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Too much to lose from office visit recording or filming
A common phrase you see on inspirational posters is “sing like nobody’s listening, dance like nobody’s watching.”
In medicine, it should be “speak as if everyone is recording, behave as if everyone is filming.”
In this day and age, you’d think that would be obvious. Every few hours there’s a viral video of someone getting upset, then losing their temper and saying something most of us would regret. A few years ago it would be a private matter, but today things are rapidly spread over Facebook and Twitter. Even if it’s entirely false, that doesn’t matter. It’s easy for anyone with a smartphone and apps to edit the clip to make it entirely different from what really happened. People go with their first reaction. By the time the facts come out, they’ve moved on and don’t care about the truth.
Occasionally, I get a request to record what I’m saying. In most cases I decline, and never allow myself to be filmed. I do this because anything can be altered, and unless I go to the effort to record it myself, I have no way to prove who’s telling the truth. So it’s easier just to not do it at all.
Unfortunately, this is often taken as “proof” of me trying to hide something. I’m certainly not. Being open and honest with patients is always something I focus on. But the truth of what happened in a 30- to 60-minute visit can be misconstrued in an edited, and possibly altered, sound bite of 5-10 seconds. People who want to do such things have their own motives and aren’t interested in reason or honesty.
Doctors, like everyone else, are susceptible to human emotions and reactions, but a big part of the job is keeping them controlled and hidden when working with patients. It’s the best way to make reasoned decisions and work with someone who’s frightened, angry, or irrational.
If you find yourself losing the battle to stay in control, sometimes it’s good to remember that your words and actions could be being recorded and posted on Facebook in an hour, whether you permitted it or not. Because you don’t want to learn the hard way.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
A common phrase you see on inspirational posters is “sing like nobody’s listening, dance like nobody’s watching.”
In medicine, it should be “speak as if everyone is recording, behave as if everyone is filming.”
In this day and age, you’d think that would be obvious. Every few hours there’s a viral video of someone getting upset, then losing their temper and saying something most of us would regret. A few years ago it would be a private matter, but today things are rapidly spread over Facebook and Twitter. Even if it’s entirely false, that doesn’t matter. It’s easy for anyone with a smartphone and apps to edit the clip to make it entirely different from what really happened. People go with their first reaction. By the time the facts come out, they’ve moved on and don’t care about the truth.
Occasionally, I get a request to record what I’m saying. In most cases I decline, and never allow myself to be filmed. I do this because anything can be altered, and unless I go to the effort to record it myself, I have no way to prove who’s telling the truth. So it’s easier just to not do it at all.
Unfortunately, this is often taken as “proof” of me trying to hide something. I’m certainly not. Being open and honest with patients is always something I focus on. But the truth of what happened in a 30- to 60-minute visit can be misconstrued in an edited, and possibly altered, sound bite of 5-10 seconds. People who want to do such things have their own motives and aren’t interested in reason or honesty.
Doctors, like everyone else, are susceptible to human emotions and reactions, but a big part of the job is keeping them controlled and hidden when working with patients. It’s the best way to make reasoned decisions and work with someone who’s frightened, angry, or irrational.
If you find yourself losing the battle to stay in control, sometimes it’s good to remember that your words and actions could be being recorded and posted on Facebook in an hour, whether you permitted it or not. Because you don’t want to learn the hard way.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
A common phrase you see on inspirational posters is “sing like nobody’s listening, dance like nobody’s watching.”
In medicine, it should be “speak as if everyone is recording, behave as if everyone is filming.”
In this day and age, you’d think that would be obvious. Every few hours there’s a viral video of someone getting upset, then losing their temper and saying something most of us would regret. A few years ago it would be a private matter, but today things are rapidly spread over Facebook and Twitter. Even if it’s entirely false, that doesn’t matter. It’s easy for anyone with a smartphone and apps to edit the clip to make it entirely different from what really happened. People go with their first reaction. By the time the facts come out, they’ve moved on and don’t care about the truth.
Occasionally, I get a request to record what I’m saying. In most cases I decline, and never allow myself to be filmed. I do this because anything can be altered, and unless I go to the effort to record it myself, I have no way to prove who’s telling the truth. So it’s easier just to not do it at all.
Unfortunately, this is often taken as “proof” of me trying to hide something. I’m certainly not. Being open and honest with patients is always something I focus on. But the truth of what happened in a 30- to 60-minute visit can be misconstrued in an edited, and possibly altered, sound bite of 5-10 seconds. People who want to do such things have their own motives and aren’t interested in reason or honesty.
Doctors, like everyone else, are susceptible to human emotions and reactions, but a big part of the job is keeping them controlled and hidden when working with patients. It’s the best way to make reasoned decisions and work with someone who’s frightened, angry, or irrational.
If you find yourself losing the battle to stay in control, sometimes it’s good to remember that your words and actions could be being recorded and posted on Facebook in an hour, whether you permitted it or not. Because you don’t want to learn the hard way.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
Unintended consequences in the drive to simplify computerized test ordering
“X marks the spot!”
It’s one of the classic pirate tropes, bringing to mind images of Long John Silver, buried treasure, and a secret map with an “X” to show the hidden gold.
Today that “X” (or, in some cases, a check mark or radio button) seems to be indicating where the money is to be lost, rather than found.
Hospital computer systems are increasingly reliant on preprogrammed order lists that you check off rather than the actual test itself. We’ve gone from having to write out the tests we want, to typing them into a box, to checking them off with a mouse.
I’ve seen systems where you’re offered a menu such as:
A. Brain MRI (noncontrast)
B. Brain MRI (w/wo contrast)
C. Head MRA (noncontrast)
D. Head MRA (with contrast)
E. Neck MRA (noncontrast)
F. Neck MRA (with contrast)
G. Brain MRI and head/neck MRA (noncontrast)
H. Brain MRI and head/neck MRA (w/wo contrast)
And that’s just for the brain and its vascular supply. Expand that to the rest of the nervous system, then to the whole body, then to other tests (labs) ... and you get the idea.
I suppose the driving force here is to make the system easier to use. Doctors are busy. It saves time just have to check a box if you want three tests, rather than note all of them individually.
But it’s really not that hard to check off three. Probably less than 5 seconds (as of my last time on call). And this is where, to me, X marks the spot where the money isn’t.
Humans, like most animals, are pretty good at defaulting to a low-energy setting. So if you only have to check off one box instead of three, or five, or whatever, why bother?
If the patient is being admitted for a stroke/TIA, then it makes sense to do the brain MRI and head/neck MRA. But what if it’s just headaches, or a new seizure, or a concussion? I see plenty of times when more tests are done than necessary, simply because the ordering physician either didn’t know what was really needed or because it was easier to just check the box.
This is not, in my experience, rare. I’d say anywhere from one-third to half of patients I’ve consulted on had an overkill neurological work-up, in which tests with no medical indications had been ordered. They’ve generally already been put in the system, or even done, before I get to the bedside.
