Hitting a Nerve

It’s not uncommon to read about neurologists of yore and be stunned, if not horrified, to think of what they had to work with.

Going back perhaps 100 years, it wasn’t uncommon for anyone with a head injury and hemiparesis to have one (or more) burr holes placed in hope of draining a subdural hematoma causing the symptoms.

In more recent memory was the dreaded ventriculogram, or pneumoencephalogram: A painful procedure in which a lumbar puncture was done in order to blow air bubbles into the spinal fluid, then use skull X-rays to watch them outline the ventricles and other structures to look for midline shift.

I remember one of my old teachers (RIP, Al) recalling that imaging in his younger era consisted of a cerebral angiogram to look for displaced vessels and an EEG for focal slowing.

The CT scan obviously changed all that, with its excellent noninvasive imaging of the brain, and the MRI made things even better by several orders of magnitude.

But where are we now? As frightening as the practices of 50-100 years ago may seem now, we have to keep in mind that, to the doctors using them, they were at the cutting edge of medical technology. They weren’t saying “this would be so much easier if the MRI had been invented.”

None of us can clearly see what the next big advances will be. We use what we have, knowing it’s the best we can do. As the leading philosopher of our era (Yogi Berra) said, “It’s tough to make predictions, especially about the future.”

So what will future doctors think of us? What tests will they look at and shudder, asking, “They actually DID that to people?”

I’m sure the CT-myelogram will be one of them. It is perhaps the last descendant of the pneumoencephalogram still in use; it’s done uncommonly, but still has value. For those who can’t have an MRI or where confirmation of an MRI is needed, it’s quite accurate.

What other tests will be considered archaic? The EMG/NCV [electromyogram and nerve conduction studies]? Lumbar puncture? Cerebral angiogram?

Of course, these are just in neurology. Every field is going to have a past test that today is looked upon with horror, and the knowledge that someday another generation will look at us the same way.

Like all scientific disciplines, what we do is based on the foundation laid by those before us, and it’s up to the next generation to push the horizon further back.

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

It’s not uncommon to read about neurologists of yore and be stunned, if not horrified, to think of what they had to work with.

Going back perhaps 100 years, it wasn’t uncommon for anyone with a head injury and hemiparesis to have one (or more) burr holes placed in hope of draining a subdural hematoma causing the symptoms.

In more recent memory was the dreaded ventriculogram, or pneumoencephalogram: A painful procedure in which a lumbar puncture was done in order to blow air bubbles into the spinal fluid, then use skull X-rays to watch them outline the ventricles and other structures to look for midline shift.

I remember one of my old teachers (RIP, Al) recalling that imaging in his younger era consisted of a cerebral angiogram to look for displaced vessels and an EEG for focal slowing.

The CT scan obviously changed all that, with its excellent noninvasive imaging of the brain, and the MRI made things even better by several orders of magnitude.

But where are we now? As frightening as the practices of 50-100 years ago may seem now, we have to keep in mind that, to the doctors using them, they were at the cutting edge of medical technology. They weren’t saying “this would be so much easier if the MRI had been invented.”

None of us can clearly see what the next big advances will be. We use what we have, knowing it’s the best we can do. As the leading philosopher of our era (Yogi Berra) said, “It’s tough to make predictions, especially about the future.”

So what will future doctors think of us? What tests will they look at and shudder, asking, “They actually DID that to people?”

I’m sure the CT-myelogram will be one of them. It is perhaps the last descendant of the pneumoencephalogram still in use; it’s done uncommonly, but still has value. For those who can’t have an MRI or where confirmation of an MRI is needed, it’s quite accurate.

What other tests will be considered archaic? The EMG/NCV [electromyogram and nerve conduction studies]? Lumbar puncture? Cerebral angiogram?

Of course, these are just in neurology. Every field is going to have a past test that today is looked upon with horror, and the knowledge that someday another generation will look at us the same way.

Like all scientific disciplines, what we do is based on the foundation laid by those before us, and it’s up to the next generation to push the horizon further back.

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

It’s not uncommon to read about neurologists of yore and be stunned, if not horrified, to think of what they had to work with.

Going back perhaps 100 years, it wasn’t uncommon for anyone with a head injury and hemiparesis to have one (or more) burr holes placed in hope of draining a subdural hematoma causing the symptoms.

In more recent memory was the dreaded ventriculogram, or pneumoencephalogram: A painful procedure in which a lumbar puncture was done in order to blow air bubbles into the spinal fluid, then use skull X-rays to watch them outline the ventricles and other structures to look for midline shift.

I remember one of my old teachers (RIP, Al) recalling that imaging in his younger era consisted of a cerebral angiogram to look for displaced vessels and an EEG for focal slowing.

The CT scan obviously changed all that, with its excellent noninvasive imaging of the brain, and the MRI made things even better by several orders of magnitude.

But where are we now? As frightening as the practices of 50-100 years ago may seem now, we have to keep in mind that, to the doctors using them, they were at the cutting edge of medical technology. They weren’t saying “this would be so much easier if the MRI had been invented.”

None of us can clearly see what the next big advances will be. We use what we have, knowing it’s the best we can do. As the leading philosopher of our era (Yogi Berra) said, “It’s tough to make predictions, especially about the future.”

So what will future doctors think of us? What tests will they look at and shudder, asking, “They actually DID that to people?”

I’m sure the CT-myelogram will be one of them. It is perhaps the last descendant of the pneumoencephalogram still in use; it’s done uncommonly, but still has value. For those who can’t have an MRI or where confirmation of an MRI is needed, it’s quite accurate.

What other tests will be considered archaic? The EMG/NCV [electromyogram and nerve conduction studies]? Lumbar puncture? Cerebral angiogram?

Of course, these are just in neurology. Every field is going to have a past test that today is looked upon with horror, and the knowledge that someday another generation will look at us the same way.

Like all scientific disciplines, what we do is based on the foundation laid by those before us, and it’s up to the next generation to push the horizon further back.

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

I’m not on Facebook, either professionally or personally.

My office doesn’t have a Twitter account.

In fact, my only nod to social media at all is a rarely updated LinkedIn page, which is really just a public CV.

Why, in this age of connectedness, do I hide from these things? One reason is time. There isn’t much of it in the course of a day. Between my practice (patients, dictations, forms, returning calls, reviewing tests, rinse, wash, repeat), my family (wife, kids, dogs, house), and all the other things that make up a day (driving, finances, bathing, sleep), I don’t have much extra time. I really have no desire to see what others had for breakfast, look at pictures of a distant cousin’s kids, or have an online political argument with in-laws.

