Hitting a Nerve

 

I was 14 when my grandmother fell and broke her hip. She went to the emergency department by ambulance from the restaurant we were at, and Dad took me to the hospital with him. He was an only child, and not a medical person. He was very worried.

There, Grandma looked older and more frail than usual. She and my dad were both anxious when told she’d need surgery.

Then the orthopedic surgeon came in. Tall and confident, he was initially quite imposing. But he was polite and had a great bedside manner. He calmed my dad and grandmother down, explained what needed to be done, and was reassuring. After surgery, he came to the waiting room to let us know things had gone well. I remember how impressed Dad and I both were.

Dean Mitchell/Thinkstock

Now, here was that surgeon again, on the other side of my desk. Arthritis had taken away some of his height. But he still carried himself with a proud dignity.

His family had brought him to me for worsening memory problems. He thought he was still in practice, although he had retired years ago. He didn’t remember his address, what city we were in, or what a clock looked like.

You hear families talk about how much Alzheimer’s disease takes away from a loved one, but you rarely have the opportunity in a practice to see for yourself. But the impression he’d made on me over 35 years ago was still strong, and I remembered every detail in comparison to the person across from me today.

In his field, he fixed things. With screws, rods, and casts he could restore broken bones, returning them to strength and use – like he had with my grandmother.

Sadly, I can’t return the favor now. I can only offer his family comfort, and answer questions, the way he once did with mine.

I started donepezil and gave them the most optimistic talk I have for these cases. But I know we’re still far away from fixing broken brains.

After he left, I found myself looking in the mirror, thinking of how I saw him then, wondering if his family saw me the same way now, and realizing that someday my children and I may be in the same situation.

 

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

 

I was 14 when my grandmother fell and broke her hip. She went to the emergency department by ambulance from the restaurant we were at, and Dad took me to the hospital with him. He was an only child, and not a medical person. He was very worried.

There, Grandma looked older and more frail than usual. She and my dad were both anxious when told she’d need surgery.

Then the orthopedic surgeon came in. Tall and confident, he was initially quite imposing. But he was polite and had a great bedside manner. He calmed my dad and grandmother down, explained what needed to be done, and was reassuring. After surgery, he came to the waiting room to let us know things had gone well. I remember how impressed Dad and I both were.

Dean Mitchell/Thinkstock

Now, here was that surgeon again, on the other side of my desk. Arthritis had taken away some of his height. But he still carried himself with a proud dignity.

His family had brought him to me for worsening memory problems. He thought he was still in practice, although he had retired years ago. He didn’t remember his address, what city we were in, or what a clock looked like.

You hear families talk about how much Alzheimer’s disease takes away from a loved one, but you rarely have the opportunity in a practice to see for yourself. But the impression he’d made on me over 35 years ago was still strong, and I remembered every detail in comparison to the person across from me today.

In his field, he fixed things. With screws, rods, and casts he could restore broken bones, returning them to strength and use – like he had with my grandmother.

Sadly, I can’t return the favor now. I can only offer his family comfort, and answer questions, the way he once did with mine.

I started donepezil and gave them the most optimistic talk I have for these cases. But I know we’re still far away from fixing broken brains.

After he left, I found myself looking in the mirror, thinking of how I saw him then, wondering if his family saw me the same way now, and realizing that someday my children and I may be in the same situation.

 

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

 

I was 14 when my grandmother fell and broke her hip. She went to the emergency department by ambulance from the restaurant we were at, and Dad took me to the hospital with him. He was an only child, and not a medical person. He was very worried.

There, Grandma looked older and more frail than usual. She and my dad were both anxious when told she’d need surgery.

Then the orthopedic surgeon came in. Tall and confident, he was initially quite imposing. But he was polite and had a great bedside manner. He calmed my dad and grandmother down, explained what needed to be done, and was reassuring. After surgery, he came to the waiting room to let us know things had gone well. I remember how impressed Dad and I both were.

Dean Mitchell/Thinkstock

Now, here was that surgeon again, on the other side of my desk. Arthritis had taken away some of his height. But he still carried himself with a proud dignity.

His family had brought him to me for worsening memory problems. He thought he was still in practice, although he had retired years ago. He didn’t remember his address, what city we were in, or what a clock looked like.

You hear families talk about how much Alzheimer’s disease takes away from a loved one, but you rarely have the opportunity in a practice to see for yourself. But the impression he’d made on me over 35 years ago was still strong, and I remembered every detail in comparison to the person across from me today.

In his field, he fixed things. With screws, rods, and casts he could restore broken bones, returning them to strength and use – like he had with my grandmother.

Sadly, I can’t return the favor now. I can only offer his family comfort, and answer questions, the way he once did with mine.

I started donepezil and gave them the most optimistic talk I have for these cases. But I know we’re still far away from fixing broken brains.

After he left, I found myself looking in the mirror, thinking of how I saw him then, wondering if his family saw me the same way now, and realizing that someday my children and I may be in the same situation.

 

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

 

“I’m giving you a bad review on Yelp over this.”

He said that, and I honestly didn’t care.

When he called for the appointment, he told my staff he was on a PPO plan that I’m contracted with. But when he came in 2 weeks later, he had a completely different card: an HMO that I’ve never been affiliated with.

Thinkstock/image altered

Not surprisingly, he didn’t see how this was his fault. He told me that my staff, if they were competent, should have reverified his insurance coverage when we made the reminder call. (I don’t know any offices that do such a thing.)

I’m an adult neurologist, and don’t see anyone under 18. If you’re an adult, you need to start taking responsibility for your actions. One of them should be knowing what your medical insurance is. This is your job. Not ours. When you tell us what your insurance is, we take you at your word.

But I’m here to help people, and he said he really needed to see me. So I offered to see him at my cash discount rate.

He said no.

I then said I’d see him, and bill it to his insurance to see if they paid anything, and we could work out what he still might owe after that. I was genuinely trying to help him.

Not surprisingly, he again said no.

Then he made me this counteroffer: See me for free, and I won’t post a negative online review about you.

No. I am here to help you. I will not be bullied into doing so. I also can’t see people for free. Heaven knows, any of us who take hospital call do enough of that as is. I have rent, staff salaries, and my kids’ education expenses. I’m pretty sure the bank that holds my mortgage wouldn’t forgive a missed payment if I threatened to write a bad Yelp review about them.

Predictably, he left. And wrote the review on a rate-a-doc site.

Does the bad review bother me? Not at all. The nature of medicine is such that you can’t please everyone. And those you do please likely won’t write a review.

I come here each day to do my best to help people. Threatening me to start a medical relationship will find you going nowhere.

And taking responsibility for your own actions, like I tell my kids, is a big part of being a grownup.
 

