory than its ability to instantly recall the lyrics of songs you haven’t heard for 20, 30, 40, or more years. A few notes and it’s like you heard them yesterday. At this point, almost 30 years since my medical school graduation, I’ve likely forgotten a large portion of what I learned there. But 70s or 80s pop from my youth? Still there, and immediately recalled.

We process music everywhere – at stores, in elevators, in the car – without realizing it, like driving down the street and automatically reading signs as we pass them. But no matter where it is in our level of realization at the time, it’s a key part of our everyday lives.

Another marvel of the remarkable human brain.

Dr. Block has a solo neurology practice in Scottsdale, Ariz.

Mike died last week.

He was a long-retired doc, in his mid-90s. One of my favorite patients to just chat with about nothing in particular. I learned more from him about restoring old grandfather clocks than I ever dreamed I’d know.

After receiving the sad news, I sat down, as I often do, to write a letter to his family. After 23 years I have a pretty standard idea of what I want to say, but it still always takes some thought.

Sealing the envelopes on these letters always seems to be more than just paperwork. There’s a symbolism to it, that I’m closing out my relationship, sometimes of 10-20 years, with the person involved.

Some patients become friends after a time. It’s a matter of chemistry. I don’t socialize with them outside my office, but still enjoy seeing them and talking about nonmedical stuff in the space around clinical questions and answers. They’re the ones it’s hardest to say goodbye to.

I’ll miss my 2-3 visits a year with Mike. We swapped medical war stories, family anecdotes, and the occasional tip about clock restoration that I’ll probably never use (but who knows, he didn’t start until after he retired).

Closing the envelope comes with the realization that I won’t be seeing him again. I don’t go to patient funerals, as I believe those are for families and close friends, and so writing the letter is the closest I’ll get to saying goodbye.

Medicine, and how we practice, is focused on what we do for the patient – which is what it should be.

But lost in the shuffle sometimes is realizing what the patient does for us. That’s also important, but harder to quantify. And sometimes we don’t realize it until we seal the envelope.

Dr. Block has a solo neurology practice in Scottsdale, Ariz.

Mike died last week.

He was a long-retired doc, in his mid-90s. One of my favorite patients to just chat with about nothing in particular. I learned more from him about restoring old grandfather clocks than I ever dreamed I’d know.

After receiving the sad news, I sat down, as I often do, to write a letter to his family. After 23 years I have a pretty standard idea of what I want to say, but it still always takes some thought.

Sealing the envelopes on these letters always seems to be more than just paperwork. There’s a symbolism to it, that I’m closing out my relationship, sometimes of 10-20 years, with the person involved.

Some patients become friends after a time. It’s a matter of chemistry. I don’t socialize with them outside my office, but still enjoy seeing them and talking about nonmedical stuff in the space around clinical questions and answers. They’re the ones it’s hardest to say goodbye to.

I’ll miss my 2-3 visits a year with Mike. We swapped medical war stories, family anecdotes, and the occasional tip about clock restoration that I’ll probably never use (but who knows, he didn’t start until after he retired).

Closing the envelope comes with the realization that I won’t be seeing him again. I don’t go to patient funerals, as I believe those are for families and close friends, and so writing the letter is the closest I’ll get to saying goodbye.

Medicine, and how we practice, is focused on what we do for the patient – which is what it should be.

But lost in the shuffle sometimes is realizing what the patient does for us. That’s also important, but harder to quantify. And sometimes we don’t realize it until we seal the envelope.

Dr. Block has a solo neurology practice in Scottsdale, Ariz.

Mike died last week.

He was a long-retired doc, in his mid-90s. One of my favorite patients to just chat with about nothing in particular. I learned more from him about restoring old grandfather clocks than I ever dreamed I’d know.

After receiving the sad news, I sat down, as I often do, to write a letter to his family. After 23 years I have a pretty standard idea of what I want to say, but it still always takes some thought.

Sealing the envelopes on these letters always seems to be more than just paperwork. There’s a symbolism to it, that I’m closing out my relationship, sometimes of 10-20 years, with the person involved.

Some patients become friends after a time. It’s a matter of chemistry. I don’t socialize with them outside my office, but still enjoy seeing them and talking about nonmedical stuff in the space around clinical questions and answers. They’re the ones it’s hardest to say goodbye to.

