Hitting a Nerve

Sandy was placed in memory care recently.

In my world, as a 23-year veteran of the neurology frontline trenches, this is a pretty common occurrence for my patients.

But Sandy isn’t my patient.

She’s a longtime friend.

My parents met Sandy and her husband on New Year’s Eve, 1968. I was 2. Phoenix wasn’t a particularly big city back then.

Growing up we had summer pool parties and get-togethers with them and other families. My mom and Sandy have close birthdays, and when they both turned 50 their husbands threw them a combined 100-year surprise party. As couples they made occasional trips to Las Vegas.

In adolescence, when my voice changed, I sounded a lot like my dad, and Sandy could never tell us apart. So when I answered the phone and she thought it was him, I’d just fly with the conversation, becoming increasingly preposterous until she said: “Okay, now I know who this is. Let me talk to your mom.” Maybe she was just humoring me the whole time. But it was good for a laugh.

Ten years ago my mom mentioned Sandy had been diagnosed with Alzheimer’s disease by another neurologist in town. For a long time her deterioration was slow.

I last saw her 8 years ago, at my dad’s services. At that time we had a nice conversation. I didn’t go into my trained “neurology mode” – I’ve never been her doctor – but enjoyed talking to her as a family friend I hadn’t seen in years. There were a few gaps in her memory, but she was still the person I’d always been fond of.

Eight years is a long time in Alzheimer’s disease, and she finally reached the point where placement was no longer an option. My mom had spoken to her the week before, but told me Sandy couldn’t really carry a conversation now.

Sandy isn’t dead, but by the same token she is. Placement in memory care is often the realization that the person we knew and loved isn’t there anymore. In a world where we can often keep people physically up and around, our ability to do the same with their minds and souls is still desperately in need of a truly effective treatment. Such treatment isn’t even on the horizon ... yet.

As a neurologist, I know this reality. I explain it to families every day.

But when it comes to someone I know outside of my profession, that doesn’t make it any easier.

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

Sandy was placed in memory care recently.

In my world, as a 23-year veteran of the neurology frontline trenches, this is a pretty common occurrence for my patients.

But Sandy isn’t my patient.

She’s a longtime friend.

My parents met Sandy and her husband on New Year’s Eve, 1968. I was 2. Phoenix wasn’t a particularly big city back then.

Growing up we had summer pool parties and get-togethers with them and other families. My mom and Sandy have close birthdays, and when they both turned 50 their husbands threw them a combined 100-year surprise party. As couples they made occasional trips to Las Vegas.

In adolescence, when my voice changed, I sounded a lot like my dad, and Sandy could never tell us apart. So when I answered the phone and she thought it was him, I’d just fly with the conversation, becoming increasingly preposterous until she said: “Okay, now I know who this is. Let me talk to your mom.” Maybe she was just humoring me the whole time. But it was good for a laugh.

Ten years ago my mom mentioned Sandy had been diagnosed with Alzheimer’s disease by another neurologist in town. For a long time her deterioration was slow.

I last saw her 8 years ago, at my dad’s services. At that time we had a nice conversation. I didn’t go into my trained “neurology mode” – I’ve never been her doctor – but enjoyed talking to her as a family friend I hadn’t seen in years. There were a few gaps in her memory, but she was still the person I’d always been fond of.

Eight years is a long time in Alzheimer’s disease, and she finally reached the point where placement was no longer an option. My mom had spoken to her the week before, but told me Sandy couldn’t really carry a conversation now.

Sandy isn’t dead, but by the same token she is. Placement in memory care is often the realization that the person we knew and loved isn’t there anymore. In a world where we can often keep people physically up and around, our ability to do the same with their minds and souls is still desperately in need of a truly effective treatment. Such treatment isn’t even on the horizon ... yet.

As a neurologist, I know this reality. I explain it to families every day.

But when it comes to someone I know outside of my profession, that doesn’t make it any easier.

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

Sandy was placed in memory care recently.

In my world, as a 23-year veteran of the neurology frontline trenches, this is a pretty common occurrence for my patients.

But Sandy isn’t my patient.

She’s a longtime friend.

My parents met Sandy and her husband on New Year’s Eve, 1968. I was 2. Phoenix wasn’t a particularly big city back then.

Growing up we had summer pool parties and get-togethers with them and other families. My mom and Sandy have close birthdays, and when they both turned 50 their husbands threw them a combined 100-year surprise party. As couples they made occasional trips to Las Vegas.

In adolescence, when my voice changed, I sounded a lot like my dad, and Sandy could never tell us apart. So when I answered the phone and she thought it was him, I’d just fly with the conversation, becoming increasingly preposterous until she said: “Okay, now I know who this is. Let me talk to your mom.” Maybe she was just humoring me the whole time. But it was good for a laugh.

Ten years ago my mom mentioned Sandy had been diagnosed with Alzheimer’s disease by another neurologist in town. For a long time her deterioration was slow.

I last saw her 8 years ago, at my dad’s services. At that time we had a nice conversation. I didn’t go into my trained “neurology mode” – I’ve never been her doctor – but enjoyed talking to her as a family friend I hadn’t seen in years. There were a few gaps in her memory, but she was still the person I’d always been fond of.

Eight years is a long time in Alzheimer’s disease, and she finally reached the point where placement was no longer an option. My mom had spoken to her the week before, but told me Sandy couldn’t really carry a conversation now.

Sandy isn’t dead, but by the same token she is. Placement in memory care is often the realization that the person we knew and loved isn’t there anymore. In a world where we can often keep people physically up and around, our ability to do the same with their minds and souls is still desperately in need of a truly effective treatment. Such treatment isn’t even on the horizon ... yet.

As a neurologist, I know this reality. I explain it to families every day.

But when it comes to someone I know outside of my profession, that doesn’t make it any easier.

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

The president question – “Who’s the current president?” – has been a standard one of basic neurology assessments for years, probably since the answer was Ulysses S. Grant. It’s routinely asked by doctors, nurses, EEG techs, medical students, and pretty much anyone else trying to figure out someone’s mental status.

When I first began doing this, the answer was “George Bush” (at that time there’d only been one president by that name, so clarification wasn’t needed). Back then people answered the question (right or wrong) and we moved on. I don’t recall ever getting a dirty look, political lecture, or eye roll as a response.

Unfortunately, it’s not that simple anymore. As people have become increasingly polarized, it’s become seemingly impossible to get a response without a statement of support or anger. At best I get a straight answer. At worst I get a lecture on the “perils of a non-White society” (that was last week). Then they want my opinion, and years of practice have taught me to never discuss politics with patients, regardless of which side they’re on.

I don’t recall this being a problem until the late ‘90s, when the answer was “Clinton.” Occasionally I’d get a sarcastic comment referring to the Lewinsky affair, but that was about it.

Since then it’s gradually escalated, to where the question has become worthless. I don’t have time to hear a political diatribe from either side. This is a doctor appointment, not a debate club. The insistence by some that Trump won leaves me guessing if the person is stubborn or serious, and either way it shouldn’t be my job to figure that out. I take your appointment seriously, so the least you can do is the same.

So I’ve ditched the question for good. The current date, the location of my office, and other less controversial things will have to do. I’m here to take care of you, not have you try to pick a fight or make a political statement.

You’d think such a simple, time-honored, assessment question wouldn’t become such a problem. But in today’s polarized and impolite society, even the seriousness of a medical evaluation is affected by what we’ve allowed ourselves to become.

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

The president question – “Who’s the current president?” – has been a standard one of basic neurology assessments for years, probably since the answer was Ulysses S. Grant. It’s routinely asked by doctors, nurses, EEG techs, medical students, and pretty much anyone else trying to figure out someone’s mental status.

When I first began doing this, the answer was “George Bush” (at that time there’d only been one president by that name, so clarification wasn’t needed). Back then people answered the question (right or wrong) and we moved on. I don’t recall ever getting a dirty look, political lecture, or eye roll as a response.

Unfortunately, it’s not that simple anymore. As people have become increasingly polarized, it’s become seemingly impossible to get a response without a statement of support or anger. At best I get a straight answer. At worst I get a lecture on the “perils of a non-White society” (that was last week). Then they want my opinion, and years of practice have taught me to never discuss politics with patients, regardless of which side they’re on.

I don’t recall this being a problem until the late ‘90s, when the answer was “Clinton.” Occasionally I’d get a sarcastic comment referring to the Lewinsky affair, but that was about it.

Since then it’s gradually escalated, to where the question has become worthless. I don’t have time to hear a political diatribe from either side. This is a doctor appointment, not a debate club. The insistence by some that Trump won leaves me guessing if the person is stubborn or serious, and either way it shouldn’t be my job to figure that out. I take your appointment seriously, so the least you can do is the same.

So I’ve ditched the question for good. The current date, the location of my office, and other less controversial things will have to do. I’m here to take care of you, not have you try to pick a fight or make a political statement.

You’d think such a simple, time-honored, assessment question wouldn’t become such a problem. But in today’s polarized and impolite society, even the seriousness of a medical evaluation is affected by what we’ve allowed ourselves to become.

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

The president question – “Who’s the current president?” – has been a standard one of basic neurology assessments for years, probably since the answer was Ulysses S. Grant. It’s routinely asked by doctors, nurses, EEG techs, medical students, and pretty much anyone else trying to figure out someone’s mental status.

When I first began doing this, the answer was “George Bush” (at that time there’d only been one president by that name, so clarification wasn’t needed). Back then people answered the question (right or wrong) and we moved on. I don’t recall ever getting a dirty look, political lecture, or eye roll as a response.

Unfortunately, it’s not that simple anymore. As people have become increasingly polarized, it’s become seemingly impossible to get a response without a statement of support or anger. At best I get a straight answer. At worst I get a lecture on the “perils of a non-White society” (that was last week). Then they want my opinion, and years of practice have taught me to never discuss politics with patients, regardless of which side they’re on.

I don’t recall this being a problem until the late ‘90s, when the answer was “Clinton.” Occasionally I’d get a sarcastic comment referring to the Lewinsky affair, but that was about it.

Since then it’s gradually escalated, to where the question has become worthless. I don’t have time to hear a political diatribe from either side. This is a doctor appointment, not a debate club. The insistence by some that Trump won leaves me guessing if the person is stubborn or serious, and either way it shouldn’t be my job to figure that out. I take your appointment seriously, so the least you can do is the same.

So I’ve ditched the question for good. The current date, the location of my office, and other less controversial things will have to do. I’m here to take care of you, not have you try to pick a fight or make a political statement.

You’d think such a simple, time-honored, assessment question wouldn’t become such a problem. But in today’s polarized and impolite society, even the seriousness of a medical evaluation is affected by what we’ve allowed ourselves to become.

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

Memantine (aka Namenda) is Food and Drug Administration–approved for Alzheimer’s disease, though its benefits are modest, at best.

It’s also, 18 years after first coming to market, relatively inexpensive.

I occasionally use it off label, as neurologists tend to do with a wide variety of medications. There are small studies that suggest it’s effective for migraine prevention and painful neuropathies. It also has a relatively benign side-effect profile.

As a result, once in a while I prescribe it for migraines or neuropathy where more typical agents haven’t helped. Like any of these drugs, sometimes it works, sometimes it doesn’t. A lot of neurology, as one of my colleagues puts it, is “guessing and voodoo.”

Since I’ve started this, however, I’ve noticed an unusual, and somewhat scary, side effect – one that has nothing to do the drug reactions.

While I don’t use any type of commercial chart system, most doctors in my area do, as well as all the hospitals. So I often see my patients’ notes from their general practitioners or after they’ve been in the hospital for whatever reason.

Those notes often list – as they should – current medications. Which includes the memantine I’ve prescribed.

But in the patient problem list I often then see “Alzheimer’s disease” or “dementia” show up, even in people who clearly have no history of such.

I’ve seen it way too many times to think it’s an accident. So one of two things is happening:

1. The computer chart system, when it sees “memantine” entered, searches its database, finds what it’s FDA-approved for, and automatically puts that in a list of current diagnoses.

2. The person entering the data, upon hearing the patient takes memantine, just enters the more commonly used indication as well, without bothering to ask the patient why they’re taking it.

Neither of these is good.

At the very least, they show a lack of proper history taking (or interest in doing so) by the person entering things in the chart (which these days could be someone with no medical training at all). It doesn’t take that much effort to say “what are you on this for?” I do it several times a day. It’s part of my job.

It’s bad form for any incorrect diagnosis to get into a chart. It can have serious repercussions on someone’s ability to get health, disability, or life insurance, not to mention the immediate impact on their care when that shows up. Someone who doesn’t know the patient opens the chart and immediately assumes it’s what they’ve got. I mean, it’s the chart. People treat it like it’s infallible and inviolable.

Once something is in a chart, it’s impossible to get it out. This isn’t a new issue – I trained at the VA when sometimes an H&P simply said “see old chart” and there were four volumes of it. But now, in the age of digital records, entries are forever. The toe you fractured surfing 8 years ago still shows up as a “current problem,” and will likely follow you to the grave. The same with any other diagnosis entered – it’s yours to keep, regardless of accuracy.

Medicine, like life, is mostly gray. But computers, and many times those who enter their data, only see things as black and white. In this field that’s liable to backfire. I’m just seeing the tip of the iceberg by using memantine off-label.

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

Memantine (aka Namenda) is Food and Drug Administration–approved for Alzheimer’s disease, though its benefits are modest, at best.

It’s also, 18 years after first coming to market, relatively inexpensive.

I occasionally use it off label, as neurologists tend to do with a wide variety of medications. There are small studies that suggest it’s effective for migraine prevention and painful neuropathies. It also has a relatively benign side-effect profile.

As a result, once in a while I prescribe it for migraines or neuropathy where more typical agents haven’t helped. Like any of these drugs, sometimes it works, sometimes it doesn’t. A lot of neurology, as one of my colleagues puts it, is “guessing and voodoo.”

Since I’ve started this, however, I’ve noticed an unusual, and somewhat scary, side effect – one that has nothing to do the drug reactions.

While I don’t use any type of commercial chart system, most doctors in my area do, as well as all the hospitals. So I often see my patients’ notes from their general practitioners or after they’ve been in the hospital for whatever reason.

Those notes often list – as they should – current medications. Which includes the memantine I’ve prescribed.

But in the patient problem list I often then see “Alzheimer’s disease” or “dementia” show up, even in people who clearly have no history of such.

I’ve seen it way too many times to think it’s an accident. So one of two things is happening:

1. The computer chart system, when it sees “memantine” entered, searches its database, finds what it’s FDA-approved for, and automatically puts that in a list of current diagnoses.

2. The person entering the data, upon hearing the patient takes memantine, just enters the more commonly used indication as well, without bothering to ask the patient why they’re taking it.

Neither of these is good.

At the very least, they show a lack of proper history taking (or interest in doing so) by the person entering things in the chart (which these days could be someone with no medical training at all). It doesn’t take that much effort to say “what are you on this for?” I do it several times a day. It’s part of my job.

It’s bad form for any incorrect diagnosis to get into a chart. It can have serious repercussions on someone’s ability to get health, disability, or life insurance, not to mention the immediate impact on their care when that shows up. Someone who doesn’t know the patient opens the chart and immediately assumes it’s what they’ve got. I mean, it’s the chart. People treat it like it’s infallible and inviolable.

Once something is in a chart, it’s impossible to get it out. This isn’t a new issue – I trained at the VA when sometimes an H&P simply said “see old chart” and there were four volumes of it. But now, in the age of digital records, entries are forever. The toe you fractured surfing 8 years ago still shows up as a “current problem,” and will likely follow you to the grave. The same with any other diagnosis entered – it’s yours to keep, regardless of accuracy.

Medicine, like life, is mostly gray. But computers, and many times those who enter their data, only see things as black and white. In this field that’s liable to backfire. I’m just seeing the tip of the iceberg by using memantine off-label.

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

Memantine (aka Namenda) is Food and Drug Administration–approved for Alzheimer’s disease, though its benefits are modest, at best.

It’s also, 18 years after first coming to market, relatively inexpensive.

I occasionally use it off label, as neurologists tend to do with a wide variety of medications. There are small studies that suggest it’s effective for migraine prevention and painful neuropathies. It also has a relatively benign side-effect profile.

As a result, once in a while I prescribe it for migraines or neuropathy where more typical agents haven’t helped. Like any of these drugs, sometimes it works, sometimes it doesn’t. A lot of neurology, as one of my colleagues puts it, is “guessing and voodoo.”

Since I’ve started this, however, I’ve noticed an unusual, and somewhat scary, side effect – one that has nothing to do the drug reactions.

While I don’t use any type of commercial chart system, most doctors in my area do, as well as all the hospitals. So I often see my patients’ notes from their general practitioners or after they’ve been in the hospital for whatever reason.

Those notes often list – as they should – current medications. Which includes the memantine I’ve prescribed.

But in the patient problem list I often then see “Alzheimer’s disease” or “dementia” show up, even in people who clearly have no history of such.

I’ve seen it way too many times to think it’s an accident. So one of two things is happening:

1. The computer chart system, when it sees “memantine” entered, searches its database, finds what it’s FDA-approved for, and automatically puts that in a list of current diagnoses.

2. The person entering the data, upon hearing the patient takes memantine, just enters the more commonly used indication as well, without bothering to ask the patient why they’re taking it.

Neither of these is good.

At the very least, they show a lack of proper history taking (or interest in doing so) by the person entering things in the chart (which these days could be someone with no medical training at all). It doesn’t take that much effort to say “what are you on this for?” I do it several times a day. It’s part of my job.

It’s bad form for any incorrect diagnosis to get into a chart. It can have serious repercussions on someone’s ability to get health, disability, or life insurance, not to mention the immediate impact on their care when that shows up. Someone who doesn’t know the patient opens the chart and immediately assumes it’s what they’ve got. I mean, it’s the chart. People treat it like it’s infallible and inviolable.

Once something is in a chart, it’s impossible to get it out. This isn’t a new issue – I trained at the VA when sometimes an H&P simply said “see old chart” and there were four volumes of it. But now, in the age of digital records, entries are forever. The toe you fractured surfing 8 years ago still shows up as a “current problem,” and will likely follow you to the grave. The same with any other diagnosis entered – it’s yours to keep, regardless of accuracy.

Medicine, like life, is mostly gray. But computers, and many times those who enter their data, only see things as black and white. In this field that’s liable to backfire. I’m just seeing the tip of the iceberg by using memantine off-label.

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

A man I saw earlier this year called my office recently. He’d read my note, and after discussing it with his attorney, wanted me to make changes. He said that the way I’d described his symptoms would be damaging to a legal action he was involved in, and so he wanted it reworded.

Obviously, I said “no.” I’m not a fiction writer. My notes are what people tell me happened. I don’t make them up.

He wasn’t happy about this, and a few days later I got a request to send his records to another neurologist, which I gladly did.

In this business a large measure of what we do is based on the patient’s symptoms. what they report to us, and how they describe it. When I put their story into a written note, my goal is to be as accurate to what they told me as possible. I’m not here to embellish, disparage, or minimize their history.

A chart, as was drilled into me throughout training, is a legal document. Once I’ve signed off on a note it can’t be changed. To do so is to look bad at the very least and open yourself up to malpractice and legal charges at worst.

This isn’t to say errors can’t be modified. I’m far from perfect. Sometimes I might misunderstand something a patient tells me, or get information crossed up. When that happens there’s nothing wrong with writing an addendum, clarifying or correcting what my earlier note said – but not changing the original note.

I asked the unhappy patient to write down what he thought was incorrect, and I’d be willing to include that in his chart. He wasn’t willing to do that, and there was no way I would ever change a note. I tried to politely explain the reasons why, but he wasn’t listening.

So I lost him as a patient. After 23 years of practice, that doesn’t bother me. I learned a long time ago that I can’t please everyone, nor can I be everyone’s doctor. Saying “no” is just as important as saying “yes,” though at times more difficult.

This time, though, the answer was pretty obvious, and will be the same next time I get the same request from a patient.

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

A man I saw earlier this year called my office recently. He’d read my note, and after discussing it with his attorney, wanted me to make changes. He said that the way I’d described his symptoms would be damaging to a legal action he was involved in, and so he wanted it reworded.

Obviously, I said “no.” I’m not a fiction writer. My notes are what people tell me happened. I don’t make them up.

He wasn’t happy about this, and a few days later I got a request to send his records to another neurologist, which I gladly did.

In this business a large measure of what we do is based on the patient’s symptoms. what they report to us, and how they describe it. When I put their story into a written note, my goal is to be as accurate to what they told me as possible. I’m not here to embellish, disparage, or minimize their history.

A chart, as was drilled into me throughout training, is a legal document. Once I’ve signed off on a note it can’t be changed. To do so is to look bad at the very least and open yourself up to malpractice and legal charges at worst.

This isn’t to say errors can’t be modified. I’m far from perfect. Sometimes I might misunderstand something a patient tells me, or get information crossed up. When that happens there’s nothing wrong with writing an addendum, clarifying or correcting what my earlier note said – but not changing the original note.

I asked the unhappy patient to write down what he thought was incorrect, and I’d be willing to include that in his chart. He wasn’t willing to do that, and there was no way I would ever change a note. I tried to politely explain the reasons why, but he wasn’t listening.

So I lost him as a patient. After 23 years of practice, that doesn’t bother me. I learned a long time ago that I can’t please everyone, nor can I be everyone’s doctor. Saying “no” is just as important as saying “yes,” though at times more difficult.

This time, though, the answer was pretty obvious, and will be the same next time I get the same request from a patient.

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

A man I saw earlier this year called my office recently. He’d read my note, and after discussing it with his attorney, wanted me to make changes. He said that the way I’d described his symptoms would be damaging to a legal action he was involved in, and so he wanted it reworded.

Obviously, I said “no.” I’m not a fiction writer. My notes are what people tell me happened. I don’t make them up.

He wasn’t happy about this, and a few days later I got a request to send his records to another neurologist, which I gladly did.

In this business a large measure of what we do is based on the patient’s symptoms. what they report to us, and how they describe it. When I put their story into a written note, my goal is to be as accurate to what they told me as possible. I’m not here to embellish, disparage, or minimize their history.

A chart, as was drilled into me throughout training, is a legal document. Once I’ve signed off on a note it can’t be changed. To do so is to look bad at the very least and open yourself up to malpractice and legal charges at worst.

This isn’t to say errors can’t be modified. I’m far from perfect. Sometimes I might misunderstand something a patient tells me, or get information crossed up. When that happens there’s nothing wrong with writing an addendum, clarifying or correcting what my earlier note said – but not changing the original note.

I asked the unhappy patient to write down what he thought was incorrect, and I’d be willing to include that in his chart. He wasn’t willing to do that, and there was no way I would ever change a note. I tried to politely explain the reasons why, but he wasn’t listening.

So I lost him as a patient. After 23 years of practice, that doesn’t bother me. I learned a long time ago that I can’t please everyone, nor can I be everyone’s doctor. Saying “no” is just as important as saying “yes,” though at times more difficult.

This time, though, the answer was pretty obvious, and will be the same next time I get the same request from a patient.

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

I passed the neurology boards, for the first time, in 1998. Then again in 2009, and most recently in 2019.

So I’m up again in 2029. Regrettably, I missed grandfathering in for life by a few years.

Some people don’t study for them, but I’m a little too compulsive not to. I’d guess I put 40-50 hours into doing so in the 3 months beforehand. I didn’t want to fail and have to pay a hefty fee to retake them (the test fee for once is enough as it is).

I’ll be 63 when my next certification is due.

So I wonder (if I’m still in practice) will it even be worthwhile to do it all again? I like what I do, but certainly don’t plan on practicing forever.

Board certification looks good on paper, but certainly isn’t a requirement to practice. One of the best cardiologists I know has never bothered to get his board certification and I don’t think any less of him for it. He also isn’t wanting for patients, and those he has think he’s awesome.

That said, there are things, like being involved in research and legal work, where board certification is strongly recommended, if not mandatory. Since I do both, I certainly wouldn’t want to do anything that might affect my participating in them – if I’m still doing this in 8 years.

By the same token, my office lease runs out when I’m 62. At that point I’ll have been in the same place for 17 years. I don’t consider that a bad thing. I like my current office, and will be perfectly happy to wrap up my career here.

It brings up the same question, though, with logistics that are an even bigger PIA. The last thing I want to do is move my office as my career is winding down. But a lease extension for a few years can be negotiated, a board certification can’t.

I can’t help but wonder: What is the point of recertification over time? If I’ve already passed it three times, hopefully that means I know what I’m doing. One side will argue that it’s purely greed, as the people who run the boards need money and a way to justify their existence. On the other side are those who argue that maintenance of certification, while not perfect, is the only way we have of making sure practicing physicians are staying up to snuff.

The truth, as always, is somewhere in between.

But it still raises a question that I, fortunately, have another 8 years to think about. Because I’m not in a position to debate if it’s right or wrong, I just have to play by the rules.

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

I passed the neurology boards, for the first time, in 1998. Then again in 2009, and most recently in 2019.

So I’m up again in 2029. Regrettably, I missed grandfathering in for life by a few years.

Some people don’t study for them, but I’m a little too compulsive not to. I’d guess I put 40-50 hours into doing so in the 3 months beforehand. I didn’t want to fail and have to pay a hefty fee to retake them (the test fee for once is enough as it is).

I’ll be 63 when my next certification is due.

So I wonder (if I’m still in practice) will it even be worthwhile to do it all again? I like what I do, but certainly don’t plan on practicing forever.

Board certification looks good on paper, but certainly isn’t a requirement to practice. One of the best cardiologists I know has never bothered to get his board certification and I don’t think any less of him for it. He also isn’t wanting for patients, and those he has think he’s awesome.

That said, there are things, like being involved in research and legal work, where board certification is strongly recommended, if not mandatory. Since I do both, I certainly wouldn’t want to do anything that might affect my participating in them – if I’m still doing this in 8 years.

By the same token, my office lease runs out when I’m 62. At that point I’ll have been in the same place for 17 years. I don’t consider that a bad thing. I like my current office, and will be perfectly happy to wrap up my career here.

It brings up the same question, though, with logistics that are an even bigger PIA. The last thing I want to do is move my office as my career is winding down. But a lease extension for a few years can be negotiated, a board certification can’t.

