Hitting a Nerve

I am, apparently, not a very good doctor. At least, that’s what some mailings I get from insurance companies make me think.

You probably get the same ones. They tell me what guidelines I’m not following or drug interactions I’m not mindful of. I suppose I should be grateful for their efforts to protect patients.

Letters I’ve gotten in the last week have reminded me that:

• Patients with elevated fasting blood sugars should be started on metformin.

• A lady on Eliquis (apixaban) after developing a deep-vein thrombosis should be considered for a less costly alternative, such as warfarin, to help her save money.

• An antihypertensive agent is recommended for a young man with persistently elevated blood pressures.

• An older gentleman’s lipid-lowering agent may interfere with his diabetes medication.

What do these have to do with anything that I, as a neurologist, am doing for the patient? Nothing.

Why are they being sent to me, as opposed to an internist or cardiologist? I have no idea. Of course, for all I know, the other docs might be getting recommendations on how to manage Parkinson’s disease or multiple sclerosis.

The insurance companies pay the bills. They obviously know which doctors are seeing who and prescribing what. Their billing systems track who practices what specialty. If I were to try submitting a claim for pulmonary evaluation, I’m sure they’d immediately notice and deny it.

So why can’t they get this straight? It seems like a big waste of time, paper, and postage all around.

On rare occasions, they actually get it right … sort of. About a month ago, I received a letter about a migraine patient, telling me that, for those with frequent migraines, a preventive medication should be considered. It even listed her current prescriptions to help me understand.

I absolutely agree with the letter, but it completely ignored that her medication list already included topiramate and nortriptyline, both commonly used for migraine prophylaxis. Since she has no other reason to be on either, I have no idea why they thought I’d use them. These kinds of notes all end with some generic comment that these are just suggestions, and only I and my patient can make the correct decisions about treatment, etc. etc.

That letter may be well intentioned, perhaps, but it is also inaccurate, unnecessary, and – to me – even a little demeaning. If you don’t think I know what I’m doing, then why are you sending patients to me? Maybe the software you’re using to screen charts and send these letters should open its own practice instead.

If the real goal of these letters is to save money (and we all know it is), then why is the company wasting it on redundant and inaccurate letters, usually not even sent to the correct doctor?

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

I am, apparently, not a very good doctor. At least, that’s what some mailings I get from insurance companies make me think.

You probably get the same ones. They tell me what guidelines I’m not following or drug interactions I’m not mindful of. I suppose I should be grateful for their efforts to protect patients.

Letters I’ve gotten in the last week have reminded me that:

• Patients with elevated fasting blood sugars should be started on metformin.

• A lady on Eliquis (apixaban) after developing a deep-vein thrombosis should be considered for a less costly alternative, such as warfarin, to help her save money.

• An antihypertensive agent is recommended for a young man with persistently elevated blood pressures.

• An older gentleman’s lipid-lowering agent may interfere with his diabetes medication.

What do these have to do with anything that I, as a neurologist, am doing for the patient? Nothing.

Why are they being sent to me, as opposed to an internist or cardiologist? I have no idea. Of course, for all I know, the other docs might be getting recommendations on how to manage Parkinson’s disease or multiple sclerosis.

The insurance companies pay the bills. They obviously know which doctors are seeing who and prescribing what. Their billing systems track who practices what specialty. If I were to try submitting a claim for pulmonary evaluation, I’m sure they’d immediately notice and deny it.

So why can’t they get this straight? It seems like a big waste of time, paper, and postage all around.

On rare occasions, they actually get it right … sort of. About a month ago, I received a letter about a migraine patient, telling me that, for those with frequent migraines, a preventive medication should be considered. It even listed her current prescriptions to help me understand.

I absolutely agree with the letter, but it completely ignored that her medication list already included topiramate and nortriptyline, both commonly used for migraine prophylaxis. Since she has no other reason to be on either, I have no idea why they thought I’d use them. These kinds of notes all end with some generic comment that these are just suggestions, and only I and my patient can make the correct decisions about treatment, etc. etc.

That letter may be well intentioned, perhaps, but it is also inaccurate, unnecessary, and – to me – even a little demeaning. If you don’t think I know what I’m doing, then why are you sending patients to me? Maybe the software you’re using to screen charts and send these letters should open its own practice instead.

If the real goal of these letters is to save money (and we all know it is), then why is the company wasting it on redundant and inaccurate letters, usually not even sent to the correct doctor?

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

I am, apparently, not a very good doctor. At least, that’s what some mailings I get from insurance companies make me think.

You probably get the same ones. They tell me what guidelines I’m not following or drug interactions I’m not mindful of. I suppose I should be grateful for their efforts to protect patients.

Letters I’ve gotten in the last week have reminded me that:

• Patients with elevated fasting blood sugars should be started on metformin.

• A lady on Eliquis (apixaban) after developing a deep-vein thrombosis should be considered for a less costly alternative, such as warfarin, to help her save money.

• An antihypertensive agent is recommended for a young man with persistently elevated blood pressures.

• An older gentleman’s lipid-lowering agent may interfere with his diabetes medication.

What do these have to do with anything that I, as a neurologist, am doing for the patient? Nothing.

Why are they being sent to me, as opposed to an internist or cardiologist? I have no idea. Of course, for all I know, the other docs might be getting recommendations on how to manage Parkinson’s disease or multiple sclerosis.

The insurance companies pay the bills. They obviously know which doctors are seeing who and prescribing what. Their billing systems track who practices what specialty. If I were to try submitting a claim for pulmonary evaluation, I’m sure they’d immediately notice and deny it.

So why can’t they get this straight? It seems like a big waste of time, paper, and postage all around.

On rare occasions, they actually get it right … sort of. About a month ago, I received a letter about a migraine patient, telling me that, for those with frequent migraines, a preventive medication should be considered. It even listed her current prescriptions to help me understand.

I absolutely agree with the letter, but it completely ignored that her medication list already included topiramate and nortriptyline, both commonly used for migraine prophylaxis. Since she has no other reason to be on either, I have no idea why they thought I’d use them. These kinds of notes all end with some generic comment that these are just suggestions, and only I and my patient can make the correct decisions about treatment, etc. etc.

That letter may be well intentioned, perhaps, but it is also inaccurate, unnecessary, and – to me – even a little demeaning. If you don’t think I know what I’m doing, then why are you sending patients to me? Maybe the software you’re using to screen charts and send these letters should open its own practice instead.

If the real goal of these letters is to save money (and we all know it is), then why is the company wasting it on redundant and inaccurate letters, usually not even sent to the correct doctor?

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

I am, apparently, not a very good doctor. At least, that’s what some mailings I get from insurance companies make me think.

You probably get the same ones. They tell me what guidelines I’m not following or drug interactions I’m not mindful of. I suppose I should be grateful for their efforts to protect patients.

Letters I’ve gotten in the last week have reminded me that:

• Patients with elevated fasting blood sugars should be started on metformin.

• A lady on Eliquis (apixaban) after developing a deep-vein thrombosis should be considered for a less costly alternative, such as warfarin, to help her save money.

• An antihypertensive agent is recommended for a young man with persistently elevated blood pressures.

• An older gentleman’s lipid-lowering agent may interfere with his diabetes medication.

What do these have to do with anything that I, as a neurologist, am doing for the patient? Nothing.

Why are they being sent to me, as opposed to an internist or cardiologist? I have no idea. Of course, for all I know, the other docs might be getting recommendations on how to manage Parkinson’s disease or multiple sclerosis.

The insurance companies pay the bills. They obviously know which doctors are seeing who and prescribing what. Their billing systems track who practices what specialty. If I were to try submitting a claim for pulmonary evaluation, I’m sure they’d immediately notice and deny it.

So why can’t they get this straight? It seems like a big waste of time, paper, and postage all around.

On rare occasions, they actually get it right … sort of. About a month ago, I received a letter about a migraine patient, telling me that, for those with frequent migraines, a preventive medication should be considered. It even listed her current prescriptions to help me understand.

I absolutely agree with the letter, but it completely ignored that her medication list already included topiramate and nortriptyline, both commonly used for migraine prophylaxis. Since she has no other reason to be on either, I have no idea why they thought I’d use them. These kinds of notes all end with some generic comment that these are just suggestions, and only I and my patient can make the correct decisions about treatment, etc. etc.

That letter may be well intentioned, perhaps, but it is also inaccurate, unnecessary, and – to me – even a little demeaning. If you don’t think I know what I’m doing, then why are you sending patients to me? Maybe the software you’re using to screen charts and send these letters should open its own practice instead.

If the real goal of these letters is to save money (and we all know it is), then why is the company wasting it on redundant and inaccurate letters, usually not even sent to the correct doctor?

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

I am, apparently, not a very good doctor. At least, that’s what some mailings I get from insurance companies make me think.

You probably get the same ones. They tell me what guidelines I’m not following or drug interactions I’m not mindful of. I suppose I should be grateful for their efforts to protect patients.

Letters I’ve gotten in the last week have reminded me that:

• Patients with elevated fasting blood sugars should be started on metformin.

• A lady on Eliquis (apixaban) after developing a deep-vein thrombosis should be considered for a less costly alternative, such as warfarin, to help her save money.

• An antihypertensive agent is recommended for a young man with persistently elevated blood pressures.

• An older gentleman’s lipid-lowering agent may interfere with his diabetes medication.

What do these have to do with anything that I, as a neurologist, am doing for the patient? Nothing.

Why are they being sent to me, as opposed to an internist or cardiologist? I have no idea. Of course, for all I know, the other docs might be getting recommendations on how to manage Parkinson’s disease or multiple sclerosis.

The insurance companies pay the bills. They obviously know which doctors are seeing who and prescribing what. Their billing systems track who practices what specialty. If I were to try submitting a claim for pulmonary evaluation, I’m sure they’d immediately notice and deny it.

So why can’t they get this straight? It seems like a big waste of time, paper, and postage all around.

On rare occasions, they actually get it right … sort of. About a month ago, I received a letter about a migraine patient, telling me that, for those with frequent migraines, a preventive medication should be considered. It even listed her current prescriptions to help me understand.

I absolutely agree with the letter, but it completely ignored that her medication list already included topiramate and nortriptyline, both commonly used for migraine prophylaxis. Since she has no other reason to be on either, I have no idea why they thought I’d use them. These kinds of notes all end with some generic comment that these are just suggestions, and only I and my patient can make the correct decisions about treatment, etc. etc.

That letter may be well intentioned, perhaps, but it is also inaccurate, unnecessary, and – to me – even a little demeaning. If you don’t think I know what I’m doing, then why are you sending patients to me? Maybe the software you’re using to screen charts and send these letters should open its own practice instead.

If the real goal of these letters is to save money (and we all know it is), then why is the company wasting it on redundant and inaccurate letters, usually not even sent to the correct doctor?

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

I am, apparently, not a very good doctor. At least, that’s what some mailings I get from insurance companies make me think.

You probably get the same ones. They tell me what guidelines I’m not following or drug interactions I’m not mindful of. I suppose I should be grateful for their efforts to protect patients.

Letters I’ve gotten in the last week have reminded me that:

• Patients with elevated fasting blood sugars should be started on metformin.

• A lady on Eliquis (apixaban) after developing a deep-vein thrombosis should be considered for a less costly alternative, such as warfarin, to help her save money.

• An antihypertensive agent is recommended for a young man with persistently elevated blood pressures.

• An older gentleman’s lipid-lowering agent may interfere with his diabetes medication.

What do these have to do with anything that I, as a neurologist, am doing for the patient? Nothing.

Why are they being sent to me, as opposed to an internist or cardiologist? I have no idea. Of course, for all I know, the other docs might be getting recommendations on how to manage Parkinson’s disease or multiple sclerosis.

The insurance companies pay the bills. They obviously know which doctors are seeing who and prescribing what. Their billing systems track who practices what specialty. If I were to try submitting a claim for pulmonary evaluation, I’m sure they’d immediately notice and deny it.

So why can’t they get this straight? It seems like a big waste of time, paper, and postage all around.

On rare occasions, they actually get it right … sort of. About a month ago, I received a letter about a migraine patient, telling me that, for those with frequent migraines, a preventive medication should be considered. It even listed her current prescriptions to help me understand.

I absolutely agree with the letter, but it completely ignored that her medication list already included topiramate and nortriptyline, both commonly used for migraine prophylaxis. Since she has no other reason to be on either, I have no idea why they thought I’d use them. These kinds of notes all end with some generic comment that these are just suggestions, and only I and my patient can make the correct decisions about treatment, etc. etc.

That letter may be well intentioned, perhaps, but it is also inaccurate, unnecessary, and – to me – even a little demeaning. If you don’t think I know what I’m doing, then why are you sending patients to me? Maybe the software you’re using to screen charts and send these letters should open its own practice instead.

If the real goal of these letters is to save money (and we all know it is), then why is the company wasting it on redundant and inaccurate letters, usually not even sent to the correct doctor?

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

The photo you see below is a reasonably thick pile of paper, roughly 2 inches high. It’s certainly not as bad as some charts I’ve seen, especially at the VA, but still a lot of pages.

What is it?

This is, believe it or not, the stacked copies of charts we had to print in the last 30 days to fax to insurance companies for billing audits. Yeah – just the last 30 days.

Courtesy Dr. Block

Mind you, to date I don’t have any sort of actual complaints or charges against me for fraudulent billing. If anything, I tend to underbill for fear of risking the ire of insurance companies.

On one level, I understand it. The news is replete with stories of physicians who made fraudulent insurance claims, and the insurance companies want to make sure others are playing fair. Just like security cameras and magnetic tags at retailers, they’re doing what they can to avoid losses. I get that.

On the other hand, this irritates me, and it is a pain in the butt. Someone here has to print up the requested notes, organize them, fill out the accompanying forms, and fax them back. I also have to sign each note in the pile. For the number of charts they typically want, this process takes about 30-45 minutes. Then we fax them, and a 100-plus-page document ties up your office fax for a while. Incoming and outgoing faxes, such as medication refills, get put on hold. Overall, it takes maybe an hour of staff time to do this, not to mention the cost of paper and ink used.

About 25% of the time the company calls us after a few days to say they never got them (even though we have a confirmation). For this reason, we always hold onto the print-out for a month so we don’t have to start over again. Then it all has to be shredded.

In a large practice, I’m sure there are dedicated medical records staff members for this. But in my small solo world it means that someone has to let phones go to voicemail, dictations get delayed, and other work piles up, just so the insurance red tape gets done. Then we have to catch up on the more routine issues of patient care.