I’ll miss my 2-3 visits a year with Mike. We swapped medical war stories, family anecdotes, and the occasional tip about clock restoration that I’ll probably never use (but who knows, he didn’t start until after he retired).

Closing the envelope comes with the realization that I won’t be seeing him again. I don’t go to patient funerals, as I believe those are for families and close friends, and so writing the letter is the closest I’ll get to saying goodbye.

Medicine, and how we practice, is focused on what we do for the patient – which is what it should be.

But lost in the shuffle sometimes is realizing what the patient does for us. That’s also important, but harder to quantify. And sometimes we don’t realize it until we seal the envelope.

Dr. Block has a solo neurology practice in Scottsdale, Ariz.

Ubrelvy and Nurtec are the latest in acute migraine treatment, both with solid data to back them up.

As with the triptans 25 years ago, my sample cabinet (and probably everyone else’s) is loaded with them, and friendly sales reps bringing coupon cards are a frequent occurrence.

Unfortunately, samples also bring up the same conundrum I faced with the triptans earlier in my career. It’s one thing to give patients samples to see if they work. It’s quite another to get them covered if they do.

This is an ongoing issue in modern medicine. It’s hard to resist the temptation to just hand something out when it’s conveniently at hand. It saves the patient a trip to the pharmacy and a medication copay up front, which is great.

But if it works, you have a whole new set of issues. The patient wants a real prescription now. So you call it in, then get a denial back saying it isn’t covered. It tells you to call a number, or try CoverMyMeds.

You do that, but the patient has to have failed three triptans, two NSAIDs, and a partridge in a pear tree to get it approved. The “copay assistance cards” don’t help if the medication isn’t covered at all. Each of these new medications is currently listed at roughly $900/month on GoodRx.com. Inevitably, your staff gets an earful when a patient with sticker shock calls your office.

One manufacturer is now eating the cost of the first script, so the patient leaves the pharmacy with a 1-month supply, under the impression that it was covered by insurance. This only kicks the can down the road 4-6 weeks, until they call for a refill.

To the chagrin of my sales reps (who are certainly going to read this), I’ve been burned on this and similar issues many times in my career, so I don’t even bother playing the game.

Certainly, there are cases where handing out a sample of Ubrelvy or Nurtec is indicated – some patients have already failed other agents, or have medical contraindications to them – but most don’t. So I start with triptans, currently going for $15/month. That doesn’t mean I’m not open to a newer agent at some point, but leaping directly to them quickly becomes an exercise in frustration.

Which brings up another issue I’ve encountered. While I try to be aware of this sort of thing, many other docs aren’t. Especially my already overburdened colleagues in primary care, who have enough on their plate with COVID-19, insurance regulations, paperwork, and an insanely busy schedule. In the controlled chaos of a general practice, it’s often easier for the staff to just hand out a sample at the same time they refer to a neurologist. So when the patient comes to me, they’re expecting I’ll be able to get it covered. After all, I’m the specialist. Getting expensive tests and medications covered seem to be something that’s expected for the higher copay to see me.

It doesn’t work that way, either.

I have nothing against new drugs. It’s the breakthroughs that keep medicine moving forward (like the COVID-19 vaccines). Nor do I have anything against samples or sales reps.

Ubrelvy and Nurtec definitely have their benefits and uses, and in appropriate cases they’re worth the battle of getting the expense covered.

But in many cases, the time you save handing out samples isn’t worth the time you have to spend on them down the line.

Dr. Block has a solo neurology practice in Scottsdale, Ariz.

Ubrelvy and Nurtec are the latest in acute migraine treatment, both with solid data to back them up.

As with the triptans 25 years ago, my sample cabinet (and probably everyone else’s) is loaded with them, and friendly sales reps bringing coupon cards are a frequent occurrence.

Unfortunately, samples also bring up the same conundrum I faced with the triptans earlier in my career. It’s one thing to give patients samples to see if they work. It’s quite another to get them covered if they do.

This is an ongoing issue in modern medicine. It’s hard to resist the temptation to just hand something out when it’s conveniently at hand. It saves the patient a trip to the pharmacy and a medication copay up front, which is great.

But if it works, you have a whole new set of issues. The patient wants a real prescription now. So you call it in, then get a denial back saying it isn’t covered. It tells you to call a number, or try CoverMyMeds.

You do that, but the patient has to have failed three triptans, two NSAIDs, and a partridge in a pear tree to get it approved. The “copay assistance cards” don’t help if the medication isn’t covered at all. Each of these new medications is currently listed at roughly $900/month on GoodRx.com. Inevitably, your staff gets an earful when a patient with sticker shock calls your office.

