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No improvement in sight for Alzheimer’s drug development
Another one bites the dust.
Yet another investigational agent joins intepirdine, verubecestat, solanezumab, bapineuzumab, latrepirdine, and many others on the scrap pile of research: The complete release of trial data on idalopirdine found the drug wasn’t of clinically significant benefit in Alzheimer’s disease (JAMA. 2018;319[2]:130-42).
The numbers are bad enough that a handful of companies, including the giant Pfizer, have decided to leave Alzheimer’s drug development entirely to focus on more promising fields. And I get that. All of us – on any exhausting, fruitless, task – will reach the point where it’s time to cut our losses and move on. I don’t blame these companies for mostly leaving the field. (Pfizer is planning to form a neuroscience venture fund to support further research.)
Optimists will argue that you still learn things from a negative trial, which is true, but nothing to date is on the immediate horizon to help. The five agents we’ve had available for the past 15-20 years are all old enough to have lost their patents, and their benefits are modest, at best.
And all this going on as the overall human population, including myself, gradually ages and dementia becomes a medical-cost time bomb on the horizon. This isn’t an American problem. Every country in the world is facing it.
Politicians love to promise hope for these things: creating fast-track programs to get drugs to market faster, finding ways to bring down costs so more people can afford them, and improving methods to treat those in need. But none of those things matter if the medications don’t work.
Many of these trials test similar molecules because the evidence to date suggests they’re targeting the cause of Alzheimer’s. But so far they aren’t working. What if, as the Firesign Theatre and others have said, everything you know is wrong?
Perhaps our greatest quality as a species is resilience. We go on because we have to. The planet keeps moving around the sun as it has for almost 5 billion years, and we face tomorrow. Caregivers wake up for another day of doing their best for a faltering parent. I wake up for another day of doing my best to help them. And the researchers go back for another day hoping to find the real answer and treatment. Without trying, no treatment for anything will ever be found. We owe our patients, and ourselves, a better future than that.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
Another one bites the dust.
Yet another investigational agent joins intepirdine, verubecestat, solanezumab, bapineuzumab, latrepirdine, and many others on the scrap pile of research: The complete release of trial data on idalopirdine found the drug wasn’t of clinically significant benefit in Alzheimer’s disease (JAMA. 2018;319[2]:130-42).
The numbers are bad enough that a handful of companies, including the giant Pfizer, have decided to leave Alzheimer’s drug development entirely to focus on more promising fields. And I get that. All of us – on any exhausting, fruitless, task – will reach the point where it’s time to cut our losses and move on. I don’t blame these companies for mostly leaving the field. (Pfizer is planning to form a neuroscience venture fund to support further research.)
Optimists will argue that you still learn things from a negative trial, which is true, but nothing to date is on the immediate horizon to help. The five agents we’ve had available for the past 15-20 years are all old enough to have lost their patents, and their benefits are modest, at best.
And all this going on as the overall human population, including myself, gradually ages and dementia becomes a medical-cost time bomb on the horizon. This isn’t an American problem. Every country in the world is facing it.
Politicians love to promise hope for these things: creating fast-track programs to get drugs to market faster, finding ways to bring down costs so more people can afford them, and improving methods to treat those in need. But none of those things matter if the medications don’t work.
Many of these trials test similar molecules because the evidence to date suggests they’re targeting the cause of Alzheimer’s. But so far they aren’t working. What if, as the Firesign Theatre and others have said, everything you know is wrong?
Perhaps our greatest quality as a species is resilience. We go on because we have to. The planet keeps moving around the sun as it has for almost 5 billion years, and we face tomorrow. Caregivers wake up for another day of doing their best for a faltering parent. I wake up for another day of doing my best to help them. And the researchers go back for another day hoping to find the real answer and treatment. Without trying, no treatment for anything will ever be found. We owe our patients, and ourselves, a better future than that.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
Another one bites the dust.
Yet another investigational agent joins intepirdine, verubecestat, solanezumab, bapineuzumab, latrepirdine, and many others on the scrap pile of research: The complete release of trial data on idalopirdine found the drug wasn’t of clinically significant benefit in Alzheimer’s disease (JAMA. 2018;319[2]:130-42).
The numbers are bad enough that a handful of companies, including the giant Pfizer, have decided to leave Alzheimer’s drug development entirely to focus on more promising fields. And I get that. All of us – on any exhausting, fruitless, task – will reach the point where it’s time to cut our losses and move on. I don’t blame these companies for mostly leaving the field. (Pfizer is planning to form a neuroscience venture fund to support further research.)
Optimists will argue that you still learn things from a negative trial, which is true, but nothing to date is on the immediate horizon to help. The five agents we’ve had available for the past 15-20 years are all old enough to have lost their patents, and their benefits are modest, at best.
And all this going on as the overall human population, including myself, gradually ages and dementia becomes a medical-cost time bomb on the horizon. This isn’t an American problem. Every country in the world is facing it.
Politicians love to promise hope for these things: creating fast-track programs to get drugs to market faster, finding ways to bring down costs so more people can afford them, and improving methods to treat those in need. But none of those things matter if the medications don’t work.
Many of these trials test similar molecules because the evidence to date suggests they’re targeting the cause of Alzheimer’s. But so far they aren’t working. What if, as the Firesign Theatre and others have said, everything you know is wrong?
Perhaps our greatest quality as a species is resilience. We go on because we have to. The planet keeps moving around the sun as it has for almost 5 billion years, and we face tomorrow. Caregivers wake up for another day of doing their best for a faltering parent. I wake up for another day of doing my best to help them. And the researchers go back for another day hoping to find the real answer and treatment. Without trying, no treatment for anything will ever be found. We owe our patients, and ourselves, a better future than that.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
Withholding elective surgery in smokers, obese patients
No one will argue that obesity and tobacco aren’t serious public health issues, underlying many causes of morbidity and mortality. As a result, they’re driving factors behind a fair amount of health care spending.
In England, the county of Hertfordshire recently adopted a new approach to this: a ban on routine, nonurgent surgeries for both. Those with a body mass index of 30-40 kg/m2 must lose 10% of their weight over 9 months to qualify for a procedure, while those with a BMI above 40 must lose 15%. Smokers have to go 8 weeks without a cigarette and take breath tests to prove it.
The group that formulated the plan noted that resources to help these groups achieve such goals are (and will continue to be) freely available.
Not unexpectedly, the plan is controversial. Robert West, MD, a professor of health psychology and director of tobacco studies at the University College London, told CNN that “rationing treatment on the basis of unhealthy behaviors betrays an extraordinary naivety about what drives those behaviors.”
Of course, this debate is nothing new. In December 2014, I wrote about surgeons in the United States who were refusing to do elective hernia repairs on smokers because of their higher complication rates.
A lot of this is framed in terms of money, since that’s the driving factor. Obese patients and smokers do have higher rates of surgical complications in general, with longer recoveries and, hence, higher costs. This policy tries to put greater responsibility on patients to maintain their own health and well-being. After all, financial resources are a finite, shared commodity.
Like everything in modern health care, there’s no easy answer. Insurers and doctors try to balance better outcomes vs. greater good and cost savings.
Medicine is, and always will be, an ongoing experiment, where some things work, some don’t, and we learn from time and experience.
Unfortunately, patients and their doctors are often caught in the middle, trapped between market and political forces on one side and caring for those who need us on the other. That’s never good, or easy, for those directly involved with individual patients on the front lines of medical care.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
No one will argue that obesity and tobacco aren’t serious public health issues, underlying many causes of morbidity and mortality. As a result, they’re driving factors behind a fair amount of health care spending.