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

 

“I’m giving you a bad review on Yelp over this.”

He said that, and I honestly didn’t care.

When he called for the appointment, he told my staff he was on a PPO plan that I’m contracted with. But when he came in 2 weeks later, he had a completely different card: an HMO that I’ve never been affiliated with.

Thinkstock/image altered

Not surprisingly, he didn’t see how this was his fault. He told me that my staff, if they were competent, should have reverified his insurance coverage when we made the reminder call. (I don’t know any offices that do such a thing.)

I’m an adult neurologist, and don’t see anyone under 18. If you’re an adult, you need to start taking responsibility for your actions. One of them should be knowing what your medical insurance is. This is your job. Not ours. When you tell us what your insurance is, we take you at your word.

But I’m here to help people, and he said he really needed to see me. So I offered to see him at my cash discount rate.

He said no.

I then said I’d see him, and bill it to his insurance to see if they paid anything, and we could work out what he still might owe after that. I was genuinely trying to help him.

Not surprisingly, he again said no.

Then he made me this counteroffer: See me for free, and I won’t post a negative online review about you.

No. I am here to help you. I will not be bullied into doing so. I also can’t see people for free. Heaven knows, any of us who take hospital call do enough of that as is. I have rent, staff salaries, and my kids’ education expenses. I’m pretty sure the bank that holds my mortgage wouldn’t forgive a missed payment if I threatened to write a bad Yelp review about them.

Predictably, he left. And wrote the review on a rate-a-doc site.

Does the bad review bother me? Not at all. The nature of medicine is such that you can’t please everyone. And those you do please likely won’t write a review.

I come here each day to do my best to help people. Threatening me to start a medical relationship will find you going nowhere.

And taking responsibility for your own actions, like I tell my kids, is a big part of being a grownup.
 

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

 

“I’m giving you a bad review on Yelp over this.”

He said that, and I honestly didn’t care.

When he called for the appointment, he told my staff he was on a PPO plan that I’m contracted with. But when he came in 2 weeks later, he had a completely different card: an HMO that I’ve never been affiliated with.

Thinkstock/image altered

Not surprisingly, he didn’t see how this was his fault. He told me that my staff, if they were competent, should have reverified his insurance coverage when we made the reminder call. (I don’t know any offices that do such a thing.)

I’m an adult neurologist, and don’t see anyone under 18. If you’re an adult, you need to start taking responsibility for your actions. One of them should be knowing what your medical insurance is. This is your job. Not ours. When you tell us what your insurance is, we take you at your word.

But I’m here to help people, and he said he really needed to see me. So I offered to see him at my cash discount rate.

He said no.

I then said I’d see him, and bill it to his insurance to see if they paid anything, and we could work out what he still might owe after that. I was genuinely trying to help him.

Not surprisingly, he again said no.

Then he made me this counteroffer: See me for free, and I won’t post a negative online review about you.

No. I am here to help you. I will not be bullied into doing so. I also can’t see people for free. Heaven knows, any of us who take hospital call do enough of that as is. I have rent, staff salaries, and my kids’ education expenses. I’m pretty sure the bank that holds my mortgage wouldn’t forgive a missed payment if I threatened to write a bad Yelp review about them.

Predictably, he left. And wrote the review on a rate-a-doc site.

Does the bad review bother me? Not at all. The nature of medicine is such that you can’t please everyone. And those you do please likely won’t write a review.

I come here each day to do my best to help people. Threatening me to start a medical relationship will find you going nowhere.

And taking responsibility for your own actions, like I tell my kids, is a big part of being a grownup.
 

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

 

We love to try and predict the future. Some of it is scientific, like checking the weather forecast to see what we’re in for. (Here in Phoenix, it’s always hot, hotter, or melting.)

On the other hand, some of it is just for entertainment, like checking a horoscope or seeing what a fortune cookie says.

©roberthyrons/thinkstockphotos.com

Now, neurology is moving into the realm of prediction, and it’s a lot more serious than the weather or what’s in store for Sagittarius.

The breakthroughs in biomarkers for Alzheimer’s disease are accelerating. Although still experimental, we’re getting pretty close to predicting the disease many years before it develops. At the same time, we aren’t nearly as close to a treatment that will have a meaningful impact on the course of the disease.

In 1993, the genetic marker for Huntington’s disease was identified, quickly leading to a blood test with high accuracy to know if you were – or were not – going to develop the fatal disorder down the road.

Some wanted to know and used the information to decide if they wanted to have families. Others, understandably fearful, decided not to and let their lives play out as they will. Sadly, either way we have nothing close to a cure for the disease.

Now, we come to Alzheimer’s disease, many times more common than Huntington’s. Close to predicting its coming and not really close to a cure.

What would you do?

[polldaddy:9778279]

In “Back to the Future,” Doc Brown said “no man should know too much about their own destiny” (though later changed his mind). But, for Doc Brown, a bulletproof vest was all he needed. In Alzheimer’s disease, it’s not that simple.

I’m sure some would see it as a way to have their affairs in order long in advance, to spare themselves and their loved ones the frantic scramble that often comes after a diagnosis. Others would be afraid to know what the future holds, with every misplaced set of keys or iPhone becoming a reason to panic.

Obviously, if we had a true cure for the disorder, the decision would be easy. Then, it becomes a preventive measure in the same category as mammograms and colonoscopies. Early detection saves lives.

Right now, it’s a Pandora’s Box with unpredictable ethical and legal issues, not to mention the varying ways a positive result will change asymptomatic individuals and their families. And, of course, it still doesn’t predict the majority of life’s changes: A person can have a negative result, then leave my office and get hit by a bus.

What would you do? And how will you guide the patients who ask your opinion?

For better or worse, these questions are coming. All of us need to think about how we’ll handle them.

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

 

We love to try and predict the future. Some of it is scientific, like checking the weather forecast to see what we’re in for. (Here in Phoenix, it’s always hot, hotter, or melting.)

On the other hand, some of it is just for entertainment, like checking a horoscope or seeing what a fortune cookie says.

©roberthyrons/thinkstockphotos.com

Now, neurology is moving into the realm of prediction, and it’s a lot more serious than the weather or what’s in store for Sagittarius.

The breakthroughs in biomarkers for Alzheimer’s disease are accelerating. Although still experimental, we’re getting pretty close to predicting the disease many years before it develops. At the same time, we aren’t nearly as close to a treatment that will have a meaningful impact on the course of the disease.

In 1993, the genetic marker for Huntington’s disease was identified, quickly leading to a blood test with high accuracy to know if you were – or were not – going to develop the fatal disorder down the road.