One manufacturer is now eating the cost of the first script, so the patient leaves the pharmacy with a 1-month supply, under the impression that it was covered by insurance. This only kicks the can down the road 4-6 weeks, until they call for a refill.

To the chagrin of my sales reps (who are certainly going to read this), I’ve been burned on this and similar issues many times in my career, so I don’t even bother playing the game.

Certainly, there are cases where handing out a sample of Ubrelvy or Nurtec is indicated – some patients have already failed other agents, or have medical contraindications to them – but most don’t. So I start with triptans, currently going for $15/month. That doesn’t mean I’m not open to a newer agent at some point, but leaping directly to them quickly becomes an exercise in frustration.

Which brings up another issue I’ve encountered. While I try to be aware of this sort of thing, many other docs aren’t. Especially my already overburdened colleagues in primary care, who have enough on their plate with COVID-19, insurance regulations, paperwork, and an insanely busy schedule. In the controlled chaos of a general practice, it’s often easier for the staff to just hand out a sample at the same time they refer to a neurologist. So when the patient comes to me, they’re expecting I’ll be able to get it covered. After all, I’m the specialist. Getting expensive tests and medications covered seem to be something that’s expected for the higher copay to see me.

It doesn’t work that way, either.

I have nothing against new drugs. It’s the breakthroughs that keep medicine moving forward (like the COVID-19 vaccines). Nor do I have anything against samples or sales reps.

Ubrelvy and Nurtec definitely have their benefits and uses, and in appropriate cases they’re worth the battle of getting the expense covered.

But in many cases, the time you save handing out samples isn’t worth the time you have to spend on them down the line.

Dr. Block has a solo neurology practice in Scottsdale, Ariz.

Ubrelvy and Nurtec are the latest in acute migraine treatment, both with solid data to back them up.

As with the triptans 25 years ago, my sample cabinet (and probably everyone else’s) is loaded with them, and friendly sales reps bringing coupon cards are a frequent occurrence.

Unfortunately, samples also bring up the same conundrum I faced with the triptans earlier in my career. It’s one thing to give patients samples to see if they work. It’s quite another to get them covered if they do.

This is an ongoing issue in modern medicine. It’s hard to resist the temptation to just hand something out when it’s conveniently at hand. It saves the patient a trip to the pharmacy and a medication copay up front, which is great.

But if it works, you have a whole new set of issues. The patient wants a real prescription now. So you call it in, then get a denial back saying it isn’t covered. It tells you to call a number, or try CoverMyMeds.

You do that, but the patient has to have failed three triptans, two NSAIDs, and a partridge in a pear tree to get it approved. The “copay assistance cards” don’t help if the medication isn’t covered at all. Each of these new medications is currently listed at roughly $900/month on GoodRx.com. Inevitably, your staff gets an earful when a patient with sticker shock calls your office.

One manufacturer is now eating the cost of the first script, so the patient leaves the pharmacy with a 1-month supply, under the impression that it was covered by insurance. This only kicks the can down the road 4-6 weeks, until they call for a refill.

To the chagrin of my sales reps (who are certainly going to read this), I’ve been burned on this and similar issues many times in my career, so I don’t even bother playing the game.

Certainly, there are cases where handing out a sample of Ubrelvy or Nurtec is indicated – some patients have already failed other agents, or have medical contraindications to them – but most don’t. So I start with triptans, currently going for $15/month. That doesn’t mean I’m not open to a newer agent at some point, but leaping directly to them quickly becomes an exercise in frustration.

Which brings up another issue I’ve encountered. While I try to be aware of this sort of thing, many other docs aren’t. Especially my already overburdened colleagues in primary care, who have enough on their plate with COVID-19, insurance regulations, paperwork, and an insanely busy schedule. In the controlled chaos of a general practice, it’s often easier for the staff to just hand out a sample at the same time they refer to a neurologist. So when the patient comes to me, they’re expecting I’ll be able to get it covered. After all, I’m the specialist. Getting expensive tests and medications covered seem to be something that’s expected for the higher copay to see me.

It doesn’t work that way, either.

I have nothing against new drugs. It’s the breakthroughs that keep medicine moving forward (like the COVID-19 vaccines). Nor do I have anything against samples or sales reps.

Ubrelvy and Nurtec definitely have their benefits and uses, and in appropriate cases they’re worth the battle of getting the expense covered.

But in many cases, the time you save handing out samples isn’t worth the time you have to spend on them down the line.

Dr. Block has a solo neurology practice in Scottsdale, Ariz.

I’ve taken care of both Bill and his wife for a few years. They’re a sweet couple, each with their own neurological issues. Bill has also battled depression on and off over time. He can be a challenge, and I’ve never envied his psychiatrist.

Bill committed suicide in the final week of April.

Patient deaths are unavoidable in medicine. It’s part of the job. Suicides, though less common, also happen. Sometimes they’re related to a sad diagnosis we’ve made, but more commonly (as in Bill’s case) they result from demons we had no control over.

I had a patient commit suicide about 6 months after I started my practice, and probably average one every 2 years (that I hear about) since then. They’re still the deaths that surprise me the most, make me take pause for a few minutes, even after doing this for 23 years.

Suicide is as old as humanity, and gets worse during difficult societal and economic times. It disproportionately affects doctors, dentists, veterinarians, and police officers, and leaves devastated families and friends in its wake.

Death because of the progression of time and disease is never easy, but perhaps more psychologically acceptable to those left behind. Death because of a tragic accident at any age is more difficult.

But when the person involved makes a conscious decision to end his or her own life, the effects on those left behind are terrible. Wondering why, questioning if they could have done something different, and, as with any loss, grieving.

Suicide remains extremely difficult to prevent. In a world where major advances have been made in many areas of medicine, including mental health, death from despair shows no sign of abating.

Maybe it’s part of the price of sentience and reason. Or civilization. I doubt it will ever stop being a public health issue, no matter how many other diseases we cure.

But, as I write a letter to Bill’s wife, that’s little consolation for those they’ve left behind.

Dr. Block has a solo neurology practice in Scottsdale, Ariz.

I’ve taken care of both Bill and his wife for a few years. They’re a sweet couple, each with their own neurological issues. Bill has also battled depression on and off over time. He can be a challenge, and I’ve never envied his psychiatrist.

Bill committed suicide in the final week of April.

Patient deaths are unavoidable in medicine. It’s part of the job. Suicides, though less common, also happen. Sometimes they’re related to a sad diagnosis we’ve made, but more commonly (as in Bill’s case) they result from demons we had no control over.

I had a patient commit suicide about 6 months after I started my practice, and probably average one every 2 years (that I hear about) since then. They’re still the deaths that surprise me the most, make me take pause for a few minutes, even after doing this for 23 years.

Suicide is as old as humanity, and gets worse during difficult societal and economic times. It disproportionately affects doctors, dentists, veterinarians, and police officers, and leaves devastated families and friends in its wake.

Death because of the progression of time and disease is never easy, but perhaps more psychologically acceptable to those left behind. Death because of a tragic accident at any age is more difficult.

But when the person involved makes a conscious decision to end his or her own life, the effects on those left behind are terrible. Wondering why, questioning if they could have done something different, and, as with any loss, grieving.

Suicide remains extremely difficult to prevent. In a world where major advances have been made in many areas of medicine, including mental health, death from despair shows no sign of abating.

Maybe it’s part of the price of sentience and reason. Or civilization. I doubt it will ever stop being a public health issue, no matter how many other diseases we cure.

But, as I write a letter to Bill’s wife, that’s little consolation for those they’ve left behind.

Dr. Block has a solo neurology practice in Scottsdale, Ariz.

I’ve taken care of both Bill and his wife for a few years. They’re a sweet couple, each with their own neurological issues. Bill has also battled depression on and off over time. He can be a challenge, and I’ve never envied his psychiatrist.

Bill committed suicide in the final week of April.

Patient deaths are unavoidable in medicine. It’s part of the job. Suicides, though less common, also happen. Sometimes they’re related to a sad diagnosis we’ve made, but more commonly (as in Bill’s case) they result from demons we had no control over.

I had a patient commit suicide about 6 months after I started my practice, and probably average one every 2 years (that I hear about) since then. They’re still the deaths that surprise me the most, make me take pause for a few minutes, even after doing this for 23 years.

Suicide is as old as humanity, and gets worse during difficult societal and economic times. It disproportionately affects doctors, dentists, veterinarians, and police officers, and leaves devastated families and friends in its wake.

Death because of the progression of time and disease is never easy, but perhaps more psychologically acceptable to those left behind. Death because of a tragic accident at any age is more difficult.

But when the person involved makes a conscious decision to end his or her own life, the effects on those left behind are terrible. Wondering why, questioning if they could have done something different, and, as with any loss, grieving.

Suicide remains extremely difficult to prevent. In a world where major advances have been made in many areas of medicine, including mental health, death from despair shows no sign of abating.

Maybe it’s part of the price of sentience and reason. Or civilization. I doubt it will ever stop being a public health issue, no matter how many other diseases we cure.

But, as I write a letter to Bill’s wife, that’s little consolation for those they’ve left behind.

Dr. Block has a solo neurology practice in Scottsdale, Ariz.

The other day, in a fairly common occurrence, I needed to fax a records request over to another office.

Not having memorized all the fax numbers in my area, I turned to the internet and quickly had their website and the needed information in front of me.

But at the top of the page, before you got to phone numbers and directions, was this statement in bold print (caps as seen):

“NOTICE TO ALL PATIENTS:

“Please show RESPECT AND KINDNESS to other patients and staff.

“We have a ZERO TOLERANCE policy for aggressive behavior, vulgar language, and violence, whether in person, on the phone, or online.”

A veterinarian I know recently put something similar up, saying: “We DO NOT TOLERATE physically or verbally abusive behavior by clients. We are compassionate and understand you are under stress, but we are also human and deserve respect. Thank you.”

I absolutely agree with this. Hell, I’m the same way.

But what is wrong with people that we actually need to have notices like that up?

Realistically, the vast majority of patients don’t need the reminder. They treat each other, and my staff, with politeness and respect, and we do the same. To me that’s part of the whole sandbox thing. Personally, I prefer my office to have the same atmosphere as a library, and am known to “shhhh” people who are too loud.

But the real point here is that we shouldn’t have to remind anyone else to behave with common courtesy. If you’re an adult, I’m going to assume your parents and teachers taught you the importance of manners and the Golden Rule.

I’ve been in practice for 23 years now, and I’ve never had to deal with this sort of behavior, this frequently, before. Is it that the pandemic, and its economic and social consequences, has gotten on everyone’s nerves? If so, hopefully it will gradually fade away as the crisis does. I’m vaccinated. My family and the majority of my patients are vaccinated. I encourage pretty much everyone who asks me about it to get vaccinated.

But I’m more concerned that isn’t really the issue. Maybe our polarized, divided society is moving in that direction. Common good is now often reduced to us against them, and the conditions of the times have just aggravated a problem that was festering.

The majority of people, of all beliefs, remain decent people. But it’s distressing that the amount of rudeness is increasing to the point where we need to remind grown-ups about its consequences.

Decency and manners, unfortunately, can’t be legislated. If you’ve forgotten yours, though, don’t think others will put up with you.

Dr. Block has a solo neurology practice in Scottsdale, Ariz.

The other day, in a fairly common occurrence, I needed to fax a records request over to another office.

Not having memorized all the fax numbers in my area, I turned to the internet and quickly had their website and the needed information in front of me.

But at the top of the page, before you got to phone numbers and directions, was this statement in bold print (caps as seen):

“NOTICE TO ALL PATIENTS:

“Please show RESPECT AND KINDNESS to other patients and staff.

“We have a ZERO TOLERANCE policy for aggressive behavior, vulgar language, and violence, whether in person, on the phone, or online.”

A veterinarian I know recently put something similar up, saying: “We DO NOT TOLERATE physically or verbally abusive behavior by clients. We are compassionate and understand you are under stress, but we are also human and deserve respect. Thank you.”

I absolutely agree with this. Hell, I’m the same way.

But what is wrong with people that we actually need to have notices like that up?

Realistically, the vast majority of patients don’t need the reminder. They treat each other, and my staff, with politeness and respect, and we do the same. To me that’s part of the whole sandbox thing. Personally, I prefer my office to have the same atmosphere as a library, and am known to “shhhh” people who are too loud.

But the real point here is that we shouldn’t have to remind anyone else to behave with common courtesy. If you’re an adult, I’m going to assume your parents and teachers taught you the importance of manners and the Golden Rule.

I’ve been in practice for 23 years now, and I’ve never had to deal with this sort of behavior, this frequently, before. Is it that the pandemic, and its economic and social consequences, has gotten on everyone’s nerves? If so, hopefully it will gradually fade away as the crisis does. I’m vaccinated. My family and the majority of my patients are vaccinated. I encourage pretty much everyone who asks me about it to get vaccinated.

But I’m more concerned that isn’t really the issue. Maybe our polarized, divided society is moving in that direction. Common good is now often reduced to us against them, and the conditions of the times have just aggravated a problem that was festering.

The majority of people, of all beliefs, remain decent people. But it’s distressing that the amount of rudeness is increasing to the point where we need to remind grown-ups about its consequences.

Decency and manners, unfortunately, can’t be legislated. If you’ve forgotten yours, though, don’t think others will put up with you.

Dr. Block has a solo neurology practice in Scottsdale, Ariz.

The other day, in a fairly common occurrence, I needed to fax a records request over to another office.

Not having memorized all the fax numbers in my area, I turned to the internet and quickly had their website and the needed information in front of me.

But at the top of the page, before you got to phone numbers and directions, was this statement in bold print (caps as seen):

“NOTICE TO ALL PATIENTS:

“Please show RESPECT AND KINDNESS to other patients and staff.

“We have a ZERO TOLERANCE policy for aggressive behavior, vulgar language, and violence, whether in person, on the phone, or online.”

A veterinarian I know recently put something similar up, saying: “We DO NOT TOLERATE physically or verbally abusive behavior by clients. We are compassionate and understand you are under stress, but we are also human and deserve respect. Thank you.”

I absolutely agree with this. Hell, I’m the same way.

But what is wrong with people that we actually need to have notices like that up?

Realistically, the vast majority of patients don’t need the reminder. They treat each other, and my staff, with politeness and respect, and we do the same. To me that’s part of the whole sandbox thing. Personally, I prefer my office to have the same atmosphere as a library, and am known to “shhhh” people who are too loud.

But the real point here is that we shouldn’t have to remind anyone else to behave with common courtesy. If you’re an adult, I’m going to assume your parents and teachers taught you the importance of manners and the Golden Rule.

I’ve been in practice for 23 years now, and I’ve never had to deal with this sort of behavior, this frequently, before. Is it that the pandemic, and its economic and social consequences, has gotten on everyone’s nerves? If so, hopefully it will gradually fade away as the crisis does. I’m vaccinated. My family and the majority of my patients are vaccinated. I encourage pretty much everyone who asks me about it to get vaccinated.

But I’m more concerned that isn’t really the issue. Maybe our polarized, divided society is moving in that direction. Common good is now often reduced to us against them, and the conditions of the times have just aggravated a problem that was festering.

The majority of people, of all beliefs, remain decent people. But it’s distressing that the amount of rudeness is increasing to the point where we need to remind grown-ups about its consequences.

Decency and manners, unfortunately, can’t be legislated. If you’ve forgotten yours, though, don’t think others will put up with you.

Dr. Block has a solo neurology practice in Scottsdale, Ariz.

“I want my life to mean something.”

She was young, energetic, and idealistic. She was seeing me for her migraines, but our conversation had turned to her applying for medical school.

“I want my life to mean something.”

I reflected on that later. I once said similar things, but now found myself wondering, two-thirds of the way through my career, did it?

The world certainly isn’t safer, geopolitically or environmentally, now than it was when I left medical school. Hell, the idea that there’d actually be another worldwide pandemic was pretty much beyond me then. That seemed so 1918.

I can’t even say I’ve made a huge difference in medicine. I’m not on the front line of research, inventing cures and tests that will change what we do.

I’m certainly far removed from the front lines of the pandemic.

But realistically, none of those things were ever really my goal, either.

“I want my life to mean something.”

Sometimes it’s hard to think I’ve made a difference. Day in and day out I’m at my office, quietly sitting behind a desk and trying to look smart. For all good intentions ... at some point it’s just a job.

Then I realized that the job isn’t about me. It’s about her, and the many other people who come to me for help. The real meaning is the impact on their lives.

Anytime we see a patient and make their lives better, either through treatment or compassion, it creates a ripple effect. It helps their family, friends, and coworkers. Whether we’re actually giving help or just understanding.

It might even inspire one of them to go into medicine, because my generation will be drifting toward retirement in the next 10 years.

Our care may set off a chain reaction we can’t see. Perhaps the patient you help will return to work and initiate some action that will bring a marked benefit to us all. Or someone in their circle, freed or inspired by their improvement, will bring about such a change.