Another reason is privacy. Most patients are good people, but there are scary ones, too. I don’t want them knowing my kids’ names, or what school they go to, or seeing their pictures. In this age trying to have a degree of personal privacy is hard enough. I don’t want to make it any easier for someone looking to cause trouble.

I have nothing against my patients. I like the majority of them. But I don’t want to be online friends with them, either. Practicing objective medicine requires a degree of emotional distance, and I don’t want to do anything to shorten that. Social media connections with someone may also clue you into their personal and political beliefs, and, as I’ve said before, I think knowing those about patients (and them knowing mine) can only make the relationship difficult.

And the last is from a medical-legal view. The definition of what constitutes medical advice seems to be quite vague, and I worry anything I innocuously post or tweet could be taken to mean that I had an established treating medical relationship with someone or that my malpractice carrier could raise my rates by saying I was doing online medicine.

There’s also the simple fact that anything can be interpreted in any way. I worry that something I might put up could be used against me in court. Let’s say a patient dies while I’m on vacation, and the family decides to sue. Pictures of me relaxing with my kids on the trip could be used to make me look like an uncaring, callous doctor, even if I had no idea what was going on back home.

I’ll keep my somewhat under-the-radar personal existence as it is. Others may feel I’m missing out on the wonders of the social age, but I’m happy with keeping my home life just that – at home.

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

I’m not on Facebook, either professionally or personally.

My office doesn’t have a Twitter account.

In fact, my only nod to social media at all is a rarely updated LinkedIn page, which is really just a public CV.

Why, in this age of connectedness, do I hide from these things? One reason is time. There isn’t much of it in the course of a day. Between my practice (patients, dictations, forms, returning calls, reviewing tests, rinse, wash, repeat), my family (wife, kids, dogs, house), and all the other things that make up a day (driving, finances, bathing, sleep), I don’t have much extra time. I really have no desire to see what others had for breakfast, look at pictures of a distant cousin’s kids, or have an online political argument with in-laws.

Another reason is privacy. Most patients are good people, but there are scary ones, too. I don’t want them knowing my kids’ names, or what school they go to, or seeing their pictures. In this age trying to have a degree of personal privacy is hard enough. I don’t want to make it any easier for someone looking to cause trouble.

I have nothing against my patients. I like the majority of them. But I don’t want to be online friends with them, either. Practicing objective medicine requires a degree of emotional distance, and I don’t want to do anything to shorten that. Social media connections with someone may also clue you into their personal and political beliefs, and, as I’ve said before, I think knowing those about patients (and them knowing mine) can only make the relationship difficult.

And the last is from a medical-legal view. The definition of what constitutes medical advice seems to be quite vague, and I worry anything I innocuously post or tweet could be taken to mean that I had an established treating medical relationship with someone or that my malpractice carrier could raise my rates by saying I was doing online medicine.

There’s also the simple fact that anything can be interpreted in any way. I worry that something I might put up could be used against me in court. Let’s say a patient dies while I’m on vacation, and the family decides to sue. Pictures of me relaxing with my kids on the trip could be used to make me look like an uncaring, callous doctor, even if I had no idea what was going on back home.

I’ll keep my somewhat under-the-radar personal existence as it is. Others may feel I’m missing out on the wonders of the social age, but I’m happy with keeping my home life just that – at home.

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

I’m not on Facebook, either professionally or personally.

My office doesn’t have a Twitter account.

In fact, my only nod to social media at all is a rarely updated LinkedIn page, which is really just a public CV.

Why, in this age of connectedness, do I hide from these things? One reason is time. There isn’t much of it in the course of a day. Between my practice (patients, dictations, forms, returning calls, reviewing tests, rinse, wash, repeat), my family (wife, kids, dogs, house), and all the other things that make up a day (driving, finances, bathing, sleep), I don’t have much extra time. I really have no desire to see what others had for breakfast, look at pictures of a distant cousin’s kids, or have an online political argument with in-laws.

Another reason is privacy. Most patients are good people, but there are scary ones, too. I don’t want them knowing my kids’ names, or what school they go to, or seeing their pictures. In this age trying to have a degree of personal privacy is hard enough. I don’t want to make it any easier for someone looking to cause trouble.

I have nothing against my patients. I like the majority of them. But I don’t want to be online friends with them, either. Practicing objective medicine requires a degree of emotional distance, and I don’t want to do anything to shorten that. Social media connections with someone may also clue you into their personal and political beliefs, and, as I’ve said before, I think knowing those about patients (and them knowing mine) can only make the relationship difficult.

And the last is from a medical-legal view. The definition of what constitutes medical advice seems to be quite vague, and I worry anything I innocuously post or tweet could be taken to mean that I had an established treating medical relationship with someone or that my malpractice carrier could raise my rates by saying I was doing online medicine.

There’s also the simple fact that anything can be interpreted in any way. I worry that something I might put up could be used against me in court. Let’s say a patient dies while I’m on vacation, and the family decides to sue. Pictures of me relaxing with my kids on the trip could be used to make me look like an uncaring, callous doctor, even if I had no idea what was going on back home.

I’ll keep my somewhat under-the-radar personal existence as it is. Others may feel I’m missing out on the wonders of the social age, but I’m happy with keeping my home life just that – at home.

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

Religion isn’t an uncommon topic in a doctor’s office, and mine is no exception. Patients often express their personal beliefs in difficult situations, and part of my job is to listen and support.

But when they ask me about my own, I don’t answer. I simply tell them that I don’t discuss such things with patients.

People can have pretty strong feelings about religion, and whether I agree or disagree with them doesn’t have a place in my office. Religion, like politics, opens a can of personal opinion worms that disrupts the doctor-patient relationship. It can make things unworkable.

The last thing I want, or need, during an appointment is a debate over evolution, the perennial Middle East crisis, or belief (or lack thereof) in a deity. There are plenty of good forums to argue such subjects, but my office isn’t one of them.

On rare occasions, someone calling for an appointment will ask about my religious orientation. My secretary has been told to say “I don’t know.” If that matters to you when you’re looking for a doctor, you’re probably better off going elsewhere.

I have nothing against social pleasantries. They’re part of the ordinary patter in my office, and help maintain a degree of doctor-patient comfort to let us talk openly. But religious beliefs are a topic that, with some people, can rapidly spiral out of control. On the rare occasions where they become acrimonious, it pretty much destroys the fabric of the professional relationship. So, my belief is that it’s best not to start in the first place.

Some find religion to be an important part of who they are, and I’m willing to listen to that and not be judgmental. But don’t expect me to share my own thoughts at an appointment. It’s not why either of us is there.

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

Religion isn’t an uncommon topic in a doctor’s office, and mine is no exception. Patients often express their personal beliefs in difficult situations, and part of my job is to listen and support.