I can’t help but wonder: What is the point of recertification over time? If I’ve already passed it three times, hopefully that means I know what I’m doing. One side will argue that it’s purely greed, as the people who run the boards need money and a way to justify their existence. On the other side are those who argue that maintenance of certification, while not perfect, is the only way we have of making sure practicing physicians are staying up to snuff.

The truth, as always, is somewhere in between.

But it still raises a question that I, fortunately, have another 8 years to think about. Because I’m not in a position to debate if it’s right or wrong, I just have to play by the rules.

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

I passed the neurology boards, for the first time, in 1998. Then again in 2009, and most recently in 2019.

So I’m up again in 2029. Regrettably, I missed grandfathering in for life by a few years.

Some people don’t study for them, but I’m a little too compulsive not to. I’d guess I put 40-50 hours into doing so in the 3 months beforehand. I didn’t want to fail and have to pay a hefty fee to retake them (the test fee for once is enough as it is).

I’ll be 63 when my next certification is due.

So I wonder (if I’m still in practice) will it even be worthwhile to do it all again? I like what I do, but certainly don’t plan on practicing forever.

Board certification looks good on paper, but certainly isn’t a requirement to practice. One of the best cardiologists I know has never bothered to get his board certification and I don’t think any less of him for it. He also isn’t wanting for patients, and those he has think he’s awesome.

That said, there are things, like being involved in research and legal work, where board certification is strongly recommended, if not mandatory. Since I do both, I certainly wouldn’t want to do anything that might affect my participating in them – if I’m still doing this in 8 years.

By the same token, my office lease runs out when I’m 62. At that point I’ll have been in the same place for 17 years. I don’t consider that a bad thing. I like my current office, and will be perfectly happy to wrap up my career here.

It brings up the same question, though, with logistics that are an even bigger PIA. The last thing I want to do is move my office as my career is winding down. But a lease extension for a few years can be negotiated, a board certification can’t.

I can’t help but wonder: What is the point of recertification over time? If I’ve already passed it three times, hopefully that means I know what I’m doing. One side will argue that it’s purely greed, as the people who run the boards need money and a way to justify their existence. On the other side are those who argue that maintenance of certification, while not perfect, is the only way we have of making sure practicing physicians are staying up to snuff.

The truth, as always, is somewhere in between.

But it still raises a question that I, fortunately, have another 8 years to think about. Because I’m not in a position to debate if it’s right or wrong, I just have to play by the rules.

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

I got an interesting fax recently.

It started with how tough things have been for small practices during the pandemic (like I need reminding) and suggests it has solutions for my practice to stay afloat.

I’m used to all kinds of these approaches, and was going to toss the fax, but decided to read on out of curiosity. I assumed it was an advertisement for a loan company, or to sell vitamins out of my office.

This one, surprisingly, suggested I buy gadgets that would allow me to “balance uneven skin tones,” “shrink pores,” “eliminate freckles and stretch marks,” and do “laser vaginal resurfacing”

Are you kidding me?

First of all, I try very hard to stay in my lane. I’m a neurologist, hopefully a competent one, and have no desire to go beyond that. Imagine how bad this would look in a legal case: I’d be pretty hard pressed to convince a malpractice lawyer and jury that “eliminating stretch marks” and “laser vaginal resurfacing” are within the scope and training of your average neurologist.

Second, I don’t see this sort of thing as reflecting well on me. Patients come here to be treated for Parkinson’s disease, strokes, and epilepsy. If I tried to change the appointment’s topic to “those issues are minor, let’s talk about your stretch marks” I’m pretty sure they’d be looking for a new neurologist. And, when it got back to the physician who referred them, so would she.

Third, my patients are tightening their belts like everyone else in this pandemic-associated economic downturn. Suddenly trying to sell them on a pricey cash-pay procedure, let alone one that’s pretty far out of my field, isn’t going to fly. Like my own family they’re watching every penny right now and shrinking pores is at the bottom of their financial priorities. If they really want that done I’d to happy to refer them to a dermatologist.

Not surprisingly, I tossed the fax. Caring for my patients is challenging enough when I stick to what I do best. Trying to push procedures I have no business doing, solely to pry extra money out of them, isn’t just outside my field, It’s flat-out wrong.

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

I got an interesting fax recently.

It started with how tough things have been for small practices during the pandemic (like I need reminding) and suggests it has solutions for my practice to stay afloat.

I’m used to all kinds of these approaches, and was going to toss the fax, but decided to read on out of curiosity. I assumed it was an advertisement for a loan company, or to sell vitamins out of my office.

This one, surprisingly, suggested I buy gadgets that would allow me to “balance uneven skin tones,” “shrink pores,” “eliminate freckles and stretch marks,” and do “laser vaginal resurfacing”

Are you kidding me?

First of all, I try very hard to stay in my lane. I’m a neurologist, hopefully a competent one, and have no desire to go beyond that. Imagine how bad this would look in a legal case: I’d be pretty hard pressed to convince a malpractice lawyer and jury that “eliminating stretch marks” and “laser vaginal resurfacing” are within the scope and training of your average neurologist.

Second, I don’t see this sort of thing as reflecting well on me. Patients come here to be treated for Parkinson’s disease, strokes, and epilepsy. If I tried to change the appointment’s topic to “those issues are minor, let’s talk about your stretch marks” I’m pretty sure they’d be looking for a new neurologist. And, when it got back to the physician who referred them, so would she.

Third, my patients are tightening their belts like everyone else in this pandemic-associated economic downturn. Suddenly trying to sell them on a pricey cash-pay procedure, let alone one that’s pretty far out of my field, isn’t going to fly. Like my own family they’re watching every penny right now and shrinking pores is at the bottom of their financial priorities. If they really want that done I’d to happy to refer them to a dermatologist.

Not surprisingly, I tossed the fax. Caring for my patients is challenging enough when I stick to what I do best. Trying to push procedures I have no business doing, solely to pry extra money out of them, isn’t just outside my field, It’s flat-out wrong.

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

I got an interesting fax recently.

It started with how tough things have been for small practices during the pandemic (like I need reminding) and suggests it has solutions for my practice to stay afloat.

I’m used to all kinds of these approaches, and was going to toss the fax, but decided to read on out of curiosity. I assumed it was an advertisement for a loan company, or to sell vitamins out of my office.

This one, surprisingly, suggested I buy gadgets that would allow me to “balance uneven skin tones,” “shrink pores,” “eliminate freckles and stretch marks,” and do “laser vaginal resurfacing”

Are you kidding me?

First of all, I try very hard to stay in my lane. I’m a neurologist, hopefully a competent one, and have no desire to go beyond that. Imagine how bad this would look in a legal case: I’d be pretty hard pressed to convince a malpractice lawyer and jury that “eliminating stretch marks” and “laser vaginal resurfacing” are within the scope and training of your average neurologist.

Second, I don’t see this sort of thing as reflecting well on me. Patients come here to be treated for Parkinson’s disease, strokes, and epilepsy. If I tried to change the appointment’s topic to “those issues are minor, let’s talk about your stretch marks” I’m pretty sure they’d be looking for a new neurologist. And, when it got back to the physician who referred them, so would she.

Third, my patients are tightening their belts like everyone else in this pandemic-associated economic downturn. Suddenly trying to sell them on a pricey cash-pay procedure, let alone one that’s pretty far out of my field, isn’t going to fly. Like my own family they’re watching every penny right now and shrinking pores is at the bottom of their financial priorities. If they really want that done I’d to happy to refer them to a dermatologist.

Not surprisingly, I tossed the fax. Caring for my patients is challenging enough when I stick to what I do best. Trying to push procedures I have no business doing, solely to pry extra money out of them, isn’t just outside my field, It’s flat-out wrong.

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

This time of year I spend weekend afternoons in my hot tub, catching up on medical journals, CME, paperbacks, and generally anything worth reading that shows up in my mailbox.

One of those items was the alumni news from my medical school. As usual, I leafed through it, reading articles of interest and glancing at updates on any classmates that were featured.

Then I stopped.

There, in the back of the magazine, was an obituary on the first of my classmates to pass (that I’m aware of).

I reread it a few times in disbelief. Maybe it was on her taking a new job or being promoted, and was in the wrong section. Nope.

I put the magazine down. She was 1 year younger than me and had gone into internal medicine. Not someone I’d kept in touch with, but certainly was friendly with during those 4 years and frequently chatted with in hallways or between classes. I remember meeting her during the first week of school, when I got her name mixed up with another girl’s in our class. I saw her at parties, meetings, and I think even played doubles tennis with her once, though who we played against I have no idea anymore.

She was at our 20th reunion, and we’d talked for a few minutes. We caught up on our lives since graduation and, as people do at these things, moved on to chat with others.

No details were given as to her death, and it really doesn’t matter.

We all face our own mortality sooner or later. For most of each day it’s a fact in the back of our minds, behind the daily activities of working, shopping, doing laundry, commuting, and cooking dinner. After all, it’s really what we do while here that matters, no matter how mundane it may seem.

But sometimes something will push that realization to the front, and make us remember how important every minute really is.

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

This time of year I spend weekend afternoons in my hot tub, catching up on medical journals, CME, paperbacks, and generally anything worth reading that shows up in my mailbox.

One of those items was the alumni news from my medical school. As usual, I leafed through it, reading articles of interest and glancing at updates on any classmates that were featured.

Then I stopped.

There, in the back of the magazine, was an obituary on the first of my classmates to pass (that I’m aware of).

I reread it a few times in disbelief. Maybe it was on her taking a new job or being promoted, and was in the wrong section. Nope.

I put the magazine down. She was 1 year younger than me and had gone into internal medicine. Not someone I’d kept in touch with, but certainly was friendly with during those 4 years and frequently chatted with in hallways or between classes. I remember meeting her during the first week of school, when I got her name mixed up with another girl’s in our class. I saw her at parties, meetings, and I think even played doubles tennis with her once, though who we played against I have no idea anymore.

She was at our 20th reunion, and we’d talked for a few minutes. We caught up on our lives since graduation and, as people do at these things, moved on to chat with others.

No details were given as to her death, and it really doesn’t matter.

We all face our own mortality sooner or later. For most of each day it’s a fact in the back of our minds, behind the daily activities of working, shopping, doing laundry, commuting, and cooking dinner. After all, it’s really what we do while here that matters, no matter how mundane it may seem.

But sometimes something will push that realization to the front, and make us remember how important every minute really is.

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

This time of year I spend weekend afternoons in my hot tub, catching up on medical journals, CME, paperbacks, and generally anything worth reading that shows up in my mailbox.

One of those items was the alumni news from my medical school. As usual, I leafed through it, reading articles of interest and glancing at updates on any classmates that were featured.

Then I stopped.

There, in the back of the magazine, was an obituary on the first of my classmates to pass (that I’m aware of).

I reread it a few times in disbelief. Maybe it was on her taking a new job or being promoted, and was in the wrong section. Nope.

I put the magazine down. She was 1 year younger than me and had gone into internal medicine. Not someone I’d kept in touch with, but certainly was friendly with during those 4 years and frequently chatted with in hallways or between classes. I remember meeting her during the first week of school, when I got her name mixed up with another girl’s in our class. I saw her at parties, meetings, and I think even played doubles tennis with her once, though who we played against I have no idea anymore.

She was at our 20th reunion, and we’d talked for a few minutes. We caught up on our lives since graduation and, as people do at these things, moved on to chat with others.

No details were given as to her death, and it really doesn’t matter.

We all face our own mortality sooner or later. For most of each day it’s a fact in the back of our minds, behind the daily activities of working, shopping, doing laundry, commuting, and cooking dinner. After all, it’s really what we do while here that matters, no matter how mundane it may seem.

But sometimes something will push that realization to the front, and make us remember how important every minute really is.

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

The January 2021 issue of JAMA Neurology had an article that stated that the current U.S. spending on emergency room (ER) and inpatient costs for patients with functional neurological disorders is $1.2 billion and climbing. That doesn’t include, obviously, the costs of treating functional disorders in other specialties.

Now, $1.2 billion is a pittance when you compare it with, say, the total costs of Alzheimer’s disease ($277 billion/year), but it’s still a lot of money. Especially when you consider that, unlike Alzheimer’s disease, a lot of the spending associated with functional disorders is avoidable.

The problem is that getting good psychiatric care isn’t easy, and that’s what many of these people really need. A lot of psychiatrists, including the excellent one my son sees, don’t take insurance. We’re fortunate to be able to pay for the visits, but most people aren’t. So the psychiatrists and mental health professionals who do accept insurance get rapidly overwhelmed and burned out, end up seeing their own psychiatrists, and then drop insurance plans, too.

Not only that, but insurers are willing to pay for these patients to go to ER and get labs and pricey imaging. At the same time mental health benefits are often limited or nonexistent, even when considerably less costly than the ER visits and imaging.

I don’t fault the ER doctors or hospitalists for ordering expensive tests on these patients. They often don’t know the patient and have to take them at face value. I’ve been there, too, when I’ve taken inpatient call. Someone comes in with a group of symptoms. You may be 99.999% sure they’re functional, but at the same time it’s not worth risking your medical license or malpractice premiums to just say that. Defensive medicine will always win that argument.

The trouble is that ER, and the inpatient setting, are often the worst possible places to be managing functional disorders. This is really a case where a stitch in time saves nine. The cost of their getting appropriate care to prevent underlying issues from driving them to ER is going to be less than the inevitable visit when they don’t.