Like tossing a stone into a pond, our actions in medicine can have effects far beyond where the pebble landed.

And that’s meaning enough for me.

Dr. Block has a solo neurology practice in Scottsdale, Ariz.

“I want my life to mean something.”

She was young, energetic, and idealistic. She was seeing me for her migraines, but our conversation had turned to her applying for medical school.

“I want my life to mean something.”

I reflected on that later. I once said similar things, but now found myself wondering, two-thirds of the way through my career, did it?

The world certainly isn’t safer, geopolitically or environmentally, now than it was when I left medical school. Hell, the idea that there’d actually be another worldwide pandemic was pretty much beyond me then. That seemed so 1918.

I can’t even say I’ve made a huge difference in medicine. I’m not on the front line of research, inventing cures and tests that will change what we do.

I’m certainly far removed from the front lines of the pandemic.

But realistically, none of those things were ever really my goal, either.

“I want my life to mean something.”

Sometimes it’s hard to think I’ve made a difference. Day in and day out I’m at my office, quietly sitting behind a desk and trying to look smart. For all good intentions ... at some point it’s just a job.

Then I realized that the job isn’t about me. It’s about her, and the many other people who come to me for help. The real meaning is the impact on their lives.

Anytime we see a patient and make their lives better, either through treatment or compassion, it creates a ripple effect. It helps their family, friends, and coworkers. Whether we’re actually giving help or just understanding.

It might even inspire one of them to go into medicine, because my generation will be drifting toward retirement in the next 10 years.

Our care may set off a chain reaction we can’t see. Perhaps the patient you help will return to work and initiate some action that will bring a marked benefit to us all. Or someone in their circle, freed or inspired by their improvement, will bring about such a change.

Like tossing a stone into a pond, our actions in medicine can have effects far beyond where the pebble landed.

And that’s meaning enough for me.

Dr. Block has a solo neurology practice in Scottsdale, Ariz.

“I want my life to mean something.”

She was young, energetic, and idealistic. She was seeing me for her migraines, but our conversation had turned to her applying for medical school.

“I want my life to mean something.”

I reflected on that later. I once said similar things, but now found myself wondering, two-thirds of the way through my career, did it?

The world certainly isn’t safer, geopolitically or environmentally, now than it was when I left medical school. Hell, the idea that there’d actually be another worldwide pandemic was pretty much beyond me then. That seemed so 1918.

I can’t even say I’ve made a huge difference in medicine. I’m not on the front line of research, inventing cures and tests that will change what we do.

I’m certainly far removed from the front lines of the pandemic.

But realistically, none of those things were ever really my goal, either.

“I want my life to mean something.”

Sometimes it’s hard to think I’ve made a difference. Day in and day out I’m at my office, quietly sitting behind a desk and trying to look smart. For all good intentions ... at some point it’s just a job.

Then I realized that the job isn’t about me. It’s about her, and the many other people who come to me for help. The real meaning is the impact on their lives.

Anytime we see a patient and make their lives better, either through treatment or compassion, it creates a ripple effect. It helps their family, friends, and coworkers. Whether we’re actually giving help or just understanding.

It might even inspire one of them to go into medicine, because my generation will be drifting toward retirement in the next 10 years.

Our care may set off a chain reaction we can’t see. Perhaps the patient you help will return to work and initiate some action that will bring a marked benefit to us all. Or someone in their circle, freed or inspired by their improvement, will bring about such a change.

Like tossing a stone into a pond, our actions in medicine can have effects far beyond where the pebble landed.

And that’s meaning enough for me.

Dr. Block has a solo neurology practice in Scottsdale, Ariz.

Recently my wife had surgery to remove some old hardware from her knee.

Although it was an outpatient procedure, it was done at the main hospital. I was told it would be about 5 hours total, so I set up shop in the waiting room with my laptop to get some work done.

There were a few other people waiting there and one volunteer at the desk. The whole time went fairly uneventfully. Others busied themselves with iPads, phones, books, etc. It was, overall, a pleasantly quiet atmosphere. There were the occasional hushed tones of someone on the phone or talking to a doctor, the sound of someone crying in the private discussion room, the voice of a volunteer answering questions, and the intermittent whirring of the Keurig machine.

I sat there and thought about how different it was from times in the past. On weekends when I’d take call I’d come through this same room. It was often packed – standing room only. Almost always there were children running amok because their parents were too distracted or tired to control them. There were food wrappers and dirty cafeteria trays sitting on tables. The Keurig machine was often empty from frequent use – the volunteer too overwhelmed to resupply it.

Now, in the COVID-19 era, it’s a whole different world with visitor restrictions, and I found myself wondering: “Why go back to that?”

Seriously. Isn’t a calm, quiet, atmosphere supposed to be what a hospital (or doctor’s) waiting room should be? Is it really critical that large numbers of an extended family be in the waiting room for every case?

Granted, there should be exceptions. Critical and terminal illness, withdrawal of care, maybe a few others. But for the majority of patients, placing limitations on the numbers of family members in the waiting room shouldn’t be an issue; it makes the difficult environment of being there easier for all to deal with.

Limiting it to one, maybe two family members for most circumstances isn’t a bad idea. A hospital isn’t an airport, and shouldn’t be run the same way.

Dr. Block has a solo neurology practice in Scottsdale, Ariz.

Recently my wife had surgery to remove some old hardware from her knee.

Although it was an outpatient procedure, it was done at the main hospital. I was told it would be about 5 hours total, so I set up shop in the waiting room with my laptop to get some work done.

There were a few other people waiting there and one volunteer at the desk. The whole time went fairly uneventfully. Others busied themselves with iPads, phones, books, etc. It was, overall, a pleasantly quiet atmosphere. There were the occasional hushed tones of someone on the phone or talking to a doctor, the sound of someone crying in the private discussion room, the voice of a volunteer answering questions, and the intermittent whirring of the Keurig machine.

I sat there and thought about how different it was from times in the past. On weekends when I’d take call I’d come through this same room. It was often packed – standing room only. Almost always there were children running amok because their parents were too distracted or tired to control them. There were food wrappers and dirty cafeteria trays sitting on tables. The Keurig machine was often empty from frequent use – the volunteer too overwhelmed to resupply it.

Now, in the COVID-19 era, it’s a whole different world with visitor restrictions, and I found myself wondering: “Why go back to that?”

Seriously. Isn’t a calm, quiet, atmosphere supposed to be what a hospital (or doctor’s) waiting room should be? Is it really critical that large numbers of an extended family be in the waiting room for every case?

Granted, there should be exceptions. Critical and terminal illness, withdrawal of care, maybe a few others. But for the majority of patients, placing limitations on the numbers of family members in the waiting room shouldn’t be an issue; it makes the difficult environment of being there easier for all to deal with.

Limiting it to one, maybe two family members for most circumstances isn’t a bad idea. A hospital isn’t an airport, and shouldn’t be run the same way.

Dr. Block has a solo neurology practice in Scottsdale, Ariz.

Recently my wife had surgery to remove some old hardware from her knee.

Although it was an outpatient procedure, it was done at the main hospital. I was told it would be about 5 hours total, so I set up shop in the waiting room with my laptop to get some work done.

There were a few other people waiting there and one volunteer at the desk. The whole time went fairly uneventfully. Others busied themselves with iPads, phones, books, etc. It was, overall, a pleasantly quiet atmosphere. There were the occasional hushed tones of someone on the phone or talking to a doctor, the sound of someone crying in the private discussion room, the voice of a volunteer answering questions, and the intermittent whirring of the Keurig machine.

I sat there and thought about how different it was from times in the past. On weekends when I’d take call I’d come through this same room. It was often packed – standing room only. Almost always there were children running amok because their parents were too distracted or tired to control them. There were food wrappers and dirty cafeteria trays sitting on tables. The Keurig machine was often empty from frequent use – the volunteer too overwhelmed to resupply it.

Now, in the COVID-19 era, it’s a whole different world with visitor restrictions, and I found myself wondering: “Why go back to that?”

Seriously. Isn’t a calm, quiet, atmosphere supposed to be what a hospital (or doctor’s) waiting room should be? Is it really critical that large numbers of an extended family be in the waiting room for every case?

Granted, there should be exceptions. Critical and terminal illness, withdrawal of care, maybe a few others. But for the majority of patients, placing limitations on the numbers of family members in the waiting room shouldn’t be an issue; it makes the difficult environment of being there easier for all to deal with.

Limiting it to one, maybe two family members for most circumstances isn’t a bad idea. A hospital isn’t an airport, and shouldn’t be run the same way.

Dr. Block has a solo neurology practice in Scottsdale, Ariz.