I can’t really refuse to send them, either. Doing so, in the insurance company’s mind, would be an admission of guilt that I never saw the patient and my claim is bogus. Then they’ll withhold payment, or ask for a refund.

This is, regrettably, a case where a few bad apples – docs filing bogus claims – have spoiled the entire barrel. Now we’re all guilty of fraud until proven innocent by sending these records. Isn’t that the reverse of the American justice system’s ideal?

I also wonder if there’s an intentional drudgery factor here. By making me do something that’s irritatingly time-wasting, is an insurance plan hoping I’ll drop them because I’m sick of this process? Does having fewer contracted neurologists work out to their benefit? It certainly isn’t to the patient’s advantage.

I don’t have an easy answer. I don’t like the wrench these requests throw into the office routine, but I also know that fraud surveillance is a necessary evil. I just wish there was a less time-consuming way of doing it.

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

The photo you see below is a reasonably thick pile of paper, roughly 2 inches high. It’s certainly not as bad as some charts I’ve seen, especially at the VA, but still a lot of pages.

What is it?

This is, believe it or not, the stacked copies of charts we had to print in the last 30 days to fax to insurance companies for billing audits. Yeah – just the last 30 days.

Courtesy Dr. Block

Mind you, to date I don’t have any sort of actual complaints or charges against me for fraudulent billing. If anything, I tend to underbill for fear of risking the ire of insurance companies.

On one level, I understand it. The news is replete with stories of physicians who made fraudulent insurance claims, and the insurance companies want to make sure others are playing fair. Just like security cameras and magnetic tags at retailers, they’re doing what they can to avoid losses. I get that.

On the other hand, this irritates me, and it is a pain in the butt. Someone here has to print up the requested notes, organize them, fill out the accompanying forms, and fax them back. I also have to sign each note in the pile. For the number of charts they typically want, this process takes about 30-45 minutes. Then we fax them, and a 100-plus-page document ties up your office fax for a while. Incoming and outgoing faxes, such as medication refills, get put on hold. Overall, it takes maybe an hour of staff time to do this, not to mention the cost of paper and ink used.

About 25% of the time the company calls us after a few days to say they never got them (even though we have a confirmation). For this reason, we always hold onto the print-out for a month so we don’t have to start over again. Then it all has to be shredded.

In a large practice, I’m sure there are dedicated medical records staff members for this. But in my small solo world it means that someone has to let phones go to voicemail, dictations get delayed, and other work piles up, just so the insurance red tape gets done. Then we have to catch up on the more routine issues of patient care.

I can’t really refuse to send them, either. Doing so, in the insurance company’s mind, would be an admission of guilt that I never saw the patient and my claim is bogus. Then they’ll withhold payment, or ask for a refund.

This is, regrettably, a case where a few bad apples – docs filing bogus claims – have spoiled the entire barrel. Now we’re all guilty of fraud until proven innocent by sending these records. Isn’t that the reverse of the American justice system’s ideal?

I also wonder if there’s an intentional drudgery factor here. By making me do something that’s irritatingly time-wasting, is an insurance plan hoping I’ll drop them because I’m sick of this process? Does having fewer contracted neurologists work out to their benefit? It certainly isn’t to the patient’s advantage.

I don’t have an easy answer. I don’t like the wrench these requests throw into the office routine, but I also know that fraud surveillance is a necessary evil. I just wish there was a less time-consuming way of doing it.

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

The photo you see below is a reasonably thick pile of paper, roughly 2 inches high. It’s certainly not as bad as some charts I’ve seen, especially at the VA, but still a lot of pages.

What is it?

This is, believe it or not, the stacked copies of charts we had to print in the last 30 days to fax to insurance companies for billing audits. Yeah – just the last 30 days.

Courtesy Dr. Block

Mind you, to date I don’t have any sort of actual complaints or charges against me for fraudulent billing. If anything, I tend to underbill for fear of risking the ire of insurance companies.

On one level, I understand it. The news is replete with stories of physicians who made fraudulent insurance claims, and the insurance companies want to make sure others are playing fair. Just like security cameras and magnetic tags at retailers, they’re doing what they can to avoid losses. I get that.

On the other hand, this irritates me, and it is a pain in the butt. Someone here has to print up the requested notes, organize them, fill out the accompanying forms, and fax them back. I also have to sign each note in the pile. For the number of charts they typically want, this process takes about 30-45 minutes. Then we fax them, and a 100-plus-page document ties up your office fax for a while. Incoming and outgoing faxes, such as medication refills, get put on hold. Overall, it takes maybe an hour of staff time to do this, not to mention the cost of paper and ink used.

About 25% of the time the company calls us after a few days to say they never got them (even though we have a confirmation). For this reason, we always hold onto the print-out for a month so we don’t have to start over again. Then it all has to be shredded.

In a large practice, I’m sure there are dedicated medical records staff members for this. But in my small solo world it means that someone has to let phones go to voicemail, dictations get delayed, and other work piles up, just so the insurance red tape gets done. Then we have to catch up on the more routine issues of patient care.

I can’t really refuse to send them, either. Doing so, in the insurance company’s mind, would be an admission of guilt that I never saw the patient and my claim is bogus. Then they’ll withhold payment, or ask for a refund.

This is, regrettably, a case where a few bad apples – docs filing bogus claims – have spoiled the entire barrel. Now we’re all guilty of fraud until proven innocent by sending these records. Isn’t that the reverse of the American justice system’s ideal?

I also wonder if there’s an intentional drudgery factor here. By making me do something that’s irritatingly time-wasting, is an insurance plan hoping I’ll drop them because I’m sick of this process? Does having fewer contracted neurologists work out to their benefit? It certainly isn’t to the patient’s advantage.

I don’t have an easy answer. I don’t like the wrench these requests throw into the office routine, but I also know that fraud surveillance is a necessary evil. I just wish there was a less time-consuming way of doing it.

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

Registered letters are a pain in the butt.

In the grand scheme of things, they’re a minor nuisance, albeit necessary. Documentation is everything is this job.

So here and there, I stop by the post office on the way home. It’s almost $7 a letter now, so maybe $28 a month, $336 a year. Not a huge sum.

But it’s annoying. It’s money that could be used for other expenses, and 80% of the time, the reason I have to do it is someone isn’t returning a call.

I suspect the scenario is similar in your practice. Patients are due for a follow-up MRI, MR angiography, labs, or whatever. So your staff calls them a few times. If they don’t return the call, you mail them letters. If they don’t respond, you send them registered letters. That way, even if they never respond, you can document that someone at that address got the letter.

Patients have several chances to answer the phone or call my office to schedule or refuse the test before I resort to the letter. But, for whatever reasons, sometimes they ignore them, leaving me with a trip to the post office and $7 down.

About one-third of the time we still never hear back, which is fine if that’s what they want. As long as I get the signed card, I don’t mind. Another third of the time they call to schedule, often wondering why I had to resort to a registered letter. “I got your call and other letter, so why did you send that?” And the others? They call us, usually to say they don’t want the test, or just angry that we sent them a registered letter, or (my favorite) to accuse us of harassing them. Because, you know, I enjoy making the extra trip and cost just to do that.

Unfortunately, the consequences of not doing this are (potentially) worse. In most cases, nothing would happen. But, sooner or later you risk having a medical disaster possibly occur because of whatever you were following. And then, correctly or not, they may blame you and call a lawyer. While it’s not guaranteed protection, it’s helpful to be able to prove, with a signed card, that they got your letter and chose to ignore it.

Is that worth the $7 and extra stop? Absolutely. But still, I wish people would be kind enough to just answer the phone or return a call. If they don’t want to do the study, I’m not offended. I just don’t like wasting time and money because someone won’t pick up a phone.

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

Registered letters are a pain in the butt.

In the grand scheme of things, they’re a minor nuisance, albeit necessary. Documentation is everything is this job.

So here and there, I stop by the post office on the way home. It’s almost $7 a letter now, so maybe $28 a month, $336 a year. Not a huge sum.

But it’s annoying. It’s money that could be used for other expenses, and 80% of the time, the reason I have to do it is someone isn’t returning a call.

I suspect the scenario is similar in your practice. Patients are due for a follow-up MRI, MR angiography, labs, or whatever. So your staff calls them a few times. If they don’t return the call, you mail them letters. If they don’t respond, you send them registered letters. That way, even if they never respond, you can document that someone at that address got the letter.

Patients have several chances to answer the phone or call my office to schedule or refuse the test before I resort to the letter. But, for whatever reasons, sometimes they ignore them, leaving me with a trip to the post office and $7 down.

About one-third of the time we still never hear back, which is fine if that’s what they want. As long as I get the signed card, I don’t mind. Another third of the time they call to schedule, often wondering why I had to resort to a registered letter. “I got your call and other letter, so why did you send that?” And the others? They call us, usually to say they don’t want the test, or just angry that we sent them a registered letter, or (my favorite) to accuse us of harassing them. Because, you know, I enjoy making the extra trip and cost just to do that.

Unfortunately, the consequences of not doing this are (potentially) worse. In most cases, nothing would happen. But, sooner or later you risk having a medical disaster possibly occur because of whatever you were following. And then, correctly or not, they may blame you and call a lawyer. While it’s not guaranteed protection, it’s helpful to be able to prove, with a signed card, that they got your letter and chose to ignore it.

Is that worth the $7 and extra stop? Absolutely. But still, I wish people would be kind enough to just answer the phone or return a call. If they don’t want to do the study, I’m not offended. I just don’t like wasting time and money because someone won’t pick up a phone.

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

Registered letters are a pain in the butt.

In the grand scheme of things, they’re a minor nuisance, albeit necessary. Documentation is everything is this job.

So here and there, I stop by the post office on the way home. It’s almost $7 a letter now, so maybe $28 a month, $336 a year. Not a huge sum.

But it’s annoying. It’s money that could be used for other expenses, and 80% of the time, the reason I have to do it is someone isn’t returning a call.

I suspect the scenario is similar in your practice. Patients are due for a follow-up MRI, MR angiography, labs, or whatever. So your staff calls them a few times. If they don’t return the call, you mail them letters. If they don’t respond, you send them registered letters. That way, even if they never respond, you can document that someone at that address got the letter.

Patients have several chances to answer the phone or call my office to schedule or refuse the test before I resort to the letter. But, for whatever reasons, sometimes they ignore them, leaving me with a trip to the post office and $7 down.

About one-third of the time we still never hear back, which is fine if that’s what they want. As long as I get the signed card, I don’t mind. Another third of the time they call to schedule, often wondering why I had to resort to a registered letter. “I got your call and other letter, so why did you send that?” And the others? They call us, usually to say they don’t want the test, or just angry that we sent them a registered letter, or (my favorite) to accuse us of harassing them. Because, you know, I enjoy making the extra trip and cost just to do that.

Unfortunately, the consequences of not doing this are (potentially) worse. In most cases, nothing would happen. But, sooner or later you risk having a medical disaster possibly occur because of whatever you were following. And then, correctly or not, they may blame you and call a lawyer. While it’s not guaranteed protection, it’s helpful to be able to prove, with a signed card, that they got your letter and chose to ignore it.

Is that worth the $7 and extra stop? Absolutely. But still, I wish people would be kind enough to just answer the phone or return a call. If they don’t want to do the study, I’m not offended. I just don’t like wasting time and money because someone won’t pick up a phone.

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

This summer my daughter spent a week at Astrocamp. She wasn’t allowed to have her phone, so we went a week wondering what she was up to.

Each night the camp staff would upload 200-300 pictures of that day’s activities, so every morning I’d go to their website and scan through them. I’d see her launching rockets, blowing things up, and doing blacksmithing. (I’m not sure how the last got in there, but she came home with a big piece of metal she calls “the brother poker.”)

It took me maybe 5 minutes to go click through all the shots. A few were of just one person, but most were of a group working on something.

While doing so I became fascinated with the brain’s ability to almost instantaneously sort faces into those that were familiar and those that weren’t, picking my daughter out quickly. We all read about these things in training, and see them in practice all the time, but it’s still a marvel when you realize how fast and precise the system is. Even when she was in the background I quickly identified her (although her habitual hat and jacket helped). After seeing other faces just one or two times I quickly recognized them in later pictures, too.

After she got back, we went on a cruise. I’m not prone to seasickness, and it’s impressive how quickly the vestibular system adjusts to the constant motion. The complex four-way rocking as the ship pushes through water quickly fades into the background. The semicircular canals and their input centers in the brain rapidly adjust to the moving world around you.

And when I return to land … the world keeps moving. For 3-4 weeks after a cruise, I continue to have a constant, mild rocking sensation. In my case, the “mal de débarquement” is more interesting than bothersome. Perhaps even a bit relaxing. My brain and vestibular apparatus, after syncing themselves to the constant motion of the ship, have trouble returning to the everyday stability of land. So my home and office slowly roll and pitch around me, gradually decreasing with each passing day.

Even as a doctor who specializes in the brain, its abilities still strike me as something to be marveled at. We take its 2-3 pounds of highly specialized nerve tissue for granted, not noticing its functioning as it guides our every activity (such as writing and reading this article). Yet, some innocuous events of this past summer again reminded me what an amazing thing it is.

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

This summer my daughter spent a week at Astrocamp. She wasn’t allowed to have her phone, so we went a week wondering what she was up to.

Each night the camp staff would upload 200-300 pictures of that day’s activities, so every morning I’d go to their website and scan through them. I’d see her launching rockets, blowing things up, and doing blacksmithing. (I’m not sure how the last got in there, but she came home with a big piece of metal she calls “the brother poker.”)

It took me maybe 5 minutes to go click through all the shots. A few were of just one person, but most were of a group working on something.

While doing so I became fascinated with the brain’s ability to almost instantaneously sort faces into those that were familiar and those that weren’t, picking my daughter out quickly. We all read about these things in training, and see them in practice all the time, but it’s still a marvel when you realize how fast and precise the system is. Even when she was in the background I quickly identified her (although her habitual hat and jacket helped). After seeing other faces just one or two times I quickly recognized them in later pictures, too.

After she got back, we went on a cruise. I’m not prone to seasickness, and it’s impressive how quickly the vestibular system adjusts to the constant motion. The complex four-way rocking as the ship pushes through water quickly fades into the background. The semicircular canals and their input centers in the brain rapidly adjust to the moving world around you.

And when I return to land … the world keeps moving. For 3-4 weeks after a cruise, I continue to have a constant, mild rocking sensation. In my case, the “mal de débarquement” is more interesting than bothersome. Perhaps even a bit relaxing. My brain and vestibular apparatus, after syncing themselves to the constant motion of the ship, have trouble returning to the everyday stability of land. So my home and office slowly roll and pitch around me, gradually decreasing with each passing day.

Even as a doctor who specializes in the brain, its abilities still strike me as something to be marveled at. We take its 2-3 pounds of highly specialized nerve tissue for granted, not noticing its functioning as it guides our every activity (such as writing and reading this article). Yet, some innocuous events of this past summer again reminded me what an amazing thing it is.

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

This summer my daughter spent a week at Astrocamp. She wasn’t allowed to have her phone, so we went a week wondering what she was up to.

Each night the camp staff would upload 200-300 pictures of that day’s activities, so every morning I’d go to their website and scan through them. I’d see her launching rockets, blowing things up, and doing blacksmithing. (I’m not sure how the last got in there, but she came home with a big piece of metal she calls “the brother poker.”)

It took me maybe 5 minutes to go click through all the shots. A few were of just one person, but most were of a group working on something.

While doing so I became fascinated with the brain’s ability to almost instantaneously sort faces into those that were familiar and those that weren’t, picking my daughter out quickly. We all read about these things in training, and see them in practice all the time, but it’s still a marvel when you realize how fast and precise the system is. Even when she was in the background I quickly identified her (although her habitual hat and jacket helped). After seeing other faces just one or two times I quickly recognized them in later pictures, too.

After she got back, we went on a cruise. I’m not prone to seasickness, and it’s impressive how quickly the vestibular system adjusts to the constant motion. The complex four-way rocking as the ship pushes through water quickly fades into the background. The semicircular canals and their input centers in the brain rapidly adjust to the moving world around you.

And when I return to land … the world keeps moving. For 3-4 weeks after a cruise, I continue to have a constant, mild rocking sensation. In my case, the “mal de débarquement” is more interesting than bothersome. Perhaps even a bit relaxing. My brain and vestibular apparatus, after syncing themselves to the constant motion of the ship, have trouble returning to the everyday stability of land. So my home and office slowly roll and pitch around me, gradually decreasing with each passing day.

Even as a doctor who specializes in the brain, its abilities still strike me as something to be marveled at. We take its 2-3 pounds of highly specialized nerve tissue for granted, not noticing its functioning as it guides our every activity (such as writing and reading this article). Yet, some innocuous events of this past summer again reminded me what an amazing thing it is.

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

I’m rich. Aren’t you?

In reality, you’re probably not (depending on what your definition of rich is), and I’m not either.

The problem, unfortunately, is the public perception that all doctors are rich. They see raw numbers, hear about well-publicized cases of criminal medical fraud, read about some world-famous brain surgeon and his 5-million-square-foot house, and immediately figure we’re all rolling in dough.

For most of us, though, that’s far from the norm. We struggle with declining reimbursements and increasing overheads: rent, staff salaries, office supplies, etc. By the time you take the myriad expenses out, there often isn’t much left for us. And, like everyone else, we have mortgages, families to take care of, student loans, and grocery bills. While most of us can still support families and a moderate lifestyle, we sure aren’t rich. When you take time into account (60-70 hours per week), my hourly salary isn’t that high.

Yet, the majority of people don’t see it that way. Granted, we may be in a better financial position than some of our patients, but it still amazes me when they ask me to waive copays or other visit costs. I always say no, and some argue, “But you’re a doctor! You can afford it.” Whether I can or can’t is immaterial. I pay my family’s medical bills in full and on time and would never dream of asking for a discount or freebie for any reason. You let one person skip, then another, then another ... and it starts to add up quickly.

I have several patients who are quite wealthy. I wouldn’t ask them to pay an extra copay “because you can afford it,” but that’s no different from others asking me to waive theirs for the same reason.

I just wish patients would see, or the lay press would show, the reality of finances for a modern-day average doctor. I, personally, am sick of people who still affiliate us with Porsches, two homes, and Wednesday-afternoon golfing. A few of those docs may still be around, but they are a rare exception, not the rule. And I don’t see that changing any time soon.

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

I’m rich. Aren’t you?

In reality, you’re probably not (depending on what your definition of rich is), and I’m not either.

The problem, unfortunately, is the public perception that all doctors are rich. They see raw numbers, hear about well-publicized cases of criminal medical fraud, read about some world-famous brain surgeon and his 5-million-square-foot house, and immediately figure we’re all rolling in dough.

For most of us, though, that’s far from the norm. We struggle with declining reimbursements and increasing overheads: rent, staff salaries, office supplies, etc. By the time you take the myriad expenses out, there often isn’t much left for us. And, like everyone else, we have mortgages, families to take care of, student loans, and grocery bills. While most of us can still support families and a moderate lifestyle, we sure aren’t rich. When you take time into account (60-70 hours per week), my hourly salary isn’t that high.

Yet, the majority of people don’t see it that way. Granted, we may be in a better financial position than some of our patients, but it still amazes me when they ask me to waive copays or other visit costs. I always say no, and some argue, “But you’re a doctor! You can afford it.” Whether I can or can’t is immaterial. I pay my family’s medical bills in full and on time and would never dream of asking for a discount or freebie for any reason. You let one person skip, then another, then another ... and it starts to add up quickly.

I have several patients who are quite wealthy. I wouldn’t ask them to pay an extra copay “because you can afford it,” but that’s no different from others asking me to waive theirs for the same reason.

I just wish patients would see, or the lay press would show, the reality of finances for a modern-day average doctor. I, personally, am sick of people who still affiliate us with Porsches, two homes, and Wednesday-afternoon golfing. A few of those docs may still be around, but they are a rare exception, not the rule. And I don’t see that changing any time soon.

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

I’m rich. Aren’t you?

In reality, you’re probably not (depending on what your definition of rich is), and I’m not either.

The problem, unfortunately, is the public perception that all doctors are rich. They see raw numbers, hear about well-publicized cases of criminal medical fraud, read about some world-famous brain surgeon and his 5-million-square-foot house, and immediately figure we’re all rolling in dough.

For most of us, though, that’s far from the norm. We struggle with declining reimbursements and increasing overheads: rent, staff salaries, office supplies, etc. By the time you take the myriad expenses out, there often isn’t much left for us. And, like everyone else, we have mortgages, families to take care of, student loans, and grocery bills. While most of us can still support families and a moderate lifestyle, we sure aren’t rich. When you take time into account (60-70 hours per week), my hourly salary isn’t that high.

Yet, the majority of people don’t see it that way. Granted, we may be in a better financial position than some of our patients, but it still amazes me when they ask me to waive copays or other visit costs. I always say no, and some argue, “But you’re a doctor! You can afford it.” Whether I can or can’t is immaterial. I pay my family’s medical bills in full and on time and would never dream of asking for a discount or freebie for any reason. You let one person skip, then another, then another ... and it starts to add up quickly.

I have several patients who are quite wealthy. I wouldn’t ask them to pay an extra copay “because you can afford it,” but that’s no different from others asking me to waive theirs for the same reason.

I just wish patients would see, or the lay press would show, the reality of finances for a modern-day average doctor. I, personally, am sick of people who still affiliate us with Porsches, two homes, and Wednesday-afternoon golfing. A few of those docs may still be around, but they are a rare exception, not the rule. And I don’t see that changing any time soon.

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

I prescribe medications. You do, too. It’s part of what we do.

What I don’t do is prescribe meds for other docs, or expect them to prescribe mine.

Seems reasonable, right? Yet, I’ve seen several recent posts on physician gripe boards talking about doctors dodging out on this in a few ways. Some examples follow:

• Specialists who diagnose a patient with epilepsy, and send a note back to the internists suggesting they start Tegretol.

• Internists who want the patient to take a drug for neuropathy, and give them a note to take to the specialist asking them to start Lyrica.

• Specialists who want the internist to manage another field entirely, such as a dermatologist telling the internist what to prescribe for a patient’s diabetes.

Personally, I wouldn’t expect any internist to continue a medication that I started prescribing. If they referred the patient to me, I assume they want me to handle it. If they’d prefer the patient return to them for continuing care of the condition, that’s fine, but I generally figure it’s now my issue.

On the flip side, it always bugs me when someone who’s not in my field tells a patient what they think I should prescribe. Sometimes I agree with the choice, but to me it undermines my relationship with the patient. If you want me to handle the case, then don’t give the patient expectations of what should be used. Otherwise, if I decide to try something else, Mr. Smith feels like he’s been short-changed and may call the internist to complain.

I wouldn’t dream of handing a patient a card that says, “Needs to be started on (Actos/Coreg/amiodarone/whatever),” so am always surprised when they bring a note saying, “Please start Dilantin, I think he has seizures.”

This isn’t, I admit, a common occurrence. In my little world, I can count on one hand the number of times it happens per year, almost always from a physician whom I haven’t previously worked with. My referral sources (hopefully) trust me to handle neurology, and I feel the same way about them to handle other issues.

But it must be happening to others, or it wouldn’t be showing up on Sermo and other sites. I have to wonder about the background mindset. Is it just laziness on the part of other doctors? A reluctance to prescribe, knowing that then you’ll be the one stuck with the prior authorization and refill requests? A paternalistic approach to medicine, where you feel you’re right, and therefore another doc should unquestioningly follow your instructions (if you know what’s best, why refer at all?).

More disturbingly, are a few docs seeing patients as someone else’s problem? I really hope not. I’d like to think that the affront, when present, is simply from a lack of practice experience and/or social skills, and will fade with time. Things that irritate other physicians only end up hurting the patient, which isn’t what we’re here for.

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

I prescribe medications. You do, too. It’s part of what we do.

What I don’t do is prescribe meds for other docs, or expect them to prescribe mine.

Seems reasonable, right? Yet, I’ve seen several recent posts on physician gripe boards talking about doctors dodging out on this in a few ways. Some examples follow:

• Specialists who diagnose a patient with epilepsy, and send a note back to the internists suggesting they start Tegretol.

• Internists who want the patient to take a drug for neuropathy, and give them a note to take to the specialist asking them to start Lyrica.

• Specialists who want the internist to manage another field entirely, such as a dermatologist telling the internist what to prescribe for a patient’s diabetes.

Personally, I wouldn’t expect any internist to continue a medication that I started prescribing. If they referred the patient to me, I assume they want me to handle it. If they’d prefer the patient return to them for continuing care of the condition, that’s fine, but I generally figure it’s now my issue.

On the flip side, it always bugs me when someone who’s not in my field tells a patient what they think I should prescribe. Sometimes I agree with the choice, but to me it undermines my relationship with the patient. If you want me to handle the case, then don’t give the patient expectations of what should be used. Otherwise, if I decide to try something else, Mr. Smith feels like he’s been short-changed and may call the internist to complain.

I wouldn’t dream of handing a patient a card that says, “Needs to be started on (Actos/Coreg/amiodarone/whatever),” so am always surprised when they bring a note saying, “Please start Dilantin, I think he has seizures.”

This isn’t, I admit, a common occurrence. In my little world, I can count on one hand the number of times it happens per year, almost always from a physician whom I haven’t previously worked with. My referral sources (hopefully) trust me to handle neurology, and I feel the same way about them to handle other issues.

But it must be happening to others, or it wouldn’t be showing up on Sermo and other sites. I have to wonder about the background mindset. Is it just laziness on the part of other doctors? A reluctance to prescribe, knowing that then you’ll be the one stuck with the prior authorization and refill requests? A paternalistic approach to medicine, where you feel you’re right, and therefore another doc should unquestioningly follow your instructions (if you know what’s best, why refer at all?).

More disturbingly, are a few docs seeing patients as someone else’s problem? I really hope not. I’d like to think that the affront, when present, is simply from a lack of practice experience and/or social skills, and will fade with time. Things that irritate other physicians only end up hurting the patient, which isn’t what we’re here for.

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

I prescribe medications. You do, too. It’s part of what we do.

What I don’t do is prescribe meds for other docs, or expect them to prescribe mine.

Seems reasonable, right? Yet, I’ve seen several recent posts on physician gripe boards talking about doctors dodging out on this in a few ways. Some examples follow:

• Specialists who diagnose a patient with epilepsy, and send a note back to the internists suggesting they start Tegretol.

• Internists who want the patient to take a drug for neuropathy, and give them a note to take to the specialist asking them to start Lyrica.

• Specialists who want the internist to manage another field entirely, such as a dermatologist telling the internist what to prescribe for a patient’s diabetes.

Personally, I wouldn’t expect any internist to continue a medication that I started prescribing. If they referred the patient to me, I assume they want me to handle it. If they’d prefer the patient return to them for continuing care of the condition, that’s fine, but I generally figure it’s now my issue.

On the flip side, it always bugs me when someone who’s not in my field tells a patient what they think I should prescribe. Sometimes I agree with the choice, but to me it undermines my relationship with the patient. If you want me to handle the case, then don’t give the patient expectations of what should be used. Otherwise, if I decide to try something else, Mr. Smith feels like he’s been short-changed and may call the internist to complain.

I wouldn’t dream of handing a patient a card that says, “Needs to be started on (Actos/Coreg/amiodarone/whatever),” so am always surprised when they bring a note saying, “Please start Dilantin, I think he has seizures.”

This isn’t, I admit, a common occurrence. In my little world, I can count on one hand the number of times it happens per year, almost always from a physician whom I haven’t previously worked with. My referral sources (hopefully) trust me to handle neurology, and I feel the same way about them to handle other issues.

But it must be happening to others, or it wouldn’t be showing up on Sermo and other sites. I have to wonder about the background mindset. Is it just laziness on the part of other doctors? A reluctance to prescribe, knowing that then you’ll be the one stuck with the prior authorization and refill requests? A paternalistic approach to medicine, where you feel you’re right, and therefore another doc should unquestioningly follow your instructions (if you know what’s best, why refer at all?).

More disturbingly, are a few docs seeing patients as someone else’s problem? I really hope not. I’d like to think that the affront, when present, is simply from a lack of practice experience and/or social skills, and will fade with time. Things that irritate other physicians only end up hurting the patient, which isn’t what we’re here for.

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

STAT. It’s often capitalized, I guess to convey urgency. It shouldn’t be, though, since it’s not an acronym. It’s a shortening of the Latin word “statim” meaning “immediately.”

Everyone in health care says it at one time or another, but I find it unsettling how many have no idea, or simply don’t care, what that really means.

To me, it’s that the test you’re ordering is urgent. You need to make a decision based on its results – STAT – to save life and/or limb. The results may make a significant difference in your treatment plan.

I find a lot of people don’t use this as the meaning anymore. They think STAT means “because I’m trying to get the patient out of here before Monday” or “a family is breathing down my neck” or “this is a VIP hospital board donor and I need to be extra nice.”

I’ve had my share of debates with other docs about those meanings, but I still stand by mine. To me, this is like pulling a fire alarm. When you do it, you want people to know you’re serious, and there’s a problem that needs to be addressed urgently.

Medicine, regrettably, has become a field of immediate gratification. Patients want results NOW. I’ve had people call me for results within 10 minutes of leaving an MRI facility or lab, even though I’d told them in advance that turnaround time would be days. Rather than accepting this, many ask that I call the radiologist or otherwise have their results rushed to make it more convenient for them. Of course, if you refuse, they may threaten to give you a bad review on Yelp or other rate-a-doc sites.

Some doctors are the same way. A syncope patient is stable, but needs to have a STAT EEG over the weekend so they can be sent home within the 24-hour observation window. It might be possible to send the patient out and get the study as an outpatient, but then they might not have it done, or another neurologist might get the billing. So better to pay the EEG tech overtime and have it done STAT.

Like the boy who cried wolf, STAT has become so commonplace at some hospitals as to be meaningless. Which only hurts the patients who legitimately need urgent studies.

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

STAT. It’s often capitalized, I guess to convey urgency. It shouldn’t be, though, since it’s not an acronym. It’s a shortening of the Latin word “statim” meaning “immediately.”

Everyone in health care says it at one time or another, but I find it unsettling how many have no idea, or simply don’t care, what that really means.

To me, it’s that the test you’re ordering is urgent. You need to make a decision based on its results – STAT – to save life and/or limb. The results may make a significant difference in your treatment plan.

I find a lot of people don’t use this as the meaning anymore. They think STAT means “because I’m trying to get the patient out of here before Monday” or “a family is breathing down my neck” or “this is a VIP hospital board donor and I need to be extra nice.”

I’ve had my share of debates with other docs about those meanings, but I still stand by mine. To me, this is like pulling a fire alarm. When you do it, you want people to know you’re serious, and there’s a problem that needs to be addressed urgently.

Medicine, regrettably, has become a field of immediate gratification. Patients want results NOW. I’ve had people call me for results within 10 minutes of leaving an MRI facility or lab, even though I’d told them in advance that turnaround time would be days. Rather than accepting this, many ask that I call the radiologist or otherwise have their results rushed to make it more convenient for them. Of course, if you refuse, they may threaten to give you a bad review on Yelp or other rate-a-doc sites.

Some doctors are the same way. A syncope patient is stable, but needs to have a STAT EEG over the weekend so they can be sent home within the 24-hour observation window. It might be possible to send the patient out and get the study as an outpatient, but then they might not have it done, or another neurologist might get the billing. So better to pay the EEG tech overtime and have it done STAT.

Like the boy who cried wolf, STAT has become so commonplace at some hospitals as to be meaningless. Which only hurts the patients who legitimately need urgent studies.

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

STAT. It’s often capitalized, I guess to convey urgency. It shouldn’t be, though, since it’s not an acronym. It’s a shortening of the Latin word “statim” meaning “immediately.”

Everyone in health care says it at one time or another, but I find it unsettling how many have no idea, or simply don’t care, what that really means.

To me, it’s that the test you’re ordering is urgent. You need to make a decision based on its results – STAT – to save life and/or limb. The results may make a significant difference in your treatment plan.

I find a lot of people don’t use this as the meaning anymore. They think STAT means “because I’m trying to get the patient out of here before Monday” or “a family is breathing down my neck” or “this is a VIP hospital board donor and I need to be extra nice.”

I’ve had my share of debates with other docs about those meanings, but I still stand by mine. To me, this is like pulling a fire alarm. When you do it, you want people to know you’re serious, and there’s a problem that needs to be addressed urgently.

Medicine, regrettably, has become a field of immediate gratification. Patients want results NOW. I’ve had people call me for results within 10 minutes of leaving an MRI facility or lab, even though I’d told them in advance that turnaround time would be days. Rather than accepting this, many ask that I call the radiologist or otherwise have their results rushed to make it more convenient for them. Of course, if you refuse, they may threaten to give you a bad review on Yelp or other rate-a-doc sites.

Some doctors are the same way. A syncope patient is stable, but needs to have a STAT EEG over the weekend so they can be sent home within the 24-hour observation window. It might be possible to send the patient out and get the study as an outpatient, but then they might not have it done, or another neurologist might get the billing. So better to pay the EEG tech overtime and have it done STAT.

Like the boy who cried wolf, STAT has become so commonplace at some hospitals as to be meaningless. Which only hurts the patients who legitimately need urgent studies.

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

When are you Dr. versus Mr./Mrs./Miss?

I try to keep a pretty solid wall between my two identities. When I’m outside the office, I’m not happy about suddenly having to change hats.

I run into patients at restaurants and stores, like everyone else. Most of the time, we just exchange waves or nods. (I’m sure some of them don’t want to acknowledge me, either.)

But there are always those who consider catching me in public as a chance to get their questions answered or meds refilled without having to call the office, and don’t care if the whole establishment hears them.

I’m pretty much blind without my glasses, so, unless asleep, I am never without them. My wife has learned that when I suddenly take them off in public, it means I’ve sighted a patient I don’t want seeing me. It’s the easiest way to quickly change my appearance.

Some will still recognize me and come over with questions, descriptions, new symptoms, or concerns about what they saw on TV, read on the Internet, or heard from a lady at the store. Provided that nothing is urgent, I tell them that, at the moment, I’m not Dr. Block. I’m Dad, or husband, or basketball fan. I suggest they call my office with their questions, and Dr. Block or his staff will get back to them. Most will, though I’ve had a few get angry and accuse me of being unreasonable or uncaring.

I don’t really care. Like everyone else, I have at least two personas (work and home) and try to keep them as separate as possible. Part of it is for practical reasons, but mostly, it’s personal. None of us want to be in the doctor role at home, or in the home persona while seeing patients.

I ask patients and family to respect this. I don’t like getting the non-urgent texts or calls from my kids when I’m at the office, either. There I’m trying to focus on patients and their problems, and distractions aren’t welcome.

We each draw this line somewhere, depending on our own comfort level. You can’t be both all the time. It’s bad for your sanity.

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

When are you Dr. versus Mr./Mrs./Miss?

I try to keep a pretty solid wall between my two identities. When I’m outside the office, I’m not happy about suddenly having to change hats.

I run into patients at restaurants and stores, like everyone else. Most of the time, we just exchange waves or nods. (I’m sure some of them don’t want to acknowledge me, either.)

But there are always those who consider catching me in public as a chance to get their questions answered or meds refilled without having to call the office, and don’t care if the whole establishment hears them.

I’m pretty much blind without my glasses, so, unless asleep, I am never without them. My wife has learned that when I suddenly take them off in public, it means I’ve sighted a patient I don’t want seeing me. It’s the easiest way to quickly change my appearance.

Some will still recognize me and come over with questions, descriptions, new symptoms, or concerns about what they saw on TV, read on the Internet, or heard from a lady at the store. Provided that nothing is urgent, I tell them that, at the moment, I’m not Dr. Block. I’m Dad, or husband, or basketball fan. I suggest they call my office with their questions, and Dr. Block or his staff will get back to them. Most will, though I’ve had a few get angry and accuse me of being unreasonable or uncaring.

I don’t really care. Like everyone else, I have at least two personas (work and home) and try to keep them as separate as possible. Part of it is for practical reasons, but mostly, it’s personal. None of us want to be in the doctor role at home, or in the home persona while seeing patients.

I ask patients and family to respect this. I don’t like getting the non-urgent texts or calls from my kids when I’m at the office, either. There I’m trying to focus on patients and their problems, and distractions aren’t welcome.

We each draw this line somewhere, depending on our own comfort level. You can’t be both all the time. It’s bad for your sanity.

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

When are you Dr. versus Mr./Mrs./Miss?

I try to keep a pretty solid wall between my two identities. When I’m outside the office, I’m not happy about suddenly having to change hats.

I run into patients at restaurants and stores, like everyone else. Most of the time, we just exchange waves or nods. (I’m sure some of them don’t want to acknowledge me, either.)

But there are always those who consider catching me in public as a chance to get their questions answered or meds refilled without having to call the office, and don’t care if the whole establishment hears them.

I’m pretty much blind without my glasses, so, unless asleep, I am never without them. My wife has learned that when I suddenly take them off in public, it means I’ve sighted a patient I don’t want seeing me. It’s the easiest way to quickly change my appearance.

Some will still recognize me and come over with questions, descriptions, new symptoms, or concerns about what they saw on TV, read on the Internet, or heard from a lady at the store. Provided that nothing is urgent, I tell them that, at the moment, I’m not Dr. Block. I’m Dad, or husband, or basketball fan. I suggest they call my office with their questions, and Dr. Block or his staff will get back to them. Most will, though I’ve had a few get angry and accuse me of being unreasonable or uncaring.

I don’t really care. Like everyone else, I have at least two personas (work and home) and try to keep them as separate as possible. Part of it is for practical reasons, but mostly, it’s personal. None of us want to be in the doctor role at home, or in the home persona while seeing patients.

I ask patients and family to respect this. I don’t like getting the non-urgent texts or calls from my kids when I’m at the office, either. There I’m trying to focus on patients and their problems, and distractions aren’t welcome.

We each draw this line somewhere, depending on our own comfort level. You can’t be both all the time. It’s bad for your sanity.

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

I’m not a zebra hunter by nature. I see them here and there, but in a general practice the odds of finding them are pretty low. If I can’t solve the case, I refer to the more accomplished zebrologists at the tertiary centers.

That’s not to say I don’t look for them as best I can. Sometimes you get the vaguest hint you’re dealing with the unusual. Maybe because you’ve seen it before, or something the patient said triggered a distant memory from training.

One problem (among many) in diagnosing a zebra is time. It takes time to draw out a complex history and do an exam. There’s also time needed for the first, second, third … and later rounds of tests to come back, as well as time at appointments to note new symptoms, ask further questions, and discuss a diagnosis and plan. And, sometimes, you need time just to follow patients and see how their symptoms change.

Unfortunately, in medicine these days time is usually what you don’t have. Doctors are always under pressure to see a lot of patients and don’t have time to sort through the complex ones. This gets even worse for those employed by a health care system, when they may be working under quota requirements. After all, you can see four to five horses in the time needed for one zebra. And they pay about the same.

In solo practice, I don’t have quite the time constraints of an employed doctor meeting set numbers, but I still have the financial ones. I get the luxury of setting the schedule to give me more minutes when I know they’ll be needed, but at the back end it still comes with a financial penalty.

All of this makes it harder to find the zebras. They’re difficult enough to see as it is, and the financial pressure to shorten visits can keep even thorough docs from getting the whole story or turning over the case mentally. As one of my residency teachers (not Yogi Berra) said of differential diagnoses, “If you don’t think of it, you don’t think of it.”

Sadly, the nature of modern medicine is that it limits your ability to think of it, making it harder than ever to find the zebras in the herd.

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

I’m not a zebra hunter by nature. I see them here and there, but in a general practice the odds of finding them are pretty low. If I can’t solve the case, I refer to the more accomplished zebrologists at the tertiary centers.

That’s not to say I don’t look for them as best I can. Sometimes you get the vaguest hint you’re dealing with the unusual. Maybe because you’ve seen it before, or something the patient said triggered a distant memory from training.

One problem (among many) in diagnosing a zebra is time. It takes time to draw out a complex history and do an exam. There’s also time needed for the first, second, third … and later rounds of tests to come back, as well as time at appointments to note new symptoms, ask further questions, and discuss a diagnosis and plan. And, sometimes, you need time just to follow patients and see how their symptoms change.

Unfortunately, in medicine these days time is usually what you don’t have. Doctors are always under pressure to see a lot of patients and don’t have time to sort through the complex ones. This gets even worse for those employed by a health care system, when they may be working under quota requirements. After all, you can see four to five horses in the time needed for one zebra. And they pay about the same.

In solo practice, I don’t have quite the time constraints of an employed doctor meeting set numbers, but I still have the financial ones. I get the luxury of setting the schedule to give me more minutes when I know they’ll be needed, but at the back end it still comes with a financial penalty.

All of this makes it harder to find the zebras. They’re difficult enough to see as it is, and the financial pressure to shorten visits can keep even thorough docs from getting the whole story or turning over the case mentally. As one of my residency teachers (not Yogi Berra) said of differential diagnoses, “If you don’t think of it, you don’t think of it.”

Sadly, the nature of modern medicine is that it limits your ability to think of it, making it harder than ever to find the zebras in the herd.

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

I’m not a zebra hunter by nature. I see them here and there, but in a general practice the odds of finding them are pretty low. If I can’t solve the case, I refer to the more accomplished zebrologists at the tertiary centers.

That’s not to say I don’t look for them as best I can. Sometimes you get the vaguest hint you’re dealing with the unusual. Maybe because you’ve seen it before, or something the patient said triggered a distant memory from training.

One problem (among many) in diagnosing a zebra is time. It takes time to draw out a complex history and do an exam. There’s also time needed for the first, second, third … and later rounds of tests to come back, as well as time at appointments to note new symptoms, ask further questions, and discuss a diagnosis and plan. And, sometimes, you need time just to follow patients and see how their symptoms change.

Unfortunately, in medicine these days time is usually what you don’t have. Doctors are always under pressure to see a lot of patients and don’t have time to sort through the complex ones. This gets even worse for those employed by a health care system, when they may be working under quota requirements. After all, you can see four to five horses in the time needed for one zebra. And they pay about the same.

In solo practice, I don’t have quite the time constraints of an employed doctor meeting set numbers, but I still have the financial ones. I get the luxury of setting the schedule to give me more minutes when I know they’ll be needed, but at the back end it still comes with a financial penalty.

All of this makes it harder to find the zebras. They’re difficult enough to see as it is, and the financial pressure to shorten visits can keep even thorough docs from getting the whole story or turning over the case mentally. As one of my residency teachers (not Yogi Berra) said of differential diagnoses, “If you don’t think of it, you don’t think of it.”

Sadly, the nature of modern medicine is that it limits your ability to think of it, making it harder than ever to find the zebras in the herd.

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