Hitting a Nerve

Why do people steal stuff from my office?

I’m not talking about pens. I’ve unintentionally walked off with more pens then I can count over the years, and never realized that I did until later. I figure others do the same with mine.

In the last few years, I’ve had a Far Side cartoon book stolen from the lobby, a stapler off my secretary’s desk, a roll of medical tape from my EMG cart, and a few other items.

Most recently, my secretary bought a candy dish at the store. It was nothing fancy, just a few bucks, but she liked it. She set it out on the front desk with some Jolly Ranchers.

A few days later, she left her desk to refill her coffee cup. While in back she heard the front door of the office open and close. When she returned up front, the dish (and candy) were gone.

None of these are a major financial loss, maybe adding up to $15-$20 a year at most. But it’s irritating to have someone steal something minor from my office.

Taking pens, or even magazines, is perhaps understandable, at times unintentional. But to reach over a desk and grab a stapler, or to walk in, grab a candy dish, and leave, are volitional and just wrong. I don’t understand this. Do people feel that, because I’m a doctor (and therefore stereotyped as rich), I can afford it? Do they do it because, since they’re giving me a copay and letting me bill their insurance, they feel entitled to something back? Or are they angry at me over something, and this is a passive-aggressive way to get even?

I don’t know. Admittedly, it’s a tiny minority who do such things. The vast majority of people wouldn’t dream of stealing a $3 candy dish from an office. But still, it points to a sad level of dishonesty among a few of the routine people I see day in and day out. I’m pretty sure they aren’t so hard up that they need to steal such petty items, either. I imagine the black market value of a used stapler is pretty low.

P.S. If someone out there is willing to return the candy dish or the Beyond The Far Side cartoon book, no questions will be asked.

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

Why do people steal stuff from my office?

I’m not talking about pens. I’ve unintentionally walked off with more pens then I can count over the years, and never realized that I did until later. I figure others do the same with mine.

In the last few years, I’ve had a Far Side cartoon book stolen from the lobby, a stapler off my secretary’s desk, a roll of medical tape from my EMG cart, and a few other items.

Most recently, my secretary bought a candy dish at the store. It was nothing fancy, just a few bucks, but she liked it. She set it out on the front desk with some Jolly Ranchers.

A few days later, she left her desk to refill her coffee cup. While in back she heard the front door of the office open and close. When she returned up front, the dish (and candy) were gone.

None of these are a major financial loss, maybe adding up to $15-$20 a year at most. But it’s irritating to have someone steal something minor from my office.

Taking pens, or even magazines, is perhaps understandable, at times unintentional. But to reach over a desk and grab a stapler, or to walk in, grab a candy dish, and leave, are volitional and just wrong. I don’t understand this. Do people feel that, because I’m a doctor (and therefore stereotyped as rich), I can afford it? Do they do it because, since they’re giving me a copay and letting me bill their insurance, they feel entitled to something back? Or are they angry at me over something, and this is a passive-aggressive way to get even?

I don’t know. Admittedly, it’s a tiny minority who do such things. The vast majority of people wouldn’t dream of stealing a $3 candy dish from an office. But still, it points to a sad level of dishonesty among a few of the routine people I see day in and day out. I’m pretty sure they aren’t so hard up that they need to steal such petty items, either. I imagine the black market value of a used stapler is pretty low.

P.S. If someone out there is willing to return the candy dish or the Beyond The Far Side cartoon book, no questions will be asked.

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

Why do people steal stuff from my office?

I’m not talking about pens. I’ve unintentionally walked off with more pens then I can count over the years, and never realized that I did until later. I figure others do the same with mine.

In the last few years, I’ve had a Far Side cartoon book stolen from the lobby, a stapler off my secretary’s desk, a roll of medical tape from my EMG cart, and a few other items.

Most recently, my secretary bought a candy dish at the store. It was nothing fancy, just a few bucks, but she liked it. She set it out on the front desk with some Jolly Ranchers.

A few days later, she left her desk to refill her coffee cup. While in back she heard the front door of the office open and close. When she returned up front, the dish (and candy) were gone.

None of these are a major financial loss, maybe adding up to $15-$20 a year at most. But it’s irritating to have someone steal something minor from my office.

Taking pens, or even magazines, is perhaps understandable, at times unintentional. But to reach over a desk and grab a stapler, or to walk in, grab a candy dish, and leave, are volitional and just wrong. I don’t understand this. Do people feel that, because I’m a doctor (and therefore stereotyped as rich), I can afford it? Do they do it because, since they’re giving me a copay and letting me bill their insurance, they feel entitled to something back? Or are they angry at me over something, and this is a passive-aggressive way to get even?

I don’t know. Admittedly, it’s a tiny minority who do such things. The vast majority of people wouldn’t dream of stealing a $3 candy dish from an office. But still, it points to a sad level of dishonesty among a few of the routine people I see day in and day out. I’m pretty sure they aren’t so hard up that they need to steal such petty items, either. I imagine the black market value of a used stapler is pretty low.

P.S. If someone out there is willing to return the candy dish or the Beyond The Far Side cartoon book, no questions will be asked.

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

I’ve previously written about how my secretary took 8 weeks off for maternity leave. Well, she’s back now, and brought a new staff member with her.

I know several doctors who are horrified that I let her bring the baby to work every day. They tell me it’s unprofessional, a distraction, inconvenient, etc.

Me? I think it’s great.

I have no problem with her being here. If anything, she adds an upbeat vibe to the office. Seeing an adorable newborn up front cheers all comers. She’s quickly become the most popular person here. Nowadays, when I call someone back from the lobby, they jokingly protest and say, but “I’m looking at the baby!” At this point, we’ve even had people coming by just to see her, once word spread there was a baby at my office.

Is it unprofessional? Maybe by someone else’s standards, but not mine. At this stage of life, she’s certainly not in the way. She’s (generally) quiet, sweet, and smiley. Besides, having her here spares my secretary the expense of child care and makes her happy. If keeping your staff happy isn’t part of being professional, I don’t know what is.

Is she a distraction? Perhaps, but not in a bad way. Maybe I take a few seconds here and there to wave at her or help my secretary with something, but nothing that compromises patient care.

Courtesy Dr. Allan M. Block

Is it inconvenient to have her here? Nope. We have an extra exam room, so it’s easy for my secretary to have a quiet, private place to feed and change her every few hours. If the phones go to voice mail for a few minutes, or I have to keep an ear out for the front door opening, I don’t mind.

She and I both have young families. When we were looking for a new office 3 years ago, one of our requirements was what we called “the sick kid room.” An extra space where, if a kid couldn’t go to school, we wouldn’t be stuck trying to figure out what to do. They’ve always been welcome here, and always will be.

