Hitting a Nerve

To go back to last week’s column, some of the best advice I ever got came from those early days when I was just starting my solo practice.

One of the family docs I met was a bit off the path. He was in a small medical building, maybe three to four offices total. It wasn’t rundown, but was obviously an older building, and not located near the hospital.

When I went in, it was clear he’d been there a while, and hadn’t bothered to redecorate at all (granted, in 2021, neither have I). The lobby reminded me more of my grandparents’ living room than a medical practice. I watched as the receptionist artfully ran through answering several lines, putting people on hold, and scheduling appointments, before she turned to me.

As soon as I started my spiel (“Hi, I’m a new neurologist in the area”) she got up and went to get the doctor. She said he always wanted to meet the new doctors who came in.

Dr. Charlie took me back to his office. His desk was covered with charts in no obvious order, and the bookcases with various journals. There was a feeling of comfortable, intentional, messiness.

He was 67 at the time, obviously still enjoying his work. He told me he’d been in solo practice since day 1, recommended it to all starting out (23 years later I’ll agree with that), and offered me this piece of advice:

“Treat your practice like you would your dog. Enjoy it, take care of it, and it will serve you well. But never, ever, let it be your master. If you do, you’ll be miserable. Raise it the right way and you’ll always be happy.”

After the brief meeting he walked me up front and I went on to the next office.

In the years to come I encountered him on and off rounding at the hospital or sending each other letters about a patient. He retired a few years later and died in 2007.

I still think about him. I’ve had one practice and owned several dogs during that time, and he was really right.

In solo practice I probably haven’t made as much money as I would have in a larger group. But I have more time to do as I wish, no one else to argue with me about a new direction for the practice, computer upgrades, or staff changes. I see, within the limits allowed by my overhead, as many or as few patients as I want. I can take vacations and days off. I have time to goof off with my staff and spend extra minutes with patients who need it. Medicine is a high-stress field, but at least I can keep the stress as low as possible.

On the flip side, I see the people he warned me about. New docs who come out with guns blazing, cramming their schedule as full as possible until they can’t possibly see more patients. Their staff gets overworked and has a high turnover. They themselves burn out quickly and either melt down or close down.

So I’ll pass the same advice to all others starting out. I still recommend solo practice. And treat your practice as you would your dog. Let it be your loyal friend, but never let it run your life.

As I say to my dogs every day, “you guys are awesome.”

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

To go back to last week’s column, some of the best advice I ever got came from those early days when I was just starting my solo practice.

One of the family docs I met was a bit off the path. He was in a small medical building, maybe three to four offices total. It wasn’t rundown, but was obviously an older building, and not located near the hospital.

When I went in, it was clear he’d been there a while, and hadn’t bothered to redecorate at all (granted, in 2021, neither have I). The lobby reminded me more of my grandparents’ living room than a medical practice. I watched as the receptionist artfully ran through answering several lines, putting people on hold, and scheduling appointments, before she turned to me.

As soon as I started my spiel (“Hi, I’m a new neurologist in the area”) she got up and went to get the doctor. She said he always wanted to meet the new doctors who came in.

Dr. Charlie took me back to his office. His desk was covered with charts in no obvious order, and the bookcases with various journals. There was a feeling of comfortable, intentional, messiness.

He was 67 at the time, obviously still enjoying his work. He told me he’d been in solo practice since day 1, recommended it to all starting out (23 years later I’ll agree with that), and offered me this piece of advice:

“Treat your practice like you would your dog. Enjoy it, take care of it, and it will serve you well. But never, ever, let it be your master. If you do, you’ll be miserable. Raise it the right way and you’ll always be happy.”

After the brief meeting he walked me up front and I went on to the next office.

In the years to come I encountered him on and off rounding at the hospital or sending each other letters about a patient. He retired a few years later and died in 2007.

I still think about him. I’ve had one practice and owned several dogs during that time, and he was really right.

In solo practice I probably haven’t made as much money as I would have in a larger group. But I have more time to do as I wish, no one else to argue with me about a new direction for the practice, computer upgrades, or staff changes. I see, within the limits allowed by my overhead, as many or as few patients as I want. I can take vacations and days off. I have time to goof off with my staff and spend extra minutes with patients who need it. Medicine is a high-stress field, but at least I can keep the stress as low as possible.

On the flip side, I see the people he warned me about. New docs who come out with guns blazing, cramming their schedule as full as possible until they can’t possibly see more patients. Their staff gets overworked and has a high turnover. They themselves burn out quickly and either melt down or close down.

So I’ll pass the same advice to all others starting out. I still recommend solo practice. And treat your practice as you would your dog. Let it be your loyal friend, but never let it run your life.

As I say to my dogs every day, “you guys are awesome.”

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

To go back to last week’s column, some of the best advice I ever got came from those early days when I was just starting my solo practice.

One of the family docs I met was a bit off the path. He was in a small medical building, maybe three to four offices total. It wasn’t rundown, but was obviously an older building, and not located near the hospital.

When I went in, it was clear he’d been there a while, and hadn’t bothered to redecorate at all (granted, in 2021, neither have I). The lobby reminded me more of my grandparents’ living room than a medical practice. I watched as the receptionist artfully ran through answering several lines, putting people on hold, and scheduling appointments, before she turned to me.

As soon as I started my spiel (“Hi, I’m a new neurologist in the area”) she got up and went to get the doctor. She said he always wanted to meet the new doctors who came in.

Dr. Charlie took me back to his office. His desk was covered with charts in no obvious order, and the bookcases with various journals. There was a feeling of comfortable, intentional, messiness.

He was 67 at the time, obviously still enjoying his work. He told me he’d been in solo practice since day 1, recommended it to all starting out (23 years later I’ll agree with that), and offered me this piece of advice:

“Treat your practice like you would your dog. Enjoy it, take care of it, and it will serve you well. But never, ever, let it be your master. If you do, you’ll be miserable. Raise it the right way and you’ll always be happy.”

After the brief meeting he walked me up front and I went on to the next office.

In the years to come I encountered him on and off rounding at the hospital or sending each other letters about a patient. He retired a few years later and died in 2007.

I still think about him. I’ve had one practice and owned several dogs during that time, and he was really right.

In solo practice I probably haven’t made as much money as I would have in a larger group. But I have more time to do as I wish, no one else to argue with me about a new direction for the practice, computer upgrades, or staff changes. I see, within the limits allowed by my overhead, as many or as few patients as I want. I can take vacations and days off. I have time to goof off with my staff and spend extra minutes with patients who need it. Medicine is a high-stress field, but at least I can keep the stress as low as possible.

On the flip side, I see the people he warned me about. New docs who come out with guns blazing, cramming their schedule as full as possible until they can’t possibly see more patients. Their staff gets overworked and has a high turnover. They themselves burn out quickly and either melt down or close down.

So I’ll pass the same advice to all others starting out. I still recommend solo practice. And treat your practice as you would your dog. Let it be your loyal friend, but never let it run your life.

As I say to my dogs every day, “you guys are awesome.”

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

In the Phoenix summer days of 1998 I did a lot of walking. It wasn’t for exercise, though it was pretty good for that, I guess.

I had privileges at three hospitals, and used their staff directories to make a map of every medical office building in the area I was trying to start my practice in. I was 32, idealistic, married for a year, a child on the way, and we’d just bought our first house. So I had a lot of incentive.

The Phoenix summer isn’t conducive to walking, especially in standard medical office attire (I didn’t give that up until 2006). But I did it. I went into one office after another, introduced myself, gave them my CV, some business cards, and my pager number (yeah, I had a pager). I cooled off and drank water in my car as I drove to the next building – wash, rinse, repeat.

Occasionally the doctors I met would have a few minutes to meet me, which I appreciated. One of them, who’d been in the same boat a few years earlier himself, invited me back to his office, and we chatted for maybe 10 minutes.

We got along, and worked well together for several years. We tended to round at the same times of day and so ran into each other a lot. He sent me patients, I sent him patients, and when we met on rounds we’d talk about nothing in particular for a few minutes.

After I cut back on my hospital work I didn’t see him as much, though we still referred patients back and forth and occasionally crossed paths while covering weekends.

I found out that he retired recently.

It gave me an odd pause. I thought of our first encounter 23 years ago, me trying to get started in my profession, him established, but close enough to recall what it was like to be starting out that he spared a few minutes for me. Remembering that, I still try to make an effort to meet new physicians who come by for the same reason. Hell, they might end up taking care of me someday. Assuming a medical career is 30-40 years, I’m past the halfway point.

Not today, not tomorrow, but in the years to come my generation of physicians will start to retire, walking away from a role that has defined both our personal and professional lives.

I both am and am not looking forward to it. This was just another reminder that time rolls on for all of us.
 

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

In the Phoenix summer days of 1998 I did a lot of walking. It wasn’t for exercise, though it was pretty good for that, I guess.

I had privileges at three hospitals, and used their staff directories to make a map of every medical office building in the area I was trying to start my practice in. I was 32, idealistic, married for a year, a child on the way, and we’d just bought our first house. So I had a lot of incentive.

The Phoenix summer isn’t conducive to walking, especially in standard medical office attire (I didn’t give that up until 2006). But I did it. I went into one office after another, introduced myself, gave them my CV, some business cards, and my pager number (yeah, I had a pager). I cooled off and drank water in my car as I drove to the next building – wash, rinse, repeat.

Occasionally the doctors I met would have a few minutes to meet me, which I appreciated. One of them, who’d been in the same boat a few years earlier himself, invited me back to his office, and we chatted for maybe 10 minutes.

We got along, and worked well together for several years. We tended to round at the same times of day and so ran into each other a lot. He sent me patients, I sent him patients, and when we met on rounds we’d talk about nothing in particular for a few minutes.

After I cut back on my hospital work I didn’t see him as much, though we still referred patients back and forth and occasionally crossed paths while covering weekends.

I found out that he retired recently.

It gave me an odd pause. I thought of our first encounter 23 years ago, me trying to get started in my profession, him established, but close enough to recall what it was like to be starting out that he spared a few minutes for me. Remembering that, I still try to make an effort to meet new physicians who come by for the same reason. Hell, they might end up taking care of me someday. Assuming a medical career is 30-40 years, I’m past the halfway point.

Not today, not tomorrow, but in the years to come my generation of physicians will start to retire, walking away from a role that has defined both our personal and professional lives.

I both am and am not looking forward to it. This was just another reminder that time rolls on for all of us.
 

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

In the Phoenix summer days of 1998 I did a lot of walking. It wasn’t for exercise, though it was pretty good for that, I guess.

I had privileges at three hospitals, and used their staff directories to make a map of every medical office building in the area I was trying to start my practice in. I was 32, idealistic, married for a year, a child on the way, and we’d just bought our first house. So I had a lot of incentive.

The Phoenix summer isn’t conducive to walking, especially in standard medical office attire (I didn’t give that up until 2006). But I did it. I went into one office after another, introduced myself, gave them my CV, some business cards, and my pager number (yeah, I had a pager). I cooled off and drank water in my car as I drove to the next building – wash, rinse, repeat.

Occasionally the doctors I met would have a few minutes to meet me, which I appreciated. One of them, who’d been in the same boat a few years earlier himself, invited me back to his office, and we chatted for maybe 10 minutes.

We got along, and worked well together for several years. We tended to round at the same times of day and so ran into each other a lot. He sent me patients, I sent him patients, and when we met on rounds we’d talk about nothing in particular for a few minutes.

After I cut back on my hospital work I didn’t see him as much, though we still referred patients back and forth and occasionally crossed paths while covering weekends.

I found out that he retired recently.

It gave me an odd pause. I thought of our first encounter 23 years ago, me trying to get started in my profession, him established, but close enough to recall what it was like to be starting out that he spared a few minutes for me. Remembering that, I still try to make an effort to meet new physicians who come by for the same reason. Hell, they might end up taking care of me someday. Assuming a medical career is 30-40 years, I’m past the halfway point.

Not today, not tomorrow, but in the years to come my generation of physicians will start to retire, walking away from a role that has defined both our personal and professional lives.

I both am and am not looking forward to it. This was just another reminder that time rolls on for all of us.
 

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

My neighbor’s house got burglarized recently.

They were on vacation, and so the thieves were able to take their time inside late at night. The neighborhood wasn’t aware anything was going on until they’d left, with a lot of jewelry and other valuables. As of this writing, they haven’t been caught.

I’m not the kind of person who needs to be close with my neighbors. Some people want a cohesive bunch that does stuff together. That’s not me. I’m fine just being collegial. I wave, I say hi, I let them know if they left a garage door open. I keep to myself and hope they do the same. If we’d been suspicious about a burglary, though, I definitely would have called 911, but all of us were asleep.

I get along with the family that lives there. We occasionally chat about nothing in particular when getting the mail or rolling out the recycling can. I’m pretty sure they don’t vote the way I do, or have the same religious beliefs, but that’s life. I mean, isn’t that the point of America, or even civilization? That we’re all supposed to get along, accept our differences, and work together for the common good? In spite of politicians trying to push the country as an us-against-them narrative, the bottom line is that people are people, with more in common than not.

I and the rest of the block offered them any help we could provide in the aftermath. A burglary isn’t as serious as a house fire or medical emergency, but it’s still something that you want to assist with if possible.

A crisis, minor or major, is a good time to step back from the inflammatory rhetoric that television’s talking heads and pundits push. The majority of us live in peace with our neighbors, want to help them if needed, and don’t take any joy in their predicaments – regardless of what we each might believe. After all, next time it could be me.

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

My neighbor’s house got burglarized recently.

They were on vacation, and so the thieves were able to take their time inside late at night. The neighborhood wasn’t aware anything was going on until they’d left, with a lot of jewelry and other valuables. As of this writing, they haven’t been caught.

I’m not the kind of person who needs to be close with my neighbors. Some people want a cohesive bunch that does stuff together. That’s not me. I’m fine just being collegial. I wave, I say hi, I let them know if they left a garage door open. I keep to myself and hope they do the same. If we’d been suspicious about a burglary, though, I definitely would have called 911, but all of us were asleep.

I get along with the family that lives there. We occasionally chat about nothing in particular when getting the mail or rolling out the recycling can. I’m pretty sure they don’t vote the way I do, or have the same religious beliefs, but that’s life. I mean, isn’t that the point of America, or even civilization? That we’re all supposed to get along, accept our differences, and work together for the common good? In spite of politicians trying to push the country as an us-against-them narrative, the bottom line is that people are people, with more in common than not.

I and the rest of the block offered them any help we could provide in the aftermath. A burglary isn’t as serious as a house fire or medical emergency, but it’s still something that you want to assist with if possible.

A crisis, minor or major, is a good time to step back from the inflammatory rhetoric that television’s talking heads and pundits push. The majority of us live in peace with our neighbors, want to help them if needed, and don’t take any joy in their predicaments – regardless of what we each might believe. After all, next time it could be me.

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

My neighbor’s house got burglarized recently.

They were on vacation, and so the thieves were able to take their time inside late at night. The neighborhood wasn’t aware anything was going on until they’d left, with a lot of jewelry and other valuables. As of this writing, they haven’t been caught.

I’m not the kind of person who needs to be close with my neighbors. Some people want a cohesive bunch that does stuff together. That’s not me. I’m fine just being collegial. I wave, I say hi, I let them know if they left a garage door open. I keep to myself and hope they do the same. If we’d been suspicious about a burglary, though, I definitely would have called 911, but all of us were asleep.

I get along with the family that lives there. We occasionally chat about nothing in particular when getting the mail or rolling out the recycling can. I’m pretty sure they don’t vote the way I do, or have the same religious beliefs, but that’s life. I mean, isn’t that the point of America, or even civilization? That we’re all supposed to get along, accept our differences, and work together for the common good? In spite of politicians trying to push the country as an us-against-them narrative, the bottom line is that people are people, with more in common than not.

I and the rest of the block offered them any help we could provide in the aftermath. A burglary isn’t as serious as a house fire or medical emergency, but it’s still something that you want to assist with if possible.