I suppose one could say they should wait for the specialist to get there before any of the costly tests are ordered, but that opens up another can of worms. What if a critical finding that needed to be acted upon isn’t found in time because of such a rule? Not only that, but waiting for me to show up and order tests means it will take longer to get them done, adding onto the hospital stay, and (again) running up costs.
So that’s not an answer, either. There really isn’t one, unfortunately.
But, in our haste to make things easier, or faster, or even just flashier, the trend seems to be at the cost of doing things reasonably. At the same time that we’re trying to save money, the single “X” may be marking the spot where we’re actually throwing it away.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
“X marks the spot!”
It’s one of the classic pirate tropes, bringing to mind images of Long John Silver, buried treasure, and a secret map with an “X” to show the hidden gold.
Today that “X” (or, in some cases, a check mark or radio button) seems to be indicating where the money is to be lost, rather than found.
Hospital computer systems are increasingly reliant on preprogrammed order lists that you check off rather than the actual test itself. We’ve gone from having to write out the tests we want, to typing them into a box, to checking them off with a mouse.
I’ve seen systems where you’re offered a menu such as:
A. Brain MRI (noncontrast)
B. Brain MRI (w/wo contrast)
C. Head MRA (noncontrast)
D. Head MRA (with contrast)
E. Neck MRA (noncontrast)
F. Neck MRA (with contrast)
G. Brain MRI and head/neck MRA (noncontrast)
H. Brain MRI and head/neck MRA (w/wo contrast)
And that’s just for the brain and its vascular supply. Expand that to the rest of the nervous system, then to the whole body, then to other tests (labs) ... and you get the idea.
I suppose the driving force here is to make the system easier to use. Doctors are busy. It saves time just have to check a box if you want three tests, rather than note all of them individually.
But it’s really not that hard to check off three. Probably less than 5 seconds (as of my last time on call). And this is where, to me, X marks the spot where the money isn’t.
Humans, like most animals, are pretty good at defaulting to a low-energy setting. So if you only have to check off one box instead of three, or five, or whatever, why bother?
If the patient is being admitted for a stroke/TIA, then it makes sense to do the brain MRI and head/neck MRA. But what if it’s just headaches, or a new seizure, or a concussion? I see plenty of times when more tests are done than necessary, simply because the ordering physician either didn’t know what was really needed or because it was easier to just check the box.
This is not, in my experience, rare. I’d say anywhere from one-third to half of patients I’ve consulted on had an overkill neurological work-up, in which tests with no medical indications had been ordered. They’ve generally already been put in the system, or even done, before I get to the bedside.
I suppose one could say they should wait for the specialist to get there before any of the costly tests are ordered, but that opens up another can of worms. What if a critical finding that needed to be acted upon isn’t found in time because of such a rule? Not only that, but waiting for me to show up and order tests means it will take longer to get them done, adding onto the hospital stay, and (again) running up costs.
So that’s not an answer, either. There really isn’t one, unfortunately.
But, in our haste to make things easier, or faster, or even just flashier, the trend seems to be at the cost of doing things reasonably. At the same time that we’re trying to save money, the single “X” may be marking the spot where we’re actually throwing it away.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
“X marks the spot!”
It’s one of the classic pirate tropes, bringing to mind images of Long John Silver, buried treasure, and a secret map with an “X” to show the hidden gold.
Today that “X” (or, in some cases, a check mark or radio button) seems to be indicating where the money is to be lost, rather than found.
Hospital computer systems are increasingly reliant on preprogrammed order lists that you check off rather than the actual test itself. We’ve gone from having to write out the tests we want, to typing them into a box, to checking them off with a mouse.
I’ve seen systems where you’re offered a menu such as:
A. Brain MRI (noncontrast)
B. Brain MRI (w/wo contrast)
C. Head MRA (noncontrast)
D. Head MRA (with contrast)
E. Neck MRA (noncontrast)
F. Neck MRA (with contrast)
G. Brain MRI and head/neck MRA (noncontrast)
H. Brain MRI and head/neck MRA (w/wo contrast)
And that’s just for the brain and its vascular supply. Expand that to the rest of the nervous system, then to the whole body, then to other tests (labs) ... and you get the idea.
I suppose the driving force here is to make the system easier to use. Doctors are busy. It saves time just have to check a box if you want three tests, rather than note all of them individually.
But it’s really not that hard to check off three. Probably less than 5 seconds (as of my last time on call). And this is where, to me, X marks the spot where the money isn’t.
Humans, like most animals, are pretty good at defaulting to a low-energy setting. So if you only have to check off one box instead of three, or five, or whatever, why bother?
If the patient is being admitted for a stroke/TIA, then it makes sense to do the brain MRI and head/neck MRA. But what if it’s just headaches, or a new seizure, or a concussion? I see plenty of times when more tests are done than necessary, simply because the ordering physician either didn’t know what was really needed or because it was easier to just check the box.
This is not, in my experience, rare. I’d say anywhere from one-third to half of patients I’ve consulted on had an overkill neurological work-up, in which tests with no medical indications had been ordered. They’ve generally already been put in the system, or even done, before I get to the bedside.
I suppose one could say they should wait for the specialist to get there before any of the costly tests are ordered, but that opens up another can of worms. What if a critical finding that needed to be acted upon isn’t found in time because of such a rule? Not only that, but waiting for me to show up and order tests means it will take longer to get them done, adding onto the hospital stay, and (again) running up costs.
So that’s not an answer, either. There really isn’t one, unfortunately.
But, in our haste to make things easier, or faster, or even just flashier, the trend seems to be at the cost of doing things reasonably. At the same time that we’re trying to save money, the single “X” may be marking the spot where we’re actually throwing it away.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
Online vitriol’s expansion into doctor discussion sites
The web is full of doctor discussion sites. Sermo, Doximity, and many others. Each is slightly different, but the idea is similar. Give docs a place to joke, discuss cases, etc. A virtual doctors’ lounge.
Roughly 10 years ago I was active on Sermo. It was fun to check in a few days a week after work, ask questions about my own cases, and see if anyone had ideas on them, make a few suggestions on others, occasionally gripe about administrative issues at my hospital and commiserate about such online.
I don’t do that anymore.
This morning I logged in to see if anyone had previously encountered an unusual case, but was quickly pushed off by venom.
Yes, they do have a political discussion board, but staying away from politics is easier said than done online. Like mud, it tends to ooze into places it doesn’t belong. Even a routine post asking about new treatments for multiple sclerosis quickly degenerates. In a demonstration of Godwin’s Law, any comment about the pros and cons of a new agent devolves into a fight over government vs. private insurance, the United States’ vs. other countries’ health systems, and, inevitably, Trump, Obama, and name calling.
Makes it hard to actually kick around thoughts on Ocrevus (or whatever).
Generally, this won’t happen in a real doctors’ lounge because you know each other. Even if you’re not friends, people generally (not always) tend to be civil in person. Even differences are usually handled with a polite agreement to disagree.
I suspect the majority of people on Sermo and similar sites are reasonable and joined the sites for the same reasons I did. Unfortunately, we’ve been drowned out by a handful of angry voices who hijack these sites by posting intentionally inflammatory statements just to pick a fight or derail a thoughtful discussion on epilepsy management with nasty jabs relating medical issues directly to politics.
So my time using these sites has dropped. Occasionally, if I was bored, I’d log in to see if there were any interesting cases in my field, but even those often get dragged down by the angry as you try to contribute thoughts and answer questions in the comments.
Sadly, this has became the norm rather then the exception. For me, at least, it’s easier to just walk away entirely.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
The web is full of doctor discussion sites. Sermo, Doximity, and many others. Each is slightly different, but the idea is similar. Give docs a place to joke, discuss cases, etc. A virtual doctors’ lounge.
Roughly 10 years ago I was active on Sermo. It was fun to check in a few days a week after work, ask questions about my own cases, and see if anyone had ideas on them, make a few suggestions on others, occasionally gripe about administrative issues at my hospital and commiserate about such online.
I don’t do that anymore.
This morning I logged in to see if anyone had previously encountered an unusual case, but was quickly pushed off by venom.
Yes, they do have a political discussion board, but staying away from politics is easier said than done online. Like mud, it tends to ooze into places it doesn’t belong. Even a routine post asking about new treatments for multiple sclerosis quickly degenerates. In a demonstration of Godwin’s Law, any comment about the pros and cons of a new agent devolves into a fight over government vs. private insurance, the United States’ vs. other countries’ health systems, and, inevitably, Trump, Obama, and name calling.
Makes it hard to actually kick around thoughts on Ocrevus (or whatever).
Generally, this won’t happen in a real doctors’ lounge because you know each other. Even if you’re not friends, people generally (not always) tend to be civil in person. Even differences are usually handled with a polite agreement to disagree.
I suspect the majority of people on Sermo and similar sites are reasonable and joined the sites for the same reasons I did. Unfortunately, we’ve been drowned out by a handful of angry voices who hijack these sites by posting intentionally inflammatory statements just to pick a fight or derail a thoughtful discussion on epilepsy management with nasty jabs relating medical issues directly to politics.
So my time using these sites has dropped. Occasionally, if I was bored, I’d log in to see if there were any interesting cases in my field, but even those often get dragged down by the angry as you try to contribute thoughts and answer questions in the comments.
Sadly, this has became the norm rather then the exception. For me, at least, it’s easier to just walk away entirely.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
The web is full of doctor discussion sites. Sermo, Doximity, and many others. Each is slightly different, but the idea is similar. Give docs a place to joke, discuss cases, etc. A virtual doctors’ lounge.
Roughly 10 years ago I was active on Sermo. It was fun to check in a few days a week after work, ask questions about my own cases, and see if anyone had ideas on them, make a few suggestions on others, occasionally gripe about administrative issues at my hospital and commiserate about such online.
I don’t do that anymore.
This morning I logged in to see if anyone had previously encountered an unusual case, but was quickly pushed off by venom.
Yes, they do have a political discussion board, but staying away from politics is easier said than done online. Like mud, it tends to ooze into places it doesn’t belong. Even a routine post asking about new treatments for multiple sclerosis quickly degenerates. In a demonstration of Godwin’s Law, any comment about the pros and cons of a new agent devolves into a fight over government vs. private insurance, the United States’ vs. other countries’ health systems, and, inevitably, Trump, Obama, and name calling.
Makes it hard to actually kick around thoughts on Ocrevus (or whatever).
Generally, this won’t happen in a real doctors’ lounge because you know each other. Even if you’re not friends, people generally (not always) tend to be civil in person. Even differences are usually handled with a polite agreement to disagree.
I suspect the majority of people on Sermo and similar sites are reasonable and joined the sites for the same reasons I did. Unfortunately, we’ve been drowned out by a handful of angry voices who hijack these sites by posting intentionally inflammatory statements just to pick a fight or derail a thoughtful discussion on epilepsy management with nasty jabs relating medical issues directly to politics.
So my time using these sites has dropped. Occasionally, if I was bored, I’d log in to see if there were any interesting cases in my field, but even those often get dragged down by the angry as you try to contribute thoughts and answer questions in the comments.
Sadly, this has became the norm rather then the exception. For me, at least, it’s easier to just walk away entirely.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
One person’s snake oil is another’s improved bottom line
“I’d be a millionaire if I could get rid of my conscience.”
A friend of mine in obstetrics said that yesterday. We were talking about the various quackery products pushed over the Internet and in some stores. These things claim to heal anything from Parkinson’s disease to a broken heart, and are generally sold by someone without real medical training. Generally, they also include some comment about this being a cure that doctors are hiding from you.
Of course, all of this is untrue. If there were actually cure for some horrible neurologic disease, I’d be thrilled to prescribe it. I’m here to reduce suffering, not prolong it.
I get it. People want to believe there’s hope when there is none. Even if it’s just something like forgetting a broken relationship, they want to believe there’s a way to make it happen quickly and painlessly.
It would be nice if it worked that way, but it doesn’t. Worse, people in these unfortunate medical or emotional situations are often vulnerable to these sales pitches, and there’s no shortage of unscrupulous individuals willing to prey on them.
What bothers me most in these cases is when doctors, with training similar to mine, push these “remedies.” Often they’re sold in a case in the waiting room and recommended during the visit. I assume these physicians either have lost their conscience and don’t care, or over time have somehow convinced themselves that what they’re doing is right.
Having a doctor selling or endorsing such a product gives it a credibility that it usually won’t get from an average Internet huckster, even if it’s for the same thing.
I’m sure some doctors have convinced themselves that the product is harmless, and therefore falls under primum non nocere. But being harmless isn’t the same as being effective, which is what the patient wants.
Like my friend said, with the financial pressures modern physicians are under, it’s easy to look at things like this as a way to improve cash flow and the bottom line. But you can’t lose sight of the patients. They’re why we are here, and selling them a product that will do them no good isn’t right.
Hippocrates’ “Do no harm” is a key part of being a doctor, but Jiminy Cricket’s “always let your conscience be your guide” is part of being a good doctor. We should never forget that.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
“I’d be a millionaire if I could get rid of my conscience.”
A friend of mine in obstetrics said that yesterday. We were talking about the various quackery products pushed over the Internet and in some stores. These things claim to heal anything from Parkinson’s disease to a broken heart, and are generally sold by someone without real medical training. Generally, they also include some comment about this being a cure that doctors are hiding from you.
Of course, all of this is untrue. If there were actually cure for some horrible neurologic disease, I’d be thrilled to prescribe it. I’m here to reduce suffering, not prolong it.
I get it. People want to believe there’s hope when there is none. Even if it’s just something like forgetting a broken relationship, they want to believe there’s a way to make it happen quickly and painlessly.
It would be nice if it worked that way, but it doesn’t. Worse, people in these unfortunate medical or emotional situations are often vulnerable to these sales pitches, and there’s no shortage of unscrupulous individuals willing to prey on them.
What bothers me most in these cases is when doctors, with training similar to mine, push these “remedies.” Often they’re sold in a case in the waiting room and recommended during the visit. I assume these physicians either have lost their conscience and don’t care, or over time have somehow convinced themselves that what they’re doing is right.
Having a doctor selling or endorsing such a product gives it a credibility that it usually won’t get from an average Internet huckster, even if it’s for the same thing.
I’m sure some doctors have convinced themselves that the product is harmless, and therefore falls under primum non nocere. But being harmless isn’t the same as being effective, which is what the patient wants.
Like my friend said, with the financial pressures modern physicians are under, it’s easy to look at things like this as a way to improve cash flow and the bottom line. But you can’t lose sight of the patients. They’re why we are here, and selling them a product that will do them no good isn’t right.
Hippocrates’ “Do no harm” is a key part of being a doctor, but Jiminy Cricket’s “always let your conscience be your guide” is part of being a good doctor. We should never forget that.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
“I’d be a millionaire if I could get rid of my conscience.”
A friend of mine in obstetrics said that yesterday. We were talking about the various quackery products pushed over the Internet and in some stores. These things claim to heal anything from Parkinson’s disease to a broken heart, and are generally sold by someone without real medical training. Generally, they also include some comment about this being a cure that doctors are hiding from you.
Of course, all of this is untrue. If there were actually cure for some horrible neurologic disease, I’d be thrilled to prescribe it. I’m here to reduce suffering, not prolong it.
I get it. People want to believe there’s hope when there is none. Even if it’s just something like forgetting a broken relationship, they want to believe there’s a way to make it happen quickly and painlessly.
It would be nice if it worked that way, but it doesn’t. Worse, people in these unfortunate medical or emotional situations are often vulnerable to these sales pitches, and there’s no shortage of unscrupulous individuals willing to prey on them.
What bothers me most in these cases is when doctors, with training similar to mine, push these “remedies.” Often they’re sold in a case in the waiting room and recommended during the visit. I assume these physicians either have lost their conscience and don’t care, or over time have somehow convinced themselves that what they’re doing is right.
Having a doctor selling or endorsing such a product gives it a credibility that it usually won’t get from an average Internet huckster, even if it’s for the same thing.
I’m sure some doctors have convinced themselves that the product is harmless, and therefore falls under primum non nocere. But being harmless isn’t the same as being effective, which is what the patient wants.
Like my friend said, with the financial pressures modern physicians are under, it’s easy to look at things like this as a way to improve cash flow and the bottom line. But you can’t lose sight of the patients. They’re why we are here, and selling them a product that will do them no good isn’t right.
Hippocrates’ “Do no harm” is a key part of being a doctor, but Jiminy Cricket’s “always let your conscience be your guide” is part of being a good doctor. We should never forget that.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
Useful financial and efficiency advice to practices is hard to come by
This time of year the nonclinical medical journals are full of articles with titles like “Make This Your Best Financial Year!”
I read them January after January, but each year they remind me less of January 1st and more of February 2nd – Groundhog Day.
It seems you could republish the same article every year and change the title. All of them mention “collect patient copays” and “submit insurance billings promptly.” I had no idea some offices don’t. To me, this is like suggesting I pay my mortgage each month as a financial tip.
They inevitably also talk about improving my “web presence.” Most small practices don’t have an IT department. I’m it here. My modest (and that’s an exaggeration) web page has a 2003 picture of me that I desperately need to update but don’t have the time or expertise to do these days. People seem to think that small practices are wallowing in time and money, but realistically we have neither.
They also highlight all the free things we can do on the web, like a blog or Twitter account, to promote a practice. They fail to realize how much time it takes to regularly write a blog post. Twitter posts from most practices are either tripe such as “Remember – our office will be closed on Christmas!” or links to some recently published study about the importance of diet and exercise.
Besides, in this day and age pretty much anything can be taken as a claim of a doctor-patient relationship. There’s always someone looking to claim your seemingly innocuous blog post constituted harmful medical advice and try to sue you.
Turn my scheduling over to an online program for greater efficiency? No thanks, I’ll leave that to my awesome secretary. After 15 years here, she knows my personality and can quickly screen out people who will be a bad match for me. She also knows our patients and has a good gestalt for figuring how much time certain people will need. This prevents me from getting too far off schedule. She may not be as efficient as an online booking program, but she’s far more valuable. I’ll take quality over quantity any day.
Year in and year out, I see these same suggestions, which apply only to larger practices, or those run by incompetents, or both. I keep reading them, hoping I’ll glean something of value that might apply to me, but to date I haven’t found that.
Time is one of any practices’ most valuable assets. Instead of posting meaningless stuff online, or working on a better website, I’d rather invest my work time where it really belongs: on my patients.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
This time of year the nonclinical medical journals are full of articles with titles like “Make This Your Best Financial Year!”
I read them January after January, but each year they remind me less of January 1st and more of February 2nd – Groundhog Day.
It seems you could republish the same article every year and change the title. All of them mention “collect patient copays” and “submit insurance billings promptly.” I had no idea some offices don’t. To me, this is like suggesting I pay my mortgage each month as a financial tip.
They inevitably also talk about improving my “web presence.” Most small practices don’t have an IT department. I’m it here. My modest (and that’s an exaggeration) web page has a 2003 picture of me that I desperately need to update but don’t have the time or expertise to do these days. People seem to think that small practices are wallowing in time and money, but realistically we have neither.
They also highlight all the free things we can do on the web, like a blog or Twitter account, to promote a practice. They fail to realize how much time it takes to regularly write a blog post. Twitter posts from most practices are either tripe such as “Remember – our office will be closed on Christmas!” or links to some recently published study about the importance of diet and exercise.
Besides, in this day and age pretty much anything can be taken as a claim of a doctor-patient relationship. There’s always someone looking to claim your seemingly innocuous blog post constituted harmful medical advice and try to sue you.
Turn my scheduling over to an online program for greater efficiency? No thanks, I’ll leave that to my awesome secretary. After 15 years here, she knows my personality and can quickly screen out people who will be a bad match for me. She also knows our patients and has a good gestalt for figuring how much time certain people will need. This prevents me from getting too far off schedule. She may not be as efficient as an online booking program, but she’s far more valuable. I’ll take quality over quantity any day.
Year in and year out, I see these same suggestions, which apply only to larger practices, or those run by incompetents, or both. I keep reading them, hoping I’ll glean something of value that might apply to me, but to date I haven’t found that.
Time is one of any practices’ most valuable assets. Instead of posting meaningless stuff online, or working on a better website, I’d rather invest my work time where it really belongs: on my patients.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
This time of year the nonclinical medical journals are full of articles with titles like “Make This Your Best Financial Year!”
I read them January after January, but each year they remind me less of January 1st and more of February 2nd – Groundhog Day.
It seems you could republish the same article every year and change the title. All of them mention “collect patient copays” and “submit insurance billings promptly.” I had no idea some offices don’t. To me, this is like suggesting I pay my mortgage each month as a financial tip.
They inevitably also talk about improving my “web presence.” Most small practices don’t have an IT department. I’m it here. My modest (and that’s an exaggeration) web page has a 2003 picture of me that I desperately need to update but don’t have the time or expertise to do these days. People seem to think that small practices are wallowing in time and money, but realistically we have neither.
They also highlight all the free things we can do on the web, like a blog or Twitter account, to promote a practice. They fail to realize how much time it takes to regularly write a blog post. Twitter posts from most practices are either tripe such as “Remember – our office will be closed on Christmas!” or links to some recently published study about the importance of diet and exercise.
Besides, in this day and age pretty much anything can be taken as a claim of a doctor-patient relationship. There’s always someone looking to claim your seemingly innocuous blog post constituted harmful medical advice and try to sue you.
Turn my scheduling over to an online program for greater efficiency? No thanks, I’ll leave that to my awesome secretary. After 15 years here, she knows my personality and can quickly screen out people who will be a bad match for me. She also knows our patients and has a good gestalt for figuring how much time certain people will need. This prevents me from getting too far off schedule. She may not be as efficient as an online booking program, but she’s far more valuable. I’ll take quality over quantity any day.
Year in and year out, I see these same suggestions, which apply only to larger practices, or those run by incompetents, or both. I keep reading them, hoping I’ll glean something of value that might apply to me, but to date I haven’t found that.
Time is one of any practices’ most valuable assets. Instead of posting meaningless stuff online, or working on a better website, I’d rather invest my work time where it really belongs: on my patients.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
Looking back to reflect on how far we’ve come
During the holiday break I took some time to organize a lot of old family pictures: deleting duplicates, merging those I pulled off my dad’s computer when he died (which was over 5 years ago), importing ones I took with old digital cameras that were in separate folders ... a bunch of stuff. Some were even childhood pics of me that had been scanned into digital formats. Lots of gigabytes. Lots of time spent watching the little “importing” wheel spin.
As I scrolled through them – literally 5,891 pics and 679 videos – I watched as it became more than a bunch of photos. I watched myself grow up, go through medical school, get married, raise a family. My hair went from brown to gray and receding. My kids went from toddlers to young adults about to leave for college.
It was the story of my life. Without meaning to, it’s what the pictures had become.
It was late at night, but I kept scrolling back and forth. My parents, wife, and others aged in front of me.
Looking in the mirror, or seeing others each day, we never notice the slow changes that time brings. You don’t really see it just thumbing through old photos, either.
But here, in the photos app (something entirely undreamed of in my childhood), I was watching it like it was a movie. Even childhood pictures of my parents. Them dating and getting married. Holding me after bringing me home from the hospital.
I’m certainly not the first to have these thoughts, nor will I be the last. We all go through life in a somewhat organized yet haphazard way, and only when looking backward do we really see how far we’ve come ... often realizing we’re past the halfway point.
Not that this is a bad thing. I mean, that’s life on Earth. It has its good and bad, and aging is part of the rules for all of us.
I suppose you could look at this in terms of our profession. We all (or at least most of us) start out as hospital patients. As we get older and become doctors, hopefully we need to see our own kind less often while at the same time seeing others as patients. As time goes by, most of us start to need to see doctors again, and as we retire and stop practicing medicine, we move back toward being patients ourselves.
For me, the pictures bring back memories and strike emotions in the way hearing or reading stories never can. They give new life to long-forgotten thoughts. Happy and sad, but overall a feeling of contentment that, so far, I feel like I’ve done more good than bad, more right than wrong.
I hope I always feel that way.
I hope everyone else does, too.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
During the holiday break I took some time to organize a lot of old family pictures: deleting duplicates, merging those I pulled off my dad’s computer when he died (which was over 5 years ago), importing ones I took with old digital cameras that were in separate folders ... a bunch of stuff. Some were even childhood pics of me that had been scanned into digital formats. Lots of gigabytes. Lots of time spent watching the little “importing” wheel spin.
As I scrolled through them – literally 5,891 pics and 679 videos – I watched as it became more than a bunch of photos. I watched myself grow up, go through medical school, get married, raise a family. My hair went from brown to gray and receding. My kids went from toddlers to young adults about to leave for college.
It was the story of my life. Without meaning to, it’s what the pictures had become.
It was late at night, but I kept scrolling back and forth. My parents, wife, and others aged in front of me.
Looking in the mirror, or seeing others each day, we never notice the slow changes that time brings. You don’t really see it just thumbing through old photos, either.
But here, in the photos app (something entirely undreamed of in my childhood), I was watching it like it was a movie. Even childhood pictures of my parents. Them dating and getting married. Holding me after bringing me home from the hospital.
I’m certainly not the first to have these thoughts, nor will I be the last. We all go through life in a somewhat organized yet haphazard way, and only when looking backward do we really see how far we’ve come ... often realizing we’re past the halfway point.
Not that this is a bad thing. I mean, that’s life on Earth. It has its good and bad, and aging is part of the rules for all of us.
I suppose you could look at this in terms of our profession. We all (or at least most of us) start out as hospital patients. As we get older and become doctors, hopefully we need to see our own kind less often while at the same time seeing others as patients. As time goes by, most of us start to need to see doctors again, and as we retire and stop practicing medicine, we move back toward being patients ourselves.
For me, the pictures bring back memories and strike emotions in the way hearing or reading stories never can. They give new life to long-forgotten thoughts. Happy and sad, but overall a feeling of contentment that, so far, I feel like I’ve done more good than bad, more right than wrong.
I hope I always feel that way.
I hope everyone else does, too.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
During the holiday break I took some time to organize a lot of old family pictures: deleting duplicates, merging those I pulled off my dad’s computer when he died (which was over 5 years ago), importing ones I took with old digital cameras that were in separate folders ... a bunch of stuff. Some were even childhood pics of me that had been scanned into digital formats. Lots of gigabytes. Lots of time spent watching the little “importing” wheel spin.
As I scrolled through them – literally 5,891 pics and 679 videos – I watched as it became more than a bunch of photos. I watched myself grow up, go through medical school, get married, raise a family. My hair went from brown to gray and receding. My kids went from toddlers to young adults about to leave for college.
It was the story of my life. Without meaning to, it’s what the pictures had become.
It was late at night, but I kept scrolling back and forth. My parents, wife, and others aged in front of me.
Looking in the mirror, or seeing others each day, we never notice the slow changes that time brings. You don’t really see it just thumbing through old photos, either.
But here, in the photos app (something entirely undreamed of in my childhood), I was watching it like it was a movie. Even childhood pictures of my parents. Them dating and getting married. Holding me after bringing me home from the hospital.
I’m certainly not the first to have these thoughts, nor will I be the last. We all go through life in a somewhat organized yet haphazard way, and only when looking backward do we really see how far we’ve come ... often realizing we’re past the halfway point.
Not that this is a bad thing. I mean, that’s life on Earth. It has its good and bad, and aging is part of the rules for all of us.
I suppose you could look at this in terms of our profession. We all (or at least most of us) start out as hospital patients. As we get older and become doctors, hopefully we need to see our own kind less often while at the same time seeing others as patients. As time goes by, most of us start to need to see doctors again, and as we retire and stop practicing medicine, we move back toward being patients ourselves.
For me, the pictures bring back memories and strike emotions in the way hearing or reading stories never can. They give new life to long-forgotten thoughts. Happy and sad, but overall a feeling of contentment that, so far, I feel like I’ve done more good than bad, more right than wrong.
I hope I always feel that way.
I hope everyone else does, too.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
Putting up with abusive patients? That’s not for me.
I’ll put up with a lot in this practice, but I will not tolerate mistreatment of my staff.
Rudeness, while never pleasant, is generally tolerated. Some people just have that sort of personality. Others may be having a crappy day for unrelated reasons. We all have those.
But those who are intentionally abusive of my hardworking assistants aren’t going to get very far here. I have no problem telling them to go elsewhere. (This doesn’t include those with neurologic reasons for such behavior.)
Some doctors are more willing to put up with this than I am. I once shared space with one who routinely told his staff to ignore abusive behaviors. He didn’t want to turn away any potential revenue or risk angering a referring doctor.
I take another view. Life is short, and medical practice is, by nature, hectic. I have little enough time to care for the patients who genuinely appreciate what my staff and I are trying to do for them. People who are abusive and belligerent can find another doctor who’s willing to put up with it. I won’t.
My staff and I don’t expect to be thanked. We all signed up to work here. But we also try to treat patients with concern and respect, and ask the same courtesy in return. Isn’t that the golden rule?
Abusive patients are difficult to deal with, time consuming, and contribute to staff burnout. The two awesome women who work here deserve better than that. If they’re not happy, I’m not happy. All it takes is one bad person to throw the day off kilter and sometimes affect the care of the next patient in line. That person deserves better, too.
Some will argue that, as a doctor, I should care for all who need my help. In the hospital, I do. I understand that people there generally are scared and hurting and do not want to be there. But in my office I expect at least some degree of civility. We have to be at our best for each person who comes in, and having patients we can work with on a polite level helps.
There’s enough insanity in this job on a good day. People who intentionally try to make it worse aren’t welcome in my little world.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
I’ll put up with a lot in this practice, but I will not tolerate mistreatment of my staff.
Rudeness, while never pleasant, is generally tolerated. Some people just have that sort of personality. Others may be having a crappy day for unrelated reasons. We all have those.
But those who are intentionally abusive of my hardworking assistants aren’t going to get very far here. I have no problem telling them to go elsewhere. (This doesn’t include those with neurologic reasons for such behavior.)
Some doctors are more willing to put up with this than I am. I once shared space with one who routinely told his staff to ignore abusive behaviors. He didn’t want to turn away any potential revenue or risk angering a referring doctor.
I take another view. Life is short, and medical practice is, by nature, hectic. I have little enough time to care for the patients who genuinely appreciate what my staff and I are trying to do for them. People who are abusive and belligerent can find another doctor who’s willing to put up with it. I won’t.
My staff and I don’t expect to be thanked. We all signed up to work here. But we also try to treat patients with concern and respect, and ask the same courtesy in return. Isn’t that the golden rule?
Abusive patients are difficult to deal with, time consuming, and contribute to staff burnout. The two awesome women who work here deserve better than that. If they’re not happy, I’m not happy. All it takes is one bad person to throw the day off kilter and sometimes affect the care of the next patient in line. That person deserves better, too.
Some will argue that, as a doctor, I should care for all who need my help. In the hospital, I do. I understand that people there generally are scared and hurting and do not want to be there. But in my office I expect at least some degree of civility. We have to be at our best for each person who comes in, and having patients we can work with on a polite level helps.
There’s enough insanity in this job on a good day. People who intentionally try to make it worse aren’t welcome in my little world.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
I’ll put up with a lot in this practice, but I will not tolerate mistreatment of my staff.
Rudeness, while never pleasant, is generally tolerated. Some people just have that sort of personality. Others may be having a crappy day for unrelated reasons. We all have those.
But those who are intentionally abusive of my hardworking assistants aren’t going to get very far here. I have no problem telling them to go elsewhere. (This doesn’t include those with neurologic reasons for such behavior.)
Some doctors are more willing to put up with this than I am. I once shared space with one who routinely told his staff to ignore abusive behaviors. He didn’t want to turn away any potential revenue or risk angering a referring doctor.
I take another view. Life is short, and medical practice is, by nature, hectic. I have little enough time to care for the patients who genuinely appreciate what my staff and I are trying to do for them. People who are abusive and belligerent can find another doctor who’s willing to put up with it. I won’t.
My staff and I don’t expect to be thanked. We all signed up to work here. But we also try to treat patients with concern and respect, and ask the same courtesy in return. Isn’t that the golden rule?
Abusive patients are difficult to deal with, time consuming, and contribute to staff burnout. The two awesome women who work here deserve better than that. If they’re not happy, I’m not happy. All it takes is one bad person to throw the day off kilter and sometimes affect the care of the next patient in line. That person deserves better, too.
Some will argue that, as a doctor, I should care for all who need my help. In the hospital, I do. I understand that people there generally are scared and hurting and do not want to be there. But in my office I expect at least some degree of civility. We have to be at our best for each person who comes in, and having patients we can work with on a polite level helps.
There’s enough insanity in this job on a good day. People who intentionally try to make it worse aren’t welcome in my little world.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
Patient treatment expectations can outweigh equivocal effectiveness data
I’m getting old and starting to fall apart. Recently, I suffered a lumbar radiculopathy when I injured myself sneezing. (No, really, I did.)
So, as time went by and I didn’t get better, I began looking stuff up. When patients come to me for this, I go through the standard conservative regimen of NSAIDs, physical therapy, steroid tapers ... the standard stuff.
But, when I began looking these things up, I was surprised to find out how much of what we do (at least for lumbar radiculopathy) is taken on faith.
I went through UpToDate, the modern Bible of medicine.
NSAIDs and acetaminophen, to my surprise, have only marginal proof of efficacy for acute lumbosacral radiculopathy pain. Several pooled analyses showed a nonsignificant trend to support their use, and the quality of the data was considered to be low.
Likewise, physical therapy also had “no convincing evidence that such treatments are effective for this indication.” Admittedly, some of the data may be affected by the difficulty in doing sham therapy as part of a placebo controlled-trial.
An oral steroid taper? Again, similar, equivocal data. Marginal improvement in functional capabilities, no improvement in pain, and no improvement in the rate of surgery at 1 year out.
But these are the things that I, and likely most family doctors, physiatrists, and other neurologists recommend on a daily basis. And, in all likelihood, will continue to do so.
Why?
Overall, they are benign when used correctly and in the right patients. That isn’t to say everyone should get them. All drugs have issues, and patients have to be carefully matched to specific treatments.
But, in the grand scheme of “do no harm,” physical therapy, NSAIDs, acetaminophen, or a few days of steroids are reasonably harmless. There certainly are some patients who will benefit, and none of these approaches have clearly been shown to be dangerous.
There’s also patient expectations. They didn’t come to us, or shell out a copay, to be told that “nothing helps, give it time.” We’re the doctors, and they want us to DO SOMETHING. So even if these treatments may be placebos, they still help if for no other reason than (as Voltaire said) to amuse the patient while nature cures the disease.
And getting them better is, after all, a big part of our job.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
I’m getting old and starting to fall apart. Recently, I suffered a lumbar radiculopathy when I injured myself sneezing. (No, really, I did.)
So, as time went by and I didn’t get better, I began looking stuff up. When patients come to me for this, I go through the standard conservative regimen of NSAIDs, physical therapy, steroid tapers ... the standard stuff.
But, when I began looking these things up, I was surprised to find out how much of what we do (at least for lumbar radiculopathy) is taken on faith.
I went through UpToDate, the modern Bible of medicine.
NSAIDs and acetaminophen, to my surprise, have only marginal proof of efficacy for acute lumbosacral radiculopathy pain. Several pooled analyses showed a nonsignificant trend to support their use, and the quality of the data was considered to be low.
Likewise, physical therapy also had “no convincing evidence that such treatments are effective for this indication.” Admittedly, some of the data may be affected by the difficulty in doing sham therapy as part of a placebo controlled-trial.
An oral steroid taper? Again, similar, equivocal data. Marginal improvement in functional capabilities, no improvement in pain, and no improvement in the rate of surgery at 1 year out.
But these are the things that I, and likely most family doctors, physiatrists, and other neurologists recommend on a daily basis. And, in all likelihood, will continue to do so.
Why?
Overall, they are benign when used correctly and in the right patients. That isn’t to say everyone should get them. All drugs have issues, and patients have to be carefully matched to specific treatments.
But, in the grand scheme of “do no harm,” physical therapy, NSAIDs, acetaminophen, or a few days of steroids are reasonably harmless. There certainly are some patients who will benefit, and none of these approaches have clearly been shown to be dangerous.
There’s also patient expectations. They didn’t come to us, or shell out a copay, to be told that “nothing helps, give it time.” We’re the doctors, and they want us to DO SOMETHING. So even if these treatments may be placebos, they still help if for no other reason than (as Voltaire said) to amuse the patient while nature cures the disease.
And getting them better is, after all, a big part of our job.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
I’m getting old and starting to fall apart. Recently, I suffered a lumbar radiculopathy when I injured myself sneezing. (No, really, I did.)
So, as time went by and I didn’t get better, I began looking stuff up. When patients come to me for this, I go through the standard conservative regimen of NSAIDs, physical therapy, steroid tapers ... the standard stuff.
But, when I began looking these things up, I was surprised to find out how much of what we do (at least for lumbar radiculopathy) is taken on faith.
I went through UpToDate, the modern Bible of medicine.
NSAIDs and acetaminophen, to my surprise, have only marginal proof of efficacy for acute lumbosacral radiculopathy pain. Several pooled analyses showed a nonsignificant trend to support their use, and the quality of the data was considered to be low.
Likewise, physical therapy also had “no convincing evidence that such treatments are effective for this indication.” Admittedly, some of the data may be affected by the difficulty in doing sham therapy as part of a placebo controlled-trial.
An oral steroid taper? Again, similar, equivocal data. Marginal improvement in functional capabilities, no improvement in pain, and no improvement in the rate of surgery at 1 year out.
But these are the things that I, and likely most family doctors, physiatrists, and other neurologists recommend on a daily basis. And, in all likelihood, will continue to do so.
Why?
Overall, they are benign when used correctly and in the right patients. That isn’t to say everyone should get them. All drugs have issues, and patients have to be carefully matched to specific treatments.
But, in the grand scheme of “do no harm,” physical therapy, NSAIDs, acetaminophen, or a few days of steroids are reasonably harmless. There certainly are some patients who will benefit, and none of these approaches have clearly been shown to be dangerous.
There’s also patient expectations. They didn’t come to us, or shell out a copay, to be told that “nothing helps, give it time.” We’re the doctors, and they want us to DO SOMETHING. So even if these treatments may be placebos, they still help if for no other reason than (as Voltaire said) to amuse the patient while nature cures the disease.
And getting them better is, after all, a big part of our job.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
The price we pay for trying to see more and more patients
In the October 2018 issue of Medscape Business of Medicine, the question was asked, “How can you practice quality medicine if you’re being asked to see patients every 15 minutes or less?”
I’m pretty sure the answer is, “you can’t.”
Yet, this is what many doctors are asked to do just to make ends meet. The majority of everyday medicine is, and always will be, a thinking game. It takes time to piece together the clues from a history and exam and decide what tests and/or treatment are the next step.
This ain’t easy. Even the shortest residencies require a combined 7 years of medical school and postgrad training. Experience and learning makes us all faster, but then the number of things that you can handle in 15 minutes is minimal. And that doesn’t even include the time needed to answer patient or family questions (which can be quite a lot) write up or transmit test orders or a prescription, and, inevitably, document the entire encounter in a meaningful way.
I don’t see patients at such a breakneck speed in my office, and yet I still end up doing most of my dictations after (or before) office hours.
In spite of lip service by politicians and administrators to correct the issue, medicine still continues to penalize those services that require thinking. And this task is the center of being a good doctor – and always has been.
Procedures are more lucrative, but imagine how my colleagues in neurosurgery would react if they were given a similar time limit on cases: A new patient has to be on the table every 15-30 minutes, and in that time you have to open, do the surgery, close, meet with family, and document the whole thing. Then get back in the OR (scrub, first) before the next case. Doesn’t matter whether you’re doing a lumbar fusion, glioma resection, or carotid endarterectomy. Those are the time limits. You get 30 minutes for lunch and to return calls. The administrator said so.
And this is where medicine continues to go. Overhead costs keep rising, and, for most docs, the only way they know to keep up is to keep cramming more patients into the day. Nobody wants to practice shoddy, hurried medicine, but neither do they want to lose their jobs to the next hungry graduate or close down a practice they spent years building.
I wish I had an answer. In fact, I think most of us do, but not one that will make patients, administrators, and doctors all happy. So the spiral continues.
And that isn’t good for patients, the people at the center of this job.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
In the October 2018 issue of Medscape Business of Medicine, the question was asked, “How can you practice quality medicine if you’re being asked to see patients every 15 minutes or less?”
I’m pretty sure the answer is, “you can’t.”
Yet, this is what many doctors are asked to do just to make ends meet. The majority of everyday medicine is, and always will be, a thinking game. It takes time to piece together the clues from a history and exam and decide what tests and/or treatment are the next step.
This ain’t easy. Even the shortest residencies require a combined 7 years of medical school and postgrad training. Experience and learning makes us all faster, but then the number of things that you can handle in 15 minutes is minimal. And that doesn’t even include the time needed to answer patient or family questions (which can be quite a lot) write up or transmit test orders or a prescription, and, inevitably, document the entire encounter in a meaningful way.
I don’t see patients at such a breakneck speed in my office, and yet I still end up doing most of my dictations after (or before) office hours.
In spite of lip service by politicians and administrators to correct the issue, medicine still continues to penalize those services that require thinking. And this task is the center of being a good doctor – and always has been.
Procedures are more lucrative, but imagine how my colleagues in neurosurgery would react if they were given a similar time limit on cases: A new patient has to be on the table every 15-30 minutes, and in that time you have to open, do the surgery, close, meet with family, and document the whole thing. Then get back in the OR (scrub, first) before the next case. Doesn’t matter whether you’re doing a lumbar fusion, glioma resection, or carotid endarterectomy. Those are the time limits. You get 30 minutes for lunch and to return calls. The administrator said so.
And this is where medicine continues to go. Overhead costs keep rising, and, for most docs, the only way they know to keep up is to keep cramming more patients into the day. Nobody wants to practice shoddy, hurried medicine, but neither do they want to lose their jobs to the next hungry graduate or close down a practice they spent years building.
I wish I had an answer. In fact, I think most of us do, but not one that will make patients, administrators, and doctors all happy. So the spiral continues.
And that isn’t good for patients, the people at the center of this job.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
In the October 2018 issue of Medscape Business of Medicine, the question was asked, “How can you practice quality medicine if you’re being asked to see patients every 15 minutes or less?”
I’m pretty sure the answer is, “you can’t.”
Yet, this is what many doctors are asked to do just to make ends meet. The majority of everyday medicine is, and always will be, a thinking game. It takes time to piece together the clues from a history and exam and decide what tests and/or treatment are the next step.
This ain’t easy. Even the shortest residencies require a combined 7 years of medical school and postgrad training. Experience and learning makes us all faster, but then the number of things that you can handle in 15 minutes is minimal. And that doesn’t even include the time needed to answer patient or family questions (which can be quite a lot) write up or transmit test orders or a prescription, and, inevitably, document the entire encounter in a meaningful way.
I don’t see patients at such a breakneck speed in my office, and yet I still end up doing most of my dictations after (or before) office hours.
In spite of lip service by politicians and administrators to correct the issue, medicine still continues to penalize those services that require thinking. And this task is the center of being a good doctor – and always has been.
Procedures are more lucrative, but imagine how my colleagues in neurosurgery would react if they were given a similar time limit on cases: A new patient has to be on the table every 15-30 minutes, and in that time you have to open, do the surgery, close, meet with family, and document the whole thing. Then get back in the OR (scrub, first) before the next case. Doesn’t matter whether you’re doing a lumbar fusion, glioma resection, or carotid endarterectomy. Those are the time limits. You get 30 minutes for lunch and to return calls. The administrator said so.
And this is where medicine continues to go. Overhead costs keep rising, and, for most docs, the only way they know to keep up is to keep cramming more patients into the day. Nobody wants to practice shoddy, hurried medicine, but neither do they want to lose their jobs to the next hungry graduate or close down a practice they spent years building.
I wish I had an answer. In fact, I think most of us do, but not one that will make patients, administrators, and doctors all happy. So the spiral continues.
And that isn’t good for patients, the people at the center of this job.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
Keeping the sample closet out of medication decisions
When I first began practice the COX-2 inhibitors had first come to market. My sample closet was awash with Celebrex and Vioxx.
I was young and naive. These drugs were allegedly safer than NSAIDs, so shouldn’t I be using them? They were new, and therefore had to be better, than plain old naproxen and ibuprofen. And hey, the samples were free.
As a result, I handed them out for pretty much all musculoskeletal stuff. “Here, try this ... ”
Of course, that came to a crashing halt when I encountered the realities of payers and drug coverage. No history of GI issues, no previous tries/fails ... Why on earth are you prescribing this? Obviously, the answer “because the samples were free” wasn’t going to pass muster.
Granted, history wasn’t particularly kind to the COX-2 drugs. Out of the three that made it to market, two were withdrawn and Celebrex’s star faded with them. But the lesson is still there.
Today, 20 years later, I use more generics. Maybe it’s because I’m familiar with them (many came to market during my career). Maybe it’s because years of calls from patients, pharmacies, and insurance companies have taught me to try them first. Probably a mixture of both.
This isn’t to say I don’t use branded drugs. I prescribe my share. There are plenty of times a generic isn’t appropriate, or a new approach is needed after a treatment failure.
But I’ve also learned that .
We learn a lot about the many different medications available in medical school and residency. But learning facts about dosing, side effects, and mechanisms of action (while quite important) is quite different from the practical aspect of learning what is more likely to be covered and affordable. Only the experience of everyday practice will teach that.
It sure taught me.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
When I first began practice the COX-2 inhibitors had first come to market. My sample closet was awash with Celebrex and Vioxx.
I was young and naive. These drugs were allegedly safer than NSAIDs, so shouldn’t I be using them? They were new, and therefore had to be better, than plain old naproxen and ibuprofen. And hey, the samples were free.
As a result, I handed them out for pretty much all musculoskeletal stuff. “Here, try this ... ”
Of course, that came to a crashing halt when I encountered the realities of payers and drug coverage. No history of GI issues, no previous tries/fails ... Why on earth are you prescribing this? Obviously, the answer “because the samples were free” wasn’t going to pass muster.
Granted, history wasn’t particularly kind to the COX-2 drugs. Out of the three that made it to market, two were withdrawn and Celebrex’s star faded with them. But the lesson is still there.
Today, 20 years later, I use more generics. Maybe it’s because I’m familiar with them (many came to market during my career). Maybe it’s because years of calls from patients, pharmacies, and insurance companies have taught me to try them first. Probably a mixture of both.
This isn’t to say I don’t use branded drugs. I prescribe my share. There are plenty of times a generic isn’t appropriate, or a new approach is needed after a treatment failure.
But I’ve also learned that .
We learn a lot about the many different medications available in medical school and residency. But learning facts about dosing, side effects, and mechanisms of action (while quite important) is quite different from the practical aspect of learning what is more likely to be covered and affordable. Only the experience of everyday practice will teach that.
It sure taught me.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
When I first began practice the COX-2 inhibitors had first come to market. My sample closet was awash with Celebrex and Vioxx.
I was young and naive. These drugs were allegedly safer than NSAIDs, so shouldn’t I be using them? They were new, and therefore had to be better, than plain old naproxen and ibuprofen. And hey, the samples were free.
As a result, I handed them out for pretty much all musculoskeletal stuff. “Here, try this ... ”
Of course, that came to a crashing halt when I encountered the realities of payers and drug coverage. No history of GI issues, no previous tries/fails ... Why on earth are you prescribing this? Obviously, the answer “because the samples were free” wasn’t going to pass muster.
Granted, history wasn’t particularly kind to the COX-2 drugs. Out of the three that made it to market, two were withdrawn and Celebrex’s star faded with them. But the lesson is still there.
Today, 20 years later, I use more generics. Maybe it’s because I’m familiar with them (many came to market during my career). Maybe it’s because years of calls from patients, pharmacies, and insurance companies have taught me to try them first. Probably a mixture of both.
This isn’t to say I don’t use branded drugs. I prescribe my share. There are plenty of times a generic isn’t appropriate, or a new approach is needed after a treatment failure.
But I’ve also learned that .
We learn a lot about the many different medications available in medical school and residency. But learning facts about dosing, side effects, and mechanisms of action (while quite important) is quite different from the practical aspect of learning what is more likely to be covered and affordable. Only the experience of everyday practice will teach that.
It sure taught me.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.