Hitting a Nerve

Looking back at the calendar, I realized that the insane year of 2020 will be the first in memory that I never took a vacation. Not a single trip outside the Phoenix metropolitan area. For that matter, there were only a handful of times I even ventured beyond the borders of Scottsdale.

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

Looking back at the calendar, I realized that the insane year of 2020 will be the first in memory that I never took a vacation. Not a single trip outside the Phoenix metropolitan area. For that matter, there were only a handful of times I even ventured beyond the borders of Scottsdale.

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

Looking back at the calendar, I realized that the insane year of 2020 will be the first in memory that I never took a vacation. Not a single trip outside the Phoenix metropolitan area. For that matter, there were only a handful of times I even ventured beyond the borders of Scottsdale.

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

“Diabetes drugs may cure dementia.”

How many of you saw that headline (or similar) earlier this year, before the pandemic took over the news?

My patients sure did. And their families. And people who aren’t my patients but found my name in the phone book after reading the headline. Of course, all of them wanted to be put on diabetes drugs to cure or prevent dementia, like the headline said.

The key word in the headline, though, is “may,” which promises nothing. Not only that, but if you actually read the story you quickly learn that the study was done in people who have diabetes, and lowers the risk of dementia.

While there could, possibly, maybe, be something interesting underlying the finding, it could also be as simple as controlling your vascular risk factors, which is good for you.

Of course, the lay public rarely reads past the first few paragraphs. To the nonmedical reader, the cure has been found, and they want it. Where’s the phone?

I’m sure this is good for business in the lay press. People see the headline and don’t bother to read the story but they immediately forward it to friends, family, Facebook and Twitter groups ... That’s a lot of clicks and advertising.

The study might genuinely mean something, but that’s a big “might.” A lot of common drugs have been hyped as being treatments for dementia – statins, ibuprofen, estrogen patches, to name a few – only to quietly die in larger controlled trials. But that part of the research never seems to make the news, only the first small, preliminary, results.

People want us to find answers. Isn’t that what doctors and scientists are supposed to do? I understand that. But by the same token, it’s generally not that easy. And if we try to explain the difficulty, then we’re often accused of being part of “them,” some secretive group trying to hide inexpensive miracle cures from the public to keep Big Pharma in business.

The real truth is that a lot of things initially seem to be good (or bad) and these things change like the seasons. Everyone should be on daily aspirin, oops, maybe not. Saccharine causes bladder cancer, wait, I take that back. And so on.

While diabetes treatments may indeed lower the risk of dementia in patients who have diabetes, people too often extrapolate that to everyone, and wishfully think the headline says “does cure” instead of “may cure.”

I have nothing against research. Everything we have now came from it. But preliminary results are just that – preliminary. Like many other things in this world, they have to be taken with a grain of salt.

Dr. Block has a solo neurology practice in Scottsdale, Arizona. He has no relevant disclosures.

“Diabetes drugs may cure dementia.”

How many of you saw that headline (or similar) earlier this year, before the pandemic took over the news?

My patients sure did. And their families. And people who aren’t my patients but found my name in the phone book after reading the headline. Of course, all of them wanted to be put on diabetes drugs to cure or prevent dementia, like the headline said.

The key word in the headline, though, is “may,” which promises nothing. Not only that, but if you actually read the story you quickly learn that the study was done in people who have diabetes, and lowers the risk of dementia.

While there could, possibly, maybe, be something interesting underlying the finding, it could also be as simple as controlling your vascular risk factors, which is good for you.

Of course, the lay public rarely reads past the first few paragraphs. To the nonmedical reader, the cure has been found, and they want it. Where’s the phone?

I’m sure this is good for business in the lay press. People see the headline and don’t bother to read the story but they immediately forward it to friends, family, Facebook and Twitter groups ... That’s a lot of clicks and advertising.

The study might genuinely mean something, but that’s a big “might.” A lot of common drugs have been hyped as being treatments for dementia – statins, ibuprofen, estrogen patches, to name a few – only to quietly die in larger controlled trials. But that part of the research never seems to make the news, only the first small, preliminary, results.

People want us to find answers. Isn’t that what doctors and scientists are supposed to do? I understand that. But by the same token, it’s generally not that easy. And if we try to explain the difficulty, then we’re often accused of being part of “them,” some secretive group trying to hide inexpensive miracle cures from the public to keep Big Pharma in business.

The real truth is that a lot of things initially seem to be good (or bad) and these things change like the seasons. Everyone should be on daily aspirin, oops, maybe not. Saccharine causes bladder cancer, wait, I take that back. And so on.

While diabetes treatments may indeed lower the risk of dementia in patients who have diabetes, people too often extrapolate that to everyone, and wishfully think the headline says “does cure” instead of “may cure.”

I have nothing against research. Everything we have now came from it. But preliminary results are just that – preliminary. Like many other things in this world, they have to be taken with a grain of salt.

Dr. Block has a solo neurology practice in Scottsdale, Arizona. He has no relevant disclosures.

“Diabetes drugs may cure dementia.”

How many of you saw that headline (or similar) earlier this year, before the pandemic took over the news?

My patients sure did. And their families. And people who aren’t my patients but found my name in the phone book after reading the headline. Of course, all of them wanted to be put on diabetes drugs to cure or prevent dementia, like the headline said.

The key word in the headline, though, is “may,” which promises nothing. Not only that, but if you actually read the story you quickly learn that the study was done in people who have diabetes, and lowers the risk of dementia.

While there could, possibly, maybe, be something interesting underlying the finding, it could also be as simple as controlling your vascular risk factors, which is good for you.

Of course, the lay public rarely reads past the first few paragraphs. To the nonmedical reader, the cure has been found, and they want it. Where’s the phone?

I’m sure this is good for business in the lay press. People see the headline and don’t bother to read the story but they immediately forward it to friends, family, Facebook and Twitter groups ... That’s a lot of clicks and advertising.

The study might genuinely mean something, but that’s a big “might.” A lot of common drugs have been hyped as being treatments for dementia – statins, ibuprofen, estrogen patches, to name a few – only to quietly die in larger controlled trials. But that part of the research never seems to make the news, only the first small, preliminary, results.

People want us to find answers. Isn’t that what doctors and scientists are supposed to do? I understand that. But by the same token, it’s generally not that easy. And if we try to explain the difficulty, then we’re often accused of being part of “them,” some secretive group trying to hide inexpensive miracle cures from the public to keep Big Pharma in business.