But when they ask me about my own, I don’t answer. I simply tell them that I don’t discuss such things with patients.

People can have pretty strong feelings about religion, and whether I agree or disagree with them doesn’t have a place in my office. Religion, like politics, opens a can of personal opinion worms that disrupts the doctor-patient relationship. It can make things unworkable.

The last thing I want, or need, during an appointment is a debate over evolution, the perennial Middle East crisis, or belief (or lack thereof) in a deity. There are plenty of good forums to argue such subjects, but my office isn’t one of them.

On rare occasions, someone calling for an appointment will ask about my religious orientation. My secretary has been told to say “I don’t know.” If that matters to you when you’re looking for a doctor, you’re probably better off going elsewhere.

I have nothing against social pleasantries. They’re part of the ordinary patter in my office, and help maintain a degree of doctor-patient comfort to let us talk openly. But religious beliefs are a topic that, with some people, can rapidly spiral out of control. On the rare occasions where they become acrimonious, it pretty much destroys the fabric of the professional relationship. So, my belief is that it’s best not to start in the first place.

Some find religion to be an important part of who they are, and I’m willing to listen to that and not be judgmental. But don’t expect me to share my own thoughts at an appointment. It’s not why either of us is there.

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

Religion isn’t an uncommon topic in a doctor’s office, and mine is no exception. Patients often express their personal beliefs in difficult situations, and part of my job is to listen and support.

But when they ask me about my own, I don’t answer. I simply tell them that I don’t discuss such things with patients.

People can have pretty strong feelings about religion, and whether I agree or disagree with them doesn’t have a place in my office. Religion, like politics, opens a can of personal opinion worms that disrupts the doctor-patient relationship. It can make things unworkable.

The last thing I want, or need, during an appointment is a debate over evolution, the perennial Middle East crisis, or belief (or lack thereof) in a deity. There are plenty of good forums to argue such subjects, but my office isn’t one of them.

On rare occasions, someone calling for an appointment will ask about my religious orientation. My secretary has been told to say “I don’t know.” If that matters to you when you’re looking for a doctor, you’re probably better off going elsewhere.

I have nothing against social pleasantries. They’re part of the ordinary patter in my office, and help maintain a degree of doctor-patient comfort to let us talk openly. But religious beliefs are a topic that, with some people, can rapidly spiral out of control. On the rare occasions where they become acrimonious, it pretty much destroys the fabric of the professional relationship. So, my belief is that it’s best not to start in the first place.

Some find religion to be an important part of who they are, and I’m willing to listen to that and not be judgmental. But don’t expect me to share my own thoughts at an appointment. It’s not why either of us is there.

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

The TPA ambulance, armed with its own CT scanner, has arrived in the United States after several successful years in Germany.

Now what?

Like all new advances, it’s a difficult balance between costs and benefits. The money, in the end, is what it really comes down to. Will the cost of a CT ambulance, the equipment needed to send images to a radiologist, the extra training for EMTs, the price of stocking TPA on board, and maybe even having a neurologist on the ride (or telemedicine for one to see the patient) be offset by money saved on rehabilitation costs, better recoveries, fewer complications, even returning a patient to work?

I have no idea. I’m not sure anyone else does, either.

Certainly, I support the idea of improved stroke care. Although far from ideal, TPA is the only thing we have right now, and the sooner it’s given, the better. Most neurologists will agree. But who’s going to pay for this?

The insurance companies, obviously. But money is finite. What if we upgrade all these ambulances, only to find that there’s no significant cost savings on rehab and recovery when TPA is used in the field? Then the money comes out of doctors’ and nurses’ salaries, higher premiums for everyone, and a cutback in treatment for some other disorder. I’m pretty sure it won’t be taken out of an insurance executive’s year-end bonus.

And just try explaining that to the family of a stroke victim.

It’s not practical to put a CT scanner in every ambulance, so where do we put those so equipped? Again, there’s no easy answer. In areas with large retirement communities? Seems like a safe bet, but young people have strokes, too. Only in cities? More people live in cities, but those in rural areas may be too far from a hospital to receive TPA early. Shouldn’t they have one, too?

Who’s going to make the decision to send the TPA ambulance vs. the regular ambulance? That’s another tough question. The layman who calls in usually isn’t sure what’s going on, only that an ambulance is needed. The dispatcher often can’t tell over the phone if the patient has had a stroke, seizure, or psychogenic event. Should a neurologist or emergency medicine physician make the decision? Maybe, but how much extra time will it take to get one on the line? And, even then, they’ll be making a critical decision with sparse, secondhand information. What if the special ambulance is mistakenly sent to deal with a conversion disorder, only to have a legitimate stroke occur elsewhere when it’s no longer immediately available? That, inevitably, will lead to a lawsuit because the wrong ambulance was sent.

I’m not against the stroke ambulance – far from it – but there are still a lot questions to be answered. Putting a CT scanner and TPA in an ambulance is, comparatively, the easiest part.

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

The TPA ambulance, armed with its own CT scanner, has arrived in the United States after several successful years in Germany.

Now what?

Like all new advances, it’s a difficult balance between costs and benefits. The money, in the end, is what it really comes down to. Will the cost of a CT ambulance, the equipment needed to send images to a radiologist, the extra training for EMTs, the price of stocking TPA on board, and maybe even having a neurologist on the ride (or telemedicine for one to see the patient) be offset by money saved on rehabilitation costs, better recoveries, fewer complications, even returning a patient to work?

I have no idea. I’m not sure anyone else does, either.

Certainly, I support the idea of improved stroke care. Although far from ideal, TPA is the only thing we have right now, and the sooner it’s given, the better. Most neurologists will agree. But who’s going to pay for this?

The insurance companies, obviously. But money is finite. What if we upgrade all these ambulances, only to find that there’s no significant cost savings on rehab and recovery when TPA is used in the field? Then the money comes out of doctors’ and nurses’ salaries, higher premiums for everyone, and a cutback in treatment for some other disorder. I’m pretty sure it won’t be taken out of an insurance executive’s year-end bonus.

And just try explaining that to the family of a stroke victim.

It’s not practical to put a CT scanner in every ambulance, so where do we put those so equipped? Again, there’s no easy answer. In areas with large retirement communities? Seems like a safe bet, but young people have strokes, too. Only in cities? More people live in cities, but those in rural areas may be too far from a hospital to receive TPA early. Shouldn’t they have one, too?

Who’s going to make the decision to send the TPA ambulance vs. the regular ambulance? That’s another tough question. The layman who calls in usually isn’t sure what’s going on, only that an ambulance is needed. The dispatcher often can’t tell over the phone if the patient has had a stroke, seizure, or psychogenic event. Should a neurologist or emergency medicine physician make the decision? Maybe, but how much extra time will it take to get one on the line? And, even then, they’ll be making a critical decision with sparse, secondhand information. What if the special ambulance is mistakenly sent to deal with a conversion disorder, only to have a legitimate stroke occur elsewhere when it’s no longer immediately available? That, inevitably, will lead to a lawsuit because the wrong ambulance was sent.

I’m not against the stroke ambulance – far from it – but there are still a lot questions to be answered. Putting a CT scanner and TPA in an ambulance is, comparatively, the easiest part.

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

The TPA ambulance, armed with its own CT scanner, has arrived in the United States after several successful years in Germany.

Now what?

Like all new advances, it’s a difficult balance between costs and benefits. The money, in the end, is what it really comes down to. Will the cost of a CT ambulance, the equipment needed to send images to a radiologist, the extra training for EMTs, the price of stocking TPA on board, and maybe even having a neurologist on the ride (or telemedicine for one to see the patient) be offset by money saved on rehabilitation costs, better recoveries, fewer complications, even returning a patient to work?

I have no idea. I’m not sure anyone else does, either.

Certainly, I support the idea of improved stroke care. Although far from ideal, TPA is the only thing we have right now, and the sooner it’s given, the better. Most neurologists will agree. But who’s going to pay for this?

The insurance companies, obviously. But money is finite. What if we upgrade all these ambulances, only to find that there’s no significant cost savings on rehab and recovery when TPA is used in the field? Then the money comes out of doctors’ and nurses’ salaries, higher premiums for everyone, and a cutback in treatment for some other disorder. I’m pretty sure it won’t be taken out of an insurance executive’s year-end bonus.

And just try explaining that to the family of a stroke victim.

It’s not practical to put a CT scanner in every ambulance, so where do we put those so equipped? Again, there’s no easy answer. In areas with large retirement communities? Seems like a safe bet, but young people have strokes, too. Only in cities? More people live in cities, but those in rural areas may be too far from a hospital to receive TPA early. Shouldn’t they have one, too?

Who’s going to make the decision to send the TPA ambulance vs. the regular ambulance? That’s another tough question. The layman who calls in usually isn’t sure what’s going on, only that an ambulance is needed. The dispatcher often can’t tell over the phone if the patient has had a stroke, seizure, or psychogenic event. Should a neurologist or emergency medicine physician make the decision? Maybe, but how much extra time will it take to get one on the line? And, even then, they’ll be making a critical decision with sparse, secondhand information. What if the special ambulance is mistakenly sent to deal with a conversion disorder, only to have a legitimate stroke occur elsewhere when it’s no longer immediately available? That, inevitably, will lead to a lawsuit because the wrong ambulance was sent.

I’m not against the stroke ambulance – far from it – but there are still a lot questions to be answered. Putting a CT scanner and TPA in an ambulance is, comparatively, the easiest part.

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

Neurology, like any other field, has its share of tragic and incurable diseases. We do our best to shepherd patients and their families through a disorder by offering advice, symptomatic treatment, Family and Medical Leave Act signatures, and a shoulder.

But, inevitably, we come down to one of the most difficult discussions: the end game.

Hospice is never an easy subject to raise. I try to initiate the discussion in advance, so that the decisions and paperwork are in place.

One of the hardest parts is the misconception that hospice means you’re giving up: giving up on caring, giving up on hoping, giving up on treating. I work to try and overcome this.

Hospice may be a change in the treatment plan, but it’s still part of treatment. Finding a way to relieve suffering and provide comfortable surroundings in the final days, while often overlooked, is very important. Peace at a difficult time is sorely needed, more so than another round of tests or invasive procedures.

Yet, it’s not seen that way. Maybe this is cultural. Here, medicine is seen as a cutting-edge field, where there’s always something else that can be done: more scans, another hi-tech bioengineered drug, or some sort of amazing interventional procedure. Although we usually think of all the things we can do, it’s equally important to focus on what we should do. They aren’t always the same – a point that’s often lost.

Sometimes the best thing to do is … everything you can to just make someone comfortable. That’s not giving up. It’s recognizing when it becomes the right decision for the patient and not their family, friends, or anyone else. The patient is the one who really matters.

In an age when newer and flashier facilities and treatments are promoted, keeping the patient’s best interests in mind is critical. Sometimes we get blindsided by the amazing breakthroughs we didn’t have 20, 10, even 5 years ago. So we need to recognize when the best treatment is … to stop.

Quality of life extends all the way up to the moment of death. Part of our job is to keep the Grim Reaper away, but we inevitably lose. It is equally important, though, and sometimes forgotten, to keep the patient as comfortable as possible on the journey. And that isn’t giving up.

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

Neurology, like any other field, has its share of tragic and incurable diseases. We do our best to shepherd patients and their families through a disorder by offering advice, symptomatic treatment, Family and Medical Leave Act signatures, and a shoulder.

But, inevitably, we come down to one of the most difficult discussions: the end game.

Hospice is never an easy subject to raise. I try to initiate the discussion in advance, so that the decisions and paperwork are in place.

One of the hardest parts is the misconception that hospice means you’re giving up: giving up on caring, giving up on hoping, giving up on treating. I work to try and overcome this.

Hospice may be a change in the treatment plan, but it’s still part of treatment. Finding a way to relieve suffering and provide comfortable surroundings in the final days, while often overlooked, is very important. Peace at a difficult time is sorely needed, more so than another round of tests or invasive procedures.

Yet, it’s not seen that way. Maybe this is cultural. Here, medicine is seen as a cutting-edge field, where there’s always something else that can be done: more scans, another hi-tech bioengineered drug, or some sort of amazing interventional procedure. Although we usually think of all the things we can do, it’s equally important to focus on what we should do. They aren’t always the same – a point that’s often lost.

Sometimes the best thing to do is … everything you can to just make someone comfortable. That’s not giving up. It’s recognizing when it becomes the right decision for the patient and not their family, friends, or anyone else. The patient is the one who really matters.

In an age when newer and flashier facilities and treatments are promoted, keeping the patient’s best interests in mind is critical. Sometimes we get blindsided by the amazing breakthroughs we didn’t have 20, 10, even 5 years ago. So we need to recognize when the best treatment is … to stop.

Quality of life extends all the way up to the moment of death. Part of our job is to keep the Grim Reaper away, but we inevitably lose. It is equally important, though, and sometimes forgotten, to keep the patient as comfortable as possible on the journey. And that isn’t giving up.

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

Neurology, like any other field, has its share of tragic and incurable diseases. We do our best to shepherd patients and their families through a disorder by offering advice, symptomatic treatment, Family and Medical Leave Act signatures, and a shoulder.

But, inevitably, we come down to one of the most difficult discussions: the end game.

Hospice is never an easy subject to raise. I try to initiate the discussion in advance, so that the decisions and paperwork are in place.

One of the hardest parts is the misconception that hospice means you’re giving up: giving up on caring, giving up on hoping, giving up on treating. I work to try and overcome this.

Hospice may be a change in the treatment plan, but it’s still part of treatment. Finding a way to relieve suffering and provide comfortable surroundings in the final days, while often overlooked, is very important. Peace at a difficult time is sorely needed, more so than another round of tests or invasive procedures.

Yet, it’s not seen that way. Maybe this is cultural. Here, medicine is seen as a cutting-edge field, where there’s always something else that can be done: more scans, another hi-tech bioengineered drug, or some sort of amazing interventional procedure. Although we usually think of all the things we can do, it’s equally important to focus on what we should do. They aren’t always the same – a point that’s often lost.

Sometimes the best thing to do is … everything you can to just make someone comfortable. That’s not giving up. It’s recognizing when it becomes the right decision for the patient and not their family, friends, or anyone else. The patient is the one who really matters.

In an age when newer and flashier facilities and treatments are promoted, keeping the patient’s best interests in mind is critical. Sometimes we get blindsided by the amazing breakthroughs we didn’t have 20, 10, even 5 years ago. So we need to recognize when the best treatment is … to stop.

Quality of life extends all the way up to the moment of death. Part of our job is to keep the Grim Reaper away, but we inevitably lose. It is equally important, though, and sometimes forgotten, to keep the patient as comfortable as possible on the journey. And that isn’t giving up.

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

I say “Thank you” a lot to patients. And I mean it.

I like being a doctor. It’s something I always wanted to do. For all the difficulties that go along with it, I still enjoy the actual job of caring for those who come to me. They’re the reason I’m here, and they keep my practice afloat and let me do what I want in life.

Like any other business, I have competitors. In my area, people have a choice of neurologists, and I appreciate that they picked me. So I always try to thank them when walking up to checkout.

A big part of what makes the job rewarding are those who feel the same way about me. It’s always nice when they thank me for helping, or trying to help, or just listening. I try to be a good doctor, so I’m glad to have someone recognize that. In this field, you can’t make everyone happy, but if I can have a solid majority who understand that I’m doing my best for them, I’ll take it.

I’m not fishing for compliments, or gifts, or a parade. Experience has taught me that patients who are overly flattering are most likely not to mean it. If someone calls me too many wonderful things, I immediately worry about their ulterior motives. Are they looking for narcotics? Disability? A legal action?

But a simple, sincere, “Thank you” from a patient can make it all worthwhile. Even on a bad day, it’s still a bright spot. It’s nice to know I’m making a difference. When I get a small note or appreciative Christmas card from a patient, I save it. They go in a drawer to be taken out and read after a particularly rough time, to remind myself that I must be doing something right.

Being appreciated reminds me why I’m here, and that this was the right choice for me. It lets me know that I’m doing what I set out to do many years ago: to help people.

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

I say “Thank you” a lot to patients. And I mean it.

I like being a doctor. It’s something I always wanted to do. For all the difficulties that go along with it, I still enjoy the actual job of caring for those who come to me. They’re the reason I’m here, and they keep my practice afloat and let me do what I want in life.

Like any other business, I have competitors. In my area, people have a choice of neurologists, and I appreciate that they picked me. So I always try to thank them when walking up to checkout.

A big part of what makes the job rewarding are those who feel the same way about me. It’s always nice when they thank me for helping, or trying to help, or just listening. I try to be a good doctor, so I’m glad to have someone recognize that. In this field, you can’t make everyone happy, but if I can have a solid majority who understand that I’m doing my best for them, I’ll take it.

I’m not fishing for compliments, or gifts, or a parade. Experience has taught me that patients who are overly flattering are most likely not to mean it. If someone calls me too many wonderful things, I immediately worry about their ulterior motives. Are they looking for narcotics? Disability? A legal action?

But a simple, sincere, “Thank you” from a patient can make it all worthwhile. Even on a bad day, it’s still a bright spot. It’s nice to know I’m making a difference. When I get a small note or appreciative Christmas card from a patient, I save it. They go in a drawer to be taken out and read after a particularly rough time, to remind myself that I must be doing something right.

Being appreciated reminds me why I’m here, and that this was the right choice for me. It lets me know that I’m doing what I set out to do many years ago: to help people.

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

I say “Thank you” a lot to patients. And I mean it.

I like being a doctor. It’s something I always wanted to do. For all the difficulties that go along with it, I still enjoy the actual job of caring for those who come to me. They’re the reason I’m here, and they keep my practice afloat and let me do what I want in life.

Like any other business, I have competitors. In my area, people have a choice of neurologists, and I appreciate that they picked me. So I always try to thank them when walking up to checkout.

A big part of what makes the job rewarding are those who feel the same way about me. It’s always nice when they thank me for helping, or trying to help, or just listening. I try to be a good doctor, so I’m glad to have someone recognize that. In this field, you can’t make everyone happy, but if I can have a solid majority who understand that I’m doing my best for them, I’ll take it.

I’m not fishing for compliments, or gifts, or a parade. Experience has taught me that patients who are overly flattering are most likely not to mean it. If someone calls me too many wonderful things, I immediately worry about their ulterior motives. Are they looking for narcotics? Disability? A legal action?

But a simple, sincere, “Thank you” from a patient can make it all worthwhile. Even on a bad day, it’s still a bright spot. It’s nice to know I’m making a difference. When I get a small note or appreciative Christmas card from a patient, I save it. They go in a drawer to be taken out and read after a particularly rough time, to remind myself that I must be doing something right.

Being appreciated reminds me why I’m here, and that this was the right choice for me. It lets me know that I’m doing what I set out to do many years ago: to help people.

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

I moved offices in April 2014, for the first time in my career. Overall, it went quite smoothly.

But one problem persists, thanks to the Internet age.

The majority of search engines and rate-a-doc sites haven’t updated my address. I’ve e-mailed them about it, but get either no response or (even better) a response saying “We’ve reviewed your note and found our information is correct.” Apparently, I don’t know my correct address, in spite of driving there every day.

But what’s even more frustrating is when my patients follow these instructions. My secretary is quite conscientious about giving patients, new and old, the correct location when they make the appointment. My practice website even has a map.

Despite this, we still have a roughly 20% rate of people going to my old office across the street, then calling to see where we went. Worse, this even happens with patients who were never even seen at that office, yet have been to my new one several times.

Then they come in and yell at my staff for giving them the wrong address. They claim my website has the wrong address. It doesn’t, but I can’t control other sites.

The problem is that most don’t trust other people as much as they trust their phones. Rather than writing down my address when talking to my secretary, it’s easier to just tell Siri, “find Dr. Allan Block’s office.” Siri checks the Internet, where the majority of incorrect listings drown out my dinky little practice site. So people follow the phone’s instructions without questioning them. Even those who’ve previously been to this office, or think, “that doesn’t sound right,” will often follow the directions without question. After all, the Internet knows best.

I’m not knocking the rise of the smartphone. They’re awesome. I rely on Siri myself a great deal. But the phone is only as good as the data supplied, and isn’t capable of questioning it. If most sites list an incorrect address, then who am I to argue? I’m just the guy who’s actually renting the place.

The problem is that information itself is often unhelpful and misleading, and the Internet isn’t always right.

When I dictate an EEG report, I often end it with “clinical correlation is advised.” We need to keep that in mind for everyday life, too.

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

I moved offices in April 2014, for the first time in my career. Overall, it went quite smoothly.

But one problem persists, thanks to the Internet age.

The majority of search engines and rate-a-doc sites haven’t updated my address. I’ve e-mailed them about it, but get either no response or (even better) a response saying “We’ve reviewed your note and found our information is correct.” Apparently, I don’t know my correct address, in spite of driving there every day.

But what’s even more frustrating is when my patients follow these instructions. My secretary is quite conscientious about giving patients, new and old, the correct location when they make the appointment. My practice website even has a map.

Despite this, we still have a roughly 20% rate of people going to my old office across the street, then calling to see where we went. Worse, this even happens with patients who were never even seen at that office, yet have been to my new one several times.

Then they come in and yell at my staff for giving them the wrong address. They claim my website has the wrong address. It doesn’t, but I can’t control other sites.

The problem is that most don’t trust other people as much as they trust their phones. Rather than writing down my address when talking to my secretary, it’s easier to just tell Siri, “find Dr. Allan Block’s office.” Siri checks the Internet, where the majority of incorrect listings drown out my dinky little practice site. So people follow the phone’s instructions without questioning them. Even those who’ve previously been to this office, or think, “that doesn’t sound right,” will often follow the directions without question. After all, the Internet knows best.

I’m not knocking the rise of the smartphone. They’re awesome. I rely on Siri myself a great deal. But the phone is only as good as the data supplied, and isn’t capable of questioning it. If most sites list an incorrect address, then who am I to argue? I’m just the guy who’s actually renting the place.

The problem is that information itself is often unhelpful and misleading, and the Internet isn’t always right.

When I dictate an EEG report, I often end it with “clinical correlation is advised.” We need to keep that in mind for everyday life, too.

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

I moved offices in April 2014, for the first time in my career. Overall, it went quite smoothly.

But one problem persists, thanks to the Internet age.

The majority of search engines and rate-a-doc sites haven’t updated my address. I’ve e-mailed them about it, but get either no response or (even better) a response saying “We’ve reviewed your note and found our information is correct.” Apparently, I don’t know my correct address, in spite of driving there every day.

But what’s even more frustrating is when my patients follow these instructions. My secretary is quite conscientious about giving patients, new and old, the correct location when they make the appointment. My practice website even has a map.

Despite this, we still have a roughly 20% rate of people going to my old office across the street, then calling to see where we went. Worse, this even happens with patients who were never even seen at that office, yet have been to my new one several times.

Then they come in and yell at my staff for giving them the wrong address. They claim my website has the wrong address. It doesn’t, but I can’t control other sites.

The problem is that most don’t trust other people as much as they trust their phones. Rather than writing down my address when talking to my secretary, it’s easier to just tell Siri, “find Dr. Allan Block’s office.” Siri checks the Internet, where the majority of incorrect listings drown out my dinky little practice site. So people follow the phone’s instructions without questioning them. Even those who’ve previously been to this office, or think, “that doesn’t sound right,” will often follow the directions without question. After all, the Internet knows best.

I’m not knocking the rise of the smartphone. They’re awesome. I rely on Siri myself a great deal. But the phone is only as good as the data supplied, and isn’t capable of questioning it. If most sites list an incorrect address, then who am I to argue? I’m just the guy who’s actually renting the place.

The problem is that information itself is often unhelpful and misleading, and the Internet isn’t always right.

When I dictate an EEG report, I often end it with “clinical correlation is advised.” We need to keep that in mind for everyday life, too.

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

Buried under news of the terrible Charlie Hebdo terrorism murders was another serious attack. A doctor was shot and killed by an angry patient at a Texas VA hospital, who then took his own life.

I’m not trying to belittle the tragedy in Paris, but instead point out that medicine can be more hazardous than many realize.

We don’t intentionally try to offend, but in a field like this, it’s impossible to please everyone. People get upset that I can’t cure them or find a cause for their (medically unexplainable) symptoms, or won’t give them as many narcotics as they want. The unhappy ones never come back, or post an angry review on Yelp, or send a nasty letter, or some combination of the above.

But, occasionally, we get threats. They’re rare in an office practice, though I suspect surprisingly common in emergency department work. Most are empty threats to sue, but occasionally my staff and I get threatened with physical harm. While most are simply words, there’s really no easy way of knowing who will or won’t actually snap and carry them out.

We live in a society where guns are common, easily obtained, and affordable. So anyone might have one. Unless your office has a metal detector or does pat downs, you’re at risk (at least hypothetically). Putting up a sign that says “no guns allowed” isn’t going to stop anyone. Neither do laws to protect health professionals. Those who have decided to harm others don’t worry about such things.

For that matter, I have several patients who usually have a gun on them. Sometimes concealed, sometimes obvious. Does it bother me? Not at all. They’re all polite and pleasant, and I understand their reason for keeping one on hand.

But doctors, unfortunately, are easy targets for the irrational and armed. The shooting in El Paso occurred in a government hospital with armed security, and that certainly didn’t make a difference. We generally keep predictable hours, park in the same spaces, and our offices aren’t locked up. We do a job where trust is assumed, because people are coming to us for help and we’re here for their benefit.

Is there an answer? I know doctors who keep a handgun under their coats, or in their desks. In a perfect world, they wouldn’t need it, but our world is far from it. Being a doctor, whether you’re on the front line in the emergency department or hidden in a nameless medical plaza, can still be a dangerous business.

Medicine is a surprising field to think of as a hazardous one, but these days, sadly, it is.

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

Buried under news of the terrible Charlie Hebdo terrorism murders was another serious attack. A doctor was shot and killed by an angry patient at a Texas VA hospital, who then took his own life.

I’m not trying to belittle the tragedy in Paris, but instead point out that medicine can be more hazardous than many realize.

We don’t intentionally try to offend, but in a field like this, it’s impossible to please everyone. People get upset that I can’t cure them or find a cause for their (medically unexplainable) symptoms, or won’t give them as many narcotics as they want. The unhappy ones never come back, or post an angry review on Yelp, or send a nasty letter, or some combination of the above.

But, occasionally, we get threats. They’re rare in an office practice, though I suspect surprisingly common in emergency department work. Most are empty threats to sue, but occasionally my staff and I get threatened with physical harm. While most are simply words, there’s really no easy way of knowing who will or won’t actually snap and carry them out.

We live in a society where guns are common, easily obtained, and affordable. So anyone might have one. Unless your office has a metal detector or does pat downs, you’re at risk (at least hypothetically). Putting up a sign that says “no guns allowed” isn’t going to stop anyone. Neither do laws to protect health professionals. Those who have decided to harm others don’t worry about such things.

For that matter, I have several patients who usually have a gun on them. Sometimes concealed, sometimes obvious. Does it bother me? Not at all. They’re all polite and pleasant, and I understand their reason for keeping one on hand.

But doctors, unfortunately, are easy targets for the irrational and armed. The shooting in El Paso occurred in a government hospital with armed security, and that certainly didn’t make a difference. We generally keep predictable hours, park in the same spaces, and our offices aren’t locked up. We do a job where trust is assumed, because people are coming to us for help and we’re here for their benefit.

Is there an answer? I know doctors who keep a handgun under their coats, or in their desks. In a perfect world, they wouldn’t need it, but our world is far from it. Being a doctor, whether you’re on the front line in the emergency department or hidden in a nameless medical plaza, can still be a dangerous business.

Medicine is a surprising field to think of as a hazardous one, but these days, sadly, it is.

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

Buried under news of the terrible Charlie Hebdo terrorism murders was another serious attack. A doctor was shot and killed by an angry patient at a Texas VA hospital, who then took his own life.

I’m not trying to belittle the tragedy in Paris, but instead point out that medicine can be more hazardous than many realize.

We don’t intentionally try to offend, but in a field like this, it’s impossible to please everyone. People get upset that I can’t cure them or find a cause for their (medically unexplainable) symptoms, or won’t give them as many narcotics as they want. The unhappy ones never come back, or post an angry review on Yelp, or send a nasty letter, or some combination of the above.

But, occasionally, we get threats. They’re rare in an office practice, though I suspect surprisingly common in emergency department work. Most are empty threats to sue, but occasionally my staff and I get threatened with physical harm. While most are simply words, there’s really no easy way of knowing who will or won’t actually snap and carry them out.

We live in a society where guns are common, easily obtained, and affordable. So anyone might have one. Unless your office has a metal detector or does pat downs, you’re at risk (at least hypothetically). Putting up a sign that says “no guns allowed” isn’t going to stop anyone. Neither do laws to protect health professionals. Those who have decided to harm others don’t worry about such things.

For that matter, I have several patients who usually have a gun on them. Sometimes concealed, sometimes obvious. Does it bother me? Not at all. They’re all polite and pleasant, and I understand their reason for keeping one on hand.

But doctors, unfortunately, are easy targets for the irrational and armed. The shooting in El Paso occurred in a government hospital with armed security, and that certainly didn’t make a difference. We generally keep predictable hours, park in the same spaces, and our offices aren’t locked up. We do a job where trust is assumed, because people are coming to us for help and we’re here for their benefit.

Is there an answer? I know doctors who keep a handgun under their coats, or in their desks. In a perfect world, they wouldn’t need it, but our world is far from it. Being a doctor, whether you’re on the front line in the emergency department or hidden in a nameless medical plaza, can still be a dangerous business.

Medicine is a surprising field to think of as a hazardous one, but these days, sadly, it is.

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

There’s a lot in the news these days about doctor burnout. More specifically, neurologist burnout.

In a 2012 survey study, about 53% of neurologists reported burnout, which was third among all specialties surveyed, behind emergency medicine physicians and general internists. Neurologists also reported the fourth lowest job satisfaction with work-life balance, with about 41% satisfied that work leaves enough time for personal or family life. Neurology was the only one out of five specialties with the highest rates of burnout that was also among the five specialties with the lowest work-life balance.

Granted, the term “burnout” can mean a lot, but these days seems to refer to the fall of the American physician: Overworked, with rising costs, and falling reimbursements, sandwiched between patients who want to be cured immediately and those who want to sue us, and even on a good day facing a litany of terrible diseases.

Heck, I’d be burned out, too. Maybe I am.

Some say this is from the worries of solo practice, since we’re usually more pressed for time and money. I disagree, as I’ve seen it on both sides.

Recently, I saw my own internist. Six months ago she closed her own solo practice to join a large, hospital-owned group. She looked exhausted, worse than I’d ever seen her. She told me that she now gets a secure paycheck, but her stress level is worse. The hospital sets her schedule, tells her how much time she can spend with each patient, gives her quotas she has to meet, and has supplied an electronic health record (EHR) system that’s less than user friendly. (Personally, all of the ones I’ve tried are terrible.) When she goes home, she told me that now after dinner she still has to log on and do 2-3 more hours of charting just to catch up.

The grass is always greener. In her, I see a doctor who doesn’t have to watch each penny and worry about whether she’ll get a paycheck next week. In me, she looks at someone who’s free to pick their vacation days and isn’t chained to a quota system and a burdensome EHR.

Who’s right? I suppose it depends on what your life preferences are. Are we both burned out? We probably are, but in different ways.

But why the high rate of burnout for neurologists? Likely because of the issues I mentioned above. For myself, I’ve seen my salary drop 50% since its highest point in 2005. We’re faced with rising costs (like many other businesses). Unlike other professions, however, we don’t have much control over our reimbursement. Peculiar to medicine is the simple fact that what we charge has no bearing on what we get paid. Those rates are set by factors over which we have no control. Worse, they’re often set by politicians and insurance executives, who see us as the enemy.

There’s also the way reimbursements are set-up: they still favor docs who do a lot of procedures. While neurologists have a few, most of our job is thinking. And that’s not compensated nearly as well as jabbing needles and scalpels in people.

Then you get beyond financial issues. Many of us go through the day feeling like we have a target on our backs, in fear of patients becoming plaintiffs. What else? The nature of our field is such that we deal with diseases that are often challenging to diagnose and sometimes difficult, if not impossible, to treat. Yet, we still have to put on our best show and attitude for those afflicted. Part of why they come to us is to have questions answered and be given any glimmer of hope we can find.

In spite of this, the majority of us go on. Even burned out, we came here to help others. It’s part of what makes us tick and drives us to look in the mirror and head to the office. I wouldn’t trade what I do for anything. But I wish I could do it in a less adversarial world where I’m forced to choose between freedom and a (even temporary) sense of security.

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

There’s a lot in the news these days about doctor burnout. More specifically, neurologist burnout.

In a 2012 survey study, about 53% of neurologists reported burnout, which was third among all specialties surveyed, behind emergency medicine physicians and general internists. Neurologists also reported the fourth lowest job satisfaction with work-life balance, with about 41% satisfied that work leaves enough time for personal or family life. Neurology was the only one out of five specialties with the highest rates of burnout that was also among the five specialties with the lowest work-life balance.

Granted, the term “burnout” can mean a lot, but these days seems to refer to the fall of the American physician: Overworked, with rising costs, and falling reimbursements, sandwiched between patients who want to be cured immediately and those who want to sue us, and even on a good day facing a litany of terrible diseases.

Heck, I’d be burned out, too. Maybe I am.

Some say this is from the worries of solo practice, since we’re usually more pressed for time and money. I disagree, as I’ve seen it on both sides.

Recently, I saw my own internist. Six months ago she closed her own solo practice to join a large, hospital-owned group. She looked exhausted, worse than I’d ever seen her. She told me that she now gets a secure paycheck, but her stress level is worse. The hospital sets her schedule, tells her how much time she can spend with each patient, gives her quotas she has to meet, and has supplied an electronic health record (EHR) system that’s less than user friendly. (Personally, all of the ones I’ve tried are terrible.) When she goes home, she told me that now after dinner she still has to log on and do 2-3 more hours of charting just to catch up.

The grass is always greener. In her, I see a doctor who doesn’t have to watch each penny and worry about whether she’ll get a paycheck next week. In me, she looks at someone who’s free to pick their vacation days and isn’t chained to a quota system and a burdensome EHR.

Who’s right? I suppose it depends on what your life preferences are. Are we both burned out? We probably are, but in different ways.

But why the high rate of burnout for neurologists? Likely because of the issues I mentioned above. For myself, I’ve seen my salary drop 50% since its highest point in 2005. We’re faced with rising costs (like many other businesses). Unlike other professions, however, we don’t have much control over our reimbursement. Peculiar to medicine is the simple fact that what we charge has no bearing on what we get paid. Those rates are set by factors over which we have no control. Worse, they’re often set by politicians and insurance executives, who see us as the enemy.

There’s also the way reimbursements are set-up: they still favor docs who do a lot of procedures. While neurologists have a few, most of our job is thinking. And that’s not compensated nearly as well as jabbing needles and scalpels in people.

Then you get beyond financial issues. Many of us go through the day feeling like we have a target on our backs, in fear of patients becoming plaintiffs. What else? The nature of our field is such that we deal with diseases that are often challenging to diagnose and sometimes difficult, if not impossible, to treat. Yet, we still have to put on our best show and attitude for those afflicted. Part of why they come to us is to have questions answered and be given any glimmer of hope we can find.

In spite of this, the majority of us go on. Even burned out, we came here to help others. It’s part of what makes us tick and drives us to look in the mirror and head to the office. I wouldn’t trade what I do for anything. But I wish I could do it in a less adversarial world where I’m forced to choose between freedom and a (even temporary) sense of security.

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

There’s a lot in the news these days about doctor burnout. More specifically, neurologist burnout.

In a 2012 survey study, about 53% of neurologists reported burnout, which was third among all specialties surveyed, behind emergency medicine physicians and general internists. Neurologists also reported the fourth lowest job satisfaction with work-life balance, with about 41% satisfied that work leaves enough time for personal or family life. Neurology was the only one out of five specialties with the highest rates of burnout that was also among the five specialties with the lowest work-life balance.

Granted, the term “burnout” can mean a lot, but these days seems to refer to the fall of the American physician: Overworked, with rising costs, and falling reimbursements, sandwiched between patients who want to be cured immediately and those who want to sue us, and even on a good day facing a litany of terrible diseases.

Heck, I’d be burned out, too. Maybe I am.

Some say this is from the worries of solo practice, since we’re usually more pressed for time and money. I disagree, as I’ve seen it on both sides.

Recently, I saw my own internist. Six months ago she closed her own solo practice to join a large, hospital-owned group. She looked exhausted, worse than I’d ever seen her. She told me that she now gets a secure paycheck, but her stress level is worse. The hospital sets her schedule, tells her how much time she can spend with each patient, gives her quotas she has to meet, and has supplied an electronic health record (EHR) system that’s less than user friendly. (Personally, all of the ones I’ve tried are terrible.) When she goes home, she told me that now after dinner she still has to log on and do 2-3 more hours of charting just to catch up.

The grass is always greener. In her, I see a doctor who doesn’t have to watch each penny and worry about whether she’ll get a paycheck next week. In me, she looks at someone who’s free to pick their vacation days and isn’t chained to a quota system and a burdensome EHR.

Who’s right? I suppose it depends on what your life preferences are. Are we both burned out? We probably are, but in different ways.

But why the high rate of burnout for neurologists? Likely because of the issues I mentioned above. For myself, I’ve seen my salary drop 50% since its highest point in 2005. We’re faced with rising costs (like many other businesses). Unlike other professions, however, we don’t have much control over our reimbursement. Peculiar to medicine is the simple fact that what we charge has no bearing on what we get paid. Those rates are set by factors over which we have no control. Worse, they’re often set by politicians and insurance executives, who see us as the enemy.

There’s also the way reimbursements are set-up: they still favor docs who do a lot of procedures. While neurologists have a few, most of our job is thinking. And that’s not compensated nearly as well as jabbing needles and scalpels in people.

Then you get beyond financial issues. Many of us go through the day feeling like we have a target on our backs, in fear of patients becoming plaintiffs. What else? The nature of our field is such that we deal with diseases that are often challenging to diagnose and sometimes difficult, if not impossible, to treat. Yet, we still have to put on our best show and attitude for those afflicted. Part of why they come to us is to have questions answered and be given any glimmer of hope we can find.

In spite of this, the majority of us go on. Even burned out, we came here to help others. It’s part of what makes us tick and drives us to look in the mirror and head to the office. I wouldn’t trade what I do for anything. But I wish I could do it in a less adversarial world where I’m forced to choose between freedom and a (even temporary) sense of security.

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