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On vacation, my patients go with me
I’m in the process of planning our family vacations for the summer. I do something different from most when on the road: I take my patients with me.
Well, obviously not physically, but I do cover everything, no matter where I am.
Yes, it takes time. In a ritual my family is used to, two to three times a day I’ll call my staff and go over a list of calls that came in, refills needed, and test results. We go back and forth for a bit. For more complicated questions, I may have to wait until I have my laptop, with the charts on it. If there’s an emergency they’ll call me, and if I can’t be reached, they’ll dial up my call partners.
• I know my patients. I think we all feel that way. I’m more comfortable, and I hope they are too, with the doc who knows them making the decisions.
• My call partners don’t know them. We’re all in solo practice. They don’t have access to my charts any more than I do to theirs. That’s an okay arrangement for a weekend call, but not 2 weeks.
• No surprises. I know that I’m not going to be coming home to a pile of MRI and lab reports that I need to review and act on. If my patient was in the ER or admitted, I spoke to the physician handling it.
A long time ago, when I first started out, I asked another neurologist in my building to cover for me when I was leaving town. I didn’t know him very well, but I was still learning the ropes. He said fine.
When I came home, I found he’d actually “poached” several who’d called, having them come in and convincing them to switch doctors. He’d also changed medications on well-controlled epilepsy and migraine patients who’d needed refills, leaving me to deal with the complications of it when I returned.
Granted, I’ve since learned that he was unusual in that degree, but it really rattled me. I decided I’d rather handle things on my own from then on.
This isn’t an easy decision, but I’m glad I do it. I come home to an office with no surprises, no test results piled up to review, no medication changes that I look at and wonder about.
Does it ruin my vacation? Not at all. Yes, it’s 30-60 minutes out of each day that I have to spend with my office, but I think it’s worth it. It’s peace of mind for me, my staff, and my patients, at least as much as you can ever have in this field.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
[polldaddy:9696724]
I’m in the process of planning our family vacations for the summer. I do something different from most when on the road: I take my patients with me.
Well, obviously not physically, but I do cover everything, no matter where I am.
Yes, it takes time. In a ritual my family is used to, two to three times a day I’ll call my staff and go over a list of calls that came in, refills needed, and test results. We go back and forth for a bit. For more complicated questions, I may have to wait until I have my laptop, with the charts on it. If there’s an emergency they’ll call me, and if I can’t be reached, they’ll dial up my call partners.
• I know my patients. I think we all feel that way. I’m more comfortable, and I hope they are too, with the doc who knows them making the decisions.
• My call partners don’t know them. We’re all in solo practice. They don’t have access to my charts any more than I do to theirs. That’s an okay arrangement for a weekend call, but not 2 weeks.
• No surprises. I know that I’m not going to be coming home to a pile of MRI and lab reports that I need to review and act on. If my patient was in the ER or admitted, I spoke to the physician handling it.
A long time ago, when I first started out, I asked another neurologist in my building to cover for me when I was leaving town. I didn’t know him very well, but I was still learning the ropes. He said fine.
When I came home, I found he’d actually “poached” several who’d called, having them come in and convincing them to switch doctors. He’d also changed medications on well-controlled epilepsy and migraine patients who’d needed refills, leaving me to deal with the complications of it when I returned.
Granted, I’ve since learned that he was unusual in that degree, but it really rattled me. I decided I’d rather handle things on my own from then on.
This isn’t an easy decision, but I’m glad I do it. I come home to an office with no surprises, no test results piled up to review, no medication changes that I look at and wonder about.
Does it ruin my vacation? Not at all. Yes, it’s 30-60 minutes out of each day that I have to spend with my office, but I think it’s worth it. It’s peace of mind for me, my staff, and my patients, at least as much as you can ever have in this field.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
[polldaddy:9696724]
I’m in the process of planning our family vacations for the summer. I do something different from most when on the road: I take my patients with me.
Well, obviously not physically, but I do cover everything, no matter where I am.
Yes, it takes time. In a ritual my family is used to, two to three times a day I’ll call my staff and go over a list of calls that came in, refills needed, and test results. We go back and forth for a bit. For more complicated questions, I may have to wait until I have my laptop, with the charts on it. If there’s an emergency they’ll call me, and if I can’t be reached, they’ll dial up my call partners.
• I know my patients. I think we all feel that way. I’m more comfortable, and I hope they are too, with the doc who knows them making the decisions.
• My call partners don’t know them. We’re all in solo practice. They don’t have access to my charts any more than I do to theirs. That’s an okay arrangement for a weekend call, but not 2 weeks.
• No surprises. I know that I’m not going to be coming home to a pile of MRI and lab reports that I need to review and act on. If my patient was in the ER or admitted, I spoke to the physician handling it.
A long time ago, when I first started out, I asked another neurologist in my building to cover for me when I was leaving town. I didn’t know him very well, but I was still learning the ropes. He said fine.
When I came home, I found he’d actually “poached” several who’d called, having them come in and convincing them to switch doctors. He’d also changed medications on well-controlled epilepsy and migraine patients who’d needed refills, leaving me to deal with the complications of it when I returned.
Granted, I’ve since learned that he was unusual in that degree, but it really rattled me. I decided I’d rather handle things on my own from then on.
This isn’t an easy decision, but I’m glad I do it. I come home to an office with no surprises, no test results piled up to review, no medication changes that I look at and wonder about.
Does it ruin my vacation? Not at all. Yes, it’s 30-60 minutes out of each day that I have to spend with my office, but I think it’s worth it. It’s peace of mind for me, my staff, and my patients, at least as much as you can ever have in this field.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
[polldaddy:9696724]
Charging for medical records: For whom and at what cost?
Do you charge for medical records?
You probably do, and so do I, at times.
Generally, I’m willing to give a patient one copy of their records or transfer them to another doctor for continuation of care, at no charge. People move away. They change insurance or doctors. They have urgent hospital admissions. To me, charging to forward records in these cases is like withholding care.
That’s not to say I don’t lose money on them. It takes a few minutes (or more) of staff time to print them up and fax them. If they need to be mailed, postage costs money. And then there’s paper, printer ink, and so on. I’m sure it adds up to something over the course of the year, although I have no idea how much.
How much you can charge is a more complex issue, with each state setting its own rules. A recent article published in JAMA Internal Medicine noted that a patient in Georgia could pay up to $111.68 for a 100-page record. Hitting someone up for that amount, who’s already having health problems and may be relocating or trying to find a new doctor, seems like making an already difficult situation worse.
But we’re in the digital age now. So how much does it cost to send records? Most files (.doc, .pdf, .jpg, and so on) are interchangeable between Mac and Windows.
Things get iffy here. I mean, it’s easy to send a .pdf file by email, but that’s not particularly secure. And I hate having to sign up and create passwords for the many allegedly safer file-sharing services out there.
Burning records on a CD or DVD certainly saves postage, though takes about the same amount of computer time as printing them up. Not only that, but this seems to be a format that’s on its way out. The last three computers I’ve bought didn’t even have optical drives. CD/DVD’s are starting to resemble VHS tapes in the late 1990s.
Flash drives are the present and immediate future of transferred records. Small, lightweight, and capable of holding a lot. But they still need to be mailed, and are more expensive than paper. They also have security risks that concern me. When a patient hands me one and asks me to plug it in, I never do. There could be a virus or spyware that can compromise the security and privacy of my office, and cost a fortune to reverse the damage.
And so, at the end of that chain of thought, paper still appears to be king. It’s not going to carry ransomware into my office. It can be mailed or faxed, and is easily adaptable to any system (like mine) with a scanner. The paper world may hypothetically no longer exist, but for many things in medicine it still does, and is critical.
Some ultimate solutions, such as a universal database of health care data on all patients or a complete interchangeability between systems, sound great. No one would need to transfer records between doctors and all would have access to their own charts. But at this point in time, while technologically achievable, the privacy concerns and high-stakes security risks make such a thing impossible.
It’s easy to hope that the age of electronic medical records will lead to, as the article states, “easy, inexpensive” reproduction of medical records. But things never seem to be that simple, for some of the reasons I’ve mentioned above.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
Do you charge for medical records?
You probably do, and so do I, at times.
Generally, I’m willing to give a patient one copy of their records or transfer them to another doctor for continuation of care, at no charge. People move away. They change insurance or doctors. They have urgent hospital admissions. To me, charging to forward records in these cases is like withholding care.
That’s not to say I don’t lose money on them. It takes a few minutes (or more) of staff time to print them up and fax them. If they need to be mailed, postage costs money. And then there’s paper, printer ink, and so on. I’m sure it adds up to something over the course of the year, although I have no idea how much.
How much you can charge is a more complex issue, with each state setting its own rules. A recent article published in JAMA Internal Medicine noted that a patient in Georgia could pay up to $111.68 for a 100-page record. Hitting someone up for that amount, who’s already having health problems and may be relocating or trying to find a new doctor, seems like making an already difficult situation worse.
But we’re in the digital age now. So how much does it cost to send records? Most files (.doc, .pdf, .jpg, and so on) are interchangeable between Mac and Windows.
Things get iffy here. I mean, it’s easy to send a .pdf file by email, but that’s not particularly secure. And I hate having to sign up and create passwords for the many allegedly safer file-sharing services out there.
Burning records on a CD or DVD certainly saves postage, though takes about the same amount of computer time as printing them up. Not only that, but this seems to be a format that’s on its way out. The last three computers I’ve bought didn’t even have optical drives. CD/DVD’s are starting to resemble VHS tapes in the late 1990s.
Flash drives are the present and immediate future of transferred records. Small, lightweight, and capable of holding a lot. But they still need to be mailed, and are more expensive than paper. They also have security risks that concern me. When a patient hands me one and asks me to plug it in, I never do. There could be a virus or spyware that can compromise the security and privacy of my office, and cost a fortune to reverse the damage.
And so, at the end of that chain of thought, paper still appears to be king. It’s not going to carry ransomware into my office. It can be mailed or faxed, and is easily adaptable to any system (like mine) with a scanner. The paper world may hypothetically no longer exist, but for many things in medicine it still does, and is critical.
Some ultimate solutions, such as a universal database of health care data on all patients or a complete interchangeability between systems, sound great. No one would need to transfer records between doctors and all would have access to their own charts. But at this point in time, while technologically achievable, the privacy concerns and high-stakes security risks make such a thing impossible.
It’s easy to hope that the age of electronic medical records will lead to, as the article states, “easy, inexpensive” reproduction of medical records. But things never seem to be that simple, for some of the reasons I’ve mentioned above.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
Do you charge for medical records?
You probably do, and so do I, at times.
Generally, I’m willing to give a patient one copy of their records or transfer them to another doctor for continuation of care, at no charge. People move away. They change insurance or doctors. They have urgent hospital admissions. To me, charging to forward records in these cases is like withholding care.
That’s not to say I don’t lose money on them. It takes a few minutes (or more) of staff time to print them up and fax them. If they need to be mailed, postage costs money. And then there’s paper, printer ink, and so on. I’m sure it adds up to something over the course of the year, although I have no idea how much.
How much you can charge is a more complex issue, with each state setting its own rules. A recent article published in JAMA Internal Medicine noted that a patient in Georgia could pay up to $111.68 for a 100-page record. Hitting someone up for that amount, who’s already having health problems and may be relocating or trying to find a new doctor, seems like making an already difficult situation worse.
But we’re in the digital age now. So how much does it cost to send records? Most files (.doc, .pdf, .jpg, and so on) are interchangeable between Mac and Windows.
Things get iffy here. I mean, it’s easy to send a .pdf file by email, but that’s not particularly secure. And I hate having to sign up and create passwords for the many allegedly safer file-sharing services out there.
Burning records on a CD or DVD certainly saves postage, though takes about the same amount of computer time as printing them up. Not only that, but this seems to be a format that’s on its way out. The last three computers I’ve bought didn’t even have optical drives. CD/DVD’s are starting to resemble VHS tapes in the late 1990s.
Flash drives are the present and immediate future of transferred records. Small, lightweight, and capable of holding a lot. But they still need to be mailed, and are more expensive than paper. They also have security risks that concern me. When a patient hands me one and asks me to plug it in, I never do. There could be a virus or spyware that can compromise the security and privacy of my office, and cost a fortune to reverse the damage.
And so, at the end of that chain of thought, paper still appears to be king. It’s not going to carry ransomware into my office. It can be mailed or faxed, and is easily adaptable to any system (like mine) with a scanner. The paper world may hypothetically no longer exist, but for many things in medicine it still does, and is critical.
Some ultimate solutions, such as a universal database of health care data on all patients or a complete interchangeability between systems, sound great. No one would need to transfer records between doctors and all would have access to their own charts. But at this point in time, while technologically achievable, the privacy concerns and high-stakes security risks make such a thing impossible.
It’s easy to hope that the age of electronic medical records will lead to, as the article states, “easy, inexpensive” reproduction of medical records. But things never seem to be that simple, for some of the reasons I’ve mentioned above.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
My declining enthusiasm for inpatient work
I’m getting old, and as I age, my desire to do inpatient work seems to diminish each year.
When I started out 20 years ago, I thrived on it. There was excitement in an urgent ED call: the chance to go in and give tissue plasminogen activator, do an emergent lumbar puncture, or break status epilepticus.
Back when I was fresh out of training, I hustled. I walked through the ED to make sure they knew I was around. I hung out in the doctors’ lounge, shaking hands and introducing myself. I was trying to build my practice and get my name out. Other neurologists, closer to retirement than I, were more than happy to let me move in and take the hospital’s late-night and weekend calls.
With time, hospital medicine becomes more of a young person’s game. As I move from being a newly minted attending to an old fogy, I’m happy to leave the work to the next generation.
My hospital work is now down to one-in-3 weekends and no weekdays. I’m not quite ready to give it up entirely and don’t want to turn my back on my call partners of 15 years. I still enjoy the challenge of the cases, the joking around with the nurses, and the family meetings to bring comfort and explain things as best I can.
But I can live without the late night runs, the driving back and forth, and the unpredictable hours. These days, my time at home is more valuable than it was when I started, and I envy those who keep banker’s hours.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
I’m getting old, and as I age, my desire to do inpatient work seems to diminish each year.
When I started out 20 years ago, I thrived on it. There was excitement in an urgent ED call: the chance to go in and give tissue plasminogen activator, do an emergent lumbar puncture, or break status epilepticus.
Back when I was fresh out of training, I hustled. I walked through the ED to make sure they knew I was around. I hung out in the doctors’ lounge, shaking hands and introducing myself. I was trying to build my practice and get my name out. Other neurologists, closer to retirement than I, were more than happy to let me move in and take the hospital’s late-night and weekend calls.
With time, hospital medicine becomes more of a young person’s game. As I move from being a newly minted attending to an old fogy, I’m happy to leave the work to the next generation.
My hospital work is now down to one-in-3 weekends and no weekdays. I’m not quite ready to give it up entirely and don’t want to turn my back on my call partners of 15 years. I still enjoy the challenge of the cases, the joking around with the nurses, and the family meetings to bring comfort and explain things as best I can.
But I can live without the late night runs, the driving back and forth, and the unpredictable hours. These days, my time at home is more valuable than it was when I started, and I envy those who keep banker’s hours.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
I’m getting old, and as I age, my desire to do inpatient work seems to diminish each year.
When I started out 20 years ago, I thrived on it. There was excitement in an urgent ED call: the chance to go in and give tissue plasminogen activator, do an emergent lumbar puncture, or break status epilepticus.
Back when I was fresh out of training, I hustled. I walked through the ED to make sure they knew I was around. I hung out in the doctors’ lounge, shaking hands and introducing myself. I was trying to build my practice and get my name out. Other neurologists, closer to retirement than I, were more than happy to let me move in and take the hospital’s late-night and weekend calls.
With time, hospital medicine becomes more of a young person’s game. As I move from being a newly minted attending to an old fogy, I’m happy to leave the work to the next generation.
My hospital work is now down to one-in-3 weekends and no weekdays. I’m not quite ready to give it up entirely and don’t want to turn my back on my call partners of 15 years. I still enjoy the challenge of the cases, the joking around with the nurses, and the family meetings to bring comfort and explain things as best I can.
But I can live without the late night runs, the driving back and forth, and the unpredictable hours. These days, my time at home is more valuable than it was when I started, and I envy those who keep banker’s hours.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
Staying open versus closed at the end of the year
To the horror of many colleagues, I close my office for the last 2 weeks of each year. I went back to work on Jan. 3.
For several years, I didn’t close for that long. My staff and I would try to work out who needed what days off for family holiday stuff, and try to be open at least 3 days each week in late December. With Hanukkah spanning 8 nights it was always easy to get around, working some days and not others since at least one weekend would be in there. But Christmas and New Year’s Day aren’t so easy. They can be any day of the week. Usually people want the day before off, and some people prefer the day after.
So in 2013, I decided that from then on we would be closed over the holidays.
Of course, being a doctor never quite stops. There are always test results, refills, and patient calls coming in, but I can handle them from my desk at home as well as the one at my office.
My kids are off from school. So we can take them to shows, light displays, movies, and other local bonding activities. Or drive 90 minutes north to spend time in the snow.
There is, of course, the financial drawback. If I’m out of the office for 2 weeks, then it means I’ll hit a shortfall 2-4 weeks later. So I have to plan ahead because I’ll likely need to skip a paycheck or two until cash flow is back up and running.
I’ll miss 10 days of December billing. But if you think about it, it’s closer to 6 days when you take away the holidays we’d be closed. And if you’re not packed full it comes down to 3-4 days ... So why bother?
I can’t do it as often as I’d like, but when they’re out of school I’ll gladly trade money for family time.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
To the horror of many colleagues, I close my office for the last 2 weeks of each year. I went back to work on Jan. 3.
For several years, I didn’t close for that long. My staff and I would try to work out who needed what days off for family holiday stuff, and try to be open at least 3 days each week in late December. With Hanukkah spanning 8 nights it was always easy to get around, working some days and not others since at least one weekend would be in there. But Christmas and New Year’s Day aren’t so easy. They can be any day of the week. Usually people want the day before off, and some people prefer the day after.
So in 2013, I decided that from then on we would be closed over the holidays.
Of course, being a doctor never quite stops. There are always test results, refills, and patient calls coming in, but I can handle them from my desk at home as well as the one at my office.
My kids are off from school. So we can take them to shows, light displays, movies, and other local bonding activities. Or drive 90 minutes north to spend time in the snow.
There is, of course, the financial drawback. If I’m out of the office for 2 weeks, then it means I’ll hit a shortfall 2-4 weeks later. So I have to plan ahead because I’ll likely need to skip a paycheck or two until cash flow is back up and running.
I’ll miss 10 days of December billing. But if you think about it, it’s closer to 6 days when you take away the holidays we’d be closed. And if you’re not packed full it comes down to 3-4 days ... So why bother?
I can’t do it as often as I’d like, but when they’re out of school I’ll gladly trade money for family time.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
To the horror of many colleagues, I close my office for the last 2 weeks of each year. I went back to work on Jan. 3.
For several years, I didn’t close for that long. My staff and I would try to work out who needed what days off for family holiday stuff, and try to be open at least 3 days each week in late December. With Hanukkah spanning 8 nights it was always easy to get around, working some days and not others since at least one weekend would be in there. But Christmas and New Year’s Day aren’t so easy. They can be any day of the week. Usually people want the day before off, and some people prefer the day after.
So in 2013, I decided that from then on we would be closed over the holidays.
Of course, being a doctor never quite stops. There are always test results, refills, and patient calls coming in, but I can handle them from my desk at home as well as the one at my office.
My kids are off from school. So we can take them to shows, light displays, movies, and other local bonding activities. Or drive 90 minutes north to spend time in the snow.
There is, of course, the financial drawback. If I’m out of the office for 2 weeks, then it means I’ll hit a shortfall 2-4 weeks later. So I have to plan ahead because I’ll likely need to skip a paycheck or two until cash flow is back up and running.
I’ll miss 10 days of December billing. But if you think about it, it’s closer to 6 days when you take away the holidays we’d be closed. And if you’re not packed full it comes down to 3-4 days ... So why bother?
I can’t do it as often as I’d like, but when they’re out of school I’ll gladly trade money for family time.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
An unclear future ahead for health care
In the aftermath of the most acrimonious presidential election of my lifetime, we are left with recriminations, celebrations, and more questions than answers. And, of course, no real answers for the medical field at all. Just as in 2008, we face an unknown future.
Will this be good or bad for us? I have no idea. Some of the health care changes that hit small practices hardest were the requirements to upgrade or be penalized. Many of us, including myself, didn’t have the financial means to do that and elected to take the penalties. It would be nice to see those rolled back. Since all insurers peg their rates to Medicare, I’d be thrilled to see those increase, too. The repeal of the hated Sustainable Growth Rate formula showed that the parties can get something done when they’re actually willing to do the work they were elected to do.
Also, there’s something wrong with a system where (as Bill Bryson wrote in his book, “Neither Here Nor There: Travels in Europe”), “no one seemed to think it particularly disgraceful that a child with a brain tumor could be allowed to die because his father didn’t have the wherewithal to pay a surgeon, or where an insurance company could be permitted by a state insurance commissioner to cancel the policies of its 14,000 sickest patients because it wasn’t having a very good year (as happened in California in 1989).”
Obamacare is far from perfect. It has serious flaws. But the idea behind it is, to me, a step in the right direction. I hope those in power, rather then destroying things and reverting to the broken system we had before, will work to remove the broken parts (such as the failing insurance exchanges here in Arizona) and replace them with something that is more sustainable and fair in the long term.
More than any natural resource, a country’s people are the key drivers of its innovation and economy. So keeping them as healthy as possible is critical to our national well-being. This has to be balanced with a way to make it affordable, since resources are finite.
Where does this leave doctors? I have no idea. Like most of us, I just want to take care of patients. That’s what I came here for. The need to run the practice of medicine as a business is a necessary evil. I hope the changes to come will allow all of us to do what we do best: help those who need us.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
In the aftermath of the most acrimonious presidential election of my lifetime, we are left with recriminations, celebrations, and more questions than answers. And, of course, no real answers for the medical field at all. Just as in 2008, we face an unknown future.
Will this be good or bad for us? I have no idea. Some of the health care changes that hit small practices hardest were the requirements to upgrade or be penalized. Many of us, including myself, didn’t have the financial means to do that and elected to take the penalties. It would be nice to see those rolled back. Since all insurers peg their rates to Medicare, I’d be thrilled to see those increase, too. The repeal of the hated Sustainable Growth Rate formula showed that the parties can get something done when they’re actually willing to do the work they were elected to do.
Also, there’s something wrong with a system where (as Bill Bryson wrote in his book, “Neither Here Nor There: Travels in Europe”), “no one seemed to think it particularly disgraceful that a child with a brain tumor could be allowed to die because his father didn’t have the wherewithal to pay a surgeon, or where an insurance company could be permitted by a state insurance commissioner to cancel the policies of its 14,000 sickest patients because it wasn’t having a very good year (as happened in California in 1989).”
Obamacare is far from perfect. It has serious flaws. But the idea behind it is, to me, a step in the right direction. I hope those in power, rather then destroying things and reverting to the broken system we had before, will work to remove the broken parts (such as the failing insurance exchanges here in Arizona) and replace them with something that is more sustainable and fair in the long term.
More than any natural resource, a country’s people are the key drivers of its innovation and economy. So keeping them as healthy as possible is critical to our national well-being. This has to be balanced with a way to make it affordable, since resources are finite.
Where does this leave doctors? I have no idea. Like most of us, I just want to take care of patients. That’s what I came here for. The need to run the practice of medicine as a business is a necessary evil. I hope the changes to come will allow all of us to do what we do best: help those who need us.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
In the aftermath of the most acrimonious presidential election of my lifetime, we are left with recriminations, celebrations, and more questions than answers. And, of course, no real answers for the medical field at all. Just as in 2008, we face an unknown future.
Will this be good or bad for us? I have no idea. Some of the health care changes that hit small practices hardest were the requirements to upgrade or be penalized. Many of us, including myself, didn’t have the financial means to do that and elected to take the penalties. It would be nice to see those rolled back. Since all insurers peg their rates to Medicare, I’d be thrilled to see those increase, too. The repeal of the hated Sustainable Growth Rate formula showed that the parties can get something done when they’re actually willing to do the work they were elected to do.
Also, there’s something wrong with a system where (as Bill Bryson wrote in his book, “Neither Here Nor There: Travels in Europe”), “no one seemed to think it particularly disgraceful that a child with a brain tumor could be allowed to die because his father didn’t have the wherewithal to pay a surgeon, or where an insurance company could be permitted by a state insurance commissioner to cancel the policies of its 14,000 sickest patients because it wasn’t having a very good year (as happened in California in 1989).”
Obamacare is far from perfect. It has serious flaws. But the idea behind it is, to me, a step in the right direction. I hope those in power, rather then destroying things and reverting to the broken system we had before, will work to remove the broken parts (such as the failing insurance exchanges here in Arizona) and replace them with something that is more sustainable and fair in the long term.
More than any natural resource, a country’s people are the key drivers of its innovation and economy. So keeping them as healthy as possible is critical to our national well-being. This has to be balanced with a way to make it affordable, since resources are finite.
Where does this leave doctors? I have no idea. Like most of us, I just want to take care of patients. That’s what I came here for. The need to run the practice of medicine as a business is a necessary evil. I hope the changes to come will allow all of us to do what we do best: help those who need us.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
Voice recognition software errors: Often silly, sometimes serious
How much is 15%?
Not that much, on paper. With any drug, at least 15% of people will get some kind of side effect. Usually they all list dizziness and headaches at the top.
Could the same be true of a seemingly harmless technology?
Voice recognition software has become pretty commonplace in modern medicine but is far from perfect. I try to be pretty careful about proofreading my dictations, but many docs, especially those in emergency room, don’t have the time to. So VR errors slip by, persisting in 71% of notes.
Most of these errors are just silly and obvious for what they are. But a recent study at a level I ER found that 15% of dictations contained one or more errors deemed as “critical,” with the potential to adversely affect patient care (Int J Med Inform. 2016 Sep;93:70-3).
Communication among doctors, nurses, and all the other key players in the hospital environment is one of the most critical areas in modern medicine. So many people often rely on the initial dictation for an idea of what’s going on that a critical error can affect the way they think about the case from the get-go.
Another issue, sadly, in today’s hospital is that no one takes (or has) the time to get a patient’s past medical history. It’s commonplace to pull the history out of previous admission notes. (Admittedly, sometimes in a demented or unconscious patient you don’t have a choice.) As a result, errors of this sort tend to propagate down the line, from an admission, to the consults, to the discharge summary, and into the next admission.
So let’s get back to that 15%.
I have to assume that 15% of people being admitted aren’t having catastrophic events from medical errors, hopefully because the doctors and nurses handling patient care are thinking for themselves, recognizing dictation errors, and addressing them appropriately.
But even if we dial it down to a tenth of that, say 1.5%, it’s still a serious concern. Bad outcomes in medicine are never entirely avoidable. That’s the nature of the job.
But bad outcomes caused by too much trust in a still-faulty technology are avoidable.
If 15% of people had a serious outcome from a medication, you’d be very cautious about using it. We need to treat these technological gadgets with the same concerns we extend to drugs and procedures. Avoidable bad outcomes, regardless of cause, are never good.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
How much is 15%?
Not that much, on paper. With any drug, at least 15% of people will get some kind of side effect. Usually they all list dizziness and headaches at the top.
Could the same be true of a seemingly harmless technology?
Voice recognition software has become pretty commonplace in modern medicine but is far from perfect. I try to be pretty careful about proofreading my dictations, but many docs, especially those in emergency room, don’t have the time to. So VR errors slip by, persisting in 71% of notes.
Most of these errors are just silly and obvious for what they are. But a recent study at a level I ER found that 15% of dictations contained one or more errors deemed as “critical,” with the potential to adversely affect patient care (Int J Med Inform. 2016 Sep;93:70-3).
Communication among doctors, nurses, and all the other key players in the hospital environment is one of the most critical areas in modern medicine. So many people often rely on the initial dictation for an idea of what’s going on that a critical error can affect the way they think about the case from the get-go.
Another issue, sadly, in today’s hospital is that no one takes (or has) the time to get a patient’s past medical history. It’s commonplace to pull the history out of previous admission notes. (Admittedly, sometimes in a demented or unconscious patient you don’t have a choice.) As a result, errors of this sort tend to propagate down the line, from an admission, to the consults, to the discharge summary, and into the next admission.
So let’s get back to that 15%.
I have to assume that 15% of people being admitted aren’t having catastrophic events from medical errors, hopefully because the doctors and nurses handling patient care are thinking for themselves, recognizing dictation errors, and addressing them appropriately.
But even if we dial it down to a tenth of that, say 1.5%, it’s still a serious concern. Bad outcomes in medicine are never entirely avoidable. That’s the nature of the job.
But bad outcomes caused by too much trust in a still-faulty technology are avoidable.
If 15% of people had a serious outcome from a medication, you’d be very cautious about using it. We need to treat these technological gadgets with the same concerns we extend to drugs and procedures. Avoidable bad outcomes, regardless of cause, are never good.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
How much is 15%?
Not that much, on paper. With any drug, at least 15% of people will get some kind of side effect. Usually they all list dizziness and headaches at the top.
Could the same be true of a seemingly harmless technology?
Voice recognition software has become pretty commonplace in modern medicine but is far from perfect. I try to be pretty careful about proofreading my dictations, but many docs, especially those in emergency room, don’t have the time to. So VR errors slip by, persisting in 71% of notes.
Most of these errors are just silly and obvious for what they are. But a recent study at a level I ER found that 15% of dictations contained one or more errors deemed as “critical,” with the potential to adversely affect patient care (Int J Med Inform. 2016 Sep;93:70-3).
Communication among doctors, nurses, and all the other key players in the hospital environment is one of the most critical areas in modern medicine. So many people often rely on the initial dictation for an idea of what’s going on that a critical error can affect the way they think about the case from the get-go.
Another issue, sadly, in today’s hospital is that no one takes (or has) the time to get a patient’s past medical history. It’s commonplace to pull the history out of previous admission notes. (Admittedly, sometimes in a demented or unconscious patient you don’t have a choice.) As a result, errors of this sort tend to propagate down the line, from an admission, to the consults, to the discharge summary, and into the next admission.
So let’s get back to that 15%.
I have to assume that 15% of people being admitted aren’t having catastrophic events from medical errors, hopefully because the doctors and nurses handling patient care are thinking for themselves, recognizing dictation errors, and addressing them appropriately.
But even if we dial it down to a tenth of that, say 1.5%, it’s still a serious concern. Bad outcomes in medicine are never entirely avoidable. That’s the nature of the job.
But bad outcomes caused by too much trust in a still-faulty technology are avoidable.
If 15% of people had a serious outcome from a medication, you’d be very cautious about using it. We need to treat these technological gadgets with the same concerns we extend to drugs and procedures. Avoidable bad outcomes, regardless of cause, are never good.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
Hanging on as small practices slowly die
I’ve had to skip several paychecks this year to keep my practice afloat. That makes it hard to pay for my routine personal expenses, like a mortgage, so I have to take the money out of my family’s “rainy day” savings.
This gets old after a few years of the same cycle. I’m pretty sick of it.
Granted, I chose this path. Solo practice suits me. I’ve been in a large group, and it took me roughly 2 years to realize it was a poor fit for me. I’ve been on my own since 2000 and been pretty happy here.
I’ve come to accept that taking a vacation means a temporary drop in salary down the road. My family is important to me, and I don’t want them to remember me as the never-home father immortalized by Harry Chapin’s “Cat’s in the Cradle.”
Trouble is this: What if you still work hard, and find your income falling? I see patients from 8 to 4 most days, with a full schedule, but reimbursements keep dropping and costs keep climbing. Isn’t the idea that hard work will bring success central to the American Dream? Especially when you toss in 9 years of medical school and residency? Apparently not. The American Dream, whatever it is, is pretty much dead for most small-practice doctors.
These are tough times for solo docs, regardless of field. I’ve seen several posts on sites such as Sermo that show I’m not the only one in this boat, skipping paychecks to keep the door open and lights on. Most small practices are running into the same issue. Some, like me, are slugging it out and hoping things get better. Others are folding up and moving, or joining large groups, or signing up with a hospital system.
I’m not sure those last two are options I want. Most of the docs I know who’ve joined hospital outpatient systems are pretty unhappy with them, too. They talk about computer systems designed for billing rather than patient care; unrealistic amounts of time allotted to each patient by a nonmedical person; and jumping through hoops to get certain tests or treatments done.
I suspect it’s a combination of factors, though others see more sinister forces at work. Some posts I read suggest that it’s part of a government and/or insurance conspiracy to destroy small practices.
Regardless, it seems to be succeeding. Small practices are in crisis. Doctor suicides are up. And solo practice has been found to be a risk factor for suicide. There are days when I can see how that seems like the only way out for those who came here just to care for people, and now find that economic circumstances won’t let them.
I don’t have a castle, or drive a Rolls-Royce, or send my kids to private school. We live fairly modestly, but even then it’s getting hard to keep up with costs.
We’re in an election year, and, as always, medical care is bandied about by both parties as a bargaining chip to get votes. But I haven’t heard either side talk about this, nor do I get the impression that either major candidate really cares. Both of them, and members of Congress, get pretty top-notch care without having to worry about cost. This isn’t reassuring to me and all the other solo docs hanging on by our fingernails and trying to practice ethical, honest medicine.
I’m sure some will say it’s progress, but I think the gradual death of the American small and solo practice is sad. It’s a model that’s been the backbone of Western medicine for a few hundred years now, caring for people in big cities, small towns, and everywhere in between. Portrayed in fiction as Marcus Welby, Michaela Quinn, Joel Fleischman, and (my favorite, from Willa Cather’s “Neighbour Rosicky”) Ed Burleigh. Sometimes brilliant, sometimes quirky, sometimes all-too-human ... but still doctors, caring for their patients and communities.
Like the unnamed protagonist in Dr. Seuss’ “I Had Trouble in getting to Solla Sollew,” I tend to find that no matter where you go there will be troubles, and sometimes you’re best off staying in one place and fighting the ones you know.
And, for now, that’s where I am and hope to stay. But I’m scared.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
I’ve had to skip several paychecks this year to keep my practice afloat. That makes it hard to pay for my routine personal expenses, like a mortgage, so I have to take the money out of my family’s “rainy day” savings.
This gets old after a few years of the same cycle. I’m pretty sick of it.
Granted, I chose this path. Solo practice suits me. I’ve been in a large group, and it took me roughly 2 years to realize it was a poor fit for me. I’ve been on my own since 2000 and been pretty happy here.
I’ve come to accept that taking a vacation means a temporary drop in salary down the road. My family is important to me, and I don’t want them to remember me as the never-home father immortalized by Harry Chapin’s “Cat’s in the Cradle.”
Trouble is this: What if you still work hard, and find your income falling? I see patients from 8 to 4 most days, with a full schedule, but reimbursements keep dropping and costs keep climbing. Isn’t the idea that hard work will bring success central to the American Dream? Especially when you toss in 9 years of medical school and residency? Apparently not. The American Dream, whatever it is, is pretty much dead for most small-practice doctors.
These are tough times for solo docs, regardless of field. I’ve seen several posts on sites such as Sermo that show I’m not the only one in this boat, skipping paychecks to keep the door open and lights on. Most small practices are running into the same issue. Some, like me, are slugging it out and hoping things get better. Others are folding up and moving, or joining large groups, or signing up with a hospital system.
I’m not sure those last two are options I want. Most of the docs I know who’ve joined hospital outpatient systems are pretty unhappy with them, too. They talk about computer systems designed for billing rather than patient care; unrealistic amounts of time allotted to each patient by a nonmedical person; and jumping through hoops to get certain tests or treatments done.
I suspect it’s a combination of factors, though others see more sinister forces at work. Some posts I read suggest that it’s part of a government and/or insurance conspiracy to destroy small practices.
Regardless, it seems to be succeeding. Small practices are in crisis. Doctor suicides are up. And solo practice has been found to be a risk factor for suicide. There are days when I can see how that seems like the only way out for those who came here just to care for people, and now find that economic circumstances won’t let them.
I don’t have a castle, or drive a Rolls-Royce, or send my kids to private school. We live fairly modestly, but even then it’s getting hard to keep up with costs.
We’re in an election year, and, as always, medical care is bandied about by both parties as a bargaining chip to get votes. But I haven’t heard either side talk about this, nor do I get the impression that either major candidate really cares. Both of them, and members of Congress, get pretty top-notch care without having to worry about cost. This isn’t reassuring to me and all the other solo docs hanging on by our fingernails and trying to practice ethical, honest medicine.
I’m sure some will say it’s progress, but I think the gradual death of the American small and solo practice is sad. It’s a model that’s been the backbone of Western medicine for a few hundred years now, caring for people in big cities, small towns, and everywhere in between. Portrayed in fiction as Marcus Welby, Michaela Quinn, Joel Fleischman, and (my favorite, from Willa Cather’s “Neighbour Rosicky”) Ed Burleigh. Sometimes brilliant, sometimes quirky, sometimes all-too-human ... but still doctors, caring for their patients and communities.
Like the unnamed protagonist in Dr. Seuss’ “I Had Trouble in getting to Solla Sollew,” I tend to find that no matter where you go there will be troubles, and sometimes you’re best off staying in one place and fighting the ones you know.
And, for now, that’s where I am and hope to stay. But I’m scared.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
I’ve had to skip several paychecks this year to keep my practice afloat. That makes it hard to pay for my routine personal expenses, like a mortgage, so I have to take the money out of my family’s “rainy day” savings.
This gets old after a few years of the same cycle. I’m pretty sick of it.
Granted, I chose this path. Solo practice suits me. I’ve been in a large group, and it took me roughly 2 years to realize it was a poor fit for me. I’ve been on my own since 2000 and been pretty happy here.
I’ve come to accept that taking a vacation means a temporary drop in salary down the road. My family is important to me, and I don’t want them to remember me as the never-home father immortalized by Harry Chapin’s “Cat’s in the Cradle.”
Trouble is this: What if you still work hard, and find your income falling? I see patients from 8 to 4 most days, with a full schedule, but reimbursements keep dropping and costs keep climbing. Isn’t the idea that hard work will bring success central to the American Dream? Especially when you toss in 9 years of medical school and residency? Apparently not. The American Dream, whatever it is, is pretty much dead for most small-practice doctors.
These are tough times for solo docs, regardless of field. I’ve seen several posts on sites such as Sermo that show I’m not the only one in this boat, skipping paychecks to keep the door open and lights on. Most small practices are running into the same issue. Some, like me, are slugging it out and hoping things get better. Others are folding up and moving, or joining large groups, or signing up with a hospital system.
I’m not sure those last two are options I want. Most of the docs I know who’ve joined hospital outpatient systems are pretty unhappy with them, too. They talk about computer systems designed for billing rather than patient care; unrealistic amounts of time allotted to each patient by a nonmedical person; and jumping through hoops to get certain tests or treatments done.
I suspect it’s a combination of factors, though others see more sinister forces at work. Some posts I read suggest that it’s part of a government and/or insurance conspiracy to destroy small practices.
Regardless, it seems to be succeeding. Small practices are in crisis. Doctor suicides are up. And solo practice has been found to be a risk factor for suicide. There are days when I can see how that seems like the only way out for those who came here just to care for people, and now find that economic circumstances won’t let them.
I don’t have a castle, or drive a Rolls-Royce, or send my kids to private school. We live fairly modestly, but even then it’s getting hard to keep up with costs.
We’re in an election year, and, as always, medical care is bandied about by both parties as a bargaining chip to get votes. But I haven’t heard either side talk about this, nor do I get the impression that either major candidate really cares. Both of them, and members of Congress, get pretty top-notch care without having to worry about cost. This isn’t reassuring to me and all the other solo docs hanging on by our fingernails and trying to practice ethical, honest medicine.
I’m sure some will say it’s progress, but I think the gradual death of the American small and solo practice is sad. It’s a model that’s been the backbone of Western medicine for a few hundred years now, caring for people in big cities, small towns, and everywhere in between. Portrayed in fiction as Marcus Welby, Michaela Quinn, Joel Fleischman, and (my favorite, from Willa Cather’s “Neighbour Rosicky”) Ed Burleigh. Sometimes brilliant, sometimes quirky, sometimes all-too-human ... but still doctors, caring for their patients and communities.
Like the unnamed protagonist in Dr. Seuss’ “I Had Trouble in getting to Solla Sollew,” I tend to find that no matter where you go there will be troubles, and sometimes you’re best off staying in one place and fighting the ones you know.
And, for now, that’s where I am and hope to stay. But I’m scared.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
The EHR time suck gets quantified
How many hours a day do you typically work?
I’m not just talking about seeing patients, although that’s included. I’m also thinking about all the time spent reviewing tests, filling out forms, returning calls, refilling meds, talking to your staff about what needs to be done for the patients who called with questions or problems, and (a big one) dictating and charting notes for the day.
Sadly, the issue appears to be getting worse. A recent study in Annals of Internal Medicine found that for every hour you spend seeing patients, you’re spending another 2 hours working on the computer EHR doing ancillary stuff for the visits. I’m pretty sure insurance companies aren’t paying for that time.
That’s just in the office. The same study found most of us spend another 1-2 hours of our home time each night doing more office work to finish up what we didn’t get done during the day. So much for that work-life balance we hear so much about.
Ready for the breakdown? Here it is:
• Percentage of the total office day spent with patients = 27%
• Percentage of the total office day spent on charting and other EHR-related tasks = 49%
That’s just overall. Now let’s look at the time you’re actually with the patient in an exam room:
• Face-to-face with patient = 53%
• Time on the computer = 37%
So even in a room with a patient in front of you, over one-third of the time is still spent on the computer.
The degree of drudgery is surprising, too. How many mouse clicks are needed, in one system, to order and record a flu shot? Take a guess. 5? 10? 15? How about 32. Yeah, you read that right. No wonder your index finger hurts.
But let’s go back to the main point here, that 1 hour of patient time equals 2 hours of computer time ratio. At its core, it suggests that in order to get everything done, you should only be seeing patients for 3 hours a day because you’ll need at least another 6 hours to get all the computer stuff for them done. You think you can make a living, or even pay your overhead, billing for 3 hours of patient time a day? Me neither. I need to put in at least 8 hours of patient time, which means another 16 hours or so of computer time crammed in somewhere, overflowing into evenings and weekends. There are, quite literally, not enough hours in the day to practice good medicine and still get all the ancillary work done quickly and correctly.
With this kind of formula it’s only a matter of time before people get hurt. And the bean counters who run many medical practices these days will never see that aspect of medicine. The more patients, the more revenue, in their minds.
Rather than making life easier for us, EHRs have taken things the opposite way. In a profession where face-to-face time is the most critical part of what we do and the center of the doctor-patient relationship, it’s now second to face-to-screen time. That can’t be good for those who need our help.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
How many hours a day do you typically work?
I’m not just talking about seeing patients, although that’s included. I’m also thinking about all the time spent reviewing tests, filling out forms, returning calls, refilling meds, talking to your staff about what needs to be done for the patients who called with questions or problems, and (a big one) dictating and charting notes for the day.
Sadly, the issue appears to be getting worse. A recent study in Annals of Internal Medicine found that for every hour you spend seeing patients, you’re spending another 2 hours working on the computer EHR doing ancillary stuff for the visits. I’m pretty sure insurance companies aren’t paying for that time.
That’s just in the office. The same study found most of us spend another 1-2 hours of our home time each night doing more office work to finish up what we didn’t get done during the day. So much for that work-life balance we hear so much about.
Ready for the breakdown? Here it is:
• Percentage of the total office day spent with patients = 27%
• Percentage of the total office day spent on charting and other EHR-related tasks = 49%
That’s just overall. Now let’s look at the time you’re actually with the patient in an exam room:
• Face-to-face with patient = 53%
• Time on the computer = 37%
So even in a room with a patient in front of you, over one-third of the time is still spent on the computer.
The degree of drudgery is surprising, too. How many mouse clicks are needed, in one system, to order and record a flu shot? Take a guess. 5? 10? 15? How about 32. Yeah, you read that right. No wonder your index finger hurts.
But let’s go back to the main point here, that 1 hour of patient time equals 2 hours of computer time ratio. At its core, it suggests that in order to get everything done, you should only be seeing patients for 3 hours a day because you’ll need at least another 6 hours to get all the computer stuff for them done. You think you can make a living, or even pay your overhead, billing for 3 hours of patient time a day? Me neither. I need to put in at least 8 hours of patient time, which means another 16 hours or so of computer time crammed in somewhere, overflowing into evenings and weekends. There are, quite literally, not enough hours in the day to practice good medicine and still get all the ancillary work done quickly and correctly.
With this kind of formula it’s only a matter of time before people get hurt. And the bean counters who run many medical practices these days will never see that aspect of medicine. The more patients, the more revenue, in their minds.
Rather than making life easier for us, EHRs have taken things the opposite way. In a profession where face-to-face time is the most critical part of what we do and the center of the doctor-patient relationship, it’s now second to face-to-screen time. That can’t be good for those who need our help.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
How many hours a day do you typically work?
I’m not just talking about seeing patients, although that’s included. I’m also thinking about all the time spent reviewing tests, filling out forms, returning calls, refilling meds, talking to your staff about what needs to be done for the patients who called with questions or problems, and (a big one) dictating and charting notes for the day.
Sadly, the issue appears to be getting worse. A recent study in Annals of Internal Medicine found that for every hour you spend seeing patients, you’re spending another 2 hours working on the computer EHR doing ancillary stuff for the visits. I’m pretty sure insurance companies aren’t paying for that time.
That’s just in the office. The same study found most of us spend another 1-2 hours of our home time each night doing more office work to finish up what we didn’t get done during the day. So much for that work-life balance we hear so much about.
Ready for the breakdown? Here it is:
• Percentage of the total office day spent with patients = 27%
• Percentage of the total office day spent on charting and other EHR-related tasks = 49%
That’s just overall. Now let’s look at the time you’re actually with the patient in an exam room:
• Face-to-face with patient = 53%
• Time on the computer = 37%
So even in a room with a patient in front of you, over one-third of the time is still spent on the computer.
The degree of drudgery is surprising, too. How many mouse clicks are needed, in one system, to order and record a flu shot? Take a guess. 5? 10? 15? How about 32. Yeah, you read that right. No wonder your index finger hurts.
But let’s go back to the main point here, that 1 hour of patient time equals 2 hours of computer time ratio. At its core, it suggests that in order to get everything done, you should only be seeing patients for 3 hours a day because you’ll need at least another 6 hours to get all the computer stuff for them done. You think you can make a living, or even pay your overhead, billing for 3 hours of patient time a day? Me neither. I need to put in at least 8 hours of patient time, which means another 16 hours or so of computer time crammed in somewhere, overflowing into evenings and weekends. There are, quite literally, not enough hours in the day to practice good medicine and still get all the ancillary work done quickly and correctly.
With this kind of formula it’s only a matter of time before people get hurt. And the bean counters who run many medical practices these days will never see that aspect of medicine. The more patients, the more revenue, in their minds.
Rather than making life easier for us, EHRs have taken things the opposite way. In a profession where face-to-face time is the most critical part of what we do and the center of the doctor-patient relationship, it’s now second to face-to-screen time. That can’t be good for those who need our help.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
DEA licenses: Is it time for a graduated approach?
I sometimes think about giving up my DEA certificate. I can’t be the only one.
It’s not strictly about the money. $731 every 3 years is small change, compared with my rent, staff salaries, and malpractice insurance, although the savings would be nice.
Part of it is the desire to unfetter myself from prescribing controlled substances. I wouldn’t have to worry about drug seekers hitting me up, or dealing with the paperwork and pharmacy calls, or doing background checks on the state monitoring site.
But, realistically, I can’t do that. Even though I try to limit my narcotic scripts, the DEA number covers many other things, such as Lyrica, Vimpat, and Klonopin for epilepsy patients; Provigil for MS fatigue; and Valium to help someone get through an MRI scan.
There are, of course, the occasional narcotics. I don’t have many patients on chronic narcotics any more, but I’m sure all of us have a few migraine patients who keep an emergency supply of some narcotic (say, 5-10 pills) on hand to be used in lieu of an ER trip. They may only get it filled once a year, which doesn’t seem unreasonable.
I think it would be unfair to make patients, many of whom I’ve seen for many years, have to find a new neurologist over such things.
But what if there were a graduated DEA license? Say, one that limited me to schedules III-V or even just level IV and V substances? That would probably make life easier. The latter would still allow tramadol and Stadol-NS for breakthrough migraines, while adding level III would still allow Tylenol with codeine No. 3. Either way, it would take oxycodone, hydrocodone, morphine, amphetamines, and other drugs of greater abuse potential out of my hands. A few less things to worry about.
There are pros and cons of this. From one view, it would limit the number of docs prescribing higher level substances, making them easier to track and control. On the other hand, patients who need them, many of whom are legitimately in pain, would be forced to change to a dwindling number of narcotic prescribers. Many of these doctors would likely start to work on a cash-only basis knowing the demand they’d be in. Who knows where that would lead? Like so many things in medicine, there are always going to be unintended consequences.
For the time being I have no plans to drop my DEA license, but it would be nice to have options besides all or nothing.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
I sometimes think about giving up my DEA certificate. I can’t be the only one.
It’s not strictly about the money. $731 every 3 years is small change, compared with my rent, staff salaries, and malpractice insurance, although the savings would be nice.
Part of it is the desire to unfetter myself from prescribing controlled substances. I wouldn’t have to worry about drug seekers hitting me up, or dealing with the paperwork and pharmacy calls, or doing background checks on the state monitoring site.
But, realistically, I can’t do that. Even though I try to limit my narcotic scripts, the DEA number covers many other things, such as Lyrica, Vimpat, and Klonopin for epilepsy patients; Provigil for MS fatigue; and Valium to help someone get through an MRI scan.
There are, of course, the occasional narcotics. I don’t have many patients on chronic narcotics any more, but I’m sure all of us have a few migraine patients who keep an emergency supply of some narcotic (say, 5-10 pills) on hand to be used in lieu of an ER trip. They may only get it filled once a year, which doesn’t seem unreasonable.
I think it would be unfair to make patients, many of whom I’ve seen for many years, have to find a new neurologist over such things.
But what if there were a graduated DEA license? Say, one that limited me to schedules III-V or even just level IV and V substances? That would probably make life easier. The latter would still allow tramadol and Stadol-NS for breakthrough migraines, while adding level III would still allow Tylenol with codeine No. 3. Either way, it would take oxycodone, hydrocodone, morphine, amphetamines, and other drugs of greater abuse potential out of my hands. A few less things to worry about.
There are pros and cons of this. From one view, it would limit the number of docs prescribing higher level substances, making them easier to track and control. On the other hand, patients who need them, many of whom are legitimately in pain, would be forced to change to a dwindling number of narcotic prescribers. Many of these doctors would likely start to work on a cash-only basis knowing the demand they’d be in. Who knows where that would lead? Like so many things in medicine, there are always going to be unintended consequences.
For the time being I have no plans to drop my DEA license, but it would be nice to have options besides all or nothing.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
I sometimes think about giving up my DEA certificate. I can’t be the only one.
It’s not strictly about the money. $731 every 3 years is small change, compared with my rent, staff salaries, and malpractice insurance, although the savings would be nice.
Part of it is the desire to unfetter myself from prescribing controlled substances. I wouldn’t have to worry about drug seekers hitting me up, or dealing with the paperwork and pharmacy calls, or doing background checks on the state monitoring site.
But, realistically, I can’t do that. Even though I try to limit my narcotic scripts, the DEA number covers many other things, such as Lyrica, Vimpat, and Klonopin for epilepsy patients; Provigil for MS fatigue; and Valium to help someone get through an MRI scan.
There are, of course, the occasional narcotics. I don’t have many patients on chronic narcotics any more, but I’m sure all of us have a few migraine patients who keep an emergency supply of some narcotic (say, 5-10 pills) on hand to be used in lieu of an ER trip. They may only get it filled once a year, which doesn’t seem unreasonable.
I think it would be unfair to make patients, many of whom I’ve seen for many years, have to find a new neurologist over such things.
But what if there were a graduated DEA license? Say, one that limited me to schedules III-V or even just level IV and V substances? That would probably make life easier. The latter would still allow tramadol and Stadol-NS for breakthrough migraines, while adding level III would still allow Tylenol with codeine No. 3. Either way, it would take oxycodone, hydrocodone, morphine, amphetamines, and other drugs of greater abuse potential out of my hands. A few less things to worry about.
There are pros and cons of this. From one view, it would limit the number of docs prescribing higher level substances, making them easier to track and control. On the other hand, patients who need them, many of whom are legitimately in pain, would be forced to change to a dwindling number of narcotic prescribers. Many of these doctors would likely start to work on a cash-only basis knowing the demand they’d be in. Who knows where that would lead? Like so many things in medicine, there are always going to be unintended consequences.
For the time being I have no plans to drop my DEA license, but it would be nice to have options besides all or nothing.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
Getting prior lab results is worth the effort
Many patients we see need blood work as part of their evaluation. Although labs are cheap compared with other tests we order, they can still be frustrating to get.
It’s not hard to order them. Ordering any test is pretty easy.
But I hate duplicating tests. Patients often say they just had labs done, which “were all fine,” but that tells me nothing. For all I know, it was a lipid panel and PSA, entirely unrelated to what I’m seeing them for.
Occasionally, they bring labs in with them, or I’ve gotten them in advance, but usually I’m working blind.
Back when I was new to practice, I just ordered everything I wanted. I figured it was easier than trying to get the previous ones. I think we all do that sometimes. And there’s kind of an ivory-tower mentality we all have early in our careers that “I’m the doctor, and I’ll do what I want.”
I quickly learned that often backfires. If the same labs were done recently, many insurance companies won’t pay for them ... and the patients get a bill. Then they call my office and complain. It didn’t take me long to realize this approach was a waste of their time, money, and blood.
So now I always ask if they’ve had labs done since the symptoms started. If the answer is yes, I’ll call or fax the other doctor to get them. This can take (depending on the other office) a few hours to days. But the majority of outpatient neurology is nonurgent, and a extra few days usually doesn’t matter in the things I treat.
When I get the labs, it’s easy to make some quick notes on what was done and what still needs to be checked. I scribble out a lab order, mail or fax it, and have my staff notify the patient the ball is rolling. It’s not hard.
Patients appreciate it. I’m saving them time, blood, money, and maybe even a venipuncture. I get the tests I want, still in a timely fashion. It also keeps insurance costs down for all of us.
Obviously, there are some cases where urgency has to take priority. But for the majority of them, duplicating tests needlessly is a bad idea for all involved.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
Many patients we see need blood work as part of their evaluation. Although labs are cheap compared with other tests we order, they can still be frustrating to get.
It’s not hard to order them. Ordering any test is pretty easy.
But I hate duplicating tests. Patients often say they just had labs done, which “were all fine,” but that tells me nothing. For all I know, it was a lipid panel and PSA, entirely unrelated to what I’m seeing them for.
Occasionally, they bring labs in with them, or I’ve gotten them in advance, but usually I’m working blind.
Back when I was new to practice, I just ordered everything I wanted. I figured it was easier than trying to get the previous ones. I think we all do that sometimes. And there’s kind of an ivory-tower mentality we all have early in our careers that “I’m the doctor, and I’ll do what I want.”
I quickly learned that often backfires. If the same labs were done recently, many insurance companies won’t pay for them ... and the patients get a bill. Then they call my office and complain. It didn’t take me long to realize this approach was a waste of their time, money, and blood.
So now I always ask if they’ve had labs done since the symptoms started. If the answer is yes, I’ll call or fax the other doctor to get them. This can take (depending on the other office) a few hours to days. But the majority of outpatient neurology is nonurgent, and a extra few days usually doesn’t matter in the things I treat.
When I get the labs, it’s easy to make some quick notes on what was done and what still needs to be checked. I scribble out a lab order, mail or fax it, and have my staff notify the patient the ball is rolling. It’s not hard.
Patients appreciate it. I’m saving them time, blood, money, and maybe even a venipuncture. I get the tests I want, still in a timely fashion. It also keeps insurance costs down for all of us.
Obviously, there are some cases where urgency has to take priority. But for the majority of them, duplicating tests needlessly is a bad idea for all involved.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
Many patients we see need blood work as part of their evaluation. Although labs are cheap compared with other tests we order, they can still be frustrating to get.
It’s not hard to order them. Ordering any test is pretty easy.
But I hate duplicating tests. Patients often say they just had labs done, which “were all fine,” but that tells me nothing. For all I know, it was a lipid panel and PSA, entirely unrelated to what I’m seeing them for.
Occasionally, they bring labs in with them, or I’ve gotten them in advance, but usually I’m working blind.
Back when I was new to practice, I just ordered everything I wanted. I figured it was easier than trying to get the previous ones. I think we all do that sometimes. And there’s kind of an ivory-tower mentality we all have early in our careers that “I’m the doctor, and I’ll do what I want.”
I quickly learned that often backfires. If the same labs were done recently, many insurance companies won’t pay for them ... and the patients get a bill. Then they call my office and complain. It didn’t take me long to realize this approach was a waste of their time, money, and blood.
So now I always ask if they’ve had labs done since the symptoms started. If the answer is yes, I’ll call or fax the other doctor to get them. This can take (depending on the other office) a few hours to days. But the majority of outpatient neurology is nonurgent, and a extra few days usually doesn’t matter in the things I treat.
When I get the labs, it’s easy to make some quick notes on what was done and what still needs to be checked. I scribble out a lab order, mail or fax it, and have my staff notify the patient the ball is rolling. It’s not hard.
Patients appreciate it. I’m saving them time, blood, money, and maybe even a venipuncture. I get the tests I want, still in a timely fashion. It also keeps insurance costs down for all of us.
Obviously, there are some cases where urgency has to take priority. But for the majority of them, duplicating tests needlessly is a bad idea for all involved.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