Some wanted to know and used the information to decide if they wanted to have families. Others, understandably fearful, decided not to and let their lives play out as they will. Sadly, either way we have nothing close to a cure for the disease.

Now, we come to Alzheimer’s disease, many times more common than Huntington’s. Close to predicting its coming and not really close to a cure.

What would you do?

[polldaddy:9778279]

In “Back to the Future,” Doc Brown said “no man should know too much about their own destiny” (though later changed his mind). But, for Doc Brown, a bulletproof vest was all he needed. In Alzheimer’s disease, it’s not that simple.

I’m sure some would see it as a way to have their affairs in order long in advance, to spare themselves and their loved ones the frantic scramble that often comes after a diagnosis. Others would be afraid to know what the future holds, with every misplaced set of keys or iPhone becoming a reason to panic.

Obviously, if we had a true cure for the disorder, the decision would be easy. Then, it becomes a preventive measure in the same category as mammograms and colonoscopies. Early detection saves lives.

Right now, it’s a Pandora’s Box with unpredictable ethical and legal issues, not to mention the varying ways a positive result will change asymptomatic individuals and their families. And, of course, it still doesn’t predict the majority of life’s changes: A person can have a negative result, then leave my office and get hit by a bus.

What would you do? And how will you guide the patients who ask your opinion?

For better or worse, these questions are coming. All of us need to think about how we’ll handle them.

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

 

We love to try and predict the future. Some of it is scientific, like checking the weather forecast to see what we’re in for. (Here in Phoenix, it’s always hot, hotter, or melting.)

On the other hand, some of it is just for entertainment, like checking a horoscope or seeing what a fortune cookie says.

©roberthyrons/thinkstockphotos.com

Now, neurology is moving into the realm of prediction, and it’s a lot more serious than the weather or what’s in store for Sagittarius.

The breakthroughs in biomarkers for Alzheimer’s disease are accelerating. Although still experimental, we’re getting pretty close to predicting the disease many years before it develops. At the same time, we aren’t nearly as close to a treatment that will have a meaningful impact on the course of the disease.

In 1993, the genetic marker for Huntington’s disease was identified, quickly leading to a blood test with high accuracy to know if you were – or were not – going to develop the fatal disorder down the road.

Some wanted to know and used the information to decide if they wanted to have families. Others, understandably fearful, decided not to and let their lives play out as they will. Sadly, either way we have nothing close to a cure for the disease.

Now, we come to Alzheimer’s disease, many times more common than Huntington’s. Close to predicting its coming and not really close to a cure.

What would you do?

[polldaddy:9778279]

In “Back to the Future,” Doc Brown said “no man should know too much about their own destiny” (though later changed his mind). But, for Doc Brown, a bulletproof vest was all he needed. In Alzheimer’s disease, it’s not that simple.

I’m sure some would see it as a way to have their affairs in order long in advance, to spare themselves and their loved ones the frantic scramble that often comes after a diagnosis. Others would be afraid to know what the future holds, with every misplaced set of keys or iPhone becoming a reason to panic.

Obviously, if we had a true cure for the disorder, the decision would be easy. Then, it becomes a preventive measure in the same category as mammograms and colonoscopies. Early detection saves lives.

Right now, it’s a Pandora’s Box with unpredictable ethical and legal issues, not to mention the varying ways a positive result will change asymptomatic individuals and their families. And, of course, it still doesn’t predict the majority of life’s changes: A person can have a negative result, then leave my office and get hit by a bus.

What would you do? And how will you guide the patients who ask your opinion?

For better or worse, these questions are coming. All of us need to think about how we’ll handle them.

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

 

I don’t stack narcotics in my office. Never have, never will.

Honestly, in this day and age, I don’t understand why anyone would.

I get the occasional patient with a bad migraine who wants to come in for “a shot.” Sorry, I don’t carry that. I suppose I could carry Ketorolac, but I try to run a simple, nonurgent practice. If you have an urgent situation, go to an emergency department or urgent care.

The paperwork and regulations surrounding narcotics only seem to get bigger each year, and I just don’t want to deal with them. Besides, Arlan Cohn, MD, once wrote that narcotics in the office “tempt the burglar latent in the junkie; they tempt the junkie latent in the doctor.”

I couldn’t agree more. It’s better to avoid the problem altogether.

In 1998, on my very first day of work as an attending, the group I’d signed with put me in a satellite office normally used by their headache specialist. While familiarizing myself with what was where, I discovered a bottle of injectable meperidine. It wasn’t locked up, just sitting next to the zolmitriptan (Zomig) samples in an unsecured cabinet. I picked it up in shock to make sure I’d read the label correctly. I put it back down then (somewhat paranoid) picked it back up, wiped my fingerprints off, and put it down in the exact same spot it had been. Although it was obviously a serious infraction, I didn’t want to jeopardize my standing as a new hire. So, I just ignored it. But, I sure worried about what would happen if a DEA inspector showed up.

So, today, I just don’t deal with it. No controlled substances, less paperwork, fewer worries. Simplicity is bliss, and modern medicine has enough worries as it is.

This still gets me the occasional complaint of, “Well, my other neurologist did!” but, frankly, I don’t care. They can run their practice how they want, and I’ll run mine.

In a world of regulations, daily press stories on “pill mills” overusing narcotics, and my quarterly prescription tracking reports from the state board, I want to keep my involvement in them as minimal as possible. I may prescribe them, but I don’t want the potential nightmares of having them on site.
 

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

 

I don’t stack narcotics in my office. Never have, never will.

Honestly, in this day and age, I don’t understand why anyone would.

I get the occasional patient with a bad migraine who wants to come in for “a shot.” Sorry, I don’t carry that. I suppose I could carry Ketorolac, but I try to run a simple, nonurgent practice. If you have an urgent situation, go to an emergency department or urgent care.

The paperwork and regulations surrounding narcotics only seem to get bigger each year, and I just don’t want to deal with them. Besides, Arlan Cohn, MD, once wrote that narcotics in the office “tempt the burglar latent in the junkie; they tempt the junkie latent in the doctor.”

I couldn’t agree more. It’s better to avoid the problem altogether.

In 1998, on my very first day of work as an attending, the group I’d signed with put me in a satellite office normally used by their headache specialist. While familiarizing myself with what was where, I discovered a bottle of injectable meperidine. It wasn’t locked up, just sitting next to the zolmitriptan (Zomig) samples in an unsecured cabinet. I picked it up in shock to make sure I’d read the label correctly. I put it back down then (somewhat paranoid) picked it back up, wiped my fingerprints off, and put it down in the exact same spot it had been. Although it was obviously a serious infraction, I didn’t want to jeopardize my standing as a new hire. So, I just ignored it. But, I sure worried about what would happen if a DEA inspector showed up.