Having kids on site isn’t perfect for every practice. Certainly, a pediatrics office (with a lot more sick kids going in and out) wouldn’t be ideal. But at my place the young lady has brightened things up for all and makes the day more fun.

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

I’ve previously written about how my secretary took 8 weeks off for maternity leave. Well, she’s back now, and brought a new staff member with her.

I know several doctors who are horrified that I let her bring the baby to work every day. They tell me it’s unprofessional, a distraction, inconvenient, etc.

Me? I think it’s great.

I have no problem with her being here. If anything, she adds an upbeat vibe to the office. Seeing an adorable newborn up front cheers all comers. She’s quickly become the most popular person here. Nowadays, when I call someone back from the lobby, they jokingly protest and say, but “I’m looking at the baby!” At this point, we’ve even had people coming by just to see her, once word spread there was a baby at my office.

Is it unprofessional? Maybe by someone else’s standards, but not mine. At this stage of life, she’s certainly not in the way. She’s (generally) quiet, sweet, and smiley. Besides, having her here spares my secretary the expense of child care and makes her happy. If keeping your staff happy isn’t part of being professional, I don’t know what is.

Is she a distraction? Perhaps, but not in a bad way. Maybe I take a few seconds here and there to wave at her or help my secretary with something, but nothing that compromises patient care.

Courtesy Dr. Allan M. Block

Is it inconvenient to have her here? Nope. We have an extra exam room, so it’s easy for my secretary to have a quiet, private place to feed and change her every few hours. If the phones go to voice mail for a few minutes, or I have to keep an ear out for the front door opening, I don’t mind.

She and I both have young families. When we were looking for a new office 3 years ago, one of our requirements was what we called “the sick kid room.” An extra space where, if a kid couldn’t go to school, we wouldn’t be stuck trying to figure out what to do. They’ve always been welcome here, and always will be.

Having kids on site isn’t perfect for every practice. Certainly, a pediatrics office (with a lot more sick kids going in and out) wouldn’t be ideal. But at my place the young lady has brightened things up for all and makes the day more fun.

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

I’ve previously written about how my secretary took 8 weeks off for maternity leave. Well, she’s back now, and brought a new staff member with her.

I know several doctors who are horrified that I let her bring the baby to work every day. They tell me it’s unprofessional, a distraction, inconvenient, etc.

Me? I think it’s great.

I have no problem with her being here. If anything, she adds an upbeat vibe to the office. Seeing an adorable newborn up front cheers all comers. She’s quickly become the most popular person here. Nowadays, when I call someone back from the lobby, they jokingly protest and say, but “I’m looking at the baby!” At this point, we’ve even had people coming by just to see her, once word spread there was a baby at my office.

Is it unprofessional? Maybe by someone else’s standards, but not mine. At this stage of life, she’s certainly not in the way. She’s (generally) quiet, sweet, and smiley. Besides, having her here spares my secretary the expense of child care and makes her happy. If keeping your staff happy isn’t part of being professional, I don’t know what is.

Is she a distraction? Perhaps, but not in a bad way. Maybe I take a few seconds here and there to wave at her or help my secretary with something, but nothing that compromises patient care.

Courtesy Dr. Allan M. Block

Is it inconvenient to have her here? Nope. We have an extra exam room, so it’s easy for my secretary to have a quiet, private place to feed and change her every few hours. If the phones go to voice mail for a few minutes, or I have to keep an ear out for the front door opening, I don’t mind.

She and I both have young families. When we were looking for a new office 3 years ago, one of our requirements was what we called “the sick kid room.” An extra space where, if a kid couldn’t go to school, we wouldn’t be stuck trying to figure out what to do. They’ve always been welcome here, and always will be.

Having kids on site isn’t perfect for every practice. Certainly, a pediatrics office (with a lot more sick kids going in and out) wouldn’t be ideal. But at my place the young lady has brightened things up for all and makes the day more fun.

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

Recently, my secretary was out on maternity leave for 6 weeks.

I run a small practice, and my medical assistant works from home on the far side of town. So I was on my own at the office. My MA and I split things up, and since I was the only one physically in the building, I took over all the front office stuff and she took the back office.

I ran the front desk for the whole time – checking people in and out, taking copays, copying insurance cards, giving referrals to therapy places, sending logs to the billing company, and doing other everyday stuff.

Plenty of people asked why I didn’t hire a temp, obviously not knowing how close to the edge a modern solo practice runs. If I hire a temp, that’s another salary to pay, meaning one of the other three of us here would have to skip a few paychecks. I’m not going to put my secretary on unpaid leave for that time. She’s awesome, has been with me since 2004, and has stuck with me through good and bad years. If I don’t pay her that time, she can’t pay her rent, and I don’t have the heart to do that to her. Maybe a big corporate person wouldn’t lose any sleep about it, but I would. Great people are hard to find, and I want to keep the ones I have.

Besides, if I hired a temp, I’d have to train them from the beginning. I don’t use off-the-shelf medical software, just a system I designed myself. It would take time out of my day to teach them how to use it, where I send patients for tests and referrals, and how to sort documents accurately into the correct e-charts. So, for 6 weeks it just seemed easier to do it myself. I know how I like it done.

It wasn’t easy for my MA as well. She had to take over scheduling appointments, handling billing questions, making reminder calls, and doing other miscellaneous stuff. Even after work was over, I’d be at home catching up on all the dictations I hadn’t had time to do, and we’d be going back and forth by phone and email to settle different issues until 8:00 at night or so. By the end of the 6 weeks, we were both pretty burned out and exhausted.

I’m sure the patients weren’t thrilled, either. During that time, they could only reach a voice mail box telling them to leave a message and we’d get back to them as quickly as possible.

I assumed my practice was the only one dinky (or poor, by medical standards) enough to have to resort to this – until I had a chance conversation with a local family practice doctor, when he mentioned he’d had to do something similar when his secretary retired and he didn’t find a replacement for several weeks. A cardiologist mentioned doing the same thing while we were chatting at the hospital. Like me, they were both in solo practice.

This is, apparently, the nature of a modern small practice. The revenue and expense streams are too tight to allow for an extra salary, so even the doctor pitches in to cover. I’m sure my colleagues in large groups will laugh at the thought, but I don’t care. I have to do what’s right for my practice and to survive in the modern medical climate. And if working the front desk for a few weeks is what’s needed to stay independent, so be it.

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

Recently, my secretary was out on maternity leave for 6 weeks.

I run a small practice, and my medical assistant works from home on the far side of town. So I was on my own at the office. My MA and I split things up, and since I was the only one physically in the building, I took over all the front office stuff and she took the back office.

I ran the front desk for the whole time – checking people in and out, taking copays, copying insurance cards, giving referrals to therapy places, sending logs to the billing company, and doing other everyday stuff.

Plenty of people asked why I didn’t hire a temp, obviously not knowing how close to the edge a modern solo practice runs. If I hire a temp, that’s another salary to pay, meaning one of the other three of us here would have to skip a few paychecks. I’m not going to put my secretary on unpaid leave for that time. She’s awesome, has been with me since 2004, and has stuck with me through good and bad years. If I don’t pay her that time, she can’t pay her rent, and I don’t have the heart to do that to her. Maybe a big corporate person wouldn’t lose any sleep about it, but I would. Great people are hard to find, and I want to keep the ones I have.

Besides, if I hired a temp, I’d have to train them from the beginning. I don’t use off-the-shelf medical software, just a system I designed myself. It would take time out of my day to teach them how to use it, where I send patients for tests and referrals, and how to sort documents accurately into the correct e-charts. So, for 6 weeks it just seemed easier to do it myself. I know how I like it done.

It wasn’t easy for my MA as well. She had to take over scheduling appointments, handling billing questions, making reminder calls, and doing other miscellaneous stuff. Even after work was over, I’d be at home catching up on all the dictations I hadn’t had time to do, and we’d be going back and forth by phone and email to settle different issues until 8:00 at night or so. By the end of the 6 weeks, we were both pretty burned out and exhausted.

I’m sure the patients weren’t thrilled, either. During that time, they could only reach a voice mail box telling them to leave a message and we’d get back to them as quickly as possible.

I assumed my practice was the only one dinky (or poor, by medical standards) enough to have to resort to this – until I had a chance conversation with a local family practice doctor, when he mentioned he’d had to do something similar when his secretary retired and he didn’t find a replacement for several weeks. A cardiologist mentioned doing the same thing while we were chatting at the hospital. Like me, they were both in solo practice.

This is, apparently, the nature of a modern small practice. The revenue and expense streams are too tight to allow for an extra salary, so even the doctor pitches in to cover. I’m sure my colleagues in large groups will laugh at the thought, but I don’t care. I have to do what’s right for my practice and to survive in the modern medical climate. And if working the front desk for a few weeks is what’s needed to stay independent, so be it.

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

Recently, my secretary was out on maternity leave for 6 weeks.

I run a small practice, and my medical assistant works from home on the far side of town. So I was on my own at the office. My MA and I split things up, and since I was the only one physically in the building, I took over all the front office stuff and she took the back office.

I ran the front desk for the whole time – checking people in and out, taking copays, copying insurance cards, giving referrals to therapy places, sending logs to the billing company, and doing other everyday stuff.

Plenty of people asked why I didn’t hire a temp, obviously not knowing how close to the edge a modern solo practice runs. If I hire a temp, that’s another salary to pay, meaning one of the other three of us here would have to skip a few paychecks. I’m not going to put my secretary on unpaid leave for that time. She’s awesome, has been with me since 2004, and has stuck with me through good and bad years. If I don’t pay her that time, she can’t pay her rent, and I don’t have the heart to do that to her. Maybe a big corporate person wouldn’t lose any sleep about it, but I would. Great people are hard to find, and I want to keep the ones I have.

Besides, if I hired a temp, I’d have to train them from the beginning. I don’t use off-the-shelf medical software, just a system I designed myself. It would take time out of my day to teach them how to use it, where I send patients for tests and referrals, and how to sort documents accurately into the correct e-charts. So, for 6 weeks it just seemed easier to do it myself. I know how I like it done.

It wasn’t easy for my MA as well. She had to take over scheduling appointments, handling billing questions, making reminder calls, and doing other miscellaneous stuff. Even after work was over, I’d be at home catching up on all the dictations I hadn’t had time to do, and we’d be going back and forth by phone and email to settle different issues until 8:00 at night or so. By the end of the 6 weeks, we were both pretty burned out and exhausted.

I’m sure the patients weren’t thrilled, either. During that time, they could only reach a voice mail box telling them to leave a message and we’d get back to them as quickly as possible.

I assumed my practice was the only one dinky (or poor, by medical standards) enough to have to resort to this – until I had a chance conversation with a local family practice doctor, when he mentioned he’d had to do something similar when his secretary retired and he didn’t find a replacement for several weeks. A cardiologist mentioned doing the same thing while we were chatting at the hospital. Like me, they were both in solo practice.

This is, apparently, the nature of a modern small practice. The revenue and expense streams are too tight to allow for an extra salary, so even the doctor pitches in to cover. I’m sure my colleagues in large groups will laugh at the thought, but I don’t care. I have to do what’s right for my practice and to survive in the modern medical climate. And if working the front desk for a few weeks is what’s needed to stay independent, so be it.

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

Years ago, I had a colleague who’d once worked for the prison system, treating people who were some of the more dangerous elements of society.

Once I asked if he’d ever gotten curious about what they were in for. He answered that, while he was always curious, he never asked. He felt as if knowing might prejudice his care. Since a key part of being a doctor is being impartial and objective, he was afraid that knowing about their previous heinous behavior would make him less concerned about treating them properly. And I agree.

When I was a younger doctor, I’d sometimes Google patients. I’d be curious about their backgrounds, or I wanted to see if there was anything on their social media I should be aware of they hadn’t told me. Maybe something like “I scored 20 percs off a neurologist today!”

I stopped after a while, and haven’t done it since. I never saw anything that would affect my treatment plan. I did, however, often learn about their political and religious views, some of which were distasteful to me. I respect anyone’s right to have an opinion, but that doesn’t mean I have to agree with them.

Like I’ve written before, I specifically avoid any discussion of religion or politics with my patients because doing so can lead to antagonism and dislike, with the potential to impact my objectivity.

The same can be said about what else you might learn online: their habits and hobbies, unflattering pictures, stories about their backgrounds, etc. All of those things can, in the right circumstances, lead to a bias against them. Perhaps it may just exist subconsciously, but it’s still there. A recent Medscape report noted the number of physicians who admitted having biases against patients, as well as the things that can trigger our visceral reactions: emotional state, weight, and intelligence, to name a few. We try hard to overcome negative feelings to provide proper care, but are still human and 100% objectivity is often difficult.

To me, Googling a patient became the same thing as asking inmates what they’d been locked up for: You learn things about them that might change how you view and care for them.

The only way to effectively treat patients is to see them as just people, like yourself. Knowing too much about their background that isn’t medically relevant is just asking for trouble.

I’d rather know less and be more objective.

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

Years ago, I had a colleague who’d once worked for the prison system, treating people who were some of the more dangerous elements of society.

Once I asked if he’d ever gotten curious about what they were in for. He answered that, while he was always curious, he never asked. He felt as if knowing might prejudice his care. Since a key part of being a doctor is being impartial and objective, he was afraid that knowing about their previous heinous behavior would make him less concerned about treating them properly. And I agree.