That’s not to say these people might have a legitimate medical issue that should be evaluated – sometimes urgently. But once that’s off the table repeated ER visits and testing quickly become an exercise in futility and diminishing returns.

Mental illness is as real as any other disease, and needs appropriate care just as much. Many health care system payers need to recognize that, so these people can be treated appropriately from the beginning, and not end up shuttling between ERs, looking for an answer and help they aren’t equipped to provide at a cost that’s not sustainable.

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

The January 2021 issue of JAMA Neurology had an article that stated that the current U.S. spending on emergency room (ER) and inpatient costs for patients with functional neurological disorders is $1.2 billion and climbing. That doesn’t include, obviously, the costs of treating functional disorders in other specialties.

Now, $1.2 billion is a pittance when you compare it with, say, the total costs of Alzheimer’s disease ($277 billion/year), but it’s still a lot of money. Especially when you consider that, unlike Alzheimer’s disease, a lot of the spending associated with functional disorders is avoidable.

The problem is that getting good psychiatric care isn’t easy, and that’s what many of these people really need. A lot of psychiatrists, including the excellent one my son sees, don’t take insurance. We’re fortunate to be able to pay for the visits, but most people aren’t. So the psychiatrists and mental health professionals who do accept insurance get rapidly overwhelmed and burned out, end up seeing their own psychiatrists, and then drop insurance plans, too.

Not only that, but insurers are willing to pay for these patients to go to ER and get labs and pricey imaging. At the same time mental health benefits are often limited or nonexistent, even when considerably less costly than the ER visits and imaging.

I don’t fault the ER doctors or hospitalists for ordering expensive tests on these patients. They often don’t know the patient and have to take them at face value. I’ve been there, too, when I’ve taken inpatient call. Someone comes in with a group of symptoms. You may be 99.999% sure they’re functional, but at the same time it’s not worth risking your medical license or malpractice premiums to just say that. Defensive medicine will always win that argument.

The trouble is that ER, and the inpatient setting, are often the worst possible places to be managing functional disorders. This is really a case where a stitch in time saves nine. The cost of their getting appropriate care to prevent underlying issues from driving them to ER is going to be less than the inevitable visit when they don’t.

That’s not to say these people might have a legitimate medical issue that should be evaluated – sometimes urgently. But once that’s off the table repeated ER visits and testing quickly become an exercise in futility and diminishing returns.

Mental illness is as real as any other disease, and needs appropriate care just as much. Many health care system payers need to recognize that, so these people can be treated appropriately from the beginning, and not end up shuttling between ERs, looking for an answer and help they aren’t equipped to provide at a cost that’s not sustainable.

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

The January 2021 issue of JAMA Neurology had an article that stated that the current U.S. spending on emergency room (ER) and inpatient costs for patients with functional neurological disorders is $1.2 billion and climbing. That doesn’t include, obviously, the costs of treating functional disorders in other specialties.

Now, $1.2 billion is a pittance when you compare it with, say, the total costs of Alzheimer’s disease ($277 billion/year), but it’s still a lot of money. Especially when you consider that, unlike Alzheimer’s disease, a lot of the spending associated with functional disorders is avoidable.

The problem is that getting good psychiatric care isn’t easy, and that’s what many of these people really need. A lot of psychiatrists, including the excellent one my son sees, don’t take insurance. We’re fortunate to be able to pay for the visits, but most people aren’t. So the psychiatrists and mental health professionals who do accept insurance get rapidly overwhelmed and burned out, end up seeing their own psychiatrists, and then drop insurance plans, too.

Not only that, but insurers are willing to pay for these patients to go to ER and get labs and pricey imaging. At the same time mental health benefits are often limited or nonexistent, even when considerably less costly than the ER visits and imaging.

I don’t fault the ER doctors or hospitalists for ordering expensive tests on these patients. They often don’t know the patient and have to take them at face value. I’ve been there, too, when I’ve taken inpatient call. Someone comes in with a group of symptoms. You may be 99.999% sure they’re functional, but at the same time it’s not worth risking your medical license or malpractice premiums to just say that. Defensive medicine will always win that argument.

The trouble is that ER, and the inpatient setting, are often the worst possible places to be managing functional disorders. This is really a case where a stitch in time saves nine. The cost of their getting appropriate care to prevent underlying issues from driving them to ER is going to be less than the inevitable visit when they don’t.

That’s not to say these people might have a legitimate medical issue that should be evaluated – sometimes urgently. But once that’s off the table repeated ER visits and testing quickly become an exercise in futility and diminishing returns.

Mental illness is as real as any other disease, and needs appropriate care just as much. Many health care system payers need to recognize that, so these people can be treated appropriately from the beginning, and not end up shuttling between ERs, looking for an answer and help they aren’t equipped to provide at a cost that’s not sustainable.

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

How much do I make compared with other doctors?

I see questions like that on surveys I get, asking me to fill something out on the Internet, then I’ll get back a list of how well other docs in my field/city/state/blood type are doing.

Nah. I’ll pass.

Realistically, why? So I can feel I’m superior or inferior to others? Isn’t keeping up with the Joneses the purpose of the doctors’ parking lot at the hospital? (Actually, the number of pricey cars there has dropped off over time).

I really don’t want to know how much others make. It’s probably more than what I make, but that’s the trade-off I accepted when I went with a small solo practice instead of a large group 20 years ago.

We become so obsessed with the question of “how much money should I be making?” and comparing it with the salaries of others that we lose track of the real question: “How much money do I need?”

That should be the real number to look at. How much money do I really need to pay for a comfortable home, support my family, pay for my kids’ education, fund my retirement?

Enough should be as good as a feast.

Yet, even when content we get caught in the trap of comparing ourselves with others. This is human nature. We’re programmed to be competitive to survive. Whether that means anything when we don’t have to be hunters and gatherers is irrelevant. It is who we are.

But we’re also intelligent enough to realize that. I for one, don’t want to know, or care, how much money the neurologist down the street is earning. All that matters to me is how much I am earning, and if it supports what I need it to.

To quote Sheryl Crow, “it’s not having what you want, it’s wanting what you’ve got.”

So I’ll skip the comparisons and focus on the only people that really matter to me.

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

How much do I make compared with other doctors?

I see questions like that on surveys I get, asking me to fill something out on the Internet, then I’ll get back a list of how well other docs in my field/city/state/blood type are doing.

Nah. I’ll pass.

Realistically, why? So I can feel I’m superior or inferior to others? Isn’t keeping up with the Joneses the purpose of the doctors’ parking lot at the hospital? (Actually, the number of pricey cars there has dropped off over time).

I really don’t want to know how much others make. It’s probably more than what I make, but that’s the trade-off I accepted when I went with a small solo practice instead of a large group 20 years ago.

We become so obsessed with the question of “how much money should I be making?” and comparing it with the salaries of others that we lose track of the real question: “How much money do I need?”

That should be the real number to look at. How much money do I really need to pay for a comfortable home, support my family, pay for my kids’ education, fund my retirement?

Enough should be as good as a feast.

Yet, even when content we get caught in the trap of comparing ourselves with others. This is human nature. We’re programmed to be competitive to survive. Whether that means anything when we don’t have to be hunters and gatherers is irrelevant. It is who we are.

But we’re also intelligent enough to realize that. I for one, don’t want to know, or care, how much money the neurologist down the street is earning. All that matters to me is how much I am earning, and if it supports what I need it to.

To quote Sheryl Crow, “it’s not having what you want, it’s wanting what you’ve got.”

So I’ll skip the comparisons and focus on the only people that really matter to me.

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

How much do I make compared with other doctors?

I see questions like that on surveys I get, asking me to fill something out on the Internet, then I’ll get back a list of how well other docs in my field/city/state/blood type are doing.

Nah. I’ll pass.

Realistically, why? So I can feel I’m superior or inferior to others? Isn’t keeping up with the Joneses the purpose of the doctors’ parking lot at the hospital? (Actually, the number of pricey cars there has dropped off over time).

I really don’t want to know how much others make. It’s probably more than what I make, but that’s the trade-off I accepted when I went with a small solo practice instead of a large group 20 years ago.

We become so obsessed with the question of “how much money should I be making?” and comparing it with the salaries of others that we lose track of the real question: “How much money do I need?”

That should be the real number to look at. How much money do I really need to pay for a comfortable home, support my family, pay for my kids’ education, fund my retirement?

Enough should be as good as a feast.

Yet, even when content we get caught in the trap of comparing ourselves with others. This is human nature. We’re programmed to be competitive to survive. Whether that means anything when we don’t have to be hunters and gatherers is irrelevant. It is who we are.

But we’re also intelligent enough to realize that. I for one, don’t want to know, or care, how much money the neurologist down the street is earning. All that matters to me is how much I am earning, and if it supports what I need it to.

To quote Sheryl Crow, “it’s not having what you want, it’s wanting what you’ve got.”

So I’ll skip the comparisons and focus on the only people that really matter to me.

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

Recently I got a referral from another office and skimmed through it, as I always do, to make sure it’s something I handle in my little practice.

Overall it seemed pretty straightforward, but on page 3 were multiple notes that the patient adamantly refused to wear a mask to visits, or took one off as soon as she got back to an exam room and refused to put it back on. She also insisted on in-person, not video, visits. Staff members had documented that she told them masks were “stupid and worthless” and called people who insisted on them “idiots.”

I looked at the notes for a minute, then flagged them to indicate she is someone who shouldn’t be scheduled if she calls, forwarded them to my secretary, and moved on to my next patient.

Some might say this is discrimination, but I disagree. Although studies vary on the degree of efficacy, the overall data show that masks help prevent the wearer from spreading COVID-19 to others, to a lesser degree protect you from catching it from others, and are safe to use.

So I insist on patients wearing masks when they come to see me. The data on COVID-19 spreading through asymptomatic people is pretty solid, so those who say “I feel fine, so I don’t need to wear a mask” are only endangering others.

Certainly, people have the right to refuse masks, but currently the laws in my area require them in public, and I definitely require them in my little practice. I’m not calling the police if someone doesn’t wear one, but I’m not going to see them in my practice, either.

Like all other doctors, health care workers, and patients, I’m as susceptible to infectious disease as everyone else. If I’m sick, I can’t take care of others.

I’m not refusing to see the sick—far from it—but if I’m going to try to help you get better, then you should be willing to wear a mask to help protect me, too.

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

Recently I got a referral from another office and skimmed through it, as I always do, to make sure it’s something I handle in my little practice.

Overall it seemed pretty straightforward, but on page 3 were multiple notes that the patient adamantly refused to wear a mask to visits, or took one off as soon as she got back to an exam room and refused to put it back on. She also insisted on in-person, not video, visits. Staff members had documented that she told them masks were “stupid and worthless” and called people who insisted on them “idiots.”

I looked at the notes for a minute, then flagged them to indicate she is someone who shouldn’t be scheduled if she calls, forwarded them to my secretary, and moved on to my next patient.

Some might say this is discrimination, but I disagree. Although studies vary on the degree of efficacy, the overall data show that masks help prevent the wearer from spreading COVID-19 to others, to a lesser degree protect you from catching it from others, and are safe to use.

So I insist on patients wearing masks when they come to see me. The data on COVID-19 spreading through asymptomatic people is pretty solid, so those who say “I feel fine, so I don’t need to wear a mask” are only endangering others.

Certainly, people have the right to refuse masks, but currently the laws in my area require them in public, and I definitely require them in my little practice. I’m not calling the police if someone doesn’t wear one, but I’m not going to see them in my practice, either.

Like all other doctors, health care workers, and patients, I’m as susceptible to infectious disease as everyone else. If I’m sick, I can’t take care of others.

I’m not refusing to see the sick—far from it—but if I’m going to try to help you get better, then you should be willing to wear a mask to help protect me, too.

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

Recently I got a referral from another office and skimmed through it, as I always do, to make sure it’s something I handle in my little practice.

Overall it seemed pretty straightforward, but on page 3 were multiple notes that the patient adamantly refused to wear a mask to visits, or took one off as soon as she got back to an exam room and refused to put it back on. She also insisted on in-person, not video, visits. Staff members had documented that she told them masks were “stupid and worthless” and called people who insisted on them “idiots.”

I looked at the notes for a minute, then flagged them to indicate she is someone who shouldn’t be scheduled if she calls, forwarded them to my secretary, and moved on to my next patient.

Some might say this is discrimination, but I disagree. Although studies vary on the degree of efficacy, the overall data show that masks help prevent the wearer from spreading COVID-19 to others, to a lesser degree protect you from catching it from others, and are safe to use.

So I insist on patients wearing masks when they come to see me. The data on COVID-19 spreading through asymptomatic people is pretty solid, so those who say “I feel fine, so I don’t need to wear a mask” are only endangering others.

Certainly, people have the right to refuse masks, but currently the laws in my area require them in public, and I definitely require them in my little practice. I’m not calling the police if someone doesn’t wear one, but I’m not going to see them in my practice, either.

Like all other doctors, health care workers, and patients, I’m as susceptible to infectious disease as everyone else. If I’m sick, I can’t take care of others.

I’m not refusing to see the sick—far from it—but if I’m going to try to help you get better, then you should be willing to wear a mask to help protect me, too.

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