In England, the county of Hertfordshire recently adopted a new approach to this: a ban on routine, nonurgent surgeries for both. Those with a body mass index of 30-40 kg/m2 must lose 10% of their weight over 9 months to qualify for a procedure, while those with a BMI above 40 must lose 15%. Smokers have to go 8 weeks without a cigarette and take breath tests to prove it.
The group that formulated the plan noted that resources to help these groups achieve such goals are (and will continue to be) freely available.
Not unexpectedly, the plan is controversial. Robert West, MD, a professor of health psychology and director of tobacco studies at the University College London, told CNN that “rationing treatment on the basis of unhealthy behaviors betrays an extraordinary naivety about what drives those behaviors.”
Of course, this debate is nothing new. In December 2014, I wrote about surgeons in the United States who were refusing to do elective hernia repairs on smokers because of their higher complication rates.
A lot of this is framed in terms of money, since that’s the driving factor. Obese patients and smokers do have higher rates of surgical complications in general, with longer recoveries and, hence, higher costs. This policy tries to put greater responsibility on patients to maintain their own health and well-being. After all, financial resources are a finite, shared commodity.
Like everything in modern health care, there’s no easy answer. Insurers and doctors try to balance better outcomes vs. greater good and cost savings.
Medicine is, and always will be, an ongoing experiment, where some things work, some don’t, and we learn from time and experience.
Unfortunately, patients and their doctors are often caught in the middle, trapped between market and political forces on one side and caring for those who need us on the other. That’s never good, or easy, for those directly involved with individual patients on the front lines of medical care.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
No one will argue that obesity and tobacco aren’t serious public health issues, underlying many causes of morbidity and mortality. As a result, they’re driving factors behind a fair amount of health care spending.
In England, the county of Hertfordshire recently adopted a new approach to this: a ban on routine, nonurgent surgeries for both. Those with a body mass index of 30-40 kg/m2 must lose 10% of their weight over 9 months to qualify for a procedure, while those with a BMI above 40 must lose 15%. Smokers have to go 8 weeks without a cigarette and take breath tests to prove it.
The group that formulated the plan noted that resources to help these groups achieve such goals are (and will continue to be) freely available.
Not unexpectedly, the plan is controversial. Robert West, MD, a professor of health psychology and director of tobacco studies at the University College London, told CNN that “rationing treatment on the basis of unhealthy behaviors betrays an extraordinary naivety about what drives those behaviors.”
Of course, this debate is nothing new. In December 2014, I wrote about surgeons in the United States who were refusing to do elective hernia repairs on smokers because of their higher complication rates.
A lot of this is framed in terms of money, since that’s the driving factor. Obese patients and smokers do have higher rates of surgical complications in general, with longer recoveries and, hence, higher costs. This policy tries to put greater responsibility on patients to maintain their own health and well-being. After all, financial resources are a finite, shared commodity.
Like everything in modern health care, there’s no easy answer. Insurers and doctors try to balance better outcomes vs. greater good and cost savings.
Medicine is, and always will be, an ongoing experiment, where some things work, some don’t, and we learn from time and experience.
Unfortunately, patients and their doctors are often caught in the middle, trapped between market and political forces on one side and caring for those who need us on the other. That’s never good, or easy, for those directly involved with individual patients on the front lines of medical care.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
Private practice’s freedom still outweighs its challenges for me
This past Thanksgiving weekend I left a message on my office machine that we were closed because my staff and I were camping in a tent outside a store to save $3 on socks on Black Friday.
Of course, I had the usual legal disclaimers about calling 911 for emergencies and how to reach the doctor on call, but the message was just silly.
This isn’t anything new for my practice. My patients are used to the occasional humor. Most of them probably expect it by now.
It’s been 17 years since I left a large group and opened up my solo operation, and I’m still here. I have no regrets. My little practice may be eclectic. I wear shorts to work. My secretary’s 2 year old is at work everyday, keeping us laughing. I get to leave goofy messages on office voice mail. But it suits me.
This doesn’t change my focus of trying to practice competent neurology. I don’t claim to be the world’s best doctor, but I hope I know what I’m doing. I may be trying to have some fun here, but that doesn’t mean I take this job any less seriously.
Although things may change, right now I just can’t see myself as part of a large institution. I know my patients. I see each of them myself. I try to understand their concerns and backgrounds so I can treat them appropriately. I don’t try to cram them through in 10 minutes while checking off electronic medical record boxes to document “meaningful use” requirements.
Of course, the flip side is that I don’t make as much money as I could. But as long as I can stay open and support my family, I don’t care. I came here to help in a way that’s meaningful to both my patients and myself, and I’ve found it.
In the November 2017 issue of Medscape Business of Medicine was an article about physicians choosing private practice. Dr. Richard May, a nephrologist in Ohio, said: “We’ve opted to stay with this model because we control our lives. We know the cost of doing that is that we are probably not making as much as we could if we were with a system, but we get up every morning feeling good about how we practice medicine. We’re happy answering to no one but ourselves and not feeling any pressure to meet patient-load quotas and hit monetary goals.”
And all I can say to that is: “Amen, brother.”
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
This past Thanksgiving weekend I left a message on my office machine that we were closed because my staff and I were camping in a tent outside a store to save $3 on socks on Black Friday.
Of course, I had the usual legal disclaimers about calling 911 for emergencies and how to reach the doctor on call, but the message was just silly.
This isn’t anything new for my practice. My patients are used to the occasional humor. Most of them probably expect it by now.
It’s been 17 years since I left a large group and opened up my solo operation, and I’m still here. I have no regrets. My little practice may be eclectic. I wear shorts to work. My secretary’s 2 year old is at work everyday, keeping us laughing. I get to leave goofy messages on office voice mail. But it suits me.
This doesn’t change my focus of trying to practice competent neurology. I don’t claim to be the world’s best doctor, but I hope I know what I’m doing. I may be trying to have some fun here, but that doesn’t mean I take this job any less seriously.
Although things may change, right now I just can’t see myself as part of a large institution. I know my patients. I see each of them myself. I try to understand their concerns and backgrounds so I can treat them appropriately. I don’t try to cram them through in 10 minutes while checking off electronic medical record boxes to document “meaningful use” requirements.
Of course, the flip side is that I don’t make as much money as I could. But as long as I can stay open and support my family, I don’t care. I came here to help in a way that’s meaningful to both my patients and myself, and I’ve found it.
In the November 2017 issue of Medscape Business of Medicine was an article about physicians choosing private practice. Dr. Richard May, a nephrologist in Ohio, said: “We’ve opted to stay with this model because we control our lives. We know the cost of doing that is that we are probably not making as much as we could if we were with a system, but we get up every morning feeling good about how we practice medicine. We’re happy answering to no one but ourselves and not feeling any pressure to meet patient-load quotas and hit monetary goals.”
And all I can say to that is: “Amen, brother.”
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
This past Thanksgiving weekend I left a message on my office machine that we were closed because my staff and I were camping in a tent outside a store to save $3 on socks on Black Friday.
Of course, I had the usual legal disclaimers about calling 911 for emergencies and how to reach the doctor on call, but the message was just silly.
This isn’t anything new for my practice. My patients are used to the occasional humor. Most of them probably expect it by now.
It’s been 17 years since I left a large group and opened up my solo operation, and I’m still here. I have no regrets. My little practice may be eclectic. I wear shorts to work. My secretary’s 2 year old is at work everyday, keeping us laughing. I get to leave goofy messages on office voice mail. But it suits me.
