User login
Sealing the envelope
Mike died last week.
He was a long-retired doc, in his mid-90s. One of my favorite patients to just chat with about nothing in particular. I learned more from him about restoring old grandfather clocks than I ever dreamed I’d know.
After receiving the sad news, I sat down, as I often do, to write a letter to his family. After 23 years I have a pretty standard idea of what I want to say, but it still always takes some thought.
Sealing the envelopes on these letters always seems to be more than just paperwork. There’s a symbolism to it, that I’m closing out my relationship, sometimes of 10-20 years, with the person involved.
Some patients become friends after a time. It’s a matter of chemistry. I don’t socialize with them outside my office, but still enjoy seeing them and talking about nonmedical stuff in the space around clinical questions and answers. They’re the ones it’s hardest to say goodbye to.
I’ll miss my 2-3 visits a year with Mike. We swapped medical war stories, family anecdotes, and the occasional tip about clock restoration that I’ll probably never use (but who knows, he didn’t start until after he retired).
Closing the envelope comes with the realization that I won’t be seeing him again. I don’t go to patient funerals, as I believe those are for families and close friends, and so writing the letter is the closest I’ll get to saying goodbye.
Medicine, and how we practice, is focused on what we do for the patient – which is what it should be.
But lost in the shuffle sometimes is realizing what the patient does for us. That’s also important, but harder to quantify. And sometimes we don’t realize it until we seal the envelope.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
Mike died last week.
He was a long-retired doc, in his mid-90s. One of my favorite patients to just chat with about nothing in particular. I learned more from him about restoring old grandfather clocks than I ever dreamed I’d know.
After receiving the sad news, I sat down, as I often do, to write a letter to his family. After 23 years I have a pretty standard idea of what I want to say, but it still always takes some thought.
Sealing the envelopes on these letters always seems to be more than just paperwork. There’s a symbolism to it, that I’m closing out my relationship, sometimes of 10-20 years, with the person involved.
Some patients become friends after a time. It’s a matter of chemistry. I don’t socialize with them outside my office, but still enjoy seeing them and talking about nonmedical stuff in the space around clinical questions and answers. They’re the ones it’s hardest to say goodbye to.
I’ll miss my 2-3 visits a year with Mike. We swapped medical war stories, family anecdotes, and the occasional tip about clock restoration that I’ll probably never use (but who knows, he didn’t start until after he retired).
Closing the envelope comes with the realization that I won’t be seeing him again. I don’t go to patient funerals, as I believe those are for families and close friends, and so writing the letter is the closest I’ll get to saying goodbye.
Medicine, and how we practice, is focused on what we do for the patient – which is what it should be.
But lost in the shuffle sometimes is realizing what the patient does for us. That’s also important, but harder to quantify. And sometimes we don’t realize it until we seal the envelope.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
Mike died last week.
He was a long-retired doc, in his mid-90s. One of my favorite patients to just chat with about nothing in particular. I learned more from him about restoring old grandfather clocks than I ever dreamed I’d know.
After receiving the sad news, I sat down, as I often do, to write a letter to his family. After 23 years I have a pretty standard idea of what I want to say, but it still always takes some thought.
Sealing the envelopes on these letters always seems to be more than just paperwork. There’s a symbolism to it, that I’m closing out my relationship, sometimes of 10-20 years, with the person involved.
Some patients become friends after a time. It’s a matter of chemistry. I don’t socialize with them outside my office, but still enjoy seeing them and talking about nonmedical stuff in the space around clinical questions and answers. They’re the ones it’s hardest to say goodbye to.
I’ll miss my 2-3 visits a year with Mike. We swapped medical war stories, family anecdotes, and the occasional tip about clock restoration that I’ll probably never use (but who knows, he didn’t start until after he retired).
Closing the envelope comes with the realization that I won’t be seeing him again. I don’t go to patient funerals, as I believe those are for families and close friends, and so writing the letter is the closest I’ll get to saying goodbye.
Medicine, and how we practice, is focused on what we do for the patient – which is what it should be.
But lost in the shuffle sometimes is realizing what the patient does for us. That’s also important, but harder to quantify. And sometimes we don’t realize it until we seal the envelope.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
The problem with samples
Ubrelvy and Nurtec are the latest in acute migraine treatment, both with solid data to back them up.
As with the triptans 25 years ago, my sample cabinet (and probably everyone else’s) is loaded with them, and friendly sales reps bringing coupon cards are a frequent occurrence.
Unfortunately, samples also bring up the same conundrum I faced with the triptans earlier in my career. It’s one thing to give patients samples to see if they work. It’s quite another to get them covered if they do.
This is an ongoing issue in modern medicine. It’s hard to resist the temptation to just hand something out when it’s conveniently at hand. It saves the patient a trip to the pharmacy and a medication copay up front, which is great.
But if it works, you have a whole new set of issues. The patient wants a real prescription now. So you call it in, then get a denial back saying it isn’t covered. It tells you to call a number, or try CoverMyMeds.
You do that, but the patient has to have failed three triptans, two NSAIDs, and a partridge in a pear tree to get it approved. The “copay assistance cards” don’t help if the medication isn’t covered at all. Each of these new medications is currently listed at roughly $900/month on GoodRx.com. Inevitably, your staff gets an earful when a patient with sticker shock calls your office.
One manufacturer is now eating the cost of the first script, so the patient leaves the pharmacy with a 1-month supply, under the impression that it was covered by insurance. This only kicks the can down the road 4-6 weeks, until they call for a refill.
To the chagrin of my sales reps (who are certainly going to read this), I’ve been burned on this and similar issues many times in my career, so I don’t even bother playing the game.
Certainly, there are cases where handing out a sample of Ubrelvy or Nurtec is indicated – some patients have already failed other agents, or have medical contraindications to them – but most don’t. So I start with triptans, currently going for $15/month. That doesn’t mean I’m not open to a newer agent at some point, but leaping directly to them quickly becomes an exercise in frustration.
Which brings up another issue I’ve encountered. While I try to be aware of this sort of thing, many other docs aren’t. Especially my already overburdened colleagues in primary care, who have enough on their plate with COVID-19, insurance regulations, paperwork, and an insanely busy schedule. In the controlled chaos of a general practice, it’s often easier for the staff to just hand out a sample at the same time they refer to a neurologist. So when the patient comes to me, they’re expecting I’ll be able to get it covered. After all, I’m the specialist. Getting expensive tests and medications covered seem to be something that’s expected for the higher copay to see me.
It doesn’t work that way, either.
I have nothing against new drugs. It’s the breakthroughs that keep medicine moving forward (like the COVID-19 vaccines). Nor do I have anything against samples or sales reps.
But in many cases, the time you save handing out samples isn’t worth the time you have to spend on them down the line.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
Ubrelvy and Nurtec are the latest in acute migraine treatment, both with solid data to back them up.
As with the triptans 25 years ago, my sample cabinet (and probably everyone else’s) is loaded with them, and friendly sales reps bringing coupon cards are a frequent occurrence.
Unfortunately, samples also bring up the same conundrum I faced with the triptans earlier in my career. It’s one thing to give patients samples to see if they work. It’s quite another to get them covered if they do.
This is an ongoing issue in modern medicine. It’s hard to resist the temptation to just hand something out when it’s conveniently at hand. It saves the patient a trip to the pharmacy and a medication copay up front, which is great.
But if it works, you have a whole new set of issues. The patient wants a real prescription now. So you call it in, then get a denial back saying it isn’t covered. It tells you to call a number, or try CoverMyMeds.
You do that, but the patient has to have failed three triptans, two NSAIDs, and a partridge in a pear tree to get it approved. The “copay assistance cards” don’t help if the medication isn’t covered at all. Each of these new medications is currently listed at roughly $900/month on GoodRx.com. Inevitably, your staff gets an earful when a patient with sticker shock calls your office.
One manufacturer is now eating the cost of the first script, so the patient leaves the pharmacy with a 1-month supply, under the impression that it was covered by insurance. This only kicks the can down the road 4-6 weeks, until they call for a refill.
To the chagrin of my sales reps (who are certainly going to read this), I’ve been burned on this and similar issues many times in my career, so I don’t even bother playing the game.
Certainly, there are cases where handing out a sample of Ubrelvy or Nurtec is indicated – some patients have already failed other agents, or have medical contraindications to them – but most don’t. So I start with triptans, currently going for $15/month. That doesn’t mean I’m not open to a newer agent at some point, but leaping directly to them quickly becomes an exercise in frustration.
Which brings up another issue I’ve encountered. While I try to be aware of this sort of thing, many other docs aren’t. Especially my already overburdened colleagues in primary care, who have enough on their plate with COVID-19, insurance regulations, paperwork, and an insanely busy schedule. In the controlled chaos of a general practice, it’s often easier for the staff to just hand out a sample at the same time they refer to a neurologist. So when the patient comes to me, they’re expecting I’ll be able to get it covered. After all, I’m the specialist. Getting expensive tests and medications covered seem to be something that’s expected for the higher copay to see me.
It doesn’t work that way, either.
I have nothing against new drugs. It’s the breakthroughs that keep medicine moving forward (like the COVID-19 vaccines). Nor do I have anything against samples or sales reps.
But in many cases, the time you save handing out samples isn’t worth the time you have to spend on them down the line.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
Ubrelvy and Nurtec are the latest in acute migraine treatment, both with solid data to back them up.
As with the triptans 25 years ago, my sample cabinet (and probably everyone else’s) is loaded with them, and friendly sales reps bringing coupon cards are a frequent occurrence.
Unfortunately, samples also bring up the same conundrum I faced with the triptans earlier in my career. It’s one thing to give patients samples to see if they work. It’s quite another to get them covered if they do.
This is an ongoing issue in modern medicine. It’s hard to resist the temptation to just hand something out when it’s conveniently at hand. It saves the patient a trip to the pharmacy and a medication copay up front, which is great.
But if it works, you have a whole new set of issues. The patient wants a real prescription now. So you call it in, then get a denial back saying it isn’t covered. It tells you to call a number, or try CoverMyMeds.
You do that, but the patient has to have failed three triptans, two NSAIDs, and a partridge in a pear tree to get it approved. The “copay assistance cards” don’t help if the medication isn’t covered at all. Each of these new medications is currently listed at roughly $900/month on GoodRx.com. Inevitably, your staff gets an earful when a patient with sticker shock calls your office.
One manufacturer is now eating the cost of the first script, so the patient leaves the pharmacy with a 1-month supply, under the impression that it was covered by insurance. This only kicks the can down the road 4-6 weeks, until they call for a refill.
To the chagrin of my sales reps (who are certainly going to read this), I’ve been burned on this and similar issues many times in my career, so I don’t even bother playing the game.
Certainly, there are cases where handing out a sample of Ubrelvy or Nurtec is indicated – some patients have already failed other agents, or have medical contraindications to them – but most don’t. So I start with triptans, currently going for $15/month. That doesn’t mean I’m not open to a newer agent at some point, but leaping directly to them quickly becomes an exercise in frustration.
Which brings up another issue I’ve encountered. While I try to be aware of this sort of thing, many other docs aren’t. Especially my already overburdened colleagues in primary care, who have enough on their plate with COVID-19, insurance regulations, paperwork, and an insanely busy schedule. In the controlled chaos of a general practice, it’s often easier for the staff to just hand out a sample at the same time they refer to a neurologist. So when the patient comes to me, they’re expecting I’ll be able to get it covered. After all, I’m the specialist. Getting expensive tests and medications covered seem to be something that’s expected for the higher copay to see me.
It doesn’t work that way, either.
I have nothing against new drugs. It’s the breakthroughs that keep medicine moving forward (like the COVID-19 vaccines). Nor do I have anything against samples or sales reps.
But in many cases, the time you save handing out samples isn’t worth the time you have to spend on them down the line.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
Death from despair
I’ve taken care of both Bill and his wife for a few years. They’re a sweet couple, each with their own neurological issues. Bill has also battled depression on and off over time. He can be a challenge, and I’ve never envied his psychiatrist.
Bill committed suicide in the final week of April.
Patient deaths are unavoidable in medicine. It’s part of the job. Suicides, though less common, also happen. Sometimes they’re related to a sad diagnosis we’ve made, but more commonly (as in Bill’s case) they result from demons we had no control over.
I had a patient commit suicide about 6 months after I started my practice, and probably average one every 2 years (that I hear about) since then. They’re still the deaths that surprise me the most, make me take pause for a few minutes, even after doing this for 23 years.
Suicide is as old as humanity, and gets worse during difficult societal and economic times. It disproportionately affects doctors, dentists, veterinarians, and police officers, and leaves devastated families and friends in its wake.
Death because of the progression of time and disease is never easy, but perhaps more psychologically acceptable to those left behind. Death because of a tragic accident at any age is more difficult.
But when the person involved makes a conscious decision to end his or her own life, the effects on those left behind are terrible. Wondering why, questioning if they could have done something different, and, as with any loss, grieving.
In a world where major advances have been made in many areas of medicine, including mental health, death from despair shows no sign of abating.
Maybe it’s part of the price of sentience and reason. Or civilization. I doubt it will ever stop being a public health issue, no matter how many other diseases we cure.
But, as I write a letter to Bill’s wife, that’s little consolation for those they’ve left behind.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
I’ve taken care of both Bill and his wife for a few years. They’re a sweet couple, each with their own neurological issues. Bill has also battled depression on and off over time. He can be a challenge, and I’ve never envied his psychiatrist.
Bill committed suicide in the final week of April.
Patient deaths are unavoidable in medicine. It’s part of the job. Suicides, though less common, also happen. Sometimes they’re related to a sad diagnosis we’ve made, but more commonly (as in Bill’s case) they result from demons we had no control over.
I had a patient commit suicide about 6 months after I started my practice, and probably average one every 2 years (that I hear about) since then. They’re still the deaths that surprise me the most, make me take pause for a few minutes, even after doing this for 23 years.
Suicide is as old as humanity, and gets worse during difficult societal and economic times. It disproportionately affects doctors, dentists, veterinarians, and police officers, and leaves devastated families and friends in its wake.
Death because of the progression of time and disease is never easy, but perhaps more psychologically acceptable to those left behind. Death because of a tragic accident at any age is more difficult.
But when the person involved makes a conscious decision to end his or her own life, the effects on those left behind are terrible. Wondering why, questioning if they could have done something different, and, as with any loss, grieving.
In a world where major advances have been made in many areas of medicine, including mental health, death from despair shows no sign of abating.
Maybe it’s part of the price of sentience and reason. Or civilization. I doubt it will ever stop being a public health issue, no matter how many other diseases we cure.
But, as I write a letter to Bill’s wife, that’s little consolation for those they’ve left behind.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
I’ve taken care of both Bill and his wife for a few years. They’re a sweet couple, each with their own neurological issues. Bill has also battled depression on and off over time. He can be a challenge, and I’ve never envied his psychiatrist.
Bill committed suicide in the final week of April.
Patient deaths are unavoidable in medicine. It’s part of the job. Suicides, though less common, also happen. Sometimes they’re related to a sad diagnosis we’ve made, but more commonly (as in Bill’s case) they result from demons we had no control over.
I had a patient commit suicide about 6 months after I started my practice, and probably average one every 2 years (that I hear about) since then. They’re still the deaths that surprise me the most, make me take pause for a few minutes, even after doing this for 23 years.
Suicide is as old as humanity, and gets worse during difficult societal and economic times. It disproportionately affects doctors, dentists, veterinarians, and police officers, and leaves devastated families and friends in its wake.
Death because of the progression of time and disease is never easy, but perhaps more psychologically acceptable to those left behind. Death because of a tragic accident at any age is more difficult.
But when the person involved makes a conscious decision to end his or her own life, the effects on those left behind are terrible. Wondering why, questioning if they could have done something different, and, as with any loss, grieving.
In a world where major advances have been made in many areas of medicine, including mental health, death from despair shows no sign of abating.
Maybe it’s part of the price of sentience and reason. Or civilization. I doubt it will ever stop being a public health issue, no matter how many other diseases we cure.
But, as I write a letter to Bill’s wife, that’s little consolation for those they’ve left behind.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
Is common courtesy no longer contagious?
The other day, in a fairly common occurrence, I needed to fax a records request over to another office.
Not having memorized all the fax numbers in my area, I turned to the internet and quickly had their website and the needed information in front of me.
But at the top of the page, before you got to phone numbers and directions, was this statement in bold print (caps as seen):
“NOTICE TO ALL PATIENTS:
“Please show RESPECT AND KINDNESS to other patients and staff.
“We have a ZERO TOLERANCE policy for aggressive behavior, vulgar language, and violence, whether in person, on the phone, or online.”
A veterinarian I know recently put something similar up, saying: “We DO NOT TOLERATE physically or verbally abusive behavior by clients. We are compassionate and understand you are under stress, but we are also human and deserve respect. Thank you.”
I absolutely agree with this. Hell, I’m the same way.
But what is wrong with people that we actually need to have notices like that up?
Realistically, the vast majority of patients don’t need the reminder. They treat each other, and my staff, with politeness and respect, and we do the same. To me that’s part of the whole sandbox thing. Personally, I prefer my office to have the same atmosphere as a library, and am known to “shhhh” people who are too loud.
But the real point here is that we shouldn’t have to remind anyone else to behave with common courtesy. If you’re an adult, I’m going to assume your parents and teachers taught you the importance of manners and the Golden Rule.
I’ve been in practice for 23 years now, and I’ve never had to deal with this sort of behavior, this frequently, before. Is it that the pandemic, and its economic and social consequences, has gotten on everyone’s nerves? If so, hopefully it will gradually fade away as the crisis does. I’m vaccinated. My family and the majority of my patients are vaccinated. I encourage pretty much everyone who asks me about it to get vaccinated.
But I’m more concerned that isn’t really the issue. Maybe our polarized, divided society is moving in that direction. Common good is now often reduced to us against them, and the conditions of the times have just aggravated a problem that was festering.
The majority of people, of all beliefs, remain decent people. But
Decency and manners, unfortunately, can’t be legislated. If you’ve forgotten yours, though, don’t think others will put up with you.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
The other day, in a fairly common occurrence, I needed to fax a records request over to another office.
Not having memorized all the fax numbers in my area, I turned to the internet and quickly had their website and the needed information in front of me.
But at the top of the page, before you got to phone numbers and directions, was this statement in bold print (caps as seen):
“NOTICE TO ALL PATIENTS:
“Please show RESPECT AND KINDNESS to other patients and staff.
“We have a ZERO TOLERANCE policy for aggressive behavior, vulgar language, and violence, whether in person, on the phone, or online.”
A veterinarian I know recently put something similar up, saying: “We DO NOT TOLERATE physically or verbally abusive behavior by clients. We are compassionate and understand you are under stress, but we are also human and deserve respect. Thank you.”
I absolutely agree with this. Hell, I’m the same way.
But what is wrong with people that we actually need to have notices like that up?
Realistically, the vast majority of patients don’t need the reminder. They treat each other, and my staff, with politeness and respect, and we do the same. To me that’s part of the whole sandbox thing. Personally, I prefer my office to have the same atmosphere as a library, and am known to “shhhh” people who are too loud.
But the real point here is that we shouldn’t have to remind anyone else to behave with common courtesy. If you’re an adult, I’m going to assume your parents and teachers taught you the importance of manners and the Golden Rule.
I’ve been in practice for 23 years now, and I’ve never had to deal with this sort of behavior, this frequently, before. Is it that the pandemic, and its economic and social consequences, has gotten on everyone’s nerves? If so, hopefully it will gradually fade away as the crisis does. I’m vaccinated. My family and the majority of my patients are vaccinated. I encourage pretty much everyone who asks me about it to get vaccinated.
But I’m more concerned that isn’t really the issue. Maybe our polarized, divided society is moving in that direction. Common good is now often reduced to us against them, and the conditions of the times have just aggravated a problem that was festering.
The majority of people, of all beliefs, remain decent people. But
Decency and manners, unfortunately, can’t be legislated. If you’ve forgotten yours, though, don’t think others will put up with you.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
The other day, in a fairly common occurrence, I needed to fax a records request over to another office.
Not having memorized all the fax numbers in my area, I turned to the internet and quickly had their website and the needed information in front of me.
But at the top of the page, before you got to phone numbers and directions, was this statement in bold print (caps as seen):
“NOTICE TO ALL PATIENTS:
“Please show RESPECT AND KINDNESS to other patients and staff.
“We have a ZERO TOLERANCE policy for aggressive behavior, vulgar language, and violence, whether in person, on the phone, or online.”
A veterinarian I know recently put something similar up, saying: “We DO NOT TOLERATE physically or verbally abusive behavior by clients. We are compassionate and understand you are under stress, but we are also human and deserve respect. Thank you.”
I absolutely agree with this. Hell, I’m the same way.
But what is wrong with people that we actually need to have notices like that up?
Realistically, the vast majority of patients don’t need the reminder. They treat each other, and my staff, with politeness and respect, and we do the same. To me that’s part of the whole sandbox thing. Personally, I prefer my office to have the same atmosphere as a library, and am known to “shhhh” people who are too loud.
But the real point here is that we shouldn’t have to remind anyone else to behave with common courtesy. If you’re an adult, I’m going to assume your parents and teachers taught you the importance of manners and the Golden Rule.
I’ve been in practice for 23 years now, and I’ve never had to deal with this sort of behavior, this frequently, before. Is it that the pandemic, and its economic and social consequences, has gotten on everyone’s nerves? If so, hopefully it will gradually fade away as the crisis does. I’m vaccinated. My family and the majority of my patients are vaccinated. I encourage pretty much everyone who asks me about it to get vaccinated.
But I’m more concerned that isn’t really the issue. Maybe our polarized, divided society is moving in that direction. Common good is now often reduced to us against them, and the conditions of the times have just aggravated a problem that was festering.
The majority of people, of all beliefs, remain decent people. But
Decency and manners, unfortunately, can’t be legislated. If you’ve forgotten yours, though, don’t think others will put up with you.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
The ripple effect
“I want my life to mean something.”
She was young, energetic, and idealistic. She was seeing me for her migraines, but our conversation had turned to her applying for medical school.
“I want my life to mean something.”
I reflected on that later. I once said similar things, but now found myself wondering, two-thirds of the way through my career, did it?
The world certainly isn’t safer, geopolitically or environmentally, now than it was when I left medical school. Hell, the idea that there’d actually be another worldwide pandemic was pretty much beyond me then. That seemed so 1918.
I can’t even say I’ve made a huge difference in medicine. I’m not on the front line of research, inventing cures and tests that will change what we do.
I’m certainly far removed from the front lines of the pandemic.
But realistically, none of those things were ever really my goal, either.
“I want my life to mean something.”
Sometimes it’s hard to think I’ve made a difference. Day in and day out I’m at my office, quietly sitting behind a desk and trying to look smart. For all good intentions ... at some point it’s just a job.
Then I realized that the job isn’t about me. It’s about her, and the many other people who come to me for help. The real meaning is the impact on their lives.
Anytime we see a patient and make their lives better, either through treatment or compassion, it creates a ripple effect. It helps their family, friends, and coworkers. Whether we’re actually giving help or just understanding.
It might even inspire one of them to go into medicine, because my generation will be drifting toward retirement in the next 10 years.
Our care may set off a chain reaction we can’t see. Perhaps the patient you help will return to work and initiate some action that will bring a marked benefit to us all. Or someone in their circle, freed or inspired by their improvement, will bring about such a change.
And that’s meaning enough for me.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
“I want my life to mean something.”
She was young, energetic, and idealistic. She was seeing me for her migraines, but our conversation had turned to her applying for medical school.
“I want my life to mean something.”
I reflected on that later. I once said similar things, but now found myself wondering, two-thirds of the way through my career, did it?
The world certainly isn’t safer, geopolitically or environmentally, now than it was when I left medical school. Hell, the idea that there’d actually be another worldwide pandemic was pretty much beyond me then. That seemed so 1918.
I can’t even say I’ve made a huge difference in medicine. I’m not on the front line of research, inventing cures and tests that will change what we do.
I’m certainly far removed from the front lines of the pandemic.
But realistically, none of those things were ever really my goal, either.
“I want my life to mean something.”
Sometimes it’s hard to think I’ve made a difference. Day in and day out I’m at my office, quietly sitting behind a desk and trying to look smart. For all good intentions ... at some point it’s just a job.
Then I realized that the job isn’t about me. It’s about her, and the many other people who come to me for help. The real meaning is the impact on their lives.
Anytime we see a patient and make their lives better, either through treatment or compassion, it creates a ripple effect. It helps their family, friends, and coworkers. Whether we’re actually giving help or just understanding.
It might even inspire one of them to go into medicine, because my generation will be drifting toward retirement in the next 10 years.
Our care may set off a chain reaction we can’t see. Perhaps the patient you help will return to work and initiate some action that will bring a marked benefit to us all. Or someone in their circle, freed or inspired by their improvement, will bring about such a change.
And that’s meaning enough for me.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
“I want my life to mean something.”
She was young, energetic, and idealistic. She was seeing me for her migraines, but our conversation had turned to her applying for medical school.
“I want my life to mean something.”
I reflected on that later. I once said similar things, but now found myself wondering, two-thirds of the way through my career, did it?
The world certainly isn’t safer, geopolitically or environmentally, now than it was when I left medical school. Hell, the idea that there’d actually be another worldwide pandemic was pretty much beyond me then. That seemed so 1918.
I can’t even say I’ve made a huge difference in medicine. I’m not on the front line of research, inventing cures and tests that will change what we do.
I’m certainly far removed from the front lines of the pandemic.
But realistically, none of those things were ever really my goal, either.
“I want my life to mean something.”
Sometimes it’s hard to think I’ve made a difference. Day in and day out I’m at my office, quietly sitting behind a desk and trying to look smart. For all good intentions ... at some point it’s just a job.
Then I realized that the job isn’t about me. It’s about her, and the many other people who come to me for help. The real meaning is the impact on their lives.
Anytime we see a patient and make their lives better, either through treatment or compassion, it creates a ripple effect. It helps their family, friends, and coworkers. Whether we’re actually giving help or just understanding.
It might even inspire one of them to go into medicine, because my generation will be drifting toward retirement in the next 10 years.
Our care may set off a chain reaction we can’t see. Perhaps the patient you help will return to work and initiate some action that will bring a marked benefit to us all. Or someone in their circle, freed or inspired by their improvement, will bring about such a change.
And that’s meaning enough for me.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
The waiting room: Then and now
Recently my wife had surgery to remove some old hardware from her knee.
Although it was an outpatient procedure, it was done at the main hospital. I was told it would be about 5 hours total, so I set up shop in the waiting room with my laptop to get some work done.
There were a few other people waiting there and one volunteer at the desk. The whole time went fairly uneventfully. Others busied themselves with iPads, phones, books, etc. It was, overall, a pleasantly quiet atmosphere. There were the occasional hushed tones of someone on the phone or talking to a doctor, the sound of someone crying in the private discussion room, the voice of a volunteer answering questions, and the intermittent whirring of the Keurig machine.
I sat there and thought about how different it was from times in the past. On weekends when I’d take call I’d come through this same room. It was often packed – standing room only. Almost always there were children running amok because their parents were too distracted or tired to control them. There were food wrappers and dirty cafeteria trays sitting on tables. The Keurig machine was often empty from frequent use – the volunteer too overwhelmed to resupply it.
Now, in the COVID-19 era, it’s a whole different world with visitor restrictions, and I found myself wondering: “Why go back to that?”
Seriously. Isn’t a calm, quiet, atmosphere supposed to be what a hospital (or doctor’s) waiting room should be? Is it really critical that large numbers of an extended family be in the waiting room for every case?
Granted, there should be exceptions. Critical and terminal illness, withdrawal of care, maybe a few others. But
Limiting it to one, maybe two family members for most circumstances isn’t a bad idea. A hospital isn’t an airport, and shouldn’t be run the same way.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
Recently my wife had surgery to remove some old hardware from her knee.
Although it was an outpatient procedure, it was done at the main hospital. I was told it would be about 5 hours total, so I set up shop in the waiting room with my laptop to get some work done.
There were a few other people waiting there and one volunteer at the desk. The whole time went fairly uneventfully. Others busied themselves with iPads, phones, books, etc. It was, overall, a pleasantly quiet atmosphere. There were the occasional hushed tones of someone on the phone or talking to a doctor, the sound of someone crying in the private discussion room, the voice of a volunteer answering questions, and the intermittent whirring of the Keurig machine.
I sat there and thought about how different it was from times in the past. On weekends when I’d take call I’d come through this same room. It was often packed – standing room only. Almost always there were children running amok because their parents were too distracted or tired to control them. There were food wrappers and dirty cafeteria trays sitting on tables. The Keurig machine was often empty from frequent use – the volunteer too overwhelmed to resupply it.
Now, in the COVID-19 era, it’s a whole different world with visitor restrictions, and I found myself wondering: “Why go back to that?”
Seriously. Isn’t a calm, quiet, atmosphere supposed to be what a hospital (or doctor’s) waiting room should be? Is it really critical that large numbers of an extended family be in the waiting room for every case?
Granted, there should be exceptions. Critical and terminal illness, withdrawal of care, maybe a few others. But
Limiting it to one, maybe two family members for most circumstances isn’t a bad idea. A hospital isn’t an airport, and shouldn’t be run the same way.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
Recently my wife had surgery to remove some old hardware from her knee.
Although it was an outpatient procedure, it was done at the main hospital. I was told it would be about 5 hours total, so I set up shop in the waiting room with my laptop to get some work done.
There were a few other people waiting there and one volunteer at the desk. The whole time went fairly uneventfully. Others busied themselves with iPads, phones, books, etc. It was, overall, a pleasantly quiet atmosphere. There were the occasional hushed tones of someone on the phone or talking to a doctor, the sound of someone crying in the private discussion room, the voice of a volunteer answering questions, and the intermittent whirring of the Keurig machine.
I sat there and thought about how different it was from times in the past. On weekends when I’d take call I’d come through this same room. It was often packed – standing room only. Almost always there were children running amok because their parents were too distracted or tired to control them. There were food wrappers and dirty cafeteria trays sitting on tables. The Keurig machine was often empty from frequent use – the volunteer too overwhelmed to resupply it.
Now, in the COVID-19 era, it’s a whole different world with visitor restrictions, and I found myself wondering: “Why go back to that?”
Seriously. Isn’t a calm, quiet, atmosphere supposed to be what a hospital (or doctor’s) waiting room should be? Is it really critical that large numbers of an extended family be in the waiting room for every case?
Granted, there should be exceptions. Critical and terminal illness, withdrawal of care, maybe a few others. But
Limiting it to one, maybe two family members for most circumstances isn’t a bad idea. A hospital isn’t an airport, and shouldn’t be run the same way.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
Hanging on to the memories
Sandy was placed in memory care recently.
In my world, as a 23-year veteran of the neurology frontline trenches, this is a pretty common occurrence for my patients.
But Sandy isn’t my patient.
She’s a longtime friend.
My parents met Sandy and her husband on New Year’s Eve, 1968. I was 2. Phoenix wasn’t a particularly big city back then.
Growing up we had summer pool parties and get-togethers with them and other families. My mom and Sandy have close birthdays, and when they both turned 50 their husbands threw them a combined 100-year surprise party. As couples they made occasional trips to Las Vegas.
In adolescence, when my voice changed, I sounded a lot like my dad, and Sandy could never tell us apart. So when I answered the phone and she thought it was him, I’d just fly with the conversation, becoming increasingly preposterous until she said: “Okay, now I know who this is. Let me talk to your mom.” Maybe she was just humoring me the whole time. But it was good for a laugh.
Ten years ago my mom mentioned Sandy had been diagnosed with Alzheimer’s disease by another neurologist in town. For a long time her deterioration was slow.
I last saw her 8 years ago, at my dad’s services. At that time we had a nice conversation. I didn’t go into my trained “neurology mode” – I’ve never been her doctor – but enjoyed talking to her as a family friend I hadn’t seen in years. There were a few gaps in her memory, but she was still the person I’d always been fond of.
Eight years is a long time in Alzheimer’s disease, and she finally reached the point where placement was no longer an option. My mom had spoken to her the week before, but told me Sandy couldn’t really carry a conversation now.
Sandy isn’t dead, but by the same token she is. Placement in memory care is often the realization that the person we knew and loved isn’t there anymore. Such treatment isn’t even on the horizon ... yet.
As a neurologist, I know this reality. I explain it to families every day.
But when it comes to someone I know outside of my profession, that doesn’t make it any easier.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
Sandy was placed in memory care recently.
In my world, as a 23-year veteran of the neurology frontline trenches, this is a pretty common occurrence for my patients.
But Sandy isn’t my patient.
She’s a longtime friend.
My parents met Sandy and her husband on New Year’s Eve, 1968. I was 2. Phoenix wasn’t a particularly big city back then.
Growing up we had summer pool parties and get-togethers with them and other families. My mom and Sandy have close birthdays, and when they both turned 50 their husbands threw them a combined 100-year surprise party. As couples they made occasional trips to Las Vegas.
In adolescence, when my voice changed, I sounded a lot like my dad, and Sandy could never tell us apart. So when I answered the phone and she thought it was him, I’d just fly with the conversation, becoming increasingly preposterous until she said: “Okay, now I know who this is. Let me talk to your mom.” Maybe she was just humoring me the whole time. But it was good for a laugh.
Ten years ago my mom mentioned Sandy had been diagnosed with Alzheimer’s disease by another neurologist in town. For a long time her deterioration was slow.
I last saw her 8 years ago, at my dad’s services. At that time we had a nice conversation. I didn’t go into my trained “neurology mode” – I’ve never been her doctor – but enjoyed talking to her as a family friend I hadn’t seen in years. There were a few gaps in her memory, but she was still the person I’d always been fond of.
Eight years is a long time in Alzheimer’s disease, and she finally reached the point where placement was no longer an option. My mom had spoken to her the week before, but told me Sandy couldn’t really carry a conversation now.
Sandy isn’t dead, but by the same token she is. Placement in memory care is often the realization that the person we knew and loved isn’t there anymore. Such treatment isn’t even on the horizon ... yet.
As a neurologist, I know this reality. I explain it to families every day.
But when it comes to someone I know outside of my profession, that doesn’t make it any easier.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
Sandy was placed in memory care recently.
In my world, as a 23-year veteran of the neurology frontline trenches, this is a pretty common occurrence for my patients.
But Sandy isn’t my patient.
She’s a longtime friend.
My parents met Sandy and her husband on New Year’s Eve, 1968. I was 2. Phoenix wasn’t a particularly big city back then.
Growing up we had summer pool parties and get-togethers with them and other families. My mom and Sandy have close birthdays, and when they both turned 50 their husbands threw them a combined 100-year surprise party. As couples they made occasional trips to Las Vegas.
In adolescence, when my voice changed, I sounded a lot like my dad, and Sandy could never tell us apart. So when I answered the phone and she thought it was him, I’d just fly with the conversation, becoming increasingly preposterous until she said: “Okay, now I know who this is. Let me talk to your mom.” Maybe she was just humoring me the whole time. But it was good for a laugh.
Ten years ago my mom mentioned Sandy had been diagnosed with Alzheimer’s disease by another neurologist in town. For a long time her deterioration was slow.
I last saw her 8 years ago, at my dad’s services. At that time we had a nice conversation. I didn’t go into my trained “neurology mode” – I’ve never been her doctor – but enjoyed talking to her as a family friend I hadn’t seen in years. There were a few gaps in her memory, but she was still the person I’d always been fond of.
Eight years is a long time in Alzheimer’s disease, and she finally reached the point where placement was no longer an option. My mom had spoken to her the week before, but told me Sandy couldn’t really carry a conversation now.
Sandy isn’t dead, but by the same token she is. Placement in memory care is often the realization that the person we knew and loved isn’t there anymore. Such treatment isn’t even on the horizon ... yet.
As a neurologist, I know this reality. I explain it to families every day.
But when it comes to someone I know outside of my profession, that doesn’t make it any easier.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
It’s time to retire the president question
The president question – “Who’s the current president?” – has been a standard one of basic neurology assessments for years, probably since the answer was Ulysses S. Grant. It’s routinely asked by doctors, nurses, EEG techs, medical students, and pretty much anyone else trying to figure out someone’s mental status.
When I first began doing this, the answer was “George Bush” (at that time there’d only been one president by that name, so clarification wasn’t needed). Back then people answered the question (right or wrong) and we moved on. I don’t recall ever getting a dirty look, political lecture, or eye roll as a response.
Unfortunately, it’s not that simple anymore. As people have become increasingly polarized, it’s become seemingly impossible to get a response without a statement of support or anger. At best I get a straight answer. At worst I get a lecture on the “perils of a non-White society” (that was last week). Then they want my opinion, and years of practice have taught me to never discuss politics with patients, regardless of which side they’re on.
I don’t recall this being a problem until the late ‘90s, when the answer was “Clinton.” Occasionally I’d get a sarcastic comment referring to the Lewinsky affair, but that was about it.
Since then it’s gradually escalated, to where the question has become worthless. I don’t have time to hear a political diatribe from either side. This is a doctor appointment, not a debate club. The insistence by some that Trump won leaves me guessing if the person is stubborn or serious, and either way it shouldn’t be my job to figure that out. I take your appointment seriously, so the least you can do is the same.
So I’ve ditched the question for good. The current date, the location of my office, and other less controversial things will have to do. I’m here to take care of you, not have you try to pick a fight or make a political statement.
You’d think such a simple, time-honored, assessment question wouldn’t become such a problem. But
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
The president question – “Who’s the current president?” – has been a standard one of basic neurology assessments for years, probably since the answer was Ulysses S. Grant. It’s routinely asked by doctors, nurses, EEG techs, medical students, and pretty much anyone else trying to figure out someone’s mental status.
When I first began doing this, the answer was “George Bush” (at that time there’d only been one president by that name, so clarification wasn’t needed). Back then people answered the question (right or wrong) and we moved on. I don’t recall ever getting a dirty look, political lecture, or eye roll as a response.
Unfortunately, it’s not that simple anymore. As people have become increasingly polarized, it’s become seemingly impossible to get a response without a statement of support or anger. At best I get a straight answer. At worst I get a lecture on the “perils of a non-White society” (that was last week). Then they want my opinion, and years of practice have taught me to never discuss politics with patients, regardless of which side they’re on.
I don’t recall this being a problem until the late ‘90s, when the answer was “Clinton.” Occasionally I’d get a sarcastic comment referring to the Lewinsky affair, but that was about it.
Since then it’s gradually escalated, to where the question has become worthless. I don’t have time to hear a political diatribe from either side. This is a doctor appointment, not a debate club. The insistence by some that Trump won leaves me guessing if the person is stubborn or serious, and either way it shouldn’t be my job to figure that out. I take your appointment seriously, so the least you can do is the same.
So I’ve ditched the question for good. The current date, the location of my office, and other less controversial things will have to do. I’m here to take care of you, not have you try to pick a fight or make a political statement.
You’d think such a simple, time-honored, assessment question wouldn’t become such a problem. But
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
The president question – “Who’s the current president?” – has been a standard one of basic neurology assessments for years, probably since the answer was Ulysses S. Grant. It’s routinely asked by doctors, nurses, EEG techs, medical students, and pretty much anyone else trying to figure out someone’s mental status.
When I first began doing this, the answer was “George Bush” (at that time there’d only been one president by that name, so clarification wasn’t needed). Back then people answered the question (right or wrong) and we moved on. I don’t recall ever getting a dirty look, political lecture, or eye roll as a response.
Unfortunately, it’s not that simple anymore. As people have become increasingly polarized, it’s become seemingly impossible to get a response without a statement of support or anger. At best I get a straight answer. At worst I get a lecture on the “perils of a non-White society” (that was last week). Then they want my opinion, and years of practice have taught me to never discuss politics with patients, regardless of which side they’re on.
I don’t recall this being a problem until the late ‘90s, when the answer was “Clinton.” Occasionally I’d get a sarcastic comment referring to the Lewinsky affair, but that was about it.
Since then it’s gradually escalated, to where the question has become worthless. I don’t have time to hear a political diatribe from either side. This is a doctor appointment, not a debate club. The insistence by some that Trump won leaves me guessing if the person is stubborn or serious, and either way it shouldn’t be my job to figure that out. I take your appointment seriously, so the least you can do is the same.
So I’ve ditched the question for good. The current date, the location of my office, and other less controversial things will have to do. I’m here to take care of you, not have you try to pick a fight or make a political statement.
You’d think such a simple, time-honored, assessment question wouldn’t become such a problem. But
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
A ‘scary’ side effect
Memantine (aka Namenda) is Food and Drug Administration–approved for Alzheimer’s disease, though its benefits are modest, at best.
It’s also, 18 years after first coming to market, relatively inexpensive.
I occasionally use it off label, as neurologists tend to do with a wide variety of medications. There are small studies that suggest it’s effective for migraine prevention and painful neuropathies. It also has a relatively benign side-effect profile.
As a result, once in a while I prescribe it for migraines or neuropathy where more typical agents haven’t helped. Like any of these drugs, sometimes it works, sometimes it doesn’t. A lot of neurology, as one of my colleagues puts it, is “guessing and voodoo.”
Since I’ve started this, however, I’ve noticed an unusual, and somewhat scary, side effect – one that has nothing to do the drug reactions.
While I don’t use any type of commercial chart system, most doctors in my area do, as well as all the hospitals. So I often see my patients’ notes from their general practitioners or after they’ve been in the hospital for whatever reason.
Those notes often list – as they should – current medications. Which includes the memantine I’ve prescribed.
But in the patient problem list I often then see “Alzheimer’s disease” or “dementia” show up, even in people who clearly have no history of such.
I’ve seen it way too many times to think it’s an accident. So one of two things is happening:
1. The computer chart system, when it sees “memantine” entered, searches its database, finds what it’s FDA-approved for, and automatically puts that in a list of current diagnoses.
2. The person entering the data, upon hearing the patient takes memantine, just enters the more commonly used indication as well, without bothering to ask the patient why they’re taking it.
Neither of these is good.
At the very least, they show a lack of proper history taking (or interest in doing so) by the person entering things in the chart (which these days could be someone with no medical training at all). It doesn’t take that much effort to say “what are you on this for?” I do it several times a day. It’s part of my job.
It’s bad form for any incorrect diagnosis to get into a chart. It can have serious repercussions on someone’s ability to get health, disability, or life insurance, not to mention the immediate impact on their care when that shows up. Someone who doesn’t know the patient opens the chart and immediately assumes it’s what they’ve got. I mean, it’s the chart. People treat it like it’s infallible and inviolable.
This isn’t a new issue – I trained at the VA when sometimes an H&P simply said “see old chart” and there were four volumes of it. But now, in the age of digital records, entries are forever. The toe you fractured surfing 8 years ago still shows up as a “current problem,” and will likely follow you to the grave. The same with any other diagnosis entered – it’s yours to keep, regardless of accuracy.
Medicine, like life, is mostly gray. But computers, and many times those who enter their data, only see things as black and white. In this field that’s liable to backfire. I’m just seeing the tip of the iceberg by using memantine off-label.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
Memantine (aka Namenda) is Food and Drug Administration–approved for Alzheimer’s disease, though its benefits are modest, at best.
It’s also, 18 years after first coming to market, relatively inexpensive.
I occasionally use it off label, as neurologists tend to do with a wide variety of medications. There are small studies that suggest it’s effective for migraine prevention and painful neuropathies. It also has a relatively benign side-effect profile.
As a result, once in a while I prescribe it for migraines or neuropathy where more typical agents haven’t helped. Like any of these drugs, sometimes it works, sometimes it doesn’t. A lot of neurology, as one of my colleagues puts it, is “guessing and voodoo.”
Since I’ve started this, however, I’ve noticed an unusual, and somewhat scary, side effect – one that has nothing to do the drug reactions.
While I don’t use any type of commercial chart system, most doctors in my area do, as well as all the hospitals. So I often see my patients’ notes from their general practitioners or after they’ve been in the hospital for whatever reason.
Those notes often list – as they should – current medications. Which includes the memantine I’ve prescribed.
But in the patient problem list I often then see “Alzheimer’s disease” or “dementia” show up, even in people who clearly have no history of such.
I’ve seen it way too many times to think it’s an accident. So one of two things is happening:
1. The computer chart system, when it sees “memantine” entered, searches its database, finds what it’s FDA-approved for, and automatically puts that in a list of current diagnoses.
2. The person entering the data, upon hearing the patient takes memantine, just enters the more commonly used indication as well, without bothering to ask the patient why they’re taking it.
Neither of these is good.
At the very least, they show a lack of proper history taking (or interest in doing so) by the person entering things in the chart (which these days could be someone with no medical training at all). It doesn’t take that much effort to say “what are you on this for?” I do it several times a day. It’s part of my job.
It’s bad form for any incorrect diagnosis to get into a chart. It can have serious repercussions on someone’s ability to get health, disability, or life insurance, not to mention the immediate impact on their care when that shows up. Someone who doesn’t know the patient opens the chart and immediately assumes it’s what they’ve got. I mean, it’s the chart. People treat it like it’s infallible and inviolable.
This isn’t a new issue – I trained at the VA when sometimes an H&P simply said “see old chart” and there were four volumes of it. But now, in the age of digital records, entries are forever. The toe you fractured surfing 8 years ago still shows up as a “current problem,” and will likely follow you to the grave. The same with any other diagnosis entered – it’s yours to keep, regardless of accuracy.
Medicine, like life, is mostly gray. But computers, and many times those who enter their data, only see things as black and white. In this field that’s liable to backfire. I’m just seeing the tip of the iceberg by using memantine off-label.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
Memantine (aka Namenda) is Food and Drug Administration–approved for Alzheimer’s disease, though its benefits are modest, at best.
It’s also, 18 years after first coming to market, relatively inexpensive.
I occasionally use it off label, as neurologists tend to do with a wide variety of medications. There are small studies that suggest it’s effective for migraine prevention and painful neuropathies. It also has a relatively benign side-effect profile.
As a result, once in a while I prescribe it for migraines or neuropathy where more typical agents haven’t helped. Like any of these drugs, sometimes it works, sometimes it doesn’t. A lot of neurology, as one of my colleagues puts it, is “guessing and voodoo.”
Since I’ve started this, however, I’ve noticed an unusual, and somewhat scary, side effect – one that has nothing to do the drug reactions.
While I don’t use any type of commercial chart system, most doctors in my area do, as well as all the hospitals. So I often see my patients’ notes from their general practitioners or after they’ve been in the hospital for whatever reason.
Those notes often list – as they should – current medications. Which includes the memantine I’ve prescribed.
But in the patient problem list I often then see “Alzheimer’s disease” or “dementia” show up, even in people who clearly have no history of such.
I’ve seen it way too many times to think it’s an accident. So one of two things is happening:
1. The computer chart system, when it sees “memantine” entered, searches its database, finds what it’s FDA-approved for, and automatically puts that in a list of current diagnoses.
2. The person entering the data, upon hearing the patient takes memantine, just enters the more commonly used indication as well, without bothering to ask the patient why they’re taking it.
Neither of these is good.
At the very least, they show a lack of proper history taking (or interest in doing so) by the person entering things in the chart (which these days could be someone with no medical training at all). It doesn’t take that much effort to say “what are you on this for?” I do it several times a day. It’s part of my job.
It’s bad form for any incorrect diagnosis to get into a chart. It can have serious repercussions on someone’s ability to get health, disability, or life insurance, not to mention the immediate impact on their care when that shows up. Someone who doesn’t know the patient opens the chart and immediately assumes it’s what they’ve got. I mean, it’s the chart. People treat it like it’s infallible and inviolable.
This isn’t a new issue – I trained at the VA when sometimes an H&P simply said “see old chart” and there were four volumes of it. But now, in the age of digital records, entries are forever. The toe you fractured surfing 8 years ago still shows up as a “current problem,” and will likely follow you to the grave. The same with any other diagnosis entered – it’s yours to keep, regardless of accuracy.
Medicine, like life, is mostly gray. But computers, and many times those who enter their data, only see things as black and white. In this field that’s liable to backfire. I’m just seeing the tip of the iceberg by using memantine off-label.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
Nota bene: Don’t change a note
A man I saw earlier this year called my office recently. He’d read my note, and after discussing it with his attorney, wanted me to make changes. He said that the way I’d described his symptoms would be damaging to a legal action he was involved in, and so he wanted it reworded.
Obviously, I said “no.” I’m not a fiction writer. My notes are what people tell me happened. I don’t make them up.
He wasn’t happy about this, and a few days later I got a request to send his records to another neurologist, which I gladly did.
In this business a large measure of what we do is based on the patient’s symptoms. what they report to us, and how they describe it. When I put their story into a written note, my goal is to be as accurate to what they told me as possible. I’m not here to embellish, disparage, or minimize their history.
To do so is to look bad at the very least and open yourself up to malpractice and legal charges at worst.
This isn’t to say errors can’t be modified. I’m far from perfect. Sometimes I might misunderstand something a patient tells me, or get information crossed up. When that happens there’s nothing wrong with writing an addendum, clarifying or correcting what my earlier note said – but not changing the original note.
I asked the unhappy patient to write down what he thought was incorrect, and I’d be willing to include that in his chart. He wasn’t willing to do that, and there was no way I would ever change a note. I tried to politely explain the reasons why, but he wasn’t listening.
So I lost him as a patient. After 23 years of practice, that doesn’t bother me. I learned a long time ago that I can’t please everyone, nor can I be everyone’s doctor. Saying “no” is just as important as saying “yes,” though at times more difficult.
This time, though, the answer was pretty obvious, and will be the same next time I get the same request from a patient.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
A man I saw earlier this year called my office recently. He’d read my note, and after discussing it with his attorney, wanted me to make changes. He said that the way I’d described his symptoms would be damaging to a legal action he was involved in, and so he wanted it reworded.
Obviously, I said “no.” I’m not a fiction writer. My notes are what people tell me happened. I don’t make them up.
He wasn’t happy about this, and a few days later I got a request to send his records to another neurologist, which I gladly did.
In this business a large measure of what we do is based on the patient’s symptoms. what they report to us, and how they describe it. When I put their story into a written note, my goal is to be as accurate to what they told me as possible. I’m not here to embellish, disparage, or minimize their history.
To do so is to look bad at the very least and open yourself up to malpractice and legal charges at worst.
This isn’t to say errors can’t be modified. I’m far from perfect. Sometimes I might misunderstand something a patient tells me, or get information crossed up. When that happens there’s nothing wrong with writing an addendum, clarifying or correcting what my earlier note said – but not changing the original note.
I asked the unhappy patient to write down what he thought was incorrect, and I’d be willing to include that in his chart. He wasn’t willing to do that, and there was no way I would ever change a note. I tried to politely explain the reasons why, but he wasn’t listening.
So I lost him as a patient. After 23 years of practice, that doesn’t bother me. I learned a long time ago that I can’t please everyone, nor can I be everyone’s doctor. Saying “no” is just as important as saying “yes,” though at times more difficult.
This time, though, the answer was pretty obvious, and will be the same next time I get the same request from a patient.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
A man I saw earlier this year called my office recently. He’d read my note, and after discussing it with his attorney, wanted me to make changes. He said that the way I’d described his symptoms would be damaging to a legal action he was involved in, and so he wanted it reworded.
Obviously, I said “no.” I’m not a fiction writer. My notes are what people tell me happened. I don’t make them up.
He wasn’t happy about this, and a few days later I got a request to send his records to another neurologist, which I gladly did.
In this business a large measure of what we do is based on the patient’s symptoms. what they report to us, and how they describe it. When I put their story into a written note, my goal is to be as accurate to what they told me as possible. I’m not here to embellish, disparage, or minimize their history.
To do so is to look bad at the very least and open yourself up to malpractice and legal charges at worst.
This isn’t to say errors can’t be modified. I’m far from perfect. Sometimes I might misunderstand something a patient tells me, or get information crossed up. When that happens there’s nothing wrong with writing an addendum, clarifying or correcting what my earlier note said – but not changing the original note.
I asked the unhappy patient to write down what he thought was incorrect, and I’d be willing to include that in his chart. He wasn’t willing to do that, and there was no way I would ever change a note. I tried to politely explain the reasons why, but he wasn’t listening.
So I lost him as a patient. After 23 years of practice, that doesn’t bother me. I learned a long time ago that I can’t please everyone, nor can I be everyone’s doctor. Saying “no” is just as important as saying “yes,” though at times more difficult.
This time, though, the answer was pretty obvious, and will be the same next time I get the same request from a patient.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.