So, today, I just don’t deal with it. No controlled substances, less paperwork, fewer worries. Simplicity is bliss, and modern medicine has enough worries as it is.

This still gets me the occasional complaint of, “Well, my other neurologist did!” but, frankly, I don’t care. They can run their practice how they want, and I’ll run mine.

In a world of regulations, daily press stories on “pill mills” overusing narcotics, and my quarterly prescription tracking reports from the state board, I want to keep my involvement in them as minimal as possible. I may prescribe them, but I don’t want the potential nightmares of having them on site.
 

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

 

I don’t stack narcotics in my office. Never have, never will.

Honestly, in this day and age, I don’t understand why anyone would.

I get the occasional patient with a bad migraine who wants to come in for “a shot.” Sorry, I don’t carry that. I suppose I could carry Ketorolac, but I try to run a simple, nonurgent practice. If you have an urgent situation, go to an emergency department or urgent care.

The paperwork and regulations surrounding narcotics only seem to get bigger each year, and I just don’t want to deal with them. Besides, Arlan Cohn, MD, once wrote that narcotics in the office “tempt the burglar latent in the junkie; they tempt the junkie latent in the doctor.”

I couldn’t agree more. It’s better to avoid the problem altogether.

In 1998, on my very first day of work as an attending, the group I’d signed with put me in a satellite office normally used by their headache specialist. While familiarizing myself with what was where, I discovered a bottle of injectable meperidine. It wasn’t locked up, just sitting next to the zolmitriptan (Zomig) samples in an unsecured cabinet. I picked it up in shock to make sure I’d read the label correctly. I put it back down then (somewhat paranoid) picked it back up, wiped my fingerprints off, and put it down in the exact same spot it had been. Although it was obviously a serious infraction, I didn’t want to jeopardize my standing as a new hire. So, I just ignored it. But, I sure worried about what would happen if a DEA inspector showed up.

So, today, I just don’t deal with it. No controlled substances, less paperwork, fewer worries. Simplicity is bliss, and modern medicine has enough worries as it is.

This still gets me the occasional complaint of, “Well, my other neurologist did!” but, frankly, I don’t care. They can run their practice how they want, and I’ll run mine.

In a world of regulations, daily press stories on “pill mills” overusing narcotics, and my quarterly prescription tracking reports from the state board, I want to keep my involvement in them as minimal as possible. I may prescribe them, but I don’t want the potential nightmares of having them on site.
 

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

 

“The little blue book” has been an office standard as long as I’ve been in practice. Every practice has a dog-eared copy in a drawer somewhere that’s constantly being pulled out to look up hospitals, other doctors, and pharmacies.

As small as it is, it’s pretty useful in the daily flow of my office routine.

So I’ve never griped about my annual payment of $39.90 to get two copies of it. In a world of expensive and unused textbooks and coding guides, this little thing is indispensable. It generally seemed a lot more reliable than Google. It even became a running office gag, where when it showed up my medical assistant would yell “THE NEW BLUE BOOKS ARE HERE! THE NEW BLUE BOOKS ARE HERE!” imitating Steve Martin in “The Jerk.”

Until now.

Sadly, 2016 was apparently the year I ordered my last copies. The publisher’s marketing people inform me that the paper version has been discontinued, and I can now get the digital version for only ... $500 per year.

Thanks, but no thanks.

I have nothing against digital editions. In fact, if it was the same price as the paper one, I’d get it. If I were a big practice that needed, say, 50 copies for the staff, the $500 per practice fee is a deal, compared with the $998 I’d pay for 50 paper copies.

But for my dinky little two-person practice? The difference between $39.90 and $500 just isn’t worth all the advantages a digital version may offer. For that kind of money, I’ll use Google.

This is another part of a gradual, and disturbing, trend in medicine: ignoring small practices. Large corporate practices are worth a lot more in sales than little one-to-three doctor groups, so companies, such as “the little blue book,” have no incentive to tailor their products to us. We have become medical persona non grata.

I understand this is a business decision. It’s not specifically directed at me.

Yet ...

I’ve been in practice for almost 20 years now, and buying two copies of the LBB is something I’ve done annually, in good and bad economic years. I’ve supported the publisher because it was a good product at a fair price. Sadly, they no longer find my little practice to be worth the effort or profit margin.
 

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

 

“The little blue book” has been an office standard as long as I’ve been in practice. Every practice has a dog-eared copy in a drawer somewhere that’s constantly being pulled out to look up hospitals, other doctors, and pharmacies.

As small as it is, it’s pretty useful in the daily flow of my office routine.

So I’ve never griped about my annual payment of $39.90 to get two copies of it. In a world of expensive and unused textbooks and coding guides, this little thing is indispensable. It generally seemed a lot more reliable than Google. It even became a running office gag, where when it showed up my medical assistant would yell “THE NEW BLUE BOOKS ARE HERE! THE NEW BLUE BOOKS ARE HERE!” imitating Steve Martin in “The Jerk.”

Until now.

Sadly, 2016 was apparently the year I ordered my last copies. The publisher’s marketing people inform me that the paper version has been discontinued, and I can now get the digital version for only ... $500 per year.

Thanks, but no thanks.

I have nothing against digital editions. In fact, if it was the same price as the paper one, I’d get it. If I were a big practice that needed, say, 50 copies for the staff, the $500 per practice fee is a deal, compared with the $998 I’d pay for 50 paper copies.

But for my dinky little two-person practice? The difference between $39.90 and $500 just isn’t worth all the advantages a digital version may offer. For that kind of money, I’ll use Google.

This is another part of a gradual, and disturbing, trend in medicine: ignoring small practices. Large corporate practices are worth a lot more in sales than little one-to-three doctor groups, so companies, such as “the little blue book,” have no incentive to tailor their products to us. We have become medical persona non grata.

I understand this is a business decision. It’s not specifically directed at me.

Yet ...

I’ve been in practice for almost 20 years now, and buying two copies of the LBB is something I’ve done annually, in good and bad economic years. I’ve supported the publisher because it was a good product at a fair price. Sadly, they no longer find my little practice to be worth the effort or profit margin.
 

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

 

“The little blue book” has been an office standard as long as I’ve been in practice. Every practice has a dog-eared copy in a drawer somewhere that’s constantly being pulled out to look up hospitals, other doctors, and pharmacies.

As small as it is, it’s pretty useful in the daily flow of my office routine.

So I’ve never griped about my annual payment of $39.90 to get two copies of it. In a world of expensive and unused textbooks and coding guides, this little thing is indispensable. It generally seemed a lot more reliable than Google. It even became a running office gag, where when it showed up my medical assistant would yell “THE NEW BLUE BOOKS ARE HERE! THE NEW BLUE BOOKS ARE HERE!” imitating Steve Martin in “The Jerk.”

Until now.

Sadly, 2016 was apparently the year I ordered my last copies. The publisher’s marketing people inform me that the paper version has been discontinued, and I can now get the digital version for only ... $500 per year.

Thanks, but no thanks.

I have nothing against digital editions. In fact, if it was the same price as the paper one, I’d get it. If I were a big practice that needed, say, 50 copies for the staff, the $500 per practice fee is a deal, compared with the $998 I’d pay for 50 paper copies.

But for my dinky little two-person practice? The difference between $39.90 and $500 just isn’t worth all the advantages a digital version may offer. For that kind of money, I’ll use Google.

This is another part of a gradual, and disturbing, trend in medicine: ignoring small practices. Large corporate practices are worth a lot more in sales than little one-to-three doctor groups, so companies, such as “the little blue book,” have no incentive to tailor their products to us. We have become medical persona non grata.

I understand this is a business decision. It’s not specifically directed at me.

Yet ...

I’ve been in practice for almost 20 years now, and buying two copies of the LBB is something I’ve done annually, in good and bad economic years. I’ve supported the publisher because it was a good product at a fair price. Sadly, they no longer find my little practice to be worth the effort or profit margin.
 

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

 

Recently, the hospital I take call at switched to Epic as its electronic health record system.

Overall, I don’t have too many complaints about it. It does some things better and some things worse than other systems I’ve used. That’s to be expected.

But with Epic has come an alarming new trend: the monster note.

The feature that automatically pastes radiology and lab results in a note has become horribly misused. I’m sure it looks good for legal purposes (“Hey, of course I read it. It’s in my note”). But what it really does is fill up a note with drivel: test results that take up space, followed by an exam that’s likely been cut and pasted from the previous day, and an impression that’s usually almost meaningless. Typically the last is along the lines of “continue current treatment” or “cardiology to see.”

Rarely does it ever give you a hint into the thought process or what’s going on that (at least to me) is so critical to medicine.

In a recent example of the insanity, one of my office patients was in the hospital overnight for a transient ischemic attack. When I went to get the discharge summary, it was 97 pages long! (Really, it was.) All of it was auto-filled in with test results, vital signs, MRI screening forms, medication administration records, and nurse, therapy, and respiratory notes. Most of it was far from the stuff that discharge summaries are supposed to contain. What part of “summary” are people not understanding anymore?

Of course, this isn’t Epic’s fault. It’s just a tool. It’s how humans use it that becomes the problem. This misuse of the system has made routine notes, as Shakespeare’s Macbeth said, “a tale told by an idiot, full of sound and fury, signifying nothing.”

For better or worse, I deliberately don’t do this. I let Epic put in the patient’s name, birthday, and most recent vital signs ... and nothing else. I’ll fill in the test results when needed, in a concise form that I can grasp. (It’s my note, after all.) To me, writing (or typing) the note is part of the thought process. As I enter results, I turn over what they mean, in a way that just seeing five paragraphs auto-pasted in doesn’t do. It also allows me to boil them down to one or two sentences.

After all, brevity is the soul of wit. And while I’m not trying to be witty in my notes, I am trying solve the problem in front of me. Taking the time write it out in my own words is essential to my thought process and letting others understand how I came to my plan. And, as a result, it is what’s best for the patient.
 

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

 

Recently, the hospital I take call at switched to Epic as its electronic health record system.

Overall, I don’t have too many complaints about it. It does some things better and some things worse than other systems I’ve used. That’s to be expected.

But with Epic has come an alarming new trend: the monster note.

The feature that automatically pastes radiology and lab results in a note has become horribly misused. I’m sure it looks good for legal purposes (“Hey, of course I read it. It’s in my note”). But what it really does is fill up a note with drivel: test results that take up space, followed by an exam that’s likely been cut and pasted from the previous day, and an impression that’s usually almost meaningless. Typically the last is along the lines of “continue current treatment” or “cardiology to see.”

Rarely does it ever give you a hint into the thought process or what’s going on that (at least to me) is so critical to medicine.

In a recent example of the insanity, one of my office patients was in the hospital overnight for a transient ischemic attack. When I went to get the discharge summary, it was 97 pages long! (Really, it was.) All of it was auto-filled in with test results, vital signs, MRI screening forms, medication administration records, and nurse, therapy, and respiratory notes. Most of it was far from the stuff that discharge summaries are supposed to contain. What part of “summary” are people not understanding anymore?

Of course, this isn’t Epic’s fault. It’s just a tool. It’s how humans use it that becomes the problem. This misuse of the system has made routine notes, as Shakespeare’s Macbeth said, “a tale told by an idiot, full of sound and fury, signifying nothing.”

For better or worse, I deliberately don’t do this. I let Epic put in the patient’s name, birthday, and most recent vital signs ... and nothing else. I’ll fill in the test results when needed, in a concise form that I can grasp. (It’s my note, after all.) To me, writing (or typing) the note is part of the thought process. As I enter results, I turn over what they mean, in a way that just seeing five paragraphs auto-pasted in doesn’t do. It also allows me to boil them down to one or two sentences.

After all, brevity is the soul of wit. And while I’m not trying to be witty in my notes, I am trying solve the problem in front of me. Taking the time write it out in my own words is essential to my thought process and letting others understand how I came to my plan. And, as a result, it is what’s best for the patient.
 

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

 

Recently, the hospital I take call at switched to Epic as its electronic health record system.

Overall, I don’t have too many complaints about it. It does some things better and some things worse than other systems I’ve used. That’s to be expected.

But with Epic has come an alarming new trend: the monster note.

The feature that automatically pastes radiology and lab results in a note has become horribly misused. I’m sure it looks good for legal purposes (“Hey, of course I read it. It’s in my note”). But what it really does is fill up a note with drivel: test results that take up space, followed by an exam that’s likely been cut and pasted from the previous day, and an impression that’s usually almost meaningless. Typically the last is along the lines of “continue current treatment” or “cardiology to see.”

Rarely does it ever give you a hint into the thought process or what’s going on that (at least to me) is so critical to medicine.

In a recent example of the insanity, one of my office patients was in the hospital overnight for a transient ischemic attack. When I went to get the discharge summary, it was 97 pages long! (Really, it was.) All of it was auto-filled in with test results, vital signs, MRI screening forms, medication administration records, and nurse, therapy, and respiratory notes. Most of it was far from the stuff that discharge summaries are supposed to contain. What part of “summary” are people not understanding anymore?