This doesn’t change my focus of trying to practice competent neurology. I don’t claim to be the world’s best doctor, but I hope I know what I’m doing. I may be trying to have some fun here, but that doesn’t mean I take this job any less seriously.
Although things may change, right now I just can’t see myself as part of a large institution. I know my patients. I see each of them myself. I try to understand their concerns and backgrounds so I can treat them appropriately. I don’t try to cram them through in 10 minutes while checking off electronic medical record boxes to document “meaningful use” requirements.
Of course, the flip side is that I don’t make as much money as I could. But as long as I can stay open and support my family, I don’t care. I came here to help in a way that’s meaningful to both my patients and myself, and I’ve found it.
In the November 2017 issue of Medscape Business of Medicine was an article about physicians choosing private practice. Dr. Richard May, a nephrologist in Ohio, said: “We’ve opted to stay with this model because we control our lives. We know the cost of doing that is that we are probably not making as much as we could if we were with a system, but we get up every morning feeling good about how we practice medicine. We’re happy answering to no one but ourselves and not feeling any pressure to meet patient-load quotas and hit monetary goals.”
And all I can say to that is: “Amen, brother.”
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
Health care panhandlers: A symptom of our system’s baked-in pressures?
A few nights a week after work I have to stop by the store for this or that.
In the last 1-2 months there’s always been a couple at the parking lot exit, both in wheelchairs, with a big sign asking for money to help one of them beat cancer. They even have the amount listed.
But, by the same token, they could be quite legitimate. The American health care system is full of cracks that seriously ill people can slip through. One recent survey found that about 30% of Americans had trouble paying their medical bills.
It’s easy to look at people like this and think, “I’ll never let that happen to me.” We assume they must be smokers, or irresponsible spenders, or some other reason that makes us feel we won’t stumble into the same pitfalls. That’s reassuring, and sometimes true, but not always. And probably more often than we want to realize.
The world is full of people and families devastated by bad luck. Through no fault of their own, they develop a terrible medical condition or suffer grievous injuries, and suddenly, decent, hard-working, previously healthy people are facing foreclosure and financial ruin. It could, quite literally, be any of us.
Case in point: My family has good insurance and has averaged $10,000 in out-of-pocket medical expenses per year for the last several years. That’s for routine stuff: meeting deductibles, copays on medications, tests, and doctor visits, a few ER trips, etc. The only real “surprise” in there was when my wife broke her leg and needed surgery.
If the panhandlers really did have legitimate medical issues, I might be willing to help out. I give to charity. My grandmother and parents stressed that value to me, and I try to teach it to my kids. But, sadly, we live in a world full of con artists who try to make money by taking advantage of caring peoples’ feelings. Look at all the scams that immediately cropped up following the recent hurricane and wildfire disasters. Without knowing the truth, I’d rather give to an organization like the Salvation Army or Red Cross, hoping they have more experience than I do in sorting out who’s really in need.
As a doctor, I also try to justify it by thinking about how much care I do for “free.” This includes uninsured hospital patients we all see on call, knowing we’ll end up writing their bill off as a loss, and bounced checks for copays and deductible portions that we know we’ll never see.
But, no matter how I try to rationalize it, it still bothers me when I see them sitting there as I leave the store. I don’t know if they’re legitimate. But if they are, they aren’t alone, and there’s something seriously wrong with our health care system.
[polldaddy:9876776]
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
A few nights a week after work I have to stop by the store for this or that.
In the last 1-2 months there’s always been a couple at the parking lot exit, both in wheelchairs, with a big sign asking for money to help one of them beat cancer. They even have the amount listed.
But, by the same token, they could be quite legitimate. The American health care system is full of cracks that seriously ill people can slip through. One recent survey found that about 30% of Americans had trouble paying their medical bills.
It’s easy to look at people like this and think, “I’ll never let that happen to me.” We assume they must be smokers, or irresponsible spenders, or some other reason that makes us feel we won’t stumble into the same pitfalls. That’s reassuring, and sometimes true, but not always. And probably more often than we want to realize.
The world is full of people and families devastated by bad luck. Through no fault of their own, they develop a terrible medical condition or suffer grievous injuries, and suddenly, decent, hard-working, previously healthy people are facing foreclosure and financial ruin. It could, quite literally, be any of us.
Case in point: My family has good insurance and has averaged $10,000 in out-of-pocket medical expenses per year for the last several years. That’s for routine stuff: meeting deductibles, copays on medications, tests, and doctor visits, a few ER trips, etc. The only real “surprise” in there was when my wife broke her leg and needed surgery.
If the panhandlers really did have legitimate medical issues, I might be willing to help out. I give to charity. My grandmother and parents stressed that value to me, and I try to teach it to my kids. But, sadly, we live in a world full of con artists who try to make money by taking advantage of caring peoples’ feelings. Look at all the scams that immediately cropped up following the recent hurricane and wildfire disasters. Without knowing the truth, I’d rather give to an organization like the Salvation Army or Red Cross, hoping they have more experience than I do in sorting out who’s really in need.
As a doctor, I also try to justify it by thinking about how much care I do for “free.” This includes uninsured hospital patients we all see on call, knowing we’ll end up writing their bill off as a loss, and bounced checks for copays and deductible portions that we know we’ll never see.
But, no matter how I try to rationalize it, it still bothers me when I see them sitting there as I leave the store. I don’t know if they’re legitimate. But if they are, they aren’t alone, and there’s something seriously wrong with our health care system.
[polldaddy:9876776]
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
A few nights a week after work I have to stop by the store for this or that.
In the last 1-2 months there’s always been a couple at the parking lot exit, both in wheelchairs, with a big sign asking for money to help one of them beat cancer. They even have the amount listed.
But, by the same token, they could be quite legitimate. The American health care system is full of cracks that seriously ill people can slip through. One recent survey found that about 30% of Americans had trouble paying their medical bills.
It’s easy to look at people like this and think, “I’ll never let that happen to me.” We assume they must be smokers, or irresponsible spenders, or some other reason that makes us feel we won’t stumble into the same pitfalls. That’s reassuring, and sometimes true, but not always. And probably more often than we want to realize.
The world is full of people and families devastated by bad luck. Through no fault of their own, they develop a terrible medical condition or suffer grievous injuries, and suddenly, decent, hard-working, previously healthy people are facing foreclosure and financial ruin. It could, quite literally, be any of us.
Case in point: My family has good insurance and has averaged $10,000 in out-of-pocket medical expenses per year for the last several years. That’s for routine stuff: meeting deductibles, copays on medications, tests, and doctor visits, a few ER trips, etc. The only real “surprise” in there was when my wife broke her leg and needed surgery.
If the panhandlers really did have legitimate medical issues, I might be willing to help out. I give to charity. My grandmother and parents stressed that value to me, and I try to teach it to my kids. But, sadly, we live in a world full of con artists who try to make money by taking advantage of caring peoples’ feelings. Look at all the scams that immediately cropped up following the recent hurricane and wildfire disasters. Without knowing the truth, I’d rather give to an organization like the Salvation Army or Red Cross, hoping they have more experience than I do in sorting out who’s really in need.
As a doctor, I also try to justify it by thinking about how much care I do for “free.” This includes uninsured hospital patients we all see on call, knowing we’ll end up writing their bill off as a loss, and bounced checks for copays and deductible portions that we know we’ll never see.
But, no matter how I try to rationalize it, it still bothers me when I see them sitting there as I leave the store. I don’t know if they’re legitimate. But if they are, they aren’t alone, and there’s something seriously wrong with our health care system.
[polldaddy:9876776]
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
Burnout takes its toll on neurology
I’m burned out.