The real truth is that a lot of things initially seem to be good (or bad) and these things change like the seasons. Everyone should be on daily aspirin, oops, maybe not. Saccharine causes bladder cancer, wait, I take that back. And so on.

While diabetes treatments may indeed lower the risk of dementia in patients who have diabetes, people too often extrapolate that to everyone, and wishfully think the headline says “does cure” instead of “may cure.”

I have nothing against research. Everything we have now came from it. But preliminary results are just that – preliminary. Like many other things in this world, they have to be taken with a grain of salt.

Dr. Block has a solo neurology practice in Scottsdale, Arizona. He has no relevant disclosures.

Recently I was in a minor car accident. No injuries, just some bent metal and scratched paint from a low-speed parking lot mishap.

The other driver and I got out of our cars, made sure we were both okay, and then I said “Let’s exchange insurance information.” We got our insurance cards out; I took a picture of her card, and she wrote down my info. Then we drove off and went on with our days. The whole thing took a few minutes.

Why am I writing about this?

Because it was all handled very politely. There were no angry words, name calling, or heated exchanges. We checked the damage, made sure the other was okay, and exchanged insurance cards ... without a single impolite phrase or gesture.

To me this is a good thing. In a world in which people yell (and sometimes brandish weapons) over imagined and minor offenses, in which political candidates exchange crude insults rather then debate policy, and in which an opposing viewpoint is treated as blasphemy rather than an honest difference of opinion, it was nice to have a polite, adult, exchange under unpleasant circumstances.

Perhaps it’s sad to find relief in such a minor event, but it’s also reassuring. In medicine (especially hospital work) we often see people at their very worst, and dealing with them can be a challenge. We live in a world of at-times seemingly endless rudeness, one-upping, and “problem-solving” with yelling, threats, and intimidation.

So I was glad the minor incident resulted in nothing more serious at the time than a brief, polite, conversation. It’s nice to know many people out there still subscribe to civil ideas and polite behavior, even when the circumstances are difficult.

Dr. Block has a solo neurology practice in Scottsdale, Arizona. He has nothing to disclose.

Recently I was in a minor car accident. No injuries, just some bent metal and scratched paint from a low-speed parking lot mishap.

The other driver and I got out of our cars, made sure we were both okay, and then I said “Let’s exchange insurance information.” We got our insurance cards out; I took a picture of her card, and she wrote down my info. Then we drove off and went on with our days. The whole thing took a few minutes.

Why am I writing about this?

Because it was all handled very politely. There were no angry words, name calling, or heated exchanges. We checked the damage, made sure the other was okay, and exchanged insurance cards ... without a single impolite phrase or gesture.

To me this is a good thing. In a world in which people yell (and sometimes brandish weapons) over imagined and minor offenses, in which political candidates exchange crude insults rather then debate policy, and in which an opposing viewpoint is treated as blasphemy rather than an honest difference of opinion, it was nice to have a polite, adult, exchange under unpleasant circumstances.

Perhaps it’s sad to find relief in such a minor event, but it’s also reassuring. In medicine (especially hospital work) we often see people at their very worst, and dealing with them can be a challenge. We live in a world of at-times seemingly endless rudeness, one-upping, and “problem-solving” with yelling, threats, and intimidation.

So I was glad the minor incident resulted in nothing more serious at the time than a brief, polite, conversation. It’s nice to know many people out there still subscribe to civil ideas and polite behavior, even when the circumstances are difficult.

Dr. Block has a solo neurology practice in Scottsdale, Arizona. He has nothing to disclose.

Recently I was in a minor car accident. No injuries, just some bent metal and scratched paint from a low-speed parking lot mishap.

The other driver and I got out of our cars, made sure we were both okay, and then I said “Let’s exchange insurance information.” We got our insurance cards out; I took a picture of her card, and she wrote down my info. Then we drove off and went on with our days. The whole thing took a few minutes.

Why am I writing about this?

Because it was all handled very politely. There were no angry words, name calling, or heated exchanges. We checked the damage, made sure the other was okay, and exchanged insurance cards ... without a single impolite phrase or gesture.

To me this is a good thing. In a world in which people yell (and sometimes brandish weapons) over imagined and minor offenses, in which political candidates exchange crude insults rather then debate policy, and in which an opposing viewpoint is treated as blasphemy rather than an honest difference of opinion, it was nice to have a polite, adult, exchange under unpleasant circumstances.

Perhaps it’s sad to find relief in such a minor event, but it’s also reassuring. In medicine (especially hospital work) we often see people at their very worst, and dealing with them can be a challenge. We live in a world of at-times seemingly endless rudeness, one-upping, and “problem-solving” with yelling, threats, and intimidation.

So I was glad the minor incident resulted in nothing more serious at the time than a brief, polite, conversation. It’s nice to know many people out there still subscribe to civil ideas and polite behavior, even when the circumstances are difficult.

Dr. Block has a solo neurology practice in Scottsdale, Arizona. He has nothing to disclose.

During my sophomore year in high school, we had to read a historical essay about cars, the author and name of which I’ve long forgotten. The basic point of it was that, as of 1982, no invention had changed Western culture more than the automobile.

In America, the car is king. A large portion of society revolves around cars and their trappings: modifications, sports, collectors auctions, parking lots and garages, and many others. The city of Detroit has become synonymous with one industry.

A few times a week I have to walk two to three blocks to and from a research office to see patients and do paperwork. This involves me cutting through a series of parking lots, including one garage, that service the office buildings in the area. For years they’ve always been full on weekdays.

Now, after 6 months of pandemic, they’re maybe 10% filled. Rows and rows of empty spaces certainly makes my walks easier.

But each time I walk there now I wonder where this will lead. The people who used to park still work there, just from home now. If they can work from home successfully for 6 months, why should they even come back to the office on a routine basis?

I don’t think it’s the end of the automobile by any means. The majority of us still depend on it for many things and will continue to do so for a long time to come. I need it to get to my office, the hospital, the store, to take my oldest to and from his job, and many other things.

But perhaps the pandemic will also bring a lasting change in how and where many do their jobs. It’s certainly driven a dramatic shift to Zoom, Teams, WebEx, Skype, and other remote platforms.

If they’re not really needed, having fewer cars on the road is probably a good thing. It saves commute time, reduces oil dependence and pollution, and provides a number of other benefits. If sustained, in the long term it will affect the calculus of office space and buildings, parking lot sizes, and a million other details.

My secretary has been working from home since late March now. While I miss having her and her daughter at the office, her lack of a commute means she starts taking calls an hour earlier and isn’t spending $60-$100 a week on gas.

We’ll have to see how it all plays out. Like other adverse events that change society, not all of the changes in the aftermath may be bad ones.

The car will be king in America for a long time to come, but its role in commuting may be fundamentally different after the pandemic, and the ripples from this may bring many more changes – hopefully for the better.

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

During my sophomore year in high school, we had to read a historical essay about cars, the author and name of which I’ve long forgotten. The basic point of it was that, as of 1982, no invention had changed Western culture more than the automobile.

In America, the car is king. A large portion of society revolves around cars and their trappings: modifications, sports, collectors auctions, parking lots and garages, and many others. The city of Detroit has become synonymous with one industry.

A few times a week I have to walk two to three blocks to and from a research office to see patients and do paperwork. This involves me cutting through a series of parking lots, including one garage, that service the office buildings in the area. For years they’ve always been full on weekdays.

Now, after 6 months of pandemic, they’re maybe 10% filled. Rows and rows of empty spaces certainly makes my walks easier.

But each time I walk there now I wonder where this will lead. The people who used to park still work there, just from home now. If they can work from home successfully for 6 months, why should they even come back to the office on a routine basis?

I don’t think it’s the end of the automobile by any means. The majority of us still depend on it for many things and will continue to do so for a long time to come. I need it to get to my office, the hospital, the store, to take my oldest to and from his job, and many other things.

But perhaps the pandemic will also bring a lasting change in how and where many do their jobs. It’s certainly driven a dramatic shift to Zoom, Teams, WebEx, Skype, and other remote platforms.

If they’re not really needed, having fewer cars on the road is probably a good thing. It saves commute time, reduces oil dependence and pollution, and provides a number of other benefits. If sustained, in the long term it will affect the calculus of office space and buildings, parking lot sizes, and a million other details.

My secretary has been working from home since late March now. While I miss having her and her daughter at the office, her lack of a commute means she starts taking calls an hour earlier and isn’t spending $60-$100 a week on gas.

We’ll have to see how it all plays out. Like other adverse events that change society, not all of the changes in the aftermath may be bad ones.

The car will be king in America for a long time to come, but its role in commuting may be fundamentally different after the pandemic, and the ripples from this may bring many more changes – hopefully for the better.

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

During my sophomore year in high school, we had to read a historical essay about cars, the author and name of which I’ve long forgotten. The basic point of it was that, as of 1982, no invention had changed Western culture more than the automobile.

In America, the car is king. A large portion of society revolves around cars and their trappings: modifications, sports, collectors auctions, parking lots and garages, and many others. The city of Detroit has become synonymous with one industry.

A few times a week I have to walk two to three blocks to and from a research office to see patients and do paperwork. This involves me cutting through a series of parking lots, including one garage, that service the office buildings in the area. For years they’ve always been full on weekdays.

Now, after 6 months of pandemic, they’re maybe 10% filled. Rows and rows of empty spaces certainly makes my walks easier.

But each time I walk there now I wonder where this will lead. The people who used to park still work there, just from home now. If they can work from home successfully for 6 months, why should they even come back to the office on a routine basis?

I don’t think it’s the end of the automobile by any means. The majority of us still depend on it for many things and will continue to do so for a long time to come. I need it to get to my office, the hospital, the store, to take my oldest to and from his job, and many other things.

But perhaps the pandemic will also bring a lasting change in how and where many do their jobs. It’s certainly driven a dramatic shift to Zoom, Teams, WebEx, Skype, and other remote platforms.

If they’re not really needed, having fewer cars on the road is probably a good thing. It saves commute time, reduces oil dependence and pollution, and provides a number of other benefits. If sustained, in the long term it will affect the calculus of office space and buildings, parking lot sizes, and a million other details.

My secretary has been working from home since late March now. While I miss having her and her daughter at the office, her lack of a commute means she starts taking calls an hour earlier and isn’t spending $60-$100 a week on gas.

We’ll have to see how it all plays out. Like other adverse events that change society, not all of the changes in the aftermath may be bad ones.

The car will be king in America for a long time to come, but its role in commuting may be fundamentally different after the pandemic, and the ripples from this may bring many more changes – hopefully for the better.

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

“Interprovider communication” is a big buzzphrase in medicine these days. Granted, it’s an important aspect of patient care. But, like many words and phrases, a lot of substance is lost in the spin of things.

I get emails, faxes, and letters all the time promising a new system that improves communication between physicians and patients. The hospital I share call at always seems to have something in its physician newsletters about a new software or app to improve communication.

The problem here isn’t that there aren’t already good ways for physicians to communicate – there are. I generally rely on the old standbys of a fax machine, with the post office as a backup for most things, and the phone for more urgent matters.

The real issue is people who don’t use the systems available, and no amount of technology will change that.

Some doctors feel they’re too busy to get a letter out, or forward tests results to another physician, or even have their office staff do it. Others just barely glance at anything that comes through, then pass it on to their staff to file it in a chart. At the hospital some doctors don’t seem to bother to read their consultants’ notes.

Granted, this isn’t entirely the doctors’ faults. As I’ve written before, many of the EMR chart systems are so full of templates and cut and paste that notes are rendered virtually meaningless. To find the impression – if it’s even in there – may need some digging. This takes time, which is always in short supply in a medical practice. The days when you could just flip through to the paragraph labeled “impression” are gone, and probably aren’t coming back. Which is good for no one on either side of the desk or bedrail.

This is sad, because that’s where the vast majority of physician communication happened. Letting people know what you’re thinking and doing, and at the same time asking specific questions you’re hoping they’ll address.

No amount of technological wizardry is going to make it easier to find meaning in a meaningless note, contact someone who isn’t listening, or hear from someone who isn’t talking.

Not all doctors are poor at communication – the vast majority are not. But for those of us trying to care for a patient with one who is, there isn’t a software breakthrough now – or ever – that will make it any easier, no matter how much time, money, and glossy marketing is thrown at it.

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

“Interprovider communication” is a big buzzphrase in medicine these days. Granted, it’s an important aspect of patient care. But, like many words and phrases, a lot of substance is lost in the spin of things.

I get emails, faxes, and letters all the time promising a new system that improves communication between physicians and patients. The hospital I share call at always seems to have something in its physician newsletters about a new software or app to improve communication.

The problem here isn’t that there aren’t already good ways for physicians to communicate – there are. I generally rely on the old standbys of a fax machine, with the post office as a backup for most things, and the phone for more urgent matters.

The real issue is people who don’t use the systems available, and no amount of technology will change that.

Some doctors feel they’re too busy to get a letter out, or forward tests results to another physician, or even have their office staff do it. Others just barely glance at anything that comes through, then pass it on to their staff to file it in a chart. At the hospital some doctors don’t seem to bother to read their consultants’ notes.

Granted, this isn’t entirely the doctors’ faults. As I’ve written before, many of the EMR chart systems are so full of templates and cut and paste that notes are rendered virtually meaningless. To find the impression – if it’s even in there – may need some digging. This takes time, which is always in short supply in a medical practice. The days when you could just flip through to the paragraph labeled “impression” are gone, and probably aren’t coming back. Which is good for no one on either side of the desk or bedrail.

This is sad, because that’s where the vast majority of physician communication happened. Letting people know what you’re thinking and doing, and at the same time asking specific questions you’re hoping they’ll address.

No amount of technological wizardry is going to make it easier to find meaning in a meaningless note, contact someone who isn’t listening, or hear from someone who isn’t talking.

Not all doctors are poor at communication – the vast majority are not. But for those of us trying to care for a patient with one who is, there isn’t a software breakthrough now – or ever – that will make it any easier, no matter how much time, money, and glossy marketing is thrown at it.

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

“Interprovider communication” is a big buzzphrase in medicine these days. Granted, it’s an important aspect of patient care. But, like many words and phrases, a lot of substance is lost in the spin of things.

I get emails, faxes, and letters all the time promising a new system that improves communication between physicians and patients. The hospital I share call at always seems to have something in its physician newsletters about a new software or app to improve communication.

The problem here isn’t that there aren’t already good ways for physicians to communicate – there are. I generally rely on the old standbys of a fax machine, with the post office as a backup for most things, and the phone for more urgent matters.

The real issue is people who don’t use the systems available, and no amount of technology will change that.

Some doctors feel they’re too busy to get a letter out, or forward tests results to another physician, or even have their office staff do it. Others just barely glance at anything that comes through, then pass it on to their staff to file it in a chart. At the hospital some doctors don’t seem to bother to read their consultants’ notes.

Granted, this isn’t entirely the doctors’ faults. As I’ve written before, many of the EMR chart systems are so full of templates and cut and paste that notes are rendered virtually meaningless. To find the impression – if it’s even in there – may need some digging. This takes time, which is always in short supply in a medical practice. The days when you could just flip through to the paragraph labeled “impression” are gone, and probably aren’t coming back. Which is good for no one on either side of the desk or bedrail.

This is sad, because that’s where the vast majority of physician communication happened. Letting people know what you’re thinking and doing, and at the same time asking specific questions you’re hoping they’ll address.

No amount of technological wizardry is going to make it easier to find meaning in a meaningless note, contact someone who isn’t listening, or hear from someone who isn’t talking.

Not all doctors are poor at communication – the vast majority are not. But for those of us trying to care for a patient with one who is, there isn’t a software breakthrough now – or ever – that will make it any easier, no matter how much time, money, and glossy marketing is thrown at it.

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

Metformin, oleander extract, azithromycin, famotidine, fluvoxamine, hydroxychloroquine, indomethacin, remdesivir, different vaccines, and many others. What does this disparate group of agents have in common? They’re all being bandied about as treatments for COVID-19.

This sort of thing makes big headlines in the news when someone even mentions them as a possible treatment, but so do proposed treatments for Alzheimer’s disease, various cancers, and other devastating illnesses. It triggers calls to doctors’ offices by patients wanting to be put on them, demands for them to be sold over the counter, and less-then-scrupulous people selling all kinds of things claiming to contain them and cure the disease for only $89.95 with free shipping if you act now.

Even in ordinary times (whatever that means anymore) it doesn’t take much for even a hint of success to make the news, spiking calls to doctors’ offices asking about “that new treatment I saw.” Of course, the number of drugs that are proven to be successful and come to market is a fraction of what’s actually tested.

Since the many failures don’t make headlines like successes do, the general public moves on and doesn’t even remember the initial story after a while. Only the medical and pharmaceutical professions are left to remember “we tried that, it didn’t work.”

We learn as much from failure as we do from success – sometimes more – but failure doesn’t make headlines or sell papers or get clicks.

The research scientists and physicians know this and how long it can take to find something that works. In some diseases it still hasn’t happened, in spite of billions spent and decades going by.

Unfortunately, nonscientific people (which is most of the population) just see our remarkable breakthroughs evidenced by shiny equipment and new drugs, and only read the headlines about successes. They don’t realize the many years and failures behind them.

In a world used to instant gratification, people want a cure for the coronavirus now. It doesn’t help to have nonmedical talking heads on the news egging this belief on. The few voices of reason are drowned out.

The polio virus was identified in 1908 (the disease is thousands of years old). The Salk vaccine came out in 1955. That’s a 47-year gap. I doubt it will take that long for COVID-19, but the point is that these things never have, and never will, happen overnight.

The problem isn’t science or medicine. It’s unreasonable expectations for immediate success. While science and diseases may change over time, human nature doesn’t.

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

Metformin, oleander extract, azithromycin, famotidine, fluvoxamine, hydroxychloroquine, indomethacin, remdesivir, different vaccines, and many others. What does this disparate group of agents have in common? They’re all being bandied about as treatments for COVID-19.

This sort of thing makes big headlines in the news when someone even mentions them as a possible treatment, but so do proposed treatments for Alzheimer’s disease, various cancers, and other devastating illnesses. It triggers calls to doctors’ offices by patients wanting to be put on them, demands for them to be sold over the counter, and less-then-scrupulous people selling all kinds of things claiming to contain them and cure the disease for only $89.95 with free shipping if you act now.

Even in ordinary times (whatever that means anymore) it doesn’t take much for even a hint of success to make the news, spiking calls to doctors’ offices asking about “that new treatment I saw.” Of course, the number of drugs that are proven to be successful and come to market is a fraction of what’s actually tested.

Since the many failures don’t make headlines like successes do, the general public moves on and doesn’t even remember the initial story after a while. Only the medical and pharmaceutical professions are left to remember “we tried that, it didn’t work.”

We learn as much from failure as we do from success – sometimes more – but failure doesn’t make headlines or sell papers or get clicks.

The research scientists and physicians know this and how long it can take to find something that works. In some diseases it still hasn’t happened, in spite of billions spent and decades going by.

Unfortunately, nonscientific people (which is most of the population) just see our remarkable breakthroughs evidenced by shiny equipment and new drugs, and only read the headlines about successes. They don’t realize the many years and failures behind them.

In a world used to instant gratification, people want a cure for the coronavirus now. It doesn’t help to have nonmedical talking heads on the news egging this belief on. The few voices of reason are drowned out.

The polio virus was identified in 1908 (the disease is thousands of years old). The Salk vaccine came out in 1955. That’s a 47-year gap. I doubt it will take that long for COVID-19, but the point is that these things never have, and never will, happen overnight.

The problem isn’t science or medicine. It’s unreasonable expectations for immediate success. While science and diseases may change over time, human nature doesn’t.

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

Metformin, oleander extract, azithromycin, famotidine, fluvoxamine, hydroxychloroquine, indomethacin, remdesivir, different vaccines, and many others. What does this disparate group of agents have in common? They’re all being bandied about as treatments for COVID-19.

This sort of thing makes big headlines in the news when someone even mentions them as a possible treatment, but so do proposed treatments for Alzheimer’s disease, various cancers, and other devastating illnesses. It triggers calls to doctors’ offices by patients wanting to be put on them, demands for them to be sold over the counter, and less-then-scrupulous people selling all kinds of things claiming to contain them and cure the disease for only $89.95 with free shipping if you act now.

Even in ordinary times (whatever that means anymore) it doesn’t take much for even a hint of success to make the news, spiking calls to doctors’ offices asking about “that new treatment I saw.” Of course, the number of drugs that are proven to be successful and come to market is a fraction of what’s actually tested.

Since the many failures don’t make headlines like successes do, the general public moves on and doesn’t even remember the initial story after a while. Only the medical and pharmaceutical professions are left to remember “we tried that, it didn’t work.”

We learn as much from failure as we do from success – sometimes more – but failure doesn’t make headlines or sell papers or get clicks.

The research scientists and physicians know this and how long it can take to find something that works. In some diseases it still hasn’t happened, in spite of billions spent and decades going by.

Unfortunately, nonscientific people (which is most of the population) just see our remarkable breakthroughs evidenced by shiny equipment and new drugs, and only read the headlines about successes. They don’t realize the many years and failures behind them.

In a world used to instant gratification, people want a cure for the coronavirus now. It doesn’t help to have nonmedical talking heads on the news egging this belief on. The few voices of reason are drowned out.

The polio virus was identified in 1908 (the disease is thousands of years old). The Salk vaccine came out in 1955. That’s a 47-year gap. I doubt it will take that long for COVID-19, but the point is that these things never have, and never will, happen overnight.

The problem isn’t science or medicine. It’s unreasonable expectations for immediate success. While science and diseases may change over time, human nature doesn’t.

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

“My other doctor has an office blog. You should have one, too. They’re really helpful.”

I hear that line a fair amount.

No, thank you.

I legitimately did try to have an office blog 7-8 years ago. I figured it might bring in a few more patients, answer FAQs from others, and give me something to do. So I did some reading, created an account on Blogger, and started one. I think my first post was on multiple sclerosis. Nothing really specific, more just generic “living with MS” tips.

I wrote another the next week, then a third post about 2 months later. Roughly 6 months after starting I gave up and quietly deleted the account.

I have no idea how some doctors have time for that sort of thing. They must have more free time than I do. Maybe they pay someone to write the posts for them. But it didn’t take me long to realize I didn’t have the time, or personal interest, to make it worthwhile. Besides, generic medical blogs spouting common sense (“Eat more vegetables! Exercise!”) are a dime a dozen. To put anything more specific in this day and age runs the risk of litigation.

I like writing, as evidenced by this column. But the time and effort that a regular office blog demanded was beyond what I could put into it, and the nature of the writing needed was more milquetoast than I enjoyed doing.

Time is, perhaps, the most precious commodity we have. Writing a nondescript office blog, as I learned, definitely wasn’t my cup of tea. I’m pretty sure an office Twitter account would be the same, and I have no interest in opening that door.

If another doctor wants to invest time in a blog, that’s fine. I hope it is something worthwhile and that they enjoy it. If a patient thinks that makes them a better doctor, they can.

But not me. If I’m going to devote time to my work, I’ll do it in the best way I know, and the one I still enjoy: seeing and treating patients.

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

“My other doctor has an office blog. You should have one, too. They’re really helpful.”

I hear that line a fair amount.

No, thank you.

I legitimately did try to have an office blog 7-8 years ago. I figured it might bring in a few more patients, answer FAQs from others, and give me something to do. So I did some reading, created an account on Blogger, and started one. I think my first post was on multiple sclerosis. Nothing really specific, more just generic “living with MS” tips.

I wrote another the next week, then a third post about 2 months later. Roughly 6 months after starting I gave up and quietly deleted the account.

I have no idea how some doctors have time for that sort of thing. They must have more free time than I do. Maybe they pay someone to write the posts for them. But it didn’t take me long to realize I didn’t have the time, or personal interest, to make it worthwhile. Besides, generic medical blogs spouting common sense (“Eat more vegetables! Exercise!”) are a dime a dozen. To put anything more specific in this day and age runs the risk of litigation.

I like writing, as evidenced by this column. But the time and effort that a regular office blog demanded was beyond what I could put into it, and the nature of the writing needed was more milquetoast than I enjoyed doing.

Time is, perhaps, the most precious commodity we have. Writing a nondescript office blog, as I learned, definitely wasn’t my cup of tea. I’m pretty sure an office Twitter account would be the same, and I have no interest in opening that door.

If another doctor wants to invest time in a blog, that’s fine. I hope it is something worthwhile and that they enjoy it. If a patient thinks that makes them a better doctor, they can.