Of course, this isn’t Epic’s fault. It’s just a tool. It’s how humans use it that becomes the problem. This misuse of the system has made routine notes, as Shakespeare’s Macbeth said, “a tale told by an idiot, full of sound and fury, signifying nothing.”

For better or worse, I deliberately don’t do this. I let Epic put in the patient’s name, birthday, and most recent vital signs ... and nothing else. I’ll fill in the test results when needed, in a concise form that I can grasp. (It’s my note, after all.) To me, writing (or typing) the note is part of the thought process. As I enter results, I turn over what they mean, in a way that just seeing five paragraphs auto-pasted in doesn’t do. It also allows me to boil them down to one or two sentences.

After all, brevity is the soul of wit. And while I’m not trying to be witty in my notes, I am trying solve the problem in front of me. Taking the time write it out in my own words is essential to my thought process and letting others understand how I came to my plan. And, as a result, it is what’s best for the patient.
 

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

 

I’ve never been particularly curious about my genetic background. We have a pretty clear family history that I’m of central European and Russian descent, with my ancestors coming over in groups between 1900 and 1938.

Recently, my mother decided she wanted more genetic information on us, so she paid $99 for us to send saliva samples to a company that advertises such services.

A few weeks went by. You read about people who find out they have a genetic background that’s quite surprising. I began to wonder: Would there be some giant family history shocker when the results came in?

Sadly, the whole thing was anticlimactic. My test showed I was ... (drum roll, please) entirely of central European and Russian descent. So much for the dream of learning I was secretly a long-lost Mayan prince.

I’ve since spoken to others who had paid for this service and found most had the same experience. The test confirmed what was already well known, except for one friend whose results suggested a trace of Polynesian blood somewhere in his background. He believes this was likely artefactual, though he enjoys the idea that somewhere in history a Tongan warrior was blown off course at sea and somehow ended up in Odessa, Ukraine.

Of course, as I’ve now learned, that’s only the start of things. These days, I get emails advertising a more detailed panel (for an additional fee), looking for genetic markers for disease and more obscure traits. I also receive the occasional one from someone who, through the company’s anonymous servers, thinks they may be related to me.

I don’t answer either of those. I have no desire to expand my family circle beyond what it already is.

As for the disease testing? Not interested. Yes, some genetic tests may be helpful in making better choices, but the majority, at least to me, are still a work in progress. We deal with both false negatives and false positives in medicine. I routinely discourage my patients from spending money on unproven testing and treatments and have no desire to do the same myself. Maybe someday it will be worth the additional dollars, but I’m not convinced it’s there.

Money is, for better or worse, the driving force for all technologies, medical and otherwise. Maybe my $99 investment will help pay dividends down the road for someone, but today it only resulted in a shoulder shrug and chuckle at what I already knew.

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

 

I’ve never been particularly curious about my genetic background. We have a pretty clear family history that I’m of central European and Russian descent, with my ancestors coming over in groups between 1900 and 1938.

Recently, my mother decided she wanted more genetic information on us, so she paid $99 for us to send saliva samples to a company that advertises such services.

A few weeks went by. You read about people who find out they have a genetic background that’s quite surprising. I began to wonder: Would there be some giant family history shocker when the results came in?

Sadly, the whole thing was anticlimactic. My test showed I was ... (drum roll, please) entirely of central European and Russian descent. So much for the dream of learning I was secretly a long-lost Mayan prince.

I’ve since spoken to others who had paid for this service and found most had the same experience. The test confirmed what was already well known, except for one friend whose results suggested a trace of Polynesian blood somewhere in his background. He believes this was likely artefactual, though he enjoys the idea that somewhere in history a Tongan warrior was blown off course at sea and somehow ended up in Odessa, Ukraine.

Of course, as I’ve now learned, that’s only the start of things. These days, I get emails advertising a more detailed panel (for an additional fee), looking for genetic markers for disease and more obscure traits. I also receive the occasional one from someone who, through the company’s anonymous servers, thinks they may be related to me.

I don’t answer either of those. I have no desire to expand my family circle beyond what it already is.

As for the disease testing? Not interested. Yes, some genetic tests may be helpful in making better choices, but the majority, at least to me, are still a work in progress. We deal with both false negatives and false positives in medicine. I routinely discourage my patients from spending money on unproven testing and treatments and have no desire to do the same myself. Maybe someday it will be worth the additional dollars, but I’m not convinced it’s there.

Money is, for better or worse, the driving force for all technologies, medical and otherwise. Maybe my $99 investment will help pay dividends down the road for someone, but today it only resulted in a shoulder shrug and chuckle at what I already knew.

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

 

I’ve never been particularly curious about my genetic background. We have a pretty clear family history that I’m of central European and Russian descent, with my ancestors coming over in groups between 1900 and 1938.

Recently, my mother decided she wanted more genetic information on us, so she paid $99 for us to send saliva samples to a company that advertises such services.

A few weeks went by. You read about people who find out they have a genetic background that’s quite surprising. I began to wonder: Would there be some giant family history shocker when the results came in?

Sadly, the whole thing was anticlimactic. My test showed I was ... (drum roll, please) entirely of central European and Russian descent. So much for the dream of learning I was secretly a long-lost Mayan prince.

I’ve since spoken to others who had paid for this service and found most had the same experience. The test confirmed what was already well known, except for one friend whose results suggested a trace of Polynesian blood somewhere in his background. He believes this was likely artefactual, though he enjoys the idea that somewhere in history a Tongan warrior was blown off course at sea and somehow ended up in Odessa, Ukraine.

Of course, as I’ve now learned, that’s only the start of things. These days, I get emails advertising a more detailed panel (for an additional fee), looking for genetic markers for disease and more obscure traits. I also receive the occasional one from someone who, through the company’s anonymous servers, thinks they may be related to me.

I don’t answer either of those. I have no desire to expand my family circle beyond what it already is.

As for the disease testing? Not interested. Yes, some genetic tests may be helpful in making better choices, but the majority, at least to me, are still a work in progress. We deal with both false negatives and false positives in medicine. I routinely discourage my patients from spending money on unproven testing and treatments and have no desire to do the same myself. Maybe someday it will be worth the additional dollars, but I’m not convinced it’s there.

Money is, for better or worse, the driving force for all technologies, medical and otherwise. Maybe my $99 investment will help pay dividends down the road for someone, but today it only resulted in a shoulder shrug and chuckle at what I already knew.

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

 

We get paid to see patients. So what happens when patients aren’t in the room?

This is a big, and growing, issue in medicine.

I do hospital call on weekends, and occasionally, I have a long meeting with families. In some cases, this involves a large group in a conference room. These meetings can take quite a bit of time, but since, technically, the patient isn’t present, it requires different charges than if he or she were, even if the whole meeting is about him or her.

Office visits are often the same way. It’s not uncommon for the family of an Alzheimer’s disease patient to want to meet with me without the patient. They’re reluctant to bring up the problems with him or her present or to discuss the future.

Unfortunately, these visits usually aren’t covered by insurance (although this is slowly changing), so families have to pay cash for them, even if they have a direct impact on patient care and take a lot of time.

Telemedicine is the same way. Although it’s getting easier to get visits paid, it’s still not consistent. After all, the patient isn’t physically in the room with you, either. This one, though, at least is starting to take off. But it still has a long way to go.

To date, I haven’t done telemedicine. In a small practice, I can’t afford to lose money on visits, so I don’t plan on starting these until the reimbursement is higher and more consistent. I have to keep the lights on for the patients who depend on me. There are liability issues with it as well since I am unable to examine the patient more than just by sight.

I’m surprised that it’s taking so long for these visits to catch on. If I see someone in my office, I may get paid $80, but if I do it remotely, even for the same amount of time, I get $0. In an era in which people are pushing “patient-centric” care, you’d think telemedicine would be about as patient-centric as you can get. But, apparently, that’s not the case, given the reluctance of many insurers to cover it. And if it’s not being adequately covered, many of us can’t afford to do it.

There needs to be a better realization among payers that patient care doesn’t always involve the patient being physically present, even though we’re still trying to help them.
 

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

 

We get paid to see patients. So what happens when patients aren’t in the room?

This is a big, and growing, issue in medicine.

I do hospital call on weekends, and occasionally, I have a long meeting with families. In some cases, this involves a large group in a conference room. These meetings can take quite a bit of time, but since, technically, the patient isn’t present, it requires different charges than if he or she were, even if the whole meeting is about him or her.

Office visits are often the same way. It’s not uncommon for the family of an Alzheimer’s disease patient to want to meet with me without the patient. They’re reluctant to bring up the problems with him or her present or to discuss the future.

Unfortunately, these visits usually aren’t covered by insurance (although this is slowly changing), so families have to pay cash for them, even if they have a direct impact on patient care and take a lot of time.

Telemedicine is the same way. Although it’s getting easier to get visits paid, it’s still not consistent. After all, the patient isn’t physically in the room with you, either. This one, though, at least is starting to take off. But it still has a long way to go.

To date, I haven’t done telemedicine. In a small practice, I can’t afford to lose money on visits, so I don’t plan on starting these until the reimbursement is higher and more consistent. I have to keep the lights on for the patients who depend on me. There are liability issues with it as well since I am unable to examine the patient more than just by sight.

I’m surprised that it’s taking so long for these visits to catch on. If I see someone in my office, I may get paid $80, but if I do it remotely, even for the same amount of time, I get $0. In an era in which people are pushing “patient-centric” care, you’d think telemedicine would be about as patient-centric as you can get. But, apparently, that’s not the case, given the reluctance of many insurers to cover it. And if it’s not being adequately covered, many of us can’t afford to do it.

There needs to be a better realization among payers that patient care doesn’t always involve the patient being physically present, even though we’re still trying to help them.
 

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

 

We get paid to see patients. So what happens when patients aren’t in the room?

This is a big, and growing, issue in medicine.

I do hospital call on weekends, and occasionally, I have a long meeting with families. In some cases, this involves a large group in a conference room. These meetings can take quite a bit of time, but since, technically, the patient isn’t present, it requires different charges than if he or she were, even if the whole meeting is about him or her.

Office visits are often the same way. It’s not uncommon for the family of an Alzheimer’s disease patient to want to meet with me without the patient. They’re reluctant to bring up the problems with him or her present or to discuss the future.

Unfortunately, these visits usually aren’t covered by insurance (although this is slowly changing), so families have to pay cash for them, even if they have a direct impact on patient care and take a lot of time.

Telemedicine is the same way. Although it’s getting easier to get visits paid, it’s still not consistent. After all, the patient isn’t physically in the room with you, either. This one, though, at least is starting to take off. But it still has a long way to go.

To date, I haven’t done telemedicine. In a small practice, I can’t afford to lose money on visits, so I don’t plan on starting these until the reimbursement is higher and more consistent. I have to keep the lights on for the patients who depend on me. There are liability issues with it as well since I am unable to examine the patient more than just by sight.

I’m surprised that it’s taking so long for these visits to catch on. If I see someone in my office, I may get paid $80, but if I do it remotely, even for the same amount of time, I get $0. In an era in which people are pushing “patient-centric” care, you’d think telemedicine would be about as patient-centric as you can get. But, apparently, that’s not the case, given the reluctance of many insurers to cover it. And if it’s not being adequately covered, many of us can’t afford to do it.

There needs to be a better realization among payers that patient care doesn’t always involve the patient being physically present, even though we’re still trying to help them.
 

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

 

Where do we go from here?

More than 20 years after IV tissue plasminogen activator was officially approved for use in acute ischemic stroke, now data suggest mechanical thrombectomy is superior, regardless of whether tPA is given.

Granted, these are preliminary trials, and a lot more research needs to be done: randomized studies, determinations of which patients are the best candidates, which devices are most useful, etc.

This led to an email exchange between another neurologist and me recently, wondering if we should be notifying the interventionalists, too, as soon as a nonhemorrhagic stroke is rolled in. Why should we have all the fun? Heck, why bother me at all? If they’re better at it, call the interventionalists and let me sleep.

Of course, it’s not that simple. The data thus far suggest thrombectomy is best when used in anterior circulation strokes, with a National Institutes of Health Stroke Scale score of greater than 6, so obviously we shouldn’t be calling them in on every case.

You have to balance that against legal issues. It certainly isn’t too far-fetched to imagine being sued because you didn’t call an interventionalist, or another neurologist testifying that you fell below the standard of care by not doing so. The right person will say that about anything, regardless of clinical data.

This is still up in the air right now, as I doubt the interventionalists want to take acute ischemic stroke off our hands, nor do we want to give it up, either. It’s a disorder of the brain, and that is what we deal with, isn’t it?

The bottom line is that rumors about the death of tPA in acute ischemic stroke are greatly exaggerated. Only time will tell.

Medicine, for better or worse, is an inexact science. No one can predict outcomes, adverse reactions, or complications with 100% certainty. Which treatment will work best for which patient is never known. That’s why we need controlled trials to know which odds are best overall, and take it from there. Preliminary trials can be very helpful at pointing us in the right directions, but are for from definitive. As with so many other things, your mileage may vary.
 

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

 

Where do we go from here?

More than 20 years after IV tissue plasminogen activator was officially approved for use in acute ischemic stroke, now data suggest mechanical thrombectomy is superior, regardless of whether tPA is given.

Granted, these are preliminary trials, and a lot more research needs to be done: randomized studies, determinations of which patients are the best candidates, which devices are most useful, etc.

This led to an email exchange between another neurologist and me recently, wondering if we should be notifying the interventionalists, too, as soon as a nonhemorrhagic stroke is rolled in. Why should we have all the fun? Heck, why bother me at all? If they’re better at it, call the interventionalists and let me sleep.

Of course, it’s not that simple. The data thus far suggest thrombectomy is best when used in anterior circulation strokes, with a National Institutes of Health Stroke Scale score of greater than 6, so obviously we shouldn’t be calling them in on every case.

You have to balance that against legal issues. It certainly isn’t too far-fetched to imagine being sued because you didn’t call an interventionalist, or another neurologist testifying that you fell below the standard of care by not doing so. The right person will say that about anything, regardless of clinical data.

This is still up in the air right now, as I doubt the interventionalists want to take acute ischemic stroke off our hands, nor do we want to give it up, either. It’s a disorder of the brain, and that is what we deal with, isn’t it?

The bottom line is that rumors about the death of tPA in acute ischemic stroke are greatly exaggerated. Only time will tell.

Medicine, for better or worse, is an inexact science. No one can predict outcomes, adverse reactions, or complications with 100% certainty. Which treatment will work best for which patient is never known. That’s why we need controlled trials to know which odds are best overall, and take it from there. Preliminary trials can be very helpful at pointing us in the right directions, but are for from definitive. As with so many other things, your mileage may vary.
 

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

 

Where do we go from here?

More than 20 years after IV tissue plasminogen activator was officially approved for use in acute ischemic stroke, now data suggest mechanical thrombectomy is superior, regardless of whether tPA is given.

Granted, these are preliminary trials, and a lot more research needs to be done: randomized studies, determinations of which patients are the best candidates, which devices are most useful, etc.

This led to an email exchange between another neurologist and me recently, wondering if we should be notifying the interventionalists, too, as soon as a nonhemorrhagic stroke is rolled in. Why should we have all the fun? Heck, why bother me at all? If they’re better at it, call the interventionalists and let me sleep.

Of course, it’s not that simple. The data thus far suggest thrombectomy is best when used in anterior circulation strokes, with a National Institutes of Health Stroke Scale score of greater than 6, so obviously we shouldn’t be calling them in on every case.

You have to balance that against legal issues. It certainly isn’t too far-fetched to imagine being sued because you didn’t call an interventionalist, or another neurologist testifying that you fell below the standard of care by not doing so. The right person will say that about anything, regardless of clinical data.

This is still up in the air right now, as I doubt the interventionalists want to take acute ischemic stroke off our hands, nor do we want to give it up, either. It’s a disorder of the brain, and that is what we deal with, isn’t it?

The bottom line is that rumors about the death of tPA in acute ischemic stroke are greatly exaggerated. Only time will tell.

Medicine, for better or worse, is an inexact science. No one can predict outcomes, adverse reactions, or complications with 100% certainty. Which treatment will work best for which patient is never known. That’s why we need controlled trials to know which odds are best overall, and take it from there. Preliminary trials can be very helpful at pointing us in the right directions, but are for from definitive. As with so many other things, your mileage may vary.
 

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

 

I’ve never been to a patient’s funeral, though I know plenty of other doctors who have.

I suppose this is a highly personal decision. Some feel they should go out of respect to the patient, or if they had a particularly strong or longstanding relationship with them.

After 18 years of practice, I have plenty of patients who meet both criteria, but I still have no plans to go.

Part of it is feeling like an outsider. To me, funerals are a chance for loved ones and close friends to say their goodbyes. I generally try to keep a professional distance. It makes the job easier.

Another is simply a reluctance to take time off from the office. Even though someone I cared for is gone, that person is not the only one that I see. I have to continue caring for the patients who still need me.

There’s also an aspect of fear. Family members who don’t know you well may see your presence as a sign of guilt that you did something wrong. Or, in the irrational nature of grief and anger, become belligerent, accusing you of incompetence. These sorts of confrontations can never end well for either side.

All of us are facing death sooner or later. As physicians, our job is to prolong and improve quality of life as best we can, knowing that inevitably we’ll lose. When that happens, the most we can ever ask is that we did our best. And that we continue to care for those who still depend on us.
 

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

[polldaddy:9711658]

 

I’ve never been to a patient’s funeral, though I know plenty of other doctors who have.

I suppose this is a highly personal decision. Some feel they should go out of respect to the patient, or if they had a particularly strong or longstanding relationship with them.

After 18 years of practice, I have plenty of patients who meet both criteria, but I still have no plans to go.

Part of it is feeling like an outsider. To me, funerals are a chance for loved ones and close friends to say their goodbyes. I generally try to keep a professional distance. It makes the job easier.

Another is simply a reluctance to take time off from the office. Even though someone I cared for is gone, that person is not the only one that I see. I have to continue caring for the patients who still need me.

There’s also an aspect of fear. Family members who don’t know you well may see your presence as a sign of guilt that you did something wrong. Or, in the irrational nature of grief and anger, become belligerent, accusing you of incompetence. These sorts of confrontations can never end well for either side.

All of us are facing death sooner or later. As physicians, our job is to prolong and improve quality of life as best we can, knowing that inevitably we’ll lose. When that happens, the most we can ever ask is that we did our best. And that we continue to care for those who still depend on us.
 

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

[polldaddy:9711658]

 

I’ve never been to a patient’s funeral, though I know plenty of other doctors who have.

I suppose this is a highly personal decision. Some feel they should go out of respect to the patient, or if they had a particularly strong or longstanding relationship with them.

After 18 years of practice, I have plenty of patients who meet both criteria, but I still have no plans to go.

Part of it is feeling like an outsider. To me, funerals are a chance for loved ones and close friends to say their goodbyes. I generally try to keep a professional distance. It makes the job easier.

Another is simply a reluctance to take time off from the office. Even though someone I cared for is gone, that person is not the only one that I see. I have to continue caring for the patients who still need me.

There’s also an aspect of fear. Family members who don’t know you well may see your presence as a sign of guilt that you did something wrong. Or, in the irrational nature of grief and anger, become belligerent, accusing you of incompetence. These sorts of confrontations can never end well for either side.

All of us are facing death sooner or later. As physicians, our job is to prolong and improve quality of life as best we can, knowing that inevitably we’ll lose. When that happens, the most we can ever ask is that we did our best. And that we continue to care for those who still depend on us.
 

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

[polldaddy:9711658]