Heck, what doctor isn’t? Politicians say we get paid too much. Lawyers say we make too many mistakes. Insurance companies say we order too many tests and too many expensive treatments. And the patients, while generally good people looking for help, can also on occasion be angry and unreasonable. The bad apples may be in the minority, but it only takes one to ruin a day full of rewarding visits.
That can’t be good.
Some of the study’s listed reasons for burnout are very familiar: complaints about maintenance of certification and about calling insurances to authorize tests and medications, crappy reimbursement for time-consuming visits, having to spend more time at work just to break even, and the constant feeling of never being caught up. I leave work, come home, have dinner with my family, do dictations, go to bed, and do it over again. No matter where I am, I’ve never left the office.
Other common complaints aren’t as much an issue for me. I don’t have, or want, an electronic health record that qualifies for meaningful use; I designed the one I have, and it works fine for me. I don’t have a nonmedical administrator telling me how many patients I’m required to see each day, and my patient population is, overall, appreciative and polite.
There are always trade-offs. When my kids have school breaks, I take that time off from the office to be with them. I enjoy it – I mean, that’s what we’re here for as parents, isn’t it? Of course, the drawback comes a few weeks later when my income drops because I wasn’t working. In solo practice, cash flow is king. I may have more freedom and control than my employed colleagues, but the downside is that I have no guaranteed salary, either. I’m the last one here who gets paid.
I see plenty of columns on how to avoid burnout, none of which seem to be written by someone who’s in a real-world practice. They all recommend taking time off for yourself, maybe seeing a counselor, finding a hobby you enjoy ... Really?
There’s no easy answer, either. We’re stuck with decreasing reimbursements, a gradual whittling away of our profession, a demand to keep putting time we don’t have into our jobs, and many other issues. It’s even worse for those who are coming out of training and are facing these same challenges with six-figure student loans over their heads and, often, the demands of young families. The idealism and energy of youth are all that seem to sustain them, and that can’t last.
I like being a doctor. I enjoy being a neurologist. I love being able to help people and have a sense of service in doing so. But the worsening financial picture for us, and the increasing demands on our often already nonexistent free time, are destroying the field. Like many other docs, I look at my savings here and there and wonder how long until I can retire. That is sad because, as we all gradually leave practice (for whatever reason), new people will need to come in and pick up the mantle. But current conditions are such that I suspect many will find something else to do unless things change.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
I’m burned out.
Heck, what doctor isn’t? Politicians say we get paid too much. Lawyers say we make too many mistakes. Insurance companies say we order too many tests and too many expensive treatments. And the patients, while generally good people looking for help, can also on occasion be angry and unreasonable. The bad apples may be in the minority, but it only takes one to ruin a day full of rewarding visits.
That can’t be good.
Some of the study’s listed reasons for burnout are very familiar: complaints about maintenance of certification and about calling insurances to authorize tests and medications, crappy reimbursement for time-consuming visits, having to spend more time at work just to break even, and the constant feeling of never being caught up. I leave work, come home, have dinner with my family, do dictations, go to bed, and do it over again. No matter where I am, I’ve never left the office.
Other common complaints aren’t as much an issue for me. I don’t have, or want, an electronic health record that qualifies for meaningful use; I designed the one I have, and it works fine for me. I don’t have a nonmedical administrator telling me how many patients I’m required to see each day, and my patient population is, overall, appreciative and polite.
There are always trade-offs. When my kids have school breaks, I take that time off from the office to be with them. I enjoy it – I mean, that’s what we’re here for as parents, isn’t it? Of course, the drawback comes a few weeks later when my income drops because I wasn’t working. In solo practice, cash flow is king. I may have more freedom and control than my employed colleagues, but the downside is that I have no guaranteed salary, either. I’m the last one here who gets paid.
I see plenty of columns on how to avoid burnout, none of which seem to be written by someone who’s in a real-world practice. They all recommend taking time off for yourself, maybe seeing a counselor, finding a hobby you enjoy ... Really?
There’s no easy answer, either. We’re stuck with decreasing reimbursements, a gradual whittling away of our profession, a demand to keep putting time we don’t have into our jobs, and many other issues. It’s even worse for those who are coming out of training and are facing these same challenges with six-figure student loans over their heads and, often, the demands of young families. The idealism and energy of youth are all that seem to sustain them, and that can’t last.
I like being a doctor. I enjoy being a neurologist. I love being able to help people and have a sense of service in doing so. But the worsening financial picture for us, and the increasing demands on our often already nonexistent free time, are destroying the field. Like many other docs, I look at my savings here and there and wonder how long until I can retire. That is sad because, as we all gradually leave practice (for whatever reason), new people will need to come in and pick up the mantle. But current conditions are such that I suspect many will find something else to do unless things change.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
I’m burned out.
Heck, what doctor isn’t? Politicians say we get paid too much. Lawyers say we make too many mistakes. Insurance companies say we order too many tests and too many expensive treatments. And the patients, while generally good people looking for help, can also on occasion be angry and unreasonable. The bad apples may be in the minority, but it only takes one to ruin a day full of rewarding visits.
That can’t be good.
Some of the study’s listed reasons for burnout are very familiar: complaints about maintenance of certification and about calling insurances to authorize tests and medications, crappy reimbursement for time-consuming visits, having to spend more time at work just to break even, and the constant feeling of never being caught up. I leave work, come home, have dinner with my family, do dictations, go to bed, and do it over again. No matter where I am, I’ve never left the office.
Other common complaints aren’t as much an issue for me. I don’t have, or want, an electronic health record that qualifies for meaningful use; I designed the one I have, and it works fine for me. I don’t have a nonmedical administrator telling me how many patients I’m required to see each day, and my patient population is, overall, appreciative and polite.
There are always trade-offs. When my kids have school breaks, I take that time off from the office to be with them. I enjoy it – I mean, that’s what we’re here for as parents, isn’t it? Of course, the drawback comes a few weeks later when my income drops because I wasn’t working. In solo practice, cash flow is king. I may have more freedom and control than my employed colleagues, but the downside is that I have no guaranteed salary, either. I’m the last one here who gets paid.
I see plenty of columns on how to avoid burnout, none of which seem to be written by someone who’s in a real-world practice. They all recommend taking time off for yourself, maybe seeing a counselor, finding a hobby you enjoy ... Really?
There’s no easy answer, either. We’re stuck with decreasing reimbursements, a gradual whittling away of our profession, a demand to keep putting time we don’t have into our jobs, and many other issues. It’s even worse for those who are coming out of training and are facing these same challenges with six-figure student loans over their heads and, often, the demands of young families. The idealism and energy of youth are all that seem to sustain them, and that can’t last.
I like being a doctor. I enjoy being a neurologist. I love being able to help people and have a sense of service in doing so. But the worsening financial picture for us, and the increasing demands on our often already nonexistent free time, are destroying the field. Like many other docs, I look at my savings here and there and wonder how long until I can retire. That is sad because, as we all gradually leave practice (for whatever reason), new people will need to come in and pick up the mantle. But current conditions are such that I suspect many will find something else to do unless things change.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
Now missing in EHR charts: a good impression
I’ve previously written about “the monster note,” a creation of autofilled blanks with vital signs and test results that tells you very little about what’s really going on.
Recently, while on call, I discovered a new problem: the lack of a decent impression.
I was covering for another doctor, and a cardiologist rounding at a rehab center called to see if he could anticoagulate a recently discharged patient. It was certainly a reasonable question.
Unfortunately, not much was there. Most notes were the usual mishmash of test results, vital signs, and medication lists, with very little about the patient. So I scrolled down to the impressions to find out what the plan was.
Sadly, that area (which to me is the most critical part of a note) was also devoid of anything useful. Hoping for something like “embolic stroke, hoping to anticoagulate in future,” I instead found things like “To SNF or rehab soon” or “case discussed with family” as the entire impression and plan. That tells me nothing. The only note I found that had some sort of assessment and plan was the initial consult, which was done before any test results were in.
This seems to be the current state of things. Notes that actually give you some idea of the thinking and plan have become an endangered species. This helps no one, as most of us rely on other doctors’ notes to coordinate and plan care. While some of this is done through talking or texts, those things aren’t in the chart. So even though the doctors involved may have a good idea of what they’re doing (and I certainly hope they do), an outsider doesn’t.
In my opinion, that does nothing to improve patient care. I suppose it works if the same doctors are involved each day, but that’s not how American hospital medicine is any more. Hospitalists rotate in and out every few days and (as in my case) others cover call on nights, weekends, and holidays.
It’s also a gateway to legal challenges. A malpractice lawyer once told me that notes should be written so that if you have to read it 5 years later, you can get a pretty good idea of what your thinking was. If the details of the plan were carried in your head, or were in conversations with other doctors, those things aren’t going to help you. The written record is everything. If the issues these notes pose to patient care don’t worry you, maybe that thought should.
Back to my patient: It took me about 15-20 minutes of skimming through the note to find the answer I needed. And it wasn’t in any of the doctors’ notes at all.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
I’ve previously written about “the monster note,” a creation of autofilled blanks with vital signs and test results that tells you very little about what’s really going on.
Recently, while on call, I discovered a new problem: the lack of a decent impression.
I was covering for another doctor, and a cardiologist rounding at a rehab center called to see if he could anticoagulate a recently discharged patient. It was certainly a reasonable question.
Unfortunately, not much was there. Most notes were the usual mishmash of test results, vital signs, and medication lists, with very little about the patient. So I scrolled down to the impressions to find out what the plan was.
Sadly, that area (which to me is the most critical part of a note) was also devoid of anything useful. Hoping for something like “embolic stroke, hoping to anticoagulate in future,” I instead found things like “To SNF or rehab soon” or “case discussed with family” as the entire impression and plan. That tells me nothing. The only note I found that had some sort of assessment and plan was the initial consult, which was done before any test results were in.
This seems to be the current state of things. Notes that actually give you some idea of the thinking and plan have become an endangered species. This helps no one, as most of us rely on other doctors’ notes to coordinate and plan care. While some of this is done through talking or texts, those things aren’t in the chart. So even though the doctors involved may have a good idea of what they’re doing (and I certainly hope they do), an outsider doesn’t.
In my opinion, that does nothing to improve patient care. I suppose it works if the same doctors are involved each day, but that’s not how American hospital medicine is any more. Hospitalists rotate in and out every few days and (as in my case) others cover call on nights, weekends, and holidays.
It’s also a gateway to legal challenges. A malpractice lawyer once told me that notes should be written so that if you have to read it 5 years later, you can get a pretty good idea of what your thinking was. If the details of the plan were carried in your head, or were in conversations with other doctors, those things aren’t going to help you. The written record is everything. If the issues these notes pose to patient care don’t worry you, maybe that thought should.
Back to my patient: It took me about 15-20 minutes of skimming through the note to find the answer I needed. And it wasn’t in any of the doctors’ notes at all.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
I’ve previously written about “the monster note,” a creation of autofilled blanks with vital signs and test results that tells you very little about what’s really going on.
Recently, while on call, I discovered a new problem: the lack of a decent impression.
I was covering for another doctor, and a cardiologist rounding at a rehab center called to see if he could anticoagulate a recently discharged patient. It was certainly a reasonable question.
Unfortunately, not much was there. Most notes were the usual mishmash of test results, vital signs, and medication lists, with very little about the patient. So I scrolled down to the impressions to find out what the plan was.
Sadly, that area (which to me is the most critical part of a note) was also devoid of anything useful. Hoping for something like “embolic stroke, hoping to anticoagulate in future,” I instead found things like “To SNF or rehab soon” or “case discussed with family” as the entire impression and plan. That tells me nothing. The only note I found that had some sort of assessment and plan was the initial consult, which was done before any test results were in.
This seems to be the current state of things. Notes that actually give you some idea of the thinking and plan have become an endangered species. This helps no one, as most of us rely on other doctors’ notes to coordinate and plan care. While some of this is done through talking or texts, those things aren’t in the chart. So even though the doctors involved may have a good idea of what they’re doing (and I certainly hope they do), an outsider doesn’t.
In my opinion, that does nothing to improve patient care. I suppose it works if the same doctors are involved each day, but that’s not how American hospital medicine is any more. Hospitalists rotate in and out every few days and (as in my case) others cover call on nights, weekends, and holidays.
It’s also a gateway to legal challenges. A malpractice lawyer once told me that notes should be written so that if you have to read it 5 years later, you can get a pretty good idea of what your thinking was. If the details of the plan were carried in your head, or were in conversations with other doctors, those things aren’t going to help you. The written record is everything. If the issues these notes pose to patient care don’t worry you, maybe that thought should.
Back to my patient: It took me about 15-20 minutes of skimming through the note to find the answer I needed. And it wasn’t in any of the doctors’ notes at all.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
In the wake of a federal lawsuit settlement, can you trust your EHR?
Who watches the watchers?
In a world where the majority of practices depend on electronic health record systems to care for patients, we also depend on the companies that make them. After all, the main (if not only) reason most practices jumped to them was to qualify for meaningful use payments.
In buying them, we’re trusting that the manufacturer is doing its best to keep them updated, operational, and compliant, right? Beyond people’s health, there’s also a lot of money at stake here.
Right? Right.
The alleged bones of the matter is that eClinicalWorks knowingly misrepresented its software to get certification in the EHR incentive program. The U.S. Department of Justice says the program was modified to retrieve only specific drugs and didn’t reliably record certain chart information (such as orders and drug interactions) or allow patient information to transfer to other systems.
I should note that, in settling this matter, eClinicalWorks did not admit wrongdoing. The company just agreed to pay that money to close the lawsuit.
Guess what? If your practice used eClinicalWorks, you’re no longer in compliance. So you could be penalized, too. Fortunately, the Centers for Medicare & Medicaid Services has recognized this and announced that practices won’t be held responsible for the vendor’s failings.
Perhaps eClinicalWorks meant no harm by these things. I understand that. Projects like this are complex. It’s easy for things to fall behind and slip through the cracks. With any software release there are always issues that aren’t recognized until it comes into widespread use. But this is patient health, not the latest version of Flappy Bird.
More worrisome is the other possibility: that eClinicalWorks was aware of the issues and covered them up so as not to affect sales. If this is the case, the company made a conscious decision to choose money over patient safety.
We’ll likely never know.
In its defense, eClinicalWorks states that most of these issues have been fixed, and the others are being actively corrected and tested. The company has agreed to do quality control oversight and to track, publish, and correct problems as they become apparent.
A decision many practices face now is whether or not to stay with the company. Can you trust eClinicalWorks from here on out? If so, how vigilant do you need to be? If not, how much time and money will a new EHR system cost to implement?
Not an easy choice for any practice trying to stay afloat these days.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
Who watches the watchers?
In a world where the majority of practices depend on electronic health record systems to care for patients, we also depend on the companies that make them. After all, the main (if not only) reason most practices jumped to them was to qualify for meaningful use payments.
In buying them, we’re trusting that the manufacturer is doing its best to keep them updated, operational, and compliant, right? Beyond people’s health, there’s also a lot of money at stake here.
Right? Right.
The alleged bones of the matter is that eClinicalWorks knowingly misrepresented its software to get certification in the EHR incentive program. The U.S. Department of Justice says the program was modified to retrieve only specific drugs and didn’t reliably record certain chart information (such as orders and drug interactions) or allow patient information to transfer to other systems.
I should note that, in settling this matter, eClinicalWorks did not admit wrongdoing. The company just agreed to pay that money to close the lawsuit.
Guess what? If your practice used eClinicalWorks, you’re no longer in compliance. So you could be penalized, too. Fortunately, the Centers for Medicare & Medicaid Services has recognized this and announced that practices won’t be held responsible for the vendor’s failings.
Perhaps eClinicalWorks meant no harm by these things. I understand that. Projects like this are complex. It’s easy for things to fall behind and slip through the cracks. With any software release there are always issues that aren’t recognized until it comes into widespread use. But this is patient health, not the latest version of Flappy Bird.
More worrisome is the other possibility: that eClinicalWorks was aware of the issues and covered them up so as not to affect sales. If this is the case, the company made a conscious decision to choose money over patient safety.
We’ll likely never know.
In its defense, eClinicalWorks states that most of these issues have been fixed, and the others are being actively corrected and tested. The company has agreed to do quality control oversight and to track, publish, and correct problems as they become apparent.
A decision many practices face now is whether or not to stay with the company. Can you trust eClinicalWorks from here on out? If so, how vigilant do you need to be? If not, how much time and money will a new EHR system cost to implement?
Not an easy choice for any practice trying to stay afloat these days.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
Who watches the watchers?
In a world where the majority of practices depend on electronic health record systems to care for patients, we also depend on the companies that make them. After all, the main (if not only) reason most practices jumped to them was to qualify for meaningful use payments.
In buying them, we’re trusting that the manufacturer is doing its best to keep them updated, operational, and compliant, right? Beyond people’s health, there’s also a lot of money at stake here.
Right? Right.
The alleged bones of the matter is that eClinicalWorks knowingly misrepresented its software to get certification in the EHR incentive program. The U.S. Department of Justice says the program was modified to retrieve only specific drugs and didn’t reliably record certain chart information (such as orders and drug interactions) or allow patient information to transfer to other systems.
I should note that, in settling this matter, eClinicalWorks did not admit wrongdoing. The company just agreed to pay that money to close the lawsuit.
Guess what? If your practice used eClinicalWorks, you’re no longer in compliance. So you could be penalized, too. Fortunately, the Centers for Medicare & Medicaid Services has recognized this and announced that practices won’t be held responsible for the vendor’s failings.
Perhaps eClinicalWorks meant no harm by these things. I understand that. Projects like this are complex. It’s easy for things to fall behind and slip through the cracks. With any software release there are always issues that aren’t recognized until it comes into widespread use. But this is patient health, not the latest version of Flappy Bird.
More worrisome is the other possibility: that eClinicalWorks was aware of the issues and covered them up so as not to affect sales. If this is the case, the company made a conscious decision to choose money over patient safety.
We’ll likely never know.
In its defense, eClinicalWorks states that most of these issues have been fixed, and the others are being actively corrected and tested. The company has agreed to do quality control oversight and to track, publish, and correct problems as they become apparent.
A decision many practices face now is whether or not to stay with the company. Can you trust eClinicalWorks from here on out? If so, how vigilant do you need to be? If not, how much time and money will a new EHR system cost to implement?
Not an easy choice for any practice trying to stay afloat these days.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
Honoring a physician who led by example
In July, mostly unnoticed by Americans, a remarkable physician died in Japan.
Dr. Shigeaki Hinohara was a young 105 years old at the end, still practicing medicine.
When he was born in 1911, the average Japanese lifespan was 40. Due in part to him, it’s now one of the longest on Earth.
No stranger to medical disasters, he cared for those injured in the 1945 firebombing of Tokyo. Fifty years later, still working, he treated 640 victims of the 1995 nerve gas terror attack on the city’s subway. Between them, he survived being taken hostage in a 4-day plane hijacking in 1970.
He didn’t believe in retirement, since keeping busy is good. At the same time he advocated for finding fun in what you were doing.
A staunch opponent of obesity, he advocated a spartan lifestyle. For breakfast he had coffee, milk, and orange juice (the last with a spoonful of olive oil mixed in). For lunch (if he didn’t skip it) hard biscuits and milk. Dinner was vegetables, rice, and a small amount of either beef or fish.
He believed in exercise, even if it was limited to your daily routine. Always take stairs. Carry your own bags and packages. Even in his last months, using a cane, he walked 2,000 steps per day.
At the end, unable to eat, he still led by example. He refused a feeding tube and opted to leave quietly, passing on at home.
Medicine today, including my own field, is full of gadgets. Amazing tests and treatments. I believe in them 100%, and use them, as we all do, to help alleviate suffering and help people live longer and better lives.
But at the same time, we need to keep in mind that prevention is the best treatment. Keeping your mind active is good. Palliative care doesn’t mean you gave up.
In a world of increasing obesity, diabetes, and vascular disease, his simple advice on exercise and eating modestly is a lesson for many, including myself.
Never underestimate the benefits of music and pets.
And always have fun.
Good night, good doctor.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
In July, mostly unnoticed by Americans, a remarkable physician died in Japan.
Dr. Shigeaki Hinohara was a young 105 years old at the end, still practicing medicine.
When he was born in 1911, the average Japanese lifespan was 40. Due in part to him, it’s now one of the longest on Earth.
No stranger to medical disasters, he cared for those injured in the 1945 firebombing of Tokyo. Fifty years later, still working, he treated 640 victims of the 1995 nerve gas terror attack on the city’s subway. Between them, he survived being taken hostage in a 4-day plane hijacking in 1970.
He didn’t believe in retirement, since keeping busy is good. At the same time he advocated for finding fun in what you were doing.
A staunch opponent of obesity, he advocated a spartan lifestyle. For breakfast he had coffee, milk, and orange juice (the last with a spoonful of olive oil mixed in). For lunch (if he didn’t skip it) hard biscuits and milk. Dinner was vegetables, rice, and a small amount of either beef or fish.
He believed in exercise, even if it was limited to your daily routine. Always take stairs. Carry your own bags and packages. Even in his last months, using a cane, he walked 2,000 steps per day.
At the end, unable to eat, he still led by example. He refused a feeding tube and opted to leave quietly, passing on at home.
Medicine today, including my own field, is full of gadgets. Amazing tests and treatments. I believe in them 100%, and use them, as we all do, to help alleviate suffering and help people live longer and better lives.
But at the same time, we need to keep in mind that prevention is the best treatment. Keeping your mind active is good. Palliative care doesn’t mean you gave up.
In a world of increasing obesity, diabetes, and vascular disease, his simple advice on exercise and eating modestly is a lesson for many, including myself.
Never underestimate the benefits of music and pets.
And always have fun.
Good night, good doctor.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
In July, mostly unnoticed by Americans, a remarkable physician died in Japan.
Dr. Shigeaki Hinohara was a young 105 years old at the end, still practicing medicine.
When he was born in 1911, the average Japanese lifespan was 40. Due in part to him, it’s now one of the longest on Earth.
No stranger to medical disasters, he cared for those injured in the 1945 firebombing of Tokyo. Fifty years later, still working, he treated 640 victims of the 1995 nerve gas terror attack on the city’s subway. Between them, he survived being taken hostage in a 4-day plane hijacking in 1970.
He didn’t believe in retirement, since keeping busy is good. At the same time he advocated for finding fun in what you were doing.
A staunch opponent of obesity, he advocated a spartan lifestyle. For breakfast he had coffee, milk, and orange juice (the last with a spoonful of olive oil mixed in). For lunch (if he didn’t skip it) hard biscuits and milk. Dinner was vegetables, rice, and a small amount of either beef or fish.
He believed in exercise, even if it was limited to your daily routine. Always take stairs. Carry your own bags and packages. Even in his last months, using a cane, he walked 2,000 steps per day.
At the end, unable to eat, he still led by example. He refused a feeding tube and opted to leave quietly, passing on at home.
Medicine today, including my own field, is full of gadgets. Amazing tests and treatments. I believe in them 100%, and use them, as we all do, to help alleviate suffering and help people live longer and better lives.
But at the same time, we need to keep in mind that prevention is the best treatment. Keeping your mind active is good. Palliative care doesn’t mean you gave up.
In a world of increasing obesity, diabetes, and vascular disease, his simple advice on exercise and eating modestly is a lesson for many, including myself.
Never underestimate the benefits of music and pets.
And always have fun.
Good night, good doctor.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
Office-based tests can have questionable value
Office based-testing is convenient and often useful.
Often, but not always.
Sadly, a number of practices are increasingly turning to tests of questionable value as a way to make up for decreasing reimbursements. While I have nothing against making money, I have to question where this trend is going. I see many of them even being done by physicians outside of their fields.
I get ads all the time from companies selling gadgets to test balance (“Be the first in your area! Fully reimbursed!”). I see reports from family doctors with the results of a pseudo-EMG/NCV surface test done there by an assistant saying a patient with diabetes has a neuropathy (shocker!).
I have nothing against tests. Lord knows I order plenty of them. But I always try to ask myself if the results will change my management plan or answer another crucial question. If the answer is “no” to both, why bother?
Test are shiny. They impress patients and their families. They represent technological progress in medicine to many. But a lot of time we forget that clinical skills are pretty useful, too. If a diabetic patient comes in with numb feet and an exam that shows decreased distal sensation, do we really need a pseudo-surface EMG/NCV (especially when done by someone who isn’t a neurologist or physiatrist) or skin punch biopsy to tell us they have a neuropathy?
If the patient is stumbling all over and is clearly ataxic, do we need a machine to say, “Hey, you’re off balance. You could fall.”
An old mentor always told me “clinical correlation is advised.” (Al, I hated you then and miss you now.)
And convenience doesn’t always mean something is good. Remember Theranos?
Like all doctors, I worry about my bottom line and keeping my practice afloat. These tests are alluring in that they promise to increase practice revenue without much change in your overhead (if you believe that). But they can also be a siren song that lures you to put money ahead of what’s best for a patient. That’s never the right course.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
Office based-testing is convenient and often useful.
Often, but not always.
Sadly, a number of practices are increasingly turning to tests of questionable value as a way to make up for decreasing reimbursements. While I have nothing against making money, I have to question where this trend is going. I see many of them even being done by physicians outside of their fields.
I get ads all the time from companies selling gadgets to test balance (“Be the first in your area! Fully reimbursed!”). I see reports from family doctors with the results of a pseudo-EMG/NCV surface test done there by an assistant saying a patient with diabetes has a neuropathy (shocker!).
I have nothing against tests. Lord knows I order plenty of them. But I always try to ask myself if the results will change my management plan or answer another crucial question. If the answer is “no” to both, why bother?
Test are shiny. They impress patients and their families. They represent technological progress in medicine to many. But a lot of time we forget that clinical skills are pretty useful, too. If a diabetic patient comes in with numb feet and an exam that shows decreased distal sensation, do we really need a pseudo-surface EMG/NCV (especially when done by someone who isn’t a neurologist or physiatrist) or skin punch biopsy to tell us they have a neuropathy?
If the patient is stumbling all over and is clearly ataxic, do we need a machine to say, “Hey, you’re off balance. You could fall.”
An old mentor always told me “clinical correlation is advised.” (Al, I hated you then and miss you now.)
And convenience doesn’t always mean something is good. Remember Theranos?
Like all doctors, I worry about my bottom line and keeping my practice afloat. These tests are alluring in that they promise to increase practice revenue without much change in your overhead (if you believe that). But they can also be a siren song that lures you to put money ahead of what’s best for a patient. That’s never the right course.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
Office based-testing is convenient and often useful.
Often, but not always.
Sadly, a number of practices are increasingly turning to tests of questionable value as a way to make up for decreasing reimbursements. While I have nothing against making money, I have to question where this trend is going. I see many of them even being done by physicians outside of their fields.
I get ads all the time from companies selling gadgets to test balance (“Be the first in your area! Fully reimbursed!”). I see reports from family doctors with the results of a pseudo-EMG/NCV surface test done there by an assistant saying a patient with diabetes has a neuropathy (shocker!).
I have nothing against tests. Lord knows I order plenty of them. But I always try to ask myself if the results will change my management plan or answer another crucial question. If the answer is “no” to both, why bother?
Test are shiny. They impress patients and their families. They represent technological progress in medicine to many. But a lot of time we forget that clinical skills are pretty useful, too. If a diabetic patient comes in with numb feet and an exam that shows decreased distal sensation, do we really need a pseudo-surface EMG/NCV (especially when done by someone who isn’t a neurologist or physiatrist) or skin punch biopsy to tell us they have a neuropathy?
If the patient is stumbling all over and is clearly ataxic, do we need a machine to say, “Hey, you’re off balance. You could fall.”
An old mentor always told me “clinical correlation is advised.” (Al, I hated you then and miss you now.)
And convenience doesn’t always mean something is good. Remember Theranos?
Like all doctors, I worry about my bottom line and keeping my practice afloat. These tests are alluring in that they promise to increase practice revenue without much change in your overhead (if you believe that). But they can also be a siren song that lures you to put money ahead of what’s best for a patient. That’s never the right course.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
Practicing medicine for all, regardless of differences
I’m a doctor, specifically a neurologist.
I’m also a father with three kids.
I’m also a small business owner and part of the American economy. My practice is small, but provides jobs to two awesome women and in doing so allows them to have insurance, raise their families with job security, own homes, and contribute to the economy. I’m not required to by law, but I provide both with insurance coverage and a retirement plan. I pay my taxes on time and to the penny.
I’m a third-generation American, and a first-generation native Arizonan.
I’m a Phoenix Suns, ASU Sun Devils, and Creighton Bluejays basketball fan.
And, somewhere in all of the above, I’m Jewish.
I’ve never understood hate very well. To me, people are people. I’ve never treated patients differently based on race, religion, political beliefs, or pretty much any other factor. That’s part of my job, and I wouldn’t have it any other way.
For the same reason, I don’t understand anti-Semitism. I’ve never ripped anyone off and try very hard to practice ethical medicine, doing what’s right for patients and not for my pocketbook. Some could even argue that this approach has cost me financially over time.
My first direct experience with hate was in 1975, when my family moved from central Phoenix to the suburbs. When we were building our house and meeting future neighbors, one lady circulated a petition to keep Jews out of the neighborhood. A few weeks later, when the school year started, her kids looked me and my sister over and asked us where our horns were.
I don’t encounter it, at least not directly, as much anymore. Perhaps one to two times a year someone will call my office to make an appointment and will ask what my religion is. My secretary tells them that we don’t discuss this professionally here.
But it never goes away entirely. There are always those looking to blame anyone who is slightly different from them for economic and social changes, perhaps because it’s easier than actually working together to solve things. Or because they find it a welcome distraction from the real issues facing our society.
The recent events in Charlottesville are frightening to all of us, regardless of religion, who are trying to get along in everyday life. All I’ve ever wanted is to be able to work and raise my family in peace, yet we’re faced with a stark reminder of those who see this as a threat. Worse, their fires are stoked by seeming indifference (at best) and overt support (at worst) at the highest level of our government – one founded on freedom of religion.
Hate is hate, whether it’s ISIS, the Westboro Baptist Church, KKK, Kahane Chai, or the modern interpretations of Nazism lurking in Europe and America. Although they’ve always been there, today the Internet has given them a larger voice. People whom I’ve never done anything to consider me an enemy.
My kids’ school is a block from a mosque, so I drive by it all the time. It’s an attractive, well-maintained building. Sometimes I see younger kids running around out in the yard, or others playing basketball on a court between buildings. Its proximity has never bothered me. But, like myself, I know those inside are hated by others who don’t even know them. Like me, all they’ve done is raise kids, work, and pay taxes.
There have always been, and will always be, bad people in all religions, races, and ethnic groups. This is the nature of humans. But the association of hating all because of a few is very troubling. I believe the majority of people are good and that none are born hating others.
I try hard to run a blind practice: treating all patients as equal, and giving them the best care I can, regardless of who they are, what they believe, or where they’re from.
Unfortunately, too many people seem to find it easier to slap labels on anyone who doesn’t look or think like them, and decide that’s all they need to hate them and avoid looking at the person inside.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
I’m a doctor, specifically a neurologist.
I’m also a father with three kids.
I’m also a small business owner and part of the American economy. My practice is small, but provides jobs to two awesome women and in doing so allows them to have insurance, raise their families with job security, own homes, and contribute to the economy. I’m not required to by law, but I provide both with insurance coverage and a retirement plan. I pay my taxes on time and to the penny.
I’m a third-generation American, and a first-generation native Arizonan.
I’m a Phoenix Suns, ASU Sun Devils, and Creighton Bluejays basketball fan.
And, somewhere in all of the above, I’m Jewish.
I’ve never understood hate very well. To me, people are people. I’ve never treated patients differently based on race, religion, political beliefs, or pretty much any other factor. That’s part of my job, and I wouldn’t have it any other way.
For the same reason, I don’t understand anti-Semitism. I’ve never ripped anyone off and try very hard to practice ethical medicine, doing what’s right for patients and not for my pocketbook. Some could even argue that this approach has cost me financially over time.
My first direct experience with hate was in 1975, when my family moved from central Phoenix to the suburbs. When we were building our house and meeting future neighbors, one lady circulated a petition to keep Jews out of the neighborhood. A few weeks later, when the school year started, her kids looked me and my sister over and asked us where our horns were.
I don’t encounter it, at least not directly, as much anymore. Perhaps one to two times a year someone will call my office to make an appointment and will ask what my religion is. My secretary tells them that we don’t discuss this professionally here.
But it never goes away entirely. There are always those looking to blame anyone who is slightly different from them for economic and social changes, perhaps because it’s easier than actually working together to solve things. Or because they find it a welcome distraction from the real issues facing our society.
The recent events in Charlottesville are frightening to all of us, regardless of religion, who are trying to get along in everyday life. All I’ve ever wanted is to be able to work and raise my family in peace, yet we’re faced with a stark reminder of those who see this as a threat. Worse, their fires are stoked by seeming indifference (at best) and overt support (at worst) at the highest level of our government – one founded on freedom of religion.
Hate is hate, whether it’s ISIS, the Westboro Baptist Church, KKK, Kahane Chai, or the modern interpretations of Nazism lurking in Europe and America. Although they’ve always been there, today the Internet has given them a larger voice. People whom I’ve never done anything to consider me an enemy.
My kids’ school is a block from a mosque, so I drive by it all the time. It’s an attractive, well-maintained building. Sometimes I see younger kids running around out in the yard, or others playing basketball on a court between buildings. Its proximity has never bothered me. But, like myself, I know those inside are hated by others who don’t even know them. Like me, all they’ve done is raise kids, work, and pay taxes.
There have always been, and will always be, bad people in all religions, races, and ethnic groups. This is the nature of humans. But the association of hating all because of a few is very troubling. I believe the majority of people are good and that none are born hating others.
I try hard to run a blind practice: treating all patients as equal, and giving them the best care I can, regardless of who they are, what they believe, or where they’re from.
Unfortunately, too many people seem to find it easier to slap labels on anyone who doesn’t look or think like them, and decide that’s all they need to hate them and avoid looking at the person inside.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
I’m a doctor, specifically a neurologist.
I’m also a father with three kids.
I’m also a small business owner and part of the American economy. My practice is small, but provides jobs to two awesome women and in doing so allows them to have insurance, raise their families with job security, own homes, and contribute to the economy. I’m not required to by law, but I provide both with insurance coverage and a retirement plan. I pay my taxes on time and to the penny.
I’m a third-generation American, and a first-generation native Arizonan.
I’m a Phoenix Suns, ASU Sun Devils, and Creighton Bluejays basketball fan.
And, somewhere in all of the above, I’m Jewish.
I’ve never understood hate very well. To me, people are people. I’ve never treated patients differently based on race, religion, political beliefs, or pretty much any other factor. That’s part of my job, and I wouldn’t have it any other way.
For the same reason, I don’t understand anti-Semitism. I’ve never ripped anyone off and try very hard to practice ethical medicine, doing what’s right for patients and not for my pocketbook. Some could even argue that this approach has cost me financially over time.
My first direct experience with hate was in 1975, when my family moved from central Phoenix to the suburbs. When we were building our house and meeting future neighbors, one lady circulated a petition to keep Jews out of the neighborhood. A few weeks later, when the school year started, her kids looked me and my sister over and asked us where our horns were.
I don’t encounter it, at least not directly, as much anymore. Perhaps one to two times a year someone will call my office to make an appointment and will ask what my religion is. My secretary tells them that we don’t discuss this professionally here.
But it never goes away entirely. There are always those looking to blame anyone who is slightly different from them for economic and social changes, perhaps because it’s easier than actually working together to solve things. Or because they find it a welcome distraction from the real issues facing our society.
The recent events in Charlottesville are frightening to all of us, regardless of religion, who are trying to get along in everyday life. All I’ve ever wanted is to be able to work and raise my family in peace, yet we’re faced with a stark reminder of those who see this as a threat. Worse, their fires are stoked by seeming indifference (at best) and overt support (at worst) at the highest level of our government – one founded on freedom of religion.
Hate is hate, whether it’s ISIS, the Westboro Baptist Church, KKK, Kahane Chai, or the modern interpretations of Nazism lurking in Europe and America. Although they’ve always been there, today the Internet has given them a larger voice. People whom I’ve never done anything to consider me an enemy.
My kids’ school is a block from a mosque, so I drive by it all the time. It’s an attractive, well-maintained building. Sometimes I see younger kids running around out in the yard, or others playing basketball on a court between buildings. Its proximity has never bothered me. But, like myself, I know those inside are hated by others who don’t even know them. Like me, all they’ve done is raise kids, work, and pay taxes.
There have always been, and will always be, bad people in all religions, races, and ethnic groups. This is the nature of humans. But the association of hating all because of a few is very troubling. I believe the majority of people are good and that none are born hating others.
I try hard to run a blind practice: treating all patients as equal, and giving them the best care I can, regardless of who they are, what they believe, or where they’re from.
Unfortunately, too many people seem to find it easier to slap labels on anyone who doesn’t look or think like them, and decide that’s all they need to hate them and avoid looking at the person inside.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.