When I was a younger doctor, I’d sometimes Google patients. I’d be curious about their backgrounds, or I wanted to see if there was anything on their social media I should be aware of they hadn’t told me. Maybe something like “I scored 20 percs off a neurologist today!”

I stopped after a while, and haven’t done it since. I never saw anything that would affect my treatment plan. I did, however, often learn about their political and religious views, some of which were distasteful to me. I respect anyone’s right to have an opinion, but that doesn’t mean I have to agree with them.

Like I’ve written before, I specifically avoid any discussion of religion or politics with my patients because doing so can lead to antagonism and dislike, with the potential to impact my objectivity.

The same can be said about what else you might learn online: their habits and hobbies, unflattering pictures, stories about their backgrounds, etc. All of those things can, in the right circumstances, lead to a bias against them. Perhaps it may just exist subconsciously, but it’s still there. A recent Medscape report noted the number of physicians who admitted having biases against patients, as well as the things that can trigger our visceral reactions: emotional state, weight, and intelligence, to name a few. We try hard to overcome negative feelings to provide proper care, but are still human and 100% objectivity is often difficult.

To me, Googling a patient became the same thing as asking inmates what they’d been locked up for: You learn things about them that might change how you view and care for them.

The only way to effectively treat patients is to see them as just people, like yourself. Knowing too much about their background that isn’t medically relevant is just asking for trouble.

I’d rather know less and be more objective.

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

Years ago, I had a colleague who’d once worked for the prison system, treating people who were some of the more dangerous elements of society.

Once I asked if he’d ever gotten curious about what they were in for. He answered that, while he was always curious, he never asked. He felt as if knowing might prejudice his care. Since a key part of being a doctor is being impartial and objective, he was afraid that knowing about their previous heinous behavior would make him less concerned about treating them properly. And I agree.

When I was a younger doctor, I’d sometimes Google patients. I’d be curious about their backgrounds, or I wanted to see if there was anything on their social media I should be aware of they hadn’t told me. Maybe something like “I scored 20 percs off a neurologist today!”

I stopped after a while, and haven’t done it since. I never saw anything that would affect my treatment plan. I did, however, often learn about their political and religious views, some of which were distasteful to me. I respect anyone’s right to have an opinion, but that doesn’t mean I have to agree with them.

Like I’ve written before, I specifically avoid any discussion of religion or politics with my patients because doing so can lead to antagonism and dislike, with the potential to impact my objectivity.

The same can be said about what else you might learn online: their habits and hobbies, unflattering pictures, stories about their backgrounds, etc. All of those things can, in the right circumstances, lead to a bias against them. Perhaps it may just exist subconsciously, but it’s still there. A recent Medscape report noted the number of physicians who admitted having biases against patients, as well as the things that can trigger our visceral reactions: emotional state, weight, and intelligence, to name a few. We try hard to overcome negative feelings to provide proper care, but are still human and 100% objectivity is often difficult.

To me, Googling a patient became the same thing as asking inmates what they’d been locked up for: You learn things about them that might change how you view and care for them.

The only way to effectively treat patients is to see them as just people, like yourself. Knowing too much about their background that isn’t medically relevant is just asking for trouble.

I’d rather know less and be more objective.

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

It’s 2016. Where am I?

2015 was a mixed year for neurologists and doctors in general. The Sustainable Growth Rate was repealed in a rare moment of bipartisan cooperation. Whether this will stem the tide of doctors leaving Medicare remains to be seen. In my area, it seems like another internist changes to concierge practice every week.

Even with these changes, I can’t say the reimbursement rates have returned to previous levels. Neurologists, in a primarily thinking field, often take the brunt of cuts on the few procedures we have. Like other fields, we try to cram more things into limited time and hope it all somehow works out.

2016 brings an election year, and again doctors will be in the unenviable position of ping-pong balls whacked between both sides to score political points. It would be nice to have political parties willing to work out what’s best for the health of Americans as a whole rather than trying to fire up the extreme ends of the political spectrum.

2015 was the year a new International Classification of Diseases system was foisted on us for reasons I still don’t understand. With it came a whole new wave of codes and modifiers to learn. This in turn takes a lot of time, for which we aren’t paid. Time is something I, and most docs, don’t have a lot of. I’d like to focus on caring for patients, and nothing more, but the powers that be appear to have a dim view of such silliness. This brings me back to watching internists gradually shift to cash-pay models and wondering how big the demand would be for a general neurologist in that world. The only one I know who actually did it shut down in a few months.

What’s on my wish list in 2016? Obviously, the health and welfare of myself and those around me comes first. For my patients, it’s some breakthroughs for the terrible diseases we still have no real treatments for. For my practice, it’s staying strong enough to remain independent. Some better reimbursement and non–snake oil sources of revenue are always nice. I’m hoping that in 1 year I’ll be able to write something more optimistic.

Wishing you all a great 2016!

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

It’s 2016. Where am I?

2015 was a mixed year for neurologists and doctors in general. The Sustainable Growth Rate was repealed in a rare moment of bipartisan cooperation. Whether this will stem the tide of doctors leaving Medicare remains to be seen. In my area, it seems like another internist changes to concierge practice every week.

Even with these changes, I can’t say the reimbursement rates have returned to previous levels. Neurologists, in a primarily thinking field, often take the brunt of cuts on the few procedures we have. Like other fields, we try to cram more things into limited time and hope it all somehow works out.

2016 brings an election year, and again doctors will be in the unenviable position of ping-pong balls whacked between both sides to score political points. It would be nice to have political parties willing to work out what’s best for the health of Americans as a whole rather than trying to fire up the extreme ends of the political spectrum.

2015 was the year a new International Classification of Diseases system was foisted on us for reasons I still don’t understand. With it came a whole new wave of codes and modifiers to learn. This in turn takes a lot of time, for which we aren’t paid. Time is something I, and most docs, don’t have a lot of. I’d like to focus on caring for patients, and nothing more, but the powers that be appear to have a dim view of such silliness. This brings me back to watching internists gradually shift to cash-pay models and wondering how big the demand would be for a general neurologist in that world. The only one I know who actually did it shut down in a few months.

What’s on my wish list in 2016? Obviously, the health and welfare of myself and those around me comes first. For my patients, it’s some breakthroughs for the terrible diseases we still have no real treatments for. For my practice, it’s staying strong enough to remain independent. Some better reimbursement and non–snake oil sources of revenue are always nice. I’m hoping that in 1 year I’ll be able to write something more optimistic.

Wishing you all a great 2016!

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

It’s 2016. Where am I?

2015 was a mixed year for neurologists and doctors in general. The Sustainable Growth Rate was repealed in a rare moment of bipartisan cooperation. Whether this will stem the tide of doctors leaving Medicare remains to be seen. In my area, it seems like another internist changes to concierge practice every week.