A crisis, minor or major, is a good time to step back from the inflammatory rhetoric that television’s talking heads and pundits push. The majority of us live in peace with our neighbors, want to help them if needed, and don’t take any joy in their predicaments – regardless of what we each might believe. After all, next time it could be me.

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

The following is not anything I’m doing. It’s written solely as a thought exercise.

What if I refused to see unvaccinated patients in my office?

I don’t think it’s illegal, any more than if I refused to see smokers, or gum chewers. I mean, it’s my practice. I’m the only one here.

It’s certainly unethical, though. Part of being a doctor is caring for those who need our help. I’m vaccinated, so hopefully I’m at lower risk of getting sick if exposed. But that’s not a guarantee.

The vaccine is 95% effective. But that still means 1 in 20 vaccinated people can still contract the disease. Of course, people who aren’t vaccinated have no protection at all, aside from their immune system.

If the decision to not vaccinate, or not wear a mask, only affected themselves, I wouldn’t have as much of an issue with it. Like bungee jumping, the consequences of something going wrong affect only the person who made the choice (not including costs to the health care system or loved ones, now caretakers).

But with an easily spread infectious disease, a better analogy is probably that of drunk drivers. Their actions affect not only themselves, but everyone else on (or near) the road: other drivers, their passengers, pedestrians. ...

In a neurology practice not all of my patients have great immune systems. Sure, there are healthy migraine patients, but I also see patients with multiple sclerosis (on drugs like Ocrevus), patients with myasthenia gravis (on steroids or Imuran), and other folks whose survival depends on keeping their immune systems working at a suboptimal level. Not to mention those with malignancies, leukemias, and lymphomas.

These people have no real defense against the virus, and many of them can’t even get the vaccine. They depend on precautions, herd immunity, and luck. So, to protect them, maybe I should keep the unvaccinated out. Granted, this isn’t a guarantee, either, and doesn’t protect them during more mundane activities, such as grocery shopping or filling up their car.

Besides, the unvaccinated have their own, unrelated, neurological issues. Migraines, seizures, neuropathy, and so they need to see me. My job is to help anyone who needs me. Isn’t that what being a doctor is all about?

It’s an interesting question. Like most things in medicine, there is no black or white, just different shades of gray.

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

The following is not anything I’m doing. It’s written solely as a thought exercise.

What if I refused to see unvaccinated patients in my office?

I don’t think it’s illegal, any more than if I refused to see smokers, or gum chewers. I mean, it’s my practice. I’m the only one here.

It’s certainly unethical, though. Part of being a doctor is caring for those who need our help. I’m vaccinated, so hopefully I’m at lower risk of getting sick if exposed. But that’s not a guarantee.

The vaccine is 95% effective. But that still means 1 in 20 vaccinated people can still contract the disease. Of course, people who aren’t vaccinated have no protection at all, aside from their immune system.

If the decision to not vaccinate, or not wear a mask, only affected themselves, I wouldn’t have as much of an issue with it. Like bungee jumping, the consequences of something going wrong affect only the person who made the choice (not including costs to the health care system or loved ones, now caretakers).

But with an easily spread infectious disease, a better analogy is probably that of drunk drivers. Their actions affect not only themselves, but everyone else on (or near) the road: other drivers, their passengers, pedestrians. ...

In a neurology practice not all of my patients have great immune systems. Sure, there are healthy migraine patients, but I also see patients with multiple sclerosis (on drugs like Ocrevus), patients with myasthenia gravis (on steroids or Imuran), and other folks whose survival depends on keeping their immune systems working at a suboptimal level. Not to mention those with malignancies, leukemias, and lymphomas.

These people have no real defense against the virus, and many of them can’t even get the vaccine. They depend on precautions, herd immunity, and luck. So, to protect them, maybe I should keep the unvaccinated out. Granted, this isn’t a guarantee, either, and doesn’t protect them during more mundane activities, such as grocery shopping or filling up their car.

Besides, the unvaccinated have their own, unrelated, neurological issues. Migraines, seizures, neuropathy, and so they need to see me. My job is to help anyone who needs me. Isn’t that what being a doctor is all about?

It’s an interesting question. Like most things in medicine, there is no black or white, just different shades of gray.

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

The following is not anything I’m doing. It’s written solely as a thought exercise.

What if I refused to see unvaccinated patients in my office?

I don’t think it’s illegal, any more than if I refused to see smokers, or gum chewers. I mean, it’s my practice. I’m the only one here.

It’s certainly unethical, though. Part of being a doctor is caring for those who need our help. I’m vaccinated, so hopefully I’m at lower risk of getting sick if exposed. But that’s not a guarantee.

The vaccine is 95% effective. But that still means 1 in 20 vaccinated people can still contract the disease. Of course, people who aren’t vaccinated have no protection at all, aside from their immune system.

If the decision to not vaccinate, or not wear a mask, only affected themselves, I wouldn’t have as much of an issue with it. Like bungee jumping, the consequences of something going wrong affect only the person who made the choice (not including costs to the health care system or loved ones, now caretakers).

But with an easily spread infectious disease, a better analogy is probably that of drunk drivers. Their actions affect not only themselves, but everyone else on (or near) the road: other drivers, their passengers, pedestrians. ...

In a neurology practice not all of my patients have great immune systems. Sure, there are healthy migraine patients, but I also see patients with multiple sclerosis (on drugs like Ocrevus), patients with myasthenia gravis (on steroids or Imuran), and other folks whose survival depends on keeping their immune systems working at a suboptimal level. Not to mention those with malignancies, leukemias, and lymphomas.

These people have no real defense against the virus, and many of them can’t even get the vaccine. They depend on precautions, herd immunity, and luck. So, to protect them, maybe I should keep the unvaccinated out. Granted, this isn’t a guarantee, either, and doesn’t protect them during more mundane activities, such as grocery shopping or filling up their car.

Besides, the unvaccinated have their own, unrelated, neurological issues. Migraines, seizures, neuropathy, and so they need to see me. My job is to help anyone who needs me. Isn’t that what being a doctor is all about?

It’s an interesting question. Like most things in medicine, there is no black or white, just different shades of gray.

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

I don’t see anyone under 18. After all, I’m not a child neurologist.

People will occasionally argue with this policy, claiming that it’s too rigid. Why not 17½? I know that some adult neurologists do see teenagers.

But not me. It’s easier to just have a solid line and stick by it.

So, by habit, I often note someone’s birthday on the schedule to make sure they’re old enough to see me. And, over the years, this has made me realize the passage of time more than a lot of things.

Not much changes in my office. I’ve been in the same building since 2013, had the same furniture for longer, and the same staff since 2004. So it’s easy to lose track of how long I’ve been doing this.

But when I started out I didn’t see anyone born after 1979. Today that’s crept up to 2003. How the hell did that happen?

With that came the even more sobering realization that my kids are now all old enough to be my patients.

Time flies by in this world. You do the same thing day in and day out, and suddenly you’re 20 years older and starting to think about retirement.

We all see ourselves in the mirror each day, but rarely notice the changes. Watching patients grow older, seeing the minimum birth year for them advance, even being surprised when a drug I thought had just come out is now generic – those are the reminders of time’s passage that get my attention at work.

Not that it’s a bad thing. Time will go on, whether we want it to or not. After 20 years I still enjoy this job, and it allows me to support my family. I can’t ask for much more than that.

But each morning I scan through the names and birthdays on my schedule, and am amazed when I think about how clearly I remember my first day of medical school, college, and even high school like it had just happened.

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

I don’t see anyone under 18. After all, I’m not a child neurologist.

People will occasionally argue with this policy, claiming that it’s too rigid. Why not 17½? I know that some adult neurologists do see teenagers.

But not me. It’s easier to just have a solid line and stick by it.

So, by habit, I often note someone’s birthday on the schedule to make sure they’re old enough to see me. And, over the years, this has made me realize the passage of time more than a lot of things.

Not much changes in my office. I’ve been in the same building since 2013, had the same furniture for longer, and the same staff since 2004. So it’s easy to lose track of how long I’ve been doing this.

But when I started out I didn’t see anyone born after 1979. Today that’s crept up to 2003. How the hell did that happen?

With that came the even more sobering realization that my kids are now all old enough to be my patients.

Time flies by in this world. You do the same thing day in and day out, and suddenly you’re 20 years older and starting to think about retirement.

We all see ourselves in the mirror each day, but rarely notice the changes. Watching patients grow older, seeing the minimum birth year for them advance, even being surprised when a drug I thought had just come out is now generic – those are the reminders of time’s passage that get my attention at work.

Not that it’s a bad thing. Time will go on, whether we want it to or not. After 20 years I still enjoy this job, and it allows me to support my family. I can’t ask for much more than that.

But each morning I scan through the names and birthdays on my schedule, and am amazed when I think about how clearly I remember my first day of medical school, college, and even high school like it had just happened.

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

I don’t see anyone under 18. After all, I’m not a child neurologist.

People will occasionally argue with this policy, claiming that it’s too rigid. Why not 17½? I know that some adult neurologists do see teenagers.

But not me. It’s easier to just have a solid line and stick by it.

So, by habit, I often note someone’s birthday on the schedule to make sure they’re old enough to see me. And, over the years, this has made me realize the passage of time more than a lot of things.

Not much changes in my office. I’ve been in the same building since 2013, had the same furniture for longer, and the same staff since 2004. So it’s easy to lose track of how long I’ve been doing this.

But when I started out I didn’t see anyone born after 1979. Today that’s crept up to 2003. How the hell did that happen?

With that came the even more sobering realization that my kids are now all old enough to be my patients.

Time flies by in this world. You do the same thing day in and day out, and suddenly you’re 20 years older and starting to think about retirement.

We all see ourselves in the mirror each day, but rarely notice the changes. Watching patients grow older, seeing the minimum birth year for them advance, even being surprised when a drug I thought had just come out is now generic – those are the reminders of time’s passage that get my attention at work.

Not that it’s a bad thing. Time will go on, whether we want it to or not. After 20 years I still enjoy this job, and it allows me to support my family. I can’t ask for much more than that.

But each morning I scan through the names and birthdays on my schedule, and am amazed when I think about how clearly I remember my first day of medical school, college, and even high school like it had just happened.

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

Like most American doctors, I take a variety of insurances and insurance plans.

Some of these, particularly HMOs, require a referring physician to send me a written, insurance-approved, referral (AKA authorization) before the visit, to submit with my bill.

Medical visits of all kinds are generally billed on a scale from 1 (brief/simple issue) to 5 (lots of time needed/very complicated).

After 23 years, I’m used to this.

But recently a new wrinkle has emerged.

In the last month I’ve gotten two referrals (both from the same internist), except these state, very clearly, that charges for any visit cannot exceed level 3.

And they’re telling me this before I’ve ever seen the patients, or have any idea how complicated they are, or how long a list of questions they and/or their families will have.

No.

I faxed them back asking for a referral allowing me to bill up to level 5 if needed. I might charge less than that, but none of us know how complicated or long a visit will be until someone comes in. There’s no crystal ball in medicine.

I’m sure someone will say I’m a money-grubbing doctor who couldn’t care less about the patient.

That’s far from the truth. I’m here for the patients. I like helping them. It’s why I do this.

But I can’t help anyone if I can’t afford to keep the office lights on, either.

I never heard back from them. Maybe they decided the patients didn’t need me that much. Maybe they sent them to another neurologist and took my name off their referral list. Maybe they never even noticed my return fax.

What will happen now, I have no idea. Maybe this was something that office tried, to see if I noticed. Maybe it’s the start of the next wave of medical cutbacks. Maybe it was a staff error at the other end.

But either way, none of us can see patients at a loss and hope to make it up on quantity. This isn’t an amusement park or thrift store. People with problems need time, and time costs money. I need to pay my staff, my rent, and my mortgage. If I can’t do those things, I won’t be able to help anyone.

That’s just, for better or worse, the way it is.

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

Like most American doctors, I take a variety of insurances and insurance plans.

Some of these, particularly HMOs, require a referring physician to send me a written, insurance-approved, referral (AKA authorization) before the visit, to submit with my bill.

Medical visits of all kinds are generally billed on a scale from 1 (brief/simple issue) to 5 (lots of time needed/very complicated).

After 23 years, I’m used to this.

But recently a new wrinkle has emerged.

In the last month I’ve gotten two referrals (both from the same internist), except these state, very clearly, that charges for any visit cannot exceed level 3.

And they’re telling me this before I’ve ever seen the patients, or have any idea how complicated they are, or how long a list of questions they and/or their families will have.

No.

I faxed them back asking for a referral allowing me to bill up to level 5 if needed. I might charge less than that, but none of us know how complicated or long a visit will be until someone comes in. There’s no crystal ball in medicine.

I’m sure someone will say I’m a money-grubbing doctor who couldn’t care less about the patient.

That’s far from the truth. I’m here for the patients. I like helping them. It’s why I do this.

But I can’t help anyone if I can’t afford to keep the office lights on, either.

I never heard back from them. Maybe they decided the patients didn’t need me that much. Maybe they sent them to another neurologist and took my name off their referral list. Maybe they never even noticed my return fax.

What will happen now, I have no idea. Maybe this was something that office tried, to see if I noticed. Maybe it’s the start of the next wave of medical cutbacks. Maybe it was a staff error at the other end.

But either way, none of us can see patients at a loss and hope to make it up on quantity. This isn’t an amusement park or thrift store. People with problems need time, and time costs money. I need to pay my staff, my rent, and my mortgage. If I can’t do those things, I won’t be able to help anyone.

That’s just, for better or worse, the way it is.

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

Like most American doctors, I take a variety of insurances and insurance plans.

Some of these, particularly HMOs, require a referring physician to send me a written, insurance-approved, referral (AKA authorization) before the visit, to submit with my bill.

Medical visits of all kinds are generally billed on a scale from 1 (brief/simple issue) to 5 (lots of time needed/very complicated).

After 23 years, I’m used to this.

But recently a new wrinkle has emerged.

In the last month I’ve gotten two referrals (both from the same internist), except these state, very clearly, that charges for any visit cannot exceed level 3.

And they’re telling me this before I’ve ever seen the patients, or have any idea how complicated they are, or how long a list of questions they and/or their families will have.

No.

I faxed them back asking for a referral allowing me to bill up to level 5 if needed. I might charge less than that, but none of us know how complicated or long a visit will be until someone comes in. There’s no crystal ball in medicine.

I’m sure someone will say I’m a money-grubbing doctor who couldn’t care less about the patient.

That’s far from the truth. I’m here for the patients. I like helping them. It’s why I do this.

But I can’t help anyone if I can’t afford to keep the office lights on, either.

I never heard back from them. Maybe they decided the patients didn’t need me that much. Maybe they sent them to another neurologist and took my name off their referral list. Maybe they never even noticed my return fax.

What will happen now, I have no idea. Maybe this was something that office tried, to see if I noticed. Maybe it’s the start of the next wave of medical cutbacks. Maybe it was a staff error at the other end.

But either way, none of us can see patients at a loss and hope to make it up on quantity. This isn’t an amusement park or thrift store. People with problems need time, and time costs money. I need to pay my staff, my rent, and my mortgage. If I can’t do those things, I won’t be able to help anyone.

That’s just, for better or worse, the way it is.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

I’m not an academic. Never will be.

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

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

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

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

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

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

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

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

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

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

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

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

That’s what data and statistics do.

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

I’m not an academic. Never will be.

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

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

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

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

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

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

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

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

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

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

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

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

That’s what data and statistics do.

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

I’m not an academic. Never will be.

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

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

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

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

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

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

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

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

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

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

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

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

That’s what data and statistics do.

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

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

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

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

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

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

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

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

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

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

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

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

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

Another marvel of the remarkable human brain.

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

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

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

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

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

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

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

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

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

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

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

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

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

Another marvel of the remarkable human brain.

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

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

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

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

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

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

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

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

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

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

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

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

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

Another marvel of the remarkable human brain.

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