But not me. If I’m going to devote time to my work, I’ll do it in the best way I know, and the one I still enjoy: seeing and treating patients.

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

“My other doctor has an office blog. You should have one, too. They’re really helpful.”

I hear that line a fair amount.

No, thank you.

I legitimately did try to have an office blog 7-8 years ago. I figured it might bring in a few more patients, answer FAQs from others, and give me something to do. So I did some reading, created an account on Blogger, and started one. I think my first post was on multiple sclerosis. Nothing really specific, more just generic “living with MS” tips.

I wrote another the next week, then a third post about 2 months later. Roughly 6 months after starting I gave up and quietly deleted the account.

I have no idea how some doctors have time for that sort of thing. They must have more free time than I do. Maybe they pay someone to write the posts for them. But it didn’t take me long to realize I didn’t have the time, or personal interest, to make it worthwhile. Besides, generic medical blogs spouting common sense (“Eat more vegetables! Exercise!”) are a dime a dozen. To put anything more specific in this day and age runs the risk of litigation.

I like writing, as evidenced by this column. But the time and effort that a regular office blog demanded was beyond what I could put into it, and the nature of the writing needed was more milquetoast than I enjoyed doing.

Time is, perhaps, the most precious commodity we have. Writing a nondescript office blog, as I learned, definitely wasn’t my cup of tea. I’m pretty sure an office Twitter account would be the same, and I have no interest in opening that door.

If another doctor wants to invest time in a blog, that’s fine. I hope it is something worthwhile and that they enjoy it. If a patient thinks that makes them a better doctor, they can.

But not me. If I’m going to devote time to my work, I’ll do it in the best way I know, and the one I still enjoy: seeing and treating patients.

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

Darth Vader is, to me, one of the most intimidating villains in movie history. I was 11 when Star Wars came out. I even cleaned my room so my mother would take me to see it.

When Darth Vader first walked on screen, it was striking. A tall, imposing figure in black, with harsh mechanical respirations. There was no question of who the bad guy was. As the movie progressed his darkness became more frightening until, in the first lightsaber battle any of us had seen, he cut down the benevolent Obi-Wan Kenobi.

Last year my family went to Disneyland. While browsing the park’s stores we saw numerous Darth Vader items ... with him now available as a teddy bear, and on T-shirts riding carousels and the Dumbo ride.

From terrifying villain to cutesy toy in 43 years.* Quite the fall from glory.

Diseases are often (and hopefully) like that. Syphilis, once the most common, feared, and incurable neurologic disease is now, for most, just a nuisance. The butt of jokes and sexual innuendos, rendered harmless by Alexander Fleming’s discoveries.

Bit by bit we see other diseases tamed. Multiple sclerosis, though still serious, becomes better controlled every year as new agents come out. The cure for Parkinson’s disease remains elusive, but agents to control the symptoms and improve quality of life are available. Even HIV, the most feared disease of the 80s and 90s, has been beaten back from a terrible death sentence to one where patients lead normal lives with antiviral therapy.

Today we face a new enemy, the COVID-19 pandemic. So far we have no definite treatments, nor shortage of ideas. Many companies are racing to develop a vaccine, and will likely, at some point, find one, but what and when are still in the future. Hopefully, like previously devastating illnesses, COVID-19 will be brought under control, too.

Alzheimer’s disease, for all practical purposes, remains untreatable and rightfully feared. Perhaps the only ones more terrifying are those we’ve reduced to just three letters: ALS (amyotrophic lateral sclerosis) and GBM (glioblastoma multiforme). Both have terrible courses and, in spite of years of research, nothing even close to an effective treatment.

I hope that changes, and soon, for all those affected by these (and many other) terrible disorders.

Like the Darth Vader teddy bear, I’ll be happy to see them become shells of their former selves, with the dread they bring now reduced to the lesser trepidation seen when facing a serious, but treatable, illness.

*Correction, 8/11/20: An earlier version of this column misstated the number of years since Star Wars debuted.
 

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

Darth Vader is, to me, one of the most intimidating villains in movie history. I was 11 when Star Wars came out. I even cleaned my room so my mother would take me to see it.

When Darth Vader first walked on screen, it was striking. A tall, imposing figure in black, with harsh mechanical respirations. There was no question of who the bad guy was. As the movie progressed his darkness became more frightening until, in the first lightsaber battle any of us had seen, he cut down the benevolent Obi-Wan Kenobi.

Last year my family went to Disneyland. While browsing the park’s stores we saw numerous Darth Vader items ... with him now available as a teddy bear, and on T-shirts riding carousels and the Dumbo ride.

From terrifying villain to cutesy toy in 43 years.* Quite the fall from glory.

Diseases are often (and hopefully) like that. Syphilis, once the most common, feared, and incurable neurologic disease is now, for most, just a nuisance. The butt of jokes and sexual innuendos, rendered harmless by Alexander Fleming’s discoveries.

Bit by bit we see other diseases tamed. Multiple sclerosis, though still serious, becomes better controlled every year as new agents come out. The cure for Parkinson’s disease remains elusive, but agents to control the symptoms and improve quality of life are available. Even HIV, the most feared disease of the 80s and 90s, has been beaten back from a terrible death sentence to one where patients lead normal lives with antiviral therapy.

Today we face a new enemy, the COVID-19 pandemic. So far we have no definite treatments, nor shortage of ideas. Many companies are racing to develop a vaccine, and will likely, at some point, find one, but what and when are still in the future. Hopefully, like previously devastating illnesses, COVID-19 will be brought under control, too.

Alzheimer’s disease, for all practical purposes, remains untreatable and rightfully feared. Perhaps the only ones more terrifying are those we’ve reduced to just three letters: ALS (amyotrophic lateral sclerosis) and GBM (glioblastoma multiforme). Both have terrible courses and, in spite of years of research, nothing even close to an effective treatment.

I hope that changes, and soon, for all those affected by these (and many other) terrible disorders.

Like the Darth Vader teddy bear, I’ll be happy to see them become shells of their former selves, with the dread they bring now reduced to the lesser trepidation seen when facing a serious, but treatable, illness.

*Correction, 8/11/20: An earlier version of this column misstated the number of years since Star Wars debuted.
 

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

Darth Vader is, to me, one of the most intimidating villains in movie history. I was 11 when Star Wars came out. I even cleaned my room so my mother would take me to see it.

When Darth Vader first walked on screen, it was striking. A tall, imposing figure in black, with harsh mechanical respirations. There was no question of who the bad guy was. As the movie progressed his darkness became more frightening until, in the first lightsaber battle any of us had seen, he cut down the benevolent Obi-Wan Kenobi.

Last year my family went to Disneyland. While browsing the park’s stores we saw numerous Darth Vader items ... with him now available as a teddy bear, and on T-shirts riding carousels and the Dumbo ride.

From terrifying villain to cutesy toy in 43 years.* Quite the fall from glory.

Diseases are often (and hopefully) like that. Syphilis, once the most common, feared, and incurable neurologic disease is now, for most, just a nuisance. The butt of jokes and sexual innuendos, rendered harmless by Alexander Fleming’s discoveries.

Bit by bit we see other diseases tamed. Multiple sclerosis, though still serious, becomes better controlled every year as new agents come out. The cure for Parkinson’s disease remains elusive, but agents to control the symptoms and improve quality of life are available. Even HIV, the most feared disease of the 80s and 90s, has been beaten back from a terrible death sentence to one where patients lead normal lives with antiviral therapy.

Today we face a new enemy, the COVID-19 pandemic. So far we have no definite treatments, nor shortage of ideas. Many companies are racing to develop a vaccine, and will likely, at some point, find one, but what and when are still in the future. Hopefully, like previously devastating illnesses, COVID-19 will be brought under control, too.

Alzheimer’s disease, for all practical purposes, remains untreatable and rightfully feared. Perhaps the only ones more terrifying are those we’ve reduced to just three letters: ALS (amyotrophic lateral sclerosis) and GBM (glioblastoma multiforme). Both have terrible courses and, in spite of years of research, nothing even close to an effective treatment.

I hope that changes, and soon, for all those affected by these (and many other) terrible disorders.

Like the Darth Vader teddy bear, I’ll be happy to see them become shells of their former selves, with the dread they bring now reduced to the lesser trepidation seen when facing a serious, but treatable, illness.

*Correction, 8/11/20: An earlier version of this column misstated the number of years since Star Wars debuted.
 

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

This is getting pretty ridiculous. The number of well-done, evidence-based trials of hydroxychloroquine in COVID-19 showing minimal-to-no benefit is increasing. There are still studies that show benefit in certain cases, but many of them are small-scale or even anecdotal.

How long is this going to go on? If the evidence supporting its use were to be put through the standard Food and Drug Administration approval panels it wouldn’t have a chance.

Yet, because it’s become a political football (like masks), science and rational research are tossed out the window. At the end of July we were all treated to videos of Dr. Stella Immanuel claiming the drug is a cure. Dr. Immanuel may have medical credentials, but she also supports beliefs that space aliens and the Illuminati are involved in running governments, and that multiple gynecologic disorders are caused by sexual relations with demons and witches during dreams.

Even so, her hydroxychloroquine statements were given heavy play during a news cycle, then endorsed by the president and his supporters, all with very little immediate background provided for other claims she’s made in the past.

Medicine is a science. Politics shouldn’t be. While hydroxychloroquine may have its uses for other disorders, at this point COVID-19 doesn’t appear to be one of them. Continuing to give it to sick people, despite the growing evidence against it, violates the “do-no-harm” tenet of our field.

There was no shame in trying it and failing. This is the process through which all treatments are tested. If they work (such as with penicillin, for example) that’s wonderful. If they fail (such as with countless Alzheimer’s trials) we learn what doesn’t work and move on.

But to keep claiming success where there isn’t any moves beyond science and into things that whiff of a hoax, such as 1989’s cold fusion or recurrent claims of capturing Bigfoot.

With an implacable enemy such as COVID-19 at the door, money and effort need to be focused on finding what works, not on putting stale milk back in the refrigerator and hoping it comes out fresh.

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

This is getting pretty ridiculous. The number of well-done, evidence-based trials of hydroxychloroquine in COVID-19 showing minimal-to-no benefit is increasing. There are still studies that show benefit in certain cases, but many of them are small-scale or even anecdotal.

How long is this going to go on? If the evidence supporting its use were to be put through the standard Food and Drug Administration approval panels it wouldn’t have a chance.

Yet, because it’s become a political football (like masks), science and rational research are tossed out the window. At the end of July we were all treated to videos of Dr. Stella Immanuel claiming the drug is a cure. Dr. Immanuel may have medical credentials, but she also supports beliefs that space aliens and the Illuminati are involved in running governments, and that multiple gynecologic disorders are caused by sexual relations with demons and witches during dreams.

Even so, her hydroxychloroquine statements were given heavy play during a news cycle, then endorsed by the president and his supporters, all with very little immediate background provided for other claims she’s made in the past.

Medicine is a science. Politics shouldn’t be. While hydroxychloroquine may have its uses for other disorders, at this point COVID-19 doesn’t appear to be one of them. Continuing to give it to sick people, despite the growing evidence against it, violates the “do-no-harm” tenet of our field.

There was no shame in trying it and failing. This is the process through which all treatments are tested. If they work (such as with penicillin, for example) that’s wonderful. If they fail (such as with countless Alzheimer’s trials) we learn what doesn’t work and move on.

But to keep claiming success where there isn’t any moves beyond science and into things that whiff of a hoax, such as 1989’s cold fusion or recurrent claims of capturing Bigfoot.

With an implacable enemy such as COVID-19 at the door, money and effort need to be focused on finding what works, not on putting stale milk back in the refrigerator and hoping it comes out fresh.

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

This is getting pretty ridiculous. The number of well-done, evidence-based trials of hydroxychloroquine in COVID-19 showing minimal-to-no benefit is increasing. There are still studies that show benefit in certain cases, but many of them are small-scale or even anecdotal.

How long is this going to go on? If the evidence supporting its use were to be put through the standard Food and Drug Administration approval panels it wouldn’t have a chance.

Yet, because it’s become a political football (like masks), science and rational research are tossed out the window. At the end of July we were all treated to videos of Dr. Stella Immanuel claiming the drug is a cure. Dr. Immanuel may have medical credentials, but she also supports beliefs that space aliens and the Illuminati are involved in running governments, and that multiple gynecologic disorders are caused by sexual relations with demons and witches during dreams.

Even so, her hydroxychloroquine statements were given heavy play during a news cycle, then endorsed by the president and his supporters, all with very little immediate background provided for other claims she’s made in the past.

Medicine is a science. Politics shouldn’t be. While hydroxychloroquine may have its uses for other disorders, at this point COVID-19 doesn’t appear to be one of them. Continuing to give it to sick people, despite the growing evidence against it, violates the “do-no-harm” tenet of our field.

There was no shame in trying it and failing. This is the process through which all treatments are tested. If they work (such as with penicillin, for example) that’s wonderful. If they fail (such as with countless Alzheimer’s trials) we learn what doesn’t work and move on.

But to keep claiming success where there isn’t any moves beyond science and into things that whiff of a hoax, such as 1989’s cold fusion or recurrent claims of capturing Bigfoot.

With an implacable enemy such as COVID-19 at the door, money and effort need to be focused on finding what works, not on putting stale milk back in the refrigerator and hoping it comes out fresh.

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

MRIs are amazing. It’s hard to imagine practicing neurology without them.

In dementia workups, or even with more benign forms of cognitive impairment, a cranial imaging study is always needed. Like most neurologists I prefer MRIs, although I am willing to settle for a head CT when I have to.

These studies aren’t cheap, but as part of the workup, to exclude other causes, they are invaluable.

Generally one is all that is needed, although there are exceptions. But some patients and families seem to think MRIs need to be repeated often, anywhere from annually to every few months, “to make sure nothing has changed.”

You usually can’t talk them out of it either. There must be “some reason” why the patient keeps getting worse. Explaining that it’s a degenerative process that doesn’t show up on MRI gets me nowhere. They read something on the Internet about it, or heard a story about the uncle of a friend of a friend, or they focus on an incidental finding that must be the cause (like an 8-mm meningioma).

Generally I stand my ground. Obviously, there are times another imaging study is warranted, such as for a dramatic, acute neurological change, but in most cases all we’re really seeing is the sad progression of disease.

I’m not unsympathetic to these people. I feel bad that this has happened to them and that they’ve been given incorrect information. I take as much time as needed to explain the disease and why another study is not needed. It’s easy to write an order for the study to appease them, but it only leads to repeating it again in a few months. Every MRI I order costs time and money, and could take the same test away from a person who truly needs it.

Sometimes the patient and family will understand after we discuss it and the request is forgotten. Other times they leave my office upset, post a bad Yelp review about me refusing to treat their ailing parent, and change neurologists. Occasionally they’re able to get their internist to give in and order a repeat MRI, and when the repeat study hasn’t changed they call me wanting to know when the next one should be done.

Throwing more money at a problem, especially when you already know what the answer will be, is never a good idea. Not now, not ever ... in medicine or anything else.

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

MRIs are amazing. It’s hard to imagine practicing neurology without them.

In dementia workups, or even with more benign forms of cognitive impairment, a cranial imaging study is always needed. Like most neurologists I prefer MRIs, although I am willing to settle for a head CT when I have to.

These studies aren’t cheap, but as part of the workup, to exclude other causes, they are invaluable.

Generally one is all that is needed, although there are exceptions. But some patients and families seem to think MRIs need to be repeated often, anywhere from annually to every few months, “to make sure nothing has changed.”

You usually can’t talk them out of it either. There must be “some reason” why the patient keeps getting worse. Explaining that it’s a degenerative process that doesn’t show up on MRI gets me nowhere. They read something on the Internet about it, or heard a story about the uncle of a friend of a friend, or they focus on an incidental finding that must be the cause (like an 8-mm meningioma).

Generally I stand my ground. Obviously, there are times another imaging study is warranted, such as for a dramatic, acute neurological change, but in most cases all we’re really seeing is the sad progression of disease.

I’m not unsympathetic to these people. I feel bad that this has happened to them and that they’ve been given incorrect information. I take as much time as needed to explain the disease and why another study is not needed. It’s easy to write an order for the study to appease them, but it only leads to repeating it again in a few months. Every MRI I order costs time and money, and could take the same test away from a person who truly needs it.

Sometimes the patient and family will understand after we discuss it and the request is forgotten. Other times they leave my office upset, post a bad Yelp review about me refusing to treat their ailing parent, and change neurologists. Occasionally they’re able to get their internist to give in and order a repeat MRI, and when the repeat study hasn’t changed they call me wanting to know when the next one should be done.

Throwing more money at a problem, especially when you already know what the answer will be, is never a good idea. Not now, not ever ... in medicine or anything else.

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

MRIs are amazing. It’s hard to imagine practicing neurology without them.

In dementia workups, or even with more benign forms of cognitive impairment, a cranial imaging study is always needed. Like most neurologists I prefer MRIs, although I am willing to settle for a head CT when I have to.

These studies aren’t cheap, but as part of the workup, to exclude other causes, they are invaluable.

Generally one is all that is needed, although there are exceptions. But some patients and families seem to think MRIs need to be repeated often, anywhere from annually to every few months, “to make sure nothing has changed.”

You usually can’t talk them out of it either. There must be “some reason” why the patient keeps getting worse. Explaining that it’s a degenerative process that doesn’t show up on MRI gets me nowhere. They read something on the Internet about it, or heard a story about the uncle of a friend of a friend, or they focus on an incidental finding that must be the cause (like an 8-mm meningioma).

Generally I stand my ground. Obviously, there are times another imaging study is warranted, such as for a dramatic, acute neurological change, but in most cases all we’re really seeing is the sad progression of disease.

I’m not unsympathetic to these people. I feel bad that this has happened to them and that they’ve been given incorrect information. I take as much time as needed to explain the disease and why another study is not needed. It’s easy to write an order for the study to appease them, but it only leads to repeating it again in a few months. Every MRI I order costs time and money, and could take the same test away from a person who truly needs it.

Sometimes the patient and family will understand after we discuss it and the request is forgotten. Other times they leave my office upset, post a bad Yelp review about me refusing to treat their ailing parent, and change neurologists. Occasionally they’re able to get their internist to give in and order a repeat MRI, and when the repeat study hasn’t changed they call me wanting to know when the next one should be done.

Throwing more money at a problem, especially when you already know what the answer will be, is never a good idea. Not now, not ever ... in medicine or anything else.

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