Even with these changes, I can’t say the reimbursement rates have returned to previous levels. Neurologists, in a primarily thinking field, often take the brunt of cuts on the few procedures we have. Like other fields, we try to cram more things into limited time and hope it all somehow works out.

2016 brings an election year, and again doctors will be in the unenviable position of ping-pong balls whacked between both sides to score political points. It would be nice to have political parties willing to work out what’s best for the health of Americans as a whole rather than trying to fire up the extreme ends of the political spectrum.

2015 was the year a new International Classification of Diseases system was foisted on us for reasons I still don’t understand. With it came a whole new wave of codes and modifiers to learn. This in turn takes a lot of time, for which we aren’t paid. Time is something I, and most docs, don’t have a lot of. I’d like to focus on caring for patients, and nothing more, but the powers that be appear to have a dim view of such silliness. This brings me back to watching internists gradually shift to cash-pay models and wondering how big the demand would be for a general neurologist in that world. The only one I know who actually did it shut down in a few months.

What’s on my wish list in 2016? Obviously, the health and welfare of myself and those around me comes first. For my patients, it’s some breakthroughs for the terrible diseases we still have no real treatments for. For my practice, it’s staying strong enough to remain independent. Some better reimbursement and non–snake oil sources of revenue are always nice. I’m hoping that in 1 year I’ll be able to write something more optimistic.

Wishing you all a great 2016!

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

Keeping up on medical literature is never easy. Time is limited between work and family. It’s often hard to know what to read. Most journals are a combination of research and practical information.

I’m not an academic and never will be. I have nothing against my colleagues who are, but it’s just not my personality type. I’m a happy-to-see-patients-all-day type of doctor.

I try to stick with reading things that have an immediate impact on how I practice: review articles, information about new diagnostic procedures and treatments, and news about the economics of medicine. That’s about it. If I can’t use it now or in the immediate future, it’s not relevant to my practice. My patients want to know what I can do for them today, not in 5-10 years. There’s enough to keep up on that’s relevant to current practice as it is.

Research in medicine is obviously crucial, since what we do is based on it. There is a lot of interesting and potentially game-changing research out there. But medical literature is full of small studies that show promise for something only to be shot down when larger investigations are done. It’s not practical or even good medicine to make treatment decisions based on small-scale preliminary data and anecdotal reports.

Even the oft-cited “green journal” – Neurology – isn’t on my reading list. I admit that it has its share of practical knowledge, but the last time I read it, the majority of pages were devoted to research that was promising, though not imminently applicable to patient care. That’s not for me.

Time is always at a premium in modern life. There’s no shortage of journals and interesting research to peruse, and so I try to stay with what’s practical for both me and my patients. I’ll leave the research to those who are good at it, and do my best to support the people who come to my office every day.

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

Keeping up on medical literature is never easy. Time is limited between work and family. It’s often hard to know what to read. Most journals are a combination of research and practical information.

I’m not an academic and never will be. I have nothing against my colleagues who are, but it’s just not my personality type. I’m a happy-to-see-patients-all-day type of doctor.

I try to stick with reading things that have an immediate impact on how I practice: review articles, information about new diagnostic procedures and treatments, and news about the economics of medicine. That’s about it. If I can’t use it now or in the immediate future, it’s not relevant to my practice. My patients want to know what I can do for them today, not in 5-10 years. There’s enough to keep up on that’s relevant to current practice as it is.

Research in medicine is obviously crucial, since what we do is based on it. There is a lot of interesting and potentially game-changing research out there. But medical literature is full of small studies that show promise for something only to be shot down when larger investigations are done. It’s not practical or even good medicine to make treatment decisions based on small-scale preliminary data and anecdotal reports.

Even the oft-cited “green journal” – Neurology – isn’t on my reading list. I admit that it has its share of practical knowledge, but the last time I read it, the majority of pages were devoted to research that was promising, though not imminently applicable to patient care. That’s not for me.

Time is always at a premium in modern life. There’s no shortage of journals and interesting research to peruse, and so I try to stay with what’s practical for both me and my patients. I’ll leave the research to those who are good at it, and do my best to support the people who come to my office every day.

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

Keeping up on medical literature is never easy. Time is limited between work and family. It’s often hard to know what to read. Most journals are a combination of research and practical information.

I’m not an academic and never will be. I have nothing against my colleagues who are, but it’s just not my personality type. I’m a happy-to-see-patients-all-day type of doctor.

I try to stick with reading things that have an immediate impact on how I practice: review articles, information about new diagnostic procedures and treatments, and news about the economics of medicine. That’s about it. If I can’t use it now or in the immediate future, it’s not relevant to my practice. My patients want to know what I can do for them today, not in 5-10 years. There’s enough to keep up on that’s relevant to current practice as it is.

Research in medicine is obviously crucial, since what we do is based on it. There is a lot of interesting and potentially game-changing research out there. But medical literature is full of small studies that show promise for something only to be shot down when larger investigations are done. It’s not practical or even good medicine to make treatment decisions based on small-scale preliminary data and anecdotal reports.

Even the oft-cited “green journal” – Neurology – isn’t on my reading list. I admit that it has its share of practical knowledge, but the last time I read it, the majority of pages were devoted to research that was promising, though not imminently applicable to patient care. That’s not for me.

Time is always at a premium in modern life. There’s no shortage of journals and interesting research to peruse, and so I try to stay with what’s practical for both me and my patients. I’ll leave the research to those who are good at it, and do my best to support the people who come to my office every day.

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

Like everyone else’s grandmother, mine gave me all kinds of advice while I was growing up. Some tips I still remember.

One came when I was home for Thanksgiving during my first year of medical school. She was frustrated over her recent visit to an internist. He kept ordering more tests but wouldn’t answer questions about what might be causing her symptoms.

She told me that, if I didn’t know what was going on, to just say so. As a patient, she felt that an honest answer was better than silence.

Today, as a doctor, I agree with her. So, while I may still be doing tests to crack the case, I have no problem, when asked what I think is going on, with saying “I don’t know.”

This approach isn’t perfect for everyone. Some docs (and patients) may see it as a sign of incompetence or weakness, thinking that admitting fallibility is a breach of the relationship or that with some tests the doctor becomes omniscient. Of course, that’s far from the truth.

In my experience, patients prefer the honesty of my saying “I don’t know.” I’m not saying I’ll never know, I’m just saying that, at present, I’m still looking for the answer.

Nobody likes being in the dark about their health, but at the same time they don’t want to feel their doctor is keeping a secret from them. By making it clear that I’m not, I’m hoping to keep a strong therapeutic relationship. I promise them that when I know, they’ll know, and that I’m honest when stumped. If I need to refer elsewhere for an answer, I have no problem doing that. Medicine, and neurology in particular, is a complex field. If every diagnosis were a slam-dunk, we wouldn’t need specialists and subspecialists (and even subsubspecialists).

Most people know and understand that, recognize the inherent uncertainty of this job, and know that I don’t know. I promise them that “I don’t know” doesn’t mean I’m done looking, it just means I’m going to keep trying. That’s the best anyone can do. Right, Granny?

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

Like everyone else’s grandmother, mine gave me all kinds of advice while I was growing up. Some tips I still remember.

One came when I was home for Thanksgiving during my first year of medical school. She was frustrated over her recent visit to an internist. He kept ordering more tests but wouldn’t answer questions about what might be causing her symptoms.

She told me that, if I didn’t know what was going on, to just say so. As a patient, she felt that an honest answer was better than silence.

Today, as a doctor, I agree with her. So, while I may still be doing tests to crack the case, I have no problem, when asked what I think is going on, with saying “I don’t know.”

This approach isn’t perfect for everyone. Some docs (and patients) may see it as a sign of incompetence or weakness, thinking that admitting fallibility is a breach of the relationship or that with some tests the doctor becomes omniscient. Of course, that’s far from the truth.

In my experience, patients prefer the honesty of my saying “I don’t know.” I’m not saying I’ll never know, I’m just saying that, at present, I’m still looking for the answer.

Nobody likes being in the dark about their health, but at the same time they don’t want to feel their doctor is keeping a secret from them. By making it clear that I’m not, I’m hoping to keep a strong therapeutic relationship. I promise them that when I know, they’ll know, and that I’m honest when stumped. If I need to refer elsewhere for an answer, I have no problem doing that. Medicine, and neurology in particular, is a complex field. If every diagnosis were a slam-dunk, we wouldn’t need specialists and subspecialists (and even subsubspecialists).

Most people know and understand that, recognize the inherent uncertainty of this job, and know that I don’t know. I promise them that “I don’t know” doesn’t mean I’m done looking, it just means I’m going to keep trying. That’s the best anyone can do. Right, Granny?

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

Like everyone else’s grandmother, mine gave me all kinds of advice while I was growing up. Some tips I still remember.

One came when I was home for Thanksgiving during my first year of medical school. She was frustrated over her recent visit to an internist. He kept ordering more tests but wouldn’t answer questions about what might be causing her symptoms.

She told me that, if I didn’t know what was going on, to just say so. As a patient, she felt that an honest answer was better than silence.

Today, as a doctor, I agree with her. So, while I may still be doing tests to crack the case, I have no problem, when asked what I think is going on, with saying “I don’t know.”

This approach isn’t perfect for everyone. Some docs (and patients) may see it as a sign of incompetence or weakness, thinking that admitting fallibility is a breach of the relationship or that with some tests the doctor becomes omniscient. Of course, that’s far from the truth.

In my experience, patients prefer the honesty of my saying “I don’t know.” I’m not saying I’ll never know, I’m just saying that, at present, I’m still looking for the answer.

Nobody likes being in the dark about their health, but at the same time they don’t want to feel their doctor is keeping a secret from them. By making it clear that I’m not, I’m hoping to keep a strong therapeutic relationship. I promise them that when I know, they’ll know, and that I’m honest when stumped. If I need to refer elsewhere for an answer, I have no problem doing that. Medicine, and neurology in particular, is a complex field. If every diagnosis were a slam-dunk, we wouldn’t need specialists and subspecialists (and even subsubspecialists).

Most people know and understand that, recognize the inherent uncertainty of this job, and know that I don’t know. I promise them that “I don’t know” doesn’t mean I’m done looking, it just means I’m going to keep trying. That’s the best anyone can do. Right, Granny?

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

When did some doctors become so wishy-washy?

A large part of what we do is guide people through an often-confusing maze of test results and treatment options. I respect patients’ right to make their own decisions, but it came as a surprise to me to find that some doctors are turning such things over to the patients. After all, doctors are the ones who went through over a decade of training to understand the risks, benefits, and goals of each step for them. Granted, I live in Arizona, where you don’t need a doctor’s order to have labs done. You can research whatever you want on Google, decide what work-up you need, and go get whatever labs you want done.

But back to my original point. Recently, one of my patients was admitted to the hospital, then followed up with me in the office. I looked through his test results and told him what I felt the next step should be, ordered a few things, and wrote an instruction sheet to start daily aspirin. I commented that it surprised me the last hadn’t been done as an inpatient.

His answer? “They said I could if I wanted to, but didn’t make a clear suggestion.” I figured this was a simple miscommunication, so I pulled up the hospital chart on my computer. There I found a note from the attending that said, “The patient was told he may or may not want to take a daily aspirin, and that doing so might or might not be to his benefit.” What on Earth?

I understand there are no guarantees in this job. There’s no crystal ball to know for sure that what we’re doing is right. Any drug can cause serious and unexpected complications. We take calculated risks and hope we come out ahead. But to phrase it like this? Where the patient isn’t given the guidance we’re supposed to provide? What’s the point of even being a doctor?

Since then, I’ve noticed similar phrasing in other charts: “We discussed doing a brain MRI, and she’ll let me know what she decides” and “I told her that starting Lamictal may or may not prevent seizures, and to consider it as something she should or shouldn’t do.”

I’m sure some of it is part of the hurried flight-of-ideas dictations we all do when we’re busy at the hospital. There’s also a component of legalese to make sure that we documented discussing risks with the patient.

But I still don’t get the ambivalence. In similar situations, I provide guidance and advice and tell people what I think they should do. I’m not going to force anyone to do anything they don’t want to. If they disagree, I note it and make whatever suggestions I think will help. In the end, it’s their decision. I get that.

When I take my car to get fixed, I don’t want the mechanic to tell me what may or may not need to be repaired, and I hope patients see me the same way.

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

When did some doctors become so wishy-washy?

A large part of what we do is guide people through an often-confusing maze of test results and treatment options. I respect patients’ right to make their own decisions, but it came as a surprise to me to find that some doctors are turning such things over to the patients. After all, doctors are the ones who went through over a decade of training to understand the risks, benefits, and goals of each step for them. Granted, I live in Arizona, where you don’t need a doctor’s order to have labs done. You can research whatever you want on Google, decide what work-up you need, and go get whatever labs you want done.

But back to my original point. Recently, one of my patients was admitted to the hospital, then followed up with me in the office. I looked through his test results and told him what I felt the next step should be, ordered a few things, and wrote an instruction sheet to start daily aspirin. I commented that it surprised me the last hadn’t been done as an inpatient.

His answer? “They said I could if I wanted to, but didn’t make a clear suggestion.” I figured this was a simple miscommunication, so I pulled up the hospital chart on my computer. There I found a note from the attending that said, “The patient was told he may or may not want to take a daily aspirin, and that doing so might or might not be to his benefit.” What on Earth?

I understand there are no guarantees in this job. There’s no crystal ball to know for sure that what we’re doing is right. Any drug can cause serious and unexpected complications. We take calculated risks and hope we come out ahead. But to phrase it like this? Where the patient isn’t given the guidance we’re supposed to provide? What’s the point of even being a doctor?

Since then, I’ve noticed similar phrasing in other charts: “We discussed doing a brain MRI, and she’ll let me know what she decides” and “I told her that starting Lamictal may or may not prevent seizures, and to consider it as something she should or shouldn’t do.”

I’m sure some of it is part of the hurried flight-of-ideas dictations we all do when we’re busy at the hospital. There’s also a component of legalese to make sure that we documented discussing risks with the patient.

But I still don’t get the ambivalence. In similar situations, I provide guidance and advice and tell people what I think they should do. I’m not going to force anyone to do anything they don’t want to. If they disagree, I note it and make whatever suggestions I think will help. In the end, it’s their decision. I get that.

When I take my car to get fixed, I don’t want the mechanic to tell me what may or may not need to be repaired, and I hope patients see me the same way.

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

When did some doctors become so wishy-washy?

A large part of what we do is guide people through an often-confusing maze of test results and treatment options. I respect patients’ right to make their own decisions, but it came as a surprise to me to find that some doctors are turning such things over to the patients. After all, doctors are the ones who went through over a decade of training to understand the risks, benefits, and goals of each step for them. Granted, I live in Arizona, where you don’t need a doctor’s order to have labs done. You can research whatever you want on Google, decide what work-up you need, and go get whatever labs you want done.

But back to my original point. Recently, one of my patients was admitted to the hospital, then followed up with me in the office. I looked through his test results and told him what I felt the next step should be, ordered a few things, and wrote an instruction sheet to start daily aspirin. I commented that it surprised me the last hadn’t been done as an inpatient.

His answer? “They said I could if I wanted to, but didn’t make a clear suggestion.” I figured this was a simple miscommunication, so I pulled up the hospital chart on my computer. There I found a note from the attending that said, “The patient was told he may or may not want to take a daily aspirin, and that doing so might or might not be to his benefit.” What on Earth?

I understand there are no guarantees in this job. There’s no crystal ball to know for sure that what we’re doing is right. Any drug can cause serious and unexpected complications. We take calculated risks and hope we come out ahead. But to phrase it like this? Where the patient isn’t given the guidance we’re supposed to provide? What’s the point of even being a doctor?

Since then, I’ve noticed similar phrasing in other charts: “We discussed doing a brain MRI, and she’ll let me know what she decides” and “I told her that starting Lamictal may or may not prevent seizures, and to consider it as something she should or shouldn’t do.”

I’m sure some of it is part of the hurried flight-of-ideas dictations we all do when we’re busy at the hospital. There’s also a component of legalese to make sure that we documented discussing risks with the patient.

But I still don’t get the ambivalence. In similar situations, I provide guidance and advice and tell people what I think they should do. I’m not going to force anyone to do anything they don’t want to. If they disagree, I note it and make whatever suggestions I think will help. In the end, it’s their decision. I get that.

When I take my car to get fixed, I don’t want the mechanic to tell me what may or may not need to be repaired, and I hope patients see me the same way.

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

Patients are often impatient. They want answers.

To some extent, I can’t blame them. When it’s your disease, you want to know what’s going on and what you can do about it. So I try to keep on top of results as they come in and have my staff contact people to relay the news.

The problem is that medicine (like life) does not provide immediate gratification. It takes time to get routine labs back, and some (such as send-outs) can even take a few weeks.

Radiology reports usually have a 24-hour turnaround, and radiologists will call me if they find something urgent. Yet, it’s amazing how many people will call for results before they even leave that facility.

Did it always used to be like this? Were people always this demanding of immediate answers and test results from their doctors?

We live in a world that gets faster and faster, and people get used to things happening quickly. It’s an age of instant gratification, and having to wait for test results seems silly to laypeople. After all, don’t TV medical shows have results coming back quickly, gleaming advanced scanners, and the machine that goes “ping”? So why doesn’t that happen when you visit a doctor in real life?

Of course, I could get the results faster. I could order everything STAT and abuse the privilege ... but crying wolf only works a few times, and then you can’t do it when you really need it. I could call the radiologists for verbal MRI reads ... but then I’m taking their time away from more urgent cases, and other patients with more concerning issues are affected. So I don’t do that routinely, either.

Even people in slow-moving lines of work can have trouble grasping that medicine is the same way. I tell them we’ll call them when we get results, and try to stay on top of things. I admit sometimes things may slip through, and they’re right to call and ask.

Most patients understand this, and are, well, patient. I just wish more were. It would save a lot of time, effort, and frustration for all involved, including them.

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

Patients are often impatient. They want answers.

To some extent, I can’t blame them. When it’s your disease, you want to know what’s going on and what you can do about it. So I try to keep on top of results as they come in and have my staff contact people to relay the news.

The problem is that medicine (like life) does not provide immediate gratification. It takes time to get routine labs back, and some (such as send-outs) can even take a few weeks.

Radiology reports usually have a 24-hour turnaround, and radiologists will call me if they find something urgent. Yet, it’s amazing how many people will call for results before they even leave that facility.

Did it always used to be like this? Were people always this demanding of immediate answers and test results from their doctors?

We live in a world that gets faster and faster, and people get used to things happening quickly. It’s an age of instant gratification, and having to wait for test results seems silly to laypeople. After all, don’t TV medical shows have results coming back quickly, gleaming advanced scanners, and the machine that goes “ping”? So why doesn’t that happen when you visit a doctor in real life?

Of course, I could get the results faster. I could order everything STAT and abuse the privilege ... but crying wolf only works a few times, and then you can’t do it when you really need it. I could call the radiologists for verbal MRI reads ... but then I’m taking their time away from more urgent cases, and other patients with more concerning issues are affected. So I don’t do that routinely, either.

Even people in slow-moving lines of work can have trouble grasping that medicine is the same way. I tell them we’ll call them when we get results, and try to stay on top of things. I admit sometimes things may slip through, and they’re right to call and ask.

Most patients understand this, and are, well, patient. I just wish more were. It would save a lot of time, effort, and frustration for all involved, including them.

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

Patients are often impatient. They want answers.

To some extent, I can’t blame them. When it’s your disease, you want to know what’s going on and what you can do about it. So I try to keep on top of results as they come in and have my staff contact people to relay the news.

The problem is that medicine (like life) does not provide immediate gratification. It takes time to get routine labs back, and some (such as send-outs) can even take a few weeks.

Radiology reports usually have a 24-hour turnaround, and radiologists will call me if they find something urgent. Yet, it’s amazing how many people will call for results before they even leave that facility.

Did it always used to be like this? Were people always this demanding of immediate answers and test results from their doctors?

We live in a world that gets faster and faster, and people get used to things happening quickly. It’s an age of instant gratification, and having to wait for test results seems silly to laypeople. After all, don’t TV medical shows have results coming back quickly, gleaming advanced scanners, and the machine that goes “ping”? So why doesn’t that happen when you visit a doctor in real life?

Of course, I could get the results faster. I could order everything STAT and abuse the privilege ... but crying wolf only works a few times, and then you can’t do it when you really need it. I could call the radiologists for verbal MRI reads ... but then I’m taking their time away from more urgent cases, and other patients with more concerning issues are affected. So I don’t do that routinely, either.

Even people in slow-moving lines of work can have trouble grasping that medicine is the same way. I tell them we’ll call them when we get results, and try to stay on top of things. I admit sometimes things may slip through, and they’re right to call and ask.

Most patients understand this, and are, well, patient. I just wish more were. It would save a lot of time, effort, and frustration for all involved, including them.

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

How often do you encounter phantom appointments?

What are phantom appointments? They’re patient visits that are nowhere on your schedule.

I’m not talking about someone who shows up on the wrong day or time. That’s at least partially understandable. I’m talking about people who you have no record of but say they have an appointment.

The first impression is to assume they’re scheduled with someone else in the building or another neurologist in my area, but they’ll often pull out a crumpled sheet of paper with my name and address on it, and a time circled.

Where on Earth do these people come from? I have no clue. When asked who made the appointment, it’s always “They made it for me,” or “They told me to be here.” It’s never clear who “they” are. These folks almost never can give you the name of their referring doctor, or who they spoke to. I’m a pretty small office here, just me and my secretary, so there aren’t many people here to talk to.

These aren’t common, maybe a handful per year, but generally unpleasant when they occur. If they happen to show up when I’ve got a gap in the schedule, I’ll try to see them, but the majority end up being turned away. We always offer to make an appointment for them, but most leave, usually angry.

I suspect some were referred for cognitive issues, which partially explains the confusion. Others may be doing it intentionally, hoping that they’ll be seen. (I suspect these are the minority.) Misinterpreted information from other offices likely plays a big part. Perhaps they were given my name and info by another office and told to make an appointment. Somehow, a time for something else got mixed in on the same sheet … and they show up here.

Although they are a minor annoyance on the scale of daily office goings-on, these patients are still a problem. Most are angry and frustrated, as they want to see me. Some are willing to schedule an appointment, but most aren’t. The awkward situation interrupts the routine flow of check-ins and phone calls, and it certainly isn’t something anyone waiting in the lobby wants to overhear. Oftentimes, I have to go up front to handle it, taking me away from a patient. In cases when the patient was referred by another doctor, they might call that office to complain.

It’s a losing situation for all involved. I wish there was some way to prevent them, but their uncertain nature makes it impossible.

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

How often do you encounter phantom appointments?

What are phantom appointments? They’re patient visits that are nowhere on your schedule.

I’m not talking about someone who shows up on the wrong day or time. That’s at least partially understandable. I’m talking about people who you have no record of but say they have an appointment.

The first impression is to assume they’re scheduled with someone else in the building or another neurologist in my area, but they’ll often pull out a crumpled sheet of paper with my name and address on it, and a time circled.

Where on Earth do these people come from? I have no clue. When asked who made the appointment, it’s always “They made it for me,” or “They told me to be here.” It’s never clear who “they” are. These folks almost never can give you the name of their referring doctor, or who they spoke to. I’m a pretty small office here, just me and my secretary, so there aren’t many people here to talk to.

These aren’t common, maybe a handful per year, but generally unpleasant when they occur. If they happen to show up when I’ve got a gap in the schedule, I’ll try to see them, but the majority end up being turned away. We always offer to make an appointment for them, but most leave, usually angry.

I suspect some were referred for cognitive issues, which partially explains the confusion. Others may be doing it intentionally, hoping that they’ll be seen. (I suspect these are the minority.) Misinterpreted information from other offices likely plays a big part. Perhaps they were given my name and info by another office and told to make an appointment. Somehow, a time for something else got mixed in on the same sheet … and they show up here.

Although they are a minor annoyance on the scale of daily office goings-on, these patients are still a problem. Most are angry and frustrated, as they want to see me. Some are willing to schedule an appointment, but most aren’t. The awkward situation interrupts the routine flow of check-ins and phone calls, and it certainly isn’t something anyone waiting in the lobby wants to overhear. Oftentimes, I have to go up front to handle it, taking me away from a patient. In cases when the patient was referred by another doctor, they might call that office to complain.

It’s a losing situation for all involved. I wish there was some way to prevent them, but their uncertain nature makes it impossible.

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

How often do you encounter phantom appointments?

What are phantom appointments? They’re patient visits that are nowhere on your schedule.

I’m not talking about someone who shows up on the wrong day or time. That’s at least partially understandable. I’m talking about people who you have no record of but say they have an appointment.

The first impression is to assume they’re scheduled with someone else in the building or another neurologist in my area, but they’ll often pull out a crumpled sheet of paper with my name and address on it, and a time circled.

Where on Earth do these people come from? I have no clue. When asked who made the appointment, it’s always “They made it for me,” or “They told me to be here.” It’s never clear who “they” are. These folks almost never can give you the name of their referring doctor, or who they spoke to. I’m a pretty small office here, just me and my secretary, so there aren’t many people here to talk to.

These aren’t common, maybe a handful per year, but generally unpleasant when they occur. If they happen to show up when I’ve got a gap in the schedule, I’ll try to see them, but the majority end up being turned away. We always offer to make an appointment for them, but most leave, usually angry.

I suspect some were referred for cognitive issues, which partially explains the confusion. Others may be doing it intentionally, hoping that they’ll be seen. (I suspect these are the minority.) Misinterpreted information from other offices likely plays a big part. Perhaps they were given my name and info by another office and told to make an appointment. Somehow, a time for something else got mixed in on the same sheet … and they show up here.

Although they are a minor annoyance on the scale of daily office goings-on, these patients are still a problem. Most are angry and frustrated, as they want to see me. Some are willing to schedule an appointment, but most aren’t. The awkward situation interrupts the routine flow of check-ins and phone calls, and it certainly isn’t something anyone waiting in the lobby wants to overhear. Oftentimes, I have to go up front to handle it, taking me away from a patient. In cases when the patient was referred by another doctor, they might call that office to complain.

It’s a losing situation for all involved. I wish there was some way to prevent them, but their uncertain nature makes it impossible.

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