Hitting a Nerve

Of all the things you learn in training, one of the most nebulous, but useful, is “Spidey Sense.”

In comics, Spider-Man had a power called Spidey Sense, which caused a skull-base tingling when danger was present. It was a prescient, clairvoyant ability that allowed him to take action to protect himself.

Somewhere along the line, most doctors I know get a similar ability, but it warns us when something is seriously wrong with a patient. Often, it fires before you even have a rational reason to be worried, and it’s almost never wrong.

As a senior in medical school, I heard a conversation between a resident and an attending. The resident was talking about how she’d seen a patient in the emergency department who she sent to the ICU without a concrete reason. An hour after arriving, the patient suffered a cardiac arrest and was successfully resuscitated. The attending told her that this was one of the most critical skills to develop: knowing when patients are really sick, even before you have any obvious reason to think they are.

I have no idea when I learned it. At some point it was just there. I assume it’s a result of years of medical training making you subconsciously recognize a bad situation. It doesn’t fire very often, but when it does it can’t be ignored. Sometimes even a few words typed on my schedule will set it off.

My staff knows when it’s hit me because I’ll bring an MRI order up to the front desk before I’ve completed the appointment and tell them to start working on it.

Not every sick patient sets it off. In fact, obviously sick people never do. In those cases, it’s not needed. But when the tingling starts when you first start talking to someone … don’t ignore it.

There are a lot of intangibles in medicine, and this is one of them. I can’t explain it, but it’s one of the most important skills I’ve learned, although I have no idea when I did. I’m just glad it’s there.

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

Of all the things you learn in training, one of the most nebulous, but useful, is “Spidey Sense.”

In comics, Spider-Man had a power called Spidey Sense, which caused a skull-base tingling when danger was present. It was a prescient, clairvoyant ability that allowed him to take action to protect himself.

Somewhere along the line, most doctors I know get a similar ability, but it warns us when something is seriously wrong with a patient. Often, it fires before you even have a rational reason to be worried, and it’s almost never wrong.

As a senior in medical school, I heard a conversation between a resident and an attending. The resident was talking about how she’d seen a patient in the emergency department who she sent to the ICU without a concrete reason. An hour after arriving, the patient suffered a cardiac arrest and was successfully resuscitated. The attending told her that this was one of the most critical skills to develop: knowing when patients are really sick, even before you have any obvious reason to think they are.

I have no idea when I learned it. At some point it was just there. I assume it’s a result of years of medical training making you subconsciously recognize a bad situation. It doesn’t fire very often, but when it does it can’t be ignored. Sometimes even a few words typed on my schedule will set it off.

My staff knows when it’s hit me because I’ll bring an MRI order up to the front desk before I’ve completed the appointment and tell them to start working on it.

Not every sick patient sets it off. In fact, obviously sick people never do. In those cases, it’s not needed. But when the tingling starts when you first start talking to someone … don’t ignore it.

There are a lot of intangibles in medicine, and this is one of them. I can’t explain it, but it’s one of the most important skills I’ve learned, although I have no idea when I did. I’m just glad it’s there.

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

Of all the things you learn in training, one of the most nebulous, but useful, is “Spidey Sense.”

In comics, Spider-Man had a power called Spidey Sense, which caused a skull-base tingling when danger was present. It was a prescient, clairvoyant ability that allowed him to take action to protect himself.

Somewhere along the line, most doctors I know get a similar ability, but it warns us when something is seriously wrong with a patient. Often, it fires before you even have a rational reason to be worried, and it’s almost never wrong.

As a senior in medical school, I heard a conversation between a resident and an attending. The resident was talking about how she’d seen a patient in the emergency department who she sent to the ICU without a concrete reason. An hour after arriving, the patient suffered a cardiac arrest and was successfully resuscitated. The attending told her that this was one of the most critical skills to develop: knowing when patients are really sick, even before you have any obvious reason to think they are.

I have no idea when I learned it. At some point it was just there. I assume it’s a result of years of medical training making you subconsciously recognize a bad situation. It doesn’t fire very often, but when it does it can’t be ignored. Sometimes even a few words typed on my schedule will set it off.

My staff knows when it’s hit me because I’ll bring an MRI order up to the front desk before I’ve completed the appointment and tell them to start working on it.

Not every sick patient sets it off. In fact, obviously sick people never do. In those cases, it’s not needed. But when the tingling starts when you first start talking to someone … don’t ignore it.

There are a lot of intangibles in medicine, and this is one of them. I can’t explain it, but it’s one of the most important skills I’ve learned, although I have no idea when I did. I’m just glad it’s there.

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

I take most, but not all insurances. I suspect the majority of doctors today would say the same.

I see a lot of articles about how patients who now have insurance can’t find doctors to see them. And, of course, generally this is blamed on doctors.

The problem is that people often equate insurance with health care, and they aren’t the same. If your insurance reimbursement is minimal, the odds are that no one in health care will be contracted with it. There may be a few newbie docs who figure they can make up the loss by sheer volume. As a result, they get badly overwhelmed, with long waiting-room times and a few months’ delay for appointments. As soon as they get established, they will drop the insurance. This creates a revolving door of doctors for some plans, as new docs use them to get started, then run away screaming and burned out at the first chance they get.

People often get upset and use the “You don’t care, you’re only in this for the money!” line when they find out I don’t take their insurance. My staff hears it frequently.

On the contrary, I do care. If I didn’t, I’d likely get out of medicine entirely. The fact that I’m still doing this after 16 years says that much.

But, in order to take care of people, I also have to pay my rent, staff, insurance, and all the other amounts that make up an overhead. If I can’t keep my office open, then I’m not able to help anyone.

This gets tricky, as some insurances will pay less than the amount needed for me to stay in practice. Some will argue that it’s better than nothing, but, if you’re not making enough to meet overhead, then nothing and less than the amount needed for me to stay in practice mean pretty much the same thing.

If I don’t take your insurance, I’m sorry. This has nothing to do with you. It means that company has decided not to pay me enough to cover my expenses (their decision, not mine), and so I had to drop them in order to continue helping others.

Like all other doctors, I’m forced to decide what works best for both me and the highest number of my patients. To continue caring for people, I need to stay open, and I select the insurances that will allow me to do that. I can’t be everyone’s doctor.

So please, don’t be angry if I no longer take your insurance. In a perfect world, overhead and business decisions wouldn’t play such a key role in medicine. But our world is far from perfect and always will be.

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

I take most, but not all insurances. I suspect the majority of doctors today would say the same.

I see a lot of articles about how patients who now have insurance can’t find doctors to see them. And, of course, generally this is blamed on doctors.

The problem is that people often equate insurance with health care, and they aren’t the same. If your insurance reimbursement is minimal, the odds are that no one in health care will be contracted with it. There may be a few newbie docs who figure they can make up the loss by sheer volume. As a result, they get badly overwhelmed, with long waiting-room times and a few months’ delay for appointments. As soon as they get established, they will drop the insurance. This creates a revolving door of doctors for some plans, as new docs use them to get started, then run away screaming and burned out at the first chance they get.

People often get upset and use the “You don’t care, you’re only in this for the money!” line when they find out I don’t take their insurance. My staff hears it frequently.

On the contrary, I do care. If I didn’t, I’d likely get out of medicine entirely. The fact that I’m still doing this after 16 years says that much.

But, in order to take care of people, I also have to pay my rent, staff, insurance, and all the other amounts that make up an overhead. If I can’t keep my office open, then I’m not able to help anyone.

This gets tricky, as some insurances will pay less than the amount needed for me to stay in practice. Some will argue that it’s better than nothing, but, if you’re not making enough to meet overhead, then nothing and less than the amount needed for me to stay in practice mean pretty much the same thing.

If I don’t take your insurance, I’m sorry. This has nothing to do with you. It means that company has decided not to pay me enough to cover my expenses (their decision, not mine), and so I had to drop them in order to continue helping others.

Like all other doctors, I’m forced to decide what works best for both me and the highest number of my patients. To continue caring for people, I need to stay open, and I select the insurances that will allow me to do that. I can’t be everyone’s doctor.

So please, don’t be angry if I no longer take your insurance. In a perfect world, overhead and business decisions wouldn’t play such a key role in medicine. But our world is far from perfect and always will be.

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

I take most, but not all insurances. I suspect the majority of doctors today would say the same.

I see a lot of articles about how patients who now have insurance can’t find doctors to see them. And, of course, generally this is blamed on doctors.

The problem is that people often equate insurance with health care, and they aren’t the same. If your insurance reimbursement is minimal, the odds are that no one in health care will be contracted with it. There may be a few newbie docs who figure they can make up the loss by sheer volume. As a result, they get badly overwhelmed, with long waiting-room times and a few months’ delay for appointments. As soon as they get established, they will drop the insurance. This creates a revolving door of doctors for some plans, as new docs use them to get started, then run away screaming and burned out at the first chance they get.

People often get upset and use the “You don’t care, you’re only in this for the money!” line when they find out I don’t take their insurance. My staff hears it frequently.

On the contrary, I do care. If I didn’t, I’d likely get out of medicine entirely. The fact that I’m still doing this after 16 years says that much.

But, in order to take care of people, I also have to pay my rent, staff, insurance, and all the other amounts that make up an overhead. If I can’t keep my office open, then I’m not able to help anyone.

This gets tricky, as some insurances will pay less than the amount needed for me to stay in practice. Some will argue that it’s better than nothing, but, if you’re not making enough to meet overhead, then nothing and less than the amount needed for me to stay in practice mean pretty much the same thing.

If I don’t take your insurance, I’m sorry. This has nothing to do with you. It means that company has decided not to pay me enough to cover my expenses (their decision, not mine), and so I had to drop them in order to continue helping others.

Like all other doctors, I’m forced to decide what works best for both me and the highest number of my patients. To continue caring for people, I need to stay open, and I select the insurances that will allow me to do that. I can’t be everyone’s doctor.

So please, don’t be angry if I no longer take your insurance. In a perfect world, overhead and business decisions wouldn’t play such a key role in medicine. But our world is far from perfect and always will be.

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

Recently, an article in JAMA Internal Medicine suggested that more than 50% of nursing home patients with advanced dementia are on “medications of questionable benefit.” The study went on to define those drugs as memantine, cholinesterase inhibitors, and statins.

Shocker, huh?

“Questionable benefit” is in the eyes of the beholder. Two of the above drugs have FDA indications for advanced dementia (statins for dyslipidemia), so you could argue there’s nothing “questionable” about it. The FDA says we can do it, so we will.

Right, but we all use drugs off label in this business without hesitation. So why should we think twice about using them on label?

It’s a valid point. Why do we prescribe these drugs to advanced dementia patients? How many of you have actually seen meaningful clinical benefit with them in this group, not just graphed points on a detail piece?

I use them, too, but I try to lower expectations with patients and their families. If all they see are direct-to-consumer ads, they’ll think this is a cure. Nope.

The fact is that the best we can do today is to slow progression ... somewhat. So if they’re already in end-stage disease, why bother? At some point, trying to keep these patients alive becomes more of an emotional torture for their families. All of us have seen these patients. How many of us want to live like that? I’m going to say none.

So, if their use in this population is “questionable,” I have to question why we do it at all.

This is where medicine gets hazy. On one side are those who claim that anyone with end-stage dementia should be treated with comfort care only. On the other are those who argue we need to do everything possible to keep them alive (usually politicians, not doctors). But most people are in a gray middle.

There’s also a big difference between what we can do and what we should do. This point, unfortunately, is often lost in the complex web of patient care. Advanced dementia patient = memantine + cholinesterase inhibitor. Medicine becomes a flowchart rather than a thinking specialty.

Then there’s the families. None of us wants to destroy hope. So we go with “Well, let’s try this medicine and see what happens.” It is, admittedly, easier than saying “I have nothing that will make a meaningful difference.” People see these advertised and want to believe these magical drugs will fix what ails grandma.

There’s also nursing staff, leaving Post-It notes on the chart that say “Patient has Alzheimer’s disease. Do you want to start Aricept?” I see that here and there, too. I think most of us okay it, because it’s easier than saying “What’s the point?”

Hiding in the background is, lastly, the specter of a malpractice suit. Even if the patient is beyond you making them worse, there’s always another neurologist out there willing to testify (for a fee) that by not prescribing these drugs, you fell beneath the standard of care.

The practice of using these drugs in end-stage dementia is indeed questionable. But the possible answers, and the dilemmas they put us in, often lead to doing what’s possible instead of simply necessary.

And when that happens, the only ones who benefit are the legal profession and drug companies.

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

Recently, an article in JAMA Internal Medicine suggested that more than 50% of nursing home patients with advanced dementia are on “medications of questionable benefit.” The study went on to define those drugs as memantine, cholinesterase inhibitors, and statins.

Shocker, huh?

“Questionable benefit” is in the eyes of the beholder. Two of the above drugs have FDA indications for advanced dementia (statins for dyslipidemia), so you could argue there’s nothing “questionable” about it. The FDA says we can do it, so we will.

Right, but we all use drugs off label in this business without hesitation. So why should we think twice about using them on label?

It’s a valid point. Why do we prescribe these drugs to advanced dementia patients? How many of you have actually seen meaningful clinical benefit with them in this group, not just graphed points on a detail piece?

I use them, too, but I try to lower expectations with patients and their families. If all they see are direct-to-consumer ads, they’ll think this is a cure. Nope.

The fact is that the best we can do today is to slow progression ... somewhat. So if they’re already in end-stage disease, why bother? At some point, trying to keep these patients alive becomes more of an emotional torture for their families. All of us have seen these patients. How many of us want to live like that? I’m going to say none.

So, if their use in this population is “questionable,” I have to question why we do it at all.

This is where medicine gets hazy. On one side are those who claim that anyone with end-stage dementia should be treated with comfort care only. On the other are those who argue we need to do everything possible to keep them alive (usually politicians, not doctors). But most people are in a gray middle.

There’s also a big difference between what we can do and what we should do. This point, unfortunately, is often lost in the complex web of patient care. Advanced dementia patient = memantine + cholinesterase inhibitor. Medicine becomes a flowchart rather than a thinking specialty.

Then there’s the families. None of us wants to destroy hope. So we go with “Well, let’s try this medicine and see what happens.” It is, admittedly, easier than saying “I have nothing that will make a meaningful difference.” People see these advertised and want to believe these magical drugs will fix what ails grandma.

There’s also nursing staff, leaving Post-It notes on the chart that say “Patient has Alzheimer’s disease. Do you want to start Aricept?” I see that here and there, too. I think most of us okay it, because it’s easier than saying “What’s the point?”

Hiding in the background is, lastly, the specter of a malpractice suit. Even if the patient is beyond you making them worse, there’s always another neurologist out there willing to testify (for a fee) that by not prescribing these drugs, you fell beneath the standard of care.

The practice of using these drugs in end-stage dementia is indeed questionable. But the possible answers, and the dilemmas they put us in, often lead to doing what’s possible instead of simply necessary.

And when that happens, the only ones who benefit are the legal profession and drug companies.

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

Recently, an article in JAMA Internal Medicine suggested that more than 50% of nursing home patients with advanced dementia are on “medications of questionable benefit.” The study went on to define those drugs as memantine, cholinesterase inhibitors, and statins.

Shocker, huh?

“Questionable benefit” is in the eyes of the beholder. Two of the above drugs have FDA indications for advanced dementia (statins for dyslipidemia), so you could argue there’s nothing “questionable” about it. The FDA says we can do it, so we will.

Right, but we all use drugs off label in this business without hesitation. So why should we think twice about using them on label?

It’s a valid point. Why do we prescribe these drugs to advanced dementia patients? How many of you have actually seen meaningful clinical benefit with them in this group, not just graphed points on a detail piece?

I use them, too, but I try to lower expectations with patients and their families. If all they see are direct-to-consumer ads, they’ll think this is a cure. Nope.

The fact is that the best we can do today is to slow progression ... somewhat. So if they’re already in end-stage disease, why bother? At some point, trying to keep these patients alive becomes more of an emotional torture for their families. All of us have seen these patients. How many of us want to live like that? I’m going to say none.

So, if their use in this population is “questionable,” I have to question why we do it at all.

This is where medicine gets hazy. On one side are those who claim that anyone with end-stage dementia should be treated with comfort care only. On the other are those who argue we need to do everything possible to keep them alive (usually politicians, not doctors). But most people are in a gray middle.

There’s also a big difference between what we can do and what we should do. This point, unfortunately, is often lost in the complex web of patient care. Advanced dementia patient = memantine + cholinesterase inhibitor. Medicine becomes a flowchart rather than a thinking specialty.

Then there’s the families. None of us wants to destroy hope. So we go with “Well, let’s try this medicine and see what happens.” It is, admittedly, easier than saying “I have nothing that will make a meaningful difference.” People see these advertised and want to believe these magical drugs will fix what ails grandma.

There’s also nursing staff, leaving Post-It notes on the chart that say “Patient has Alzheimer’s disease. Do you want to start Aricept?” I see that here and there, too. I think most of us okay it, because it’s easier than saying “What’s the point?”

Hiding in the background is, lastly, the specter of a malpractice suit. Even if the patient is beyond you making them worse, there’s always another neurologist out there willing to testify (for a fee) that by not prescribing these drugs, you fell beneath the standard of care.

The practice of using these drugs in end-stage dementia is indeed questionable. But the possible answers, and the dilemmas they put us in, often lead to doing what’s possible instead of simply necessary.

And when that happens, the only ones who benefit are the legal profession and drug companies.

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

I generally like drug reps. Some doctors don’t want to deal with them, but I don’t mind. Most are people just trying to support their families, like me. I don’t do lunches anymore, but I never mind briefly chatting and signing for samples.

I’ve fired a few, though. Obviously, I can’t get them tossed from their jobs, but I tell them to never set foot in my office again.

What sort of things really tick me off?

1. Excessive pushiness. Yes, I know you have to sell a product. But endlessly emphasizing it and asking for my support is irritating. I signed for your samples.

2. Not respecting time constraints. Most reps know that doctors only have a few seconds to sign and exchange a few words and respect that, but some will chatter on about their drug at length, even when I’m obviously trying to run to see a patient. My responsibility is to those who need my help, not to those trying to show me a slick iPad graphic.

3. Stalking me. I’ve had reps follow me over to the hospital and out to my car while still talking. Don’t make me get a restraining order.

4. Wasting my staff’s time. My awesome receptionist is very busy. She also is not the one prescribing your product. Do not interfere with her job by rambling about your drug’s dosing, mechanism of action, plan coverage, or pretty much anything. I am paying her. You aren’t. She has a patient to check out, 12 things to fax, an MRI to schedule, and two calls on hold. When you are done talking to me, you are done here. Pack up your bag and move on.

5. Overt rudeness to me and my staff. Believe it or not, I’ve had reps blatantly accuse my secretary of lying to them about such things as not scheduling lunches or not needing samples. Telling her to just “get the doctor” won’t get you anywhere. She runs the office up front, and if you cross her you won’t get to me, either. I will back her up every time.

6. Trespassing. Back before we installed a lock on the door between the lobby and office, I had a rep just walk on back without checking in with the staff. He came to my office and interrupted me with a patient. If your company encourages this, you should work somewhere else. This is a fast way to be told to get out and never come back.

7. Discuss politics. You are welcome to your viewpoints. So am I. They have no place in the interaction between a doctor and a rep. Around the 2012 election, one rep expressed viewpoints that were extreme to the point of being delusional. When she discovered that none of us agreed with her, she became quite angry and confrontational. I told her to never come back.

8. Whip out my prescribing data. Allegedly, mine is shielded, but some reps still seem to be able to access it. Quoting to me (or showing me graphs) as to how much of your product I’m writing vs. another company’s is rude. I will make my decisions based on my patients’ needs, not your sales figures.

9. Selling to my patients. They see enough direct-to-consumer advertising on TV. And magazines. And online. If they ask you questions, I have no problem with you answering them, but don’t start randomly handing them your sales brochures and telling them your drug is better than whatever I have them on.

10. Telling me that my prescribing your drug can help improve your salary or bonus. Like I don’t know that. But, again, that doesn’t and shouldn’t ever factor in to how I manage a patient. Their health, not your car payments, is my concern.

I don’t think I’m unreasonable. Like them, I have a job to do. And, at my office, the patients will always be my priority. As it should be.

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

I generally like drug reps. Some doctors don’t want to deal with them, but I don’t mind. Most are people just trying to support their families, like me. I don’t do lunches anymore, but I never mind briefly chatting and signing for samples.

I’ve fired a few, though. Obviously, I can’t get them tossed from their jobs, but I tell them to never set foot in my office again.

What sort of things really tick me off?

1. Excessive pushiness. Yes, I know you have to sell a product. But endlessly emphasizing it and asking for my support is irritating. I signed for your samples.

2. Not respecting time constraints. Most reps know that doctors only have a few seconds to sign and exchange a few words and respect that, but some will chatter on about their drug at length, even when I’m obviously trying to run to see a patient. My responsibility is to those who need my help, not to those trying to show me a slick iPad graphic.

3. Stalking me. I’ve had reps follow me over to the hospital and out to my car while still talking. Don’t make me get a restraining order.

4. Wasting my staff’s time. My awesome receptionist is very busy. She also is not the one prescribing your product. Do not interfere with her job by rambling about your drug’s dosing, mechanism of action, plan coverage, or pretty much anything. I am paying her. You aren’t. She has a patient to check out, 12 things to fax, an MRI to schedule, and two calls on hold. When you are done talking to me, you are done here. Pack up your bag and move on.

5. Overt rudeness to me and my staff. Believe it or not, I’ve had reps blatantly accuse my secretary of lying to them about such things as not scheduling lunches or not needing samples. Telling her to just “get the doctor” won’t get you anywhere. She runs the office up front, and if you cross her you won’t get to me, either. I will back her up every time.

6. Trespassing. Back before we installed a lock on the door between the lobby and office, I had a rep just walk on back without checking in with the staff. He came to my office and interrupted me with a patient. If your company encourages this, you should work somewhere else. This is a fast way to be told to get out and never come back.

7. Discuss politics. You are welcome to your viewpoints. So am I. They have no place in the interaction between a doctor and a rep. Around the 2012 election, one rep expressed viewpoints that were extreme to the point of being delusional. When she discovered that none of us agreed with her, she became quite angry and confrontational. I told her to never come back.

8. Whip out my prescribing data. Allegedly, mine is shielded, but some reps still seem to be able to access it. Quoting to me (or showing me graphs) as to how much of your product I’m writing vs. another company’s is rude. I will make my decisions based on my patients’ needs, not your sales figures.

9. Selling to my patients. They see enough direct-to-consumer advertising on TV. And magazines. And online. If they ask you questions, I have no problem with you answering them, but don’t start randomly handing them your sales brochures and telling them your drug is better than whatever I have them on.

10. Telling me that my prescribing your drug can help improve your salary or bonus. Like I don’t know that. But, again, that doesn’t and shouldn’t ever factor in to how I manage a patient. Their health, not your car payments, is my concern.

I don’t think I’m unreasonable. Like them, I have a job to do. And, at my office, the patients will always be my priority. As it should be.

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

I generally like drug reps. Some doctors don’t want to deal with them, but I don’t mind. Most are people just trying to support their families, like me. I don’t do lunches anymore, but I never mind briefly chatting and signing for samples.

I’ve fired a few, though. Obviously, I can’t get them tossed from their jobs, but I tell them to never set foot in my office again.

What sort of things really tick me off?

1. Excessive pushiness. Yes, I know you have to sell a product. But endlessly emphasizing it and asking for my support is irritating. I signed for your samples.

2. Not respecting time constraints. Most reps know that doctors only have a few seconds to sign and exchange a few words and respect that, but some will chatter on about their drug at length, even when I’m obviously trying to run to see a patient. My responsibility is to those who need my help, not to those trying to show me a slick iPad graphic.

3. Stalking me. I’ve had reps follow me over to the hospital and out to my car while still talking. Don’t make me get a restraining order.

4. Wasting my staff’s time. My awesome receptionist is very busy. She also is not the one prescribing your product. Do not interfere with her job by rambling about your drug’s dosing, mechanism of action, plan coverage, or pretty much anything. I am paying her. You aren’t. She has a patient to check out, 12 things to fax, an MRI to schedule, and two calls on hold. When you are done talking to me, you are done here. Pack up your bag and move on.

5. Overt rudeness to me and my staff. Believe it or not, I’ve had reps blatantly accuse my secretary of lying to them about such things as not scheduling lunches or not needing samples. Telling her to just “get the doctor” won’t get you anywhere. She runs the office up front, and if you cross her you won’t get to me, either. I will back her up every time.

6. Trespassing. Back before we installed a lock on the door between the lobby and office, I had a rep just walk on back without checking in with the staff. He came to my office and interrupted me with a patient. If your company encourages this, you should work somewhere else. This is a fast way to be told to get out and never come back.

7. Discuss politics. You are welcome to your viewpoints. So am I. They have no place in the interaction between a doctor and a rep. Around the 2012 election, one rep expressed viewpoints that were extreme to the point of being delusional. When she discovered that none of us agreed with her, she became quite angry and confrontational. I told her to never come back.

8. Whip out my prescribing data. Allegedly, mine is shielded, but some reps still seem to be able to access it. Quoting to me (or showing me graphs) as to how much of your product I’m writing vs. another company’s is rude. I will make my decisions based on my patients’ needs, not your sales figures.

9. Selling to my patients. They see enough direct-to-consumer advertising on TV. And magazines. And online. If they ask you questions, I have no problem with you answering them, but don’t start randomly handing them your sales brochures and telling them your drug is better than whatever I have them on.

10. Telling me that my prescribing your drug can help improve your salary or bonus. Like I don’t know that. But, again, that doesn’t and shouldn’t ever factor in to how I manage a patient. Their health, not your car payments, is my concern.

I don’t think I’m unreasonable. Like them, I have a job to do. And, at my office, the patients will always be my priority. As it should be.

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

I don’t do meet-and-greets.

It is not that we get a huge number of calls for them. Maybe once a week a new patient will call, asking to “interview” me to see if we’re a good match and to review my credentials.

I’m not playing this game. My credentials are on my office website, as well as many rate-a-doc sites that I have no affiliation with. I’m not running a concierge practice where I ask you to pay up front.

My time is valuable. If you need a neurologist, I’m happy to see you and try to help. But your insurance doesn’t pay me to do “interviews.” And when we’ve quoted people a fee for the time, they get indignant and hang up. They tell my secretary they’ll take their business elsewhere, which is fine with me.

I have to wonder how many other neurologists they go through with this routine. I don’t know any who do this, at least in my area of town. By the time they call my office, they’ve likely already tried five other neurologists.

I suppose some will argue in favor of it, maybe as a way of weeding out people who you really don’t want in your practice or with whom you are genuinely a bad personality match. To me, it’s not worth it.

Unfortunately, modern medicine is trying to squeeze as many dollars out of the limited office time you have. I already work through lunch. I’m not going to take unpaid visits just so that people can decide if my dress habits, hygiene, or personality are up to their standards.

I see patients as they come. If they don’t like me, nobody is forcing them to stay. But I’m not going to do a complimentary meet-and-greet so they can judge me or try to get free medical advice.

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

I don’t do meet-and-greets.

It is not that we get a huge number of calls for them. Maybe once a week a new patient will call, asking to “interview” me to see if we’re a good match and to review my credentials.

I’m not playing this game. My credentials are on my office website, as well as many rate-a-doc sites that I have no affiliation with. I’m not running a concierge practice where I ask you to pay up front.

My time is valuable. If you need a neurologist, I’m happy to see you and try to help. But your insurance doesn’t pay me to do “interviews.” And when we’ve quoted people a fee for the time, they get indignant and hang up. They tell my secretary they’ll take their business elsewhere, which is fine with me.

I have to wonder how many other neurologists they go through with this routine. I don’t know any who do this, at least in my area of town. By the time they call my office, they’ve likely already tried five other neurologists.

I suppose some will argue in favor of it, maybe as a way of weeding out people who you really don’t want in your practice or with whom you are genuinely a bad personality match. To me, it’s not worth it.

Unfortunately, modern medicine is trying to squeeze as many dollars out of the limited office time you have. I already work through lunch. I’m not going to take unpaid visits just so that people can decide if my dress habits, hygiene, or personality are up to their standards.

I see patients as they come. If they don’t like me, nobody is forcing them to stay. But I’m not going to do a complimentary meet-and-greet so they can judge me or try to get free medical advice.

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

I don’t do meet-and-greets.

It is not that we get a huge number of calls for them. Maybe once a week a new patient will call, asking to “interview” me to see if we’re a good match and to review my credentials.

I’m not playing this game. My credentials are on my office website, as well as many rate-a-doc sites that I have no affiliation with. I’m not running a concierge practice where I ask you to pay up front.

My time is valuable. If you need a neurologist, I’m happy to see you and try to help. But your insurance doesn’t pay me to do “interviews.” And when we’ve quoted people a fee for the time, they get indignant and hang up. They tell my secretary they’ll take their business elsewhere, which is fine with me.

I have to wonder how many other neurologists they go through with this routine. I don’t know any who do this, at least in my area of town. By the time they call my office, they’ve likely already tried five other neurologists.

I suppose some will argue in favor of it, maybe as a way of weeding out people who you really don’t want in your practice or with whom you are genuinely a bad personality match. To me, it’s not worth it.

Unfortunately, modern medicine is trying to squeeze as many dollars out of the limited office time you have. I already work through lunch. I’m not going to take unpaid visits just so that people can decide if my dress habits, hygiene, or personality are up to their standards.

I see patients as they come. If they don’t like me, nobody is forcing them to stay. But I’m not going to do a complimentary meet-and-greet so they can judge me or try to get free medical advice.

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

How did you pick your field?

Neurology, for me, was a combination of personal likes and dislikes. I found it interesting, but also learned I didn’t enjoy most other branches of medicine.

Like other medical students, I went through a series of rotations, gradually crossing things off my list. Eventually, I found that internal medicine fit my personality best, but I didn’t like having to know something about everything. Neurology was a good fit for the way my mind and temperament work. Now, after 16 years in practice, I have no regrets. I still like the job, in spite of having to deal with insurance companies, excessive paperwork, and hospital administrators.

I’m not an adrenaline junkie, living to run in and save lives at the drop of a hat. Nor am I someone who enjoys procedures. I’m the thinking type, and happy to spend my days sitting behind a desk and trying to look smart. I’d have to say I nailed it, my atypical wardrobe notwithstanding.

Medical fields, like cars and music, are incredibly diverse. There’s something out there for every personality type. And that’s excluding all the subspecialties a field gets further broken down to. (In my world there’s movement disorder docs, epileptologists, and stroke-ologists, to name a few.)

When I was in training, an adviser told me that one’s choice of field is as much success as failure. By becoming a neurologist, I’m admitting that I’ve failed to understand pretty much everything else in medicine. On the opposite side, an internist has conceded failure to understand any given organ system in depth.

Most importantly, you don’t care that you’ve failed the rest. This frees you to focus only on what you enjoy and what interests you, and to not worry about anything else.

Using this argument, the best care is from someone who failed everything else. Or, in a better light, who only does one thing, but does it well. No matter how you play it, it’s what works out best for all involved – especially our patients.

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

How did you pick your field?

Neurology, for me, was a combination of personal likes and dislikes. I found it interesting, but also learned I didn’t enjoy most other branches of medicine.

Like other medical students, I went through a series of rotations, gradually crossing things off my list. Eventually, I found that internal medicine fit my personality best, but I didn’t like having to know something about everything. Neurology was a good fit for the way my mind and temperament work. Now, after 16 years in practice, I have no regrets. I still like the job, in spite of having to deal with insurance companies, excessive paperwork, and hospital administrators.

I’m not an adrenaline junkie, living to run in and save lives at the drop of a hat. Nor am I someone who enjoys procedures. I’m the thinking type, and happy to spend my days sitting behind a desk and trying to look smart. I’d have to say I nailed it, my atypical wardrobe notwithstanding.

Medical fields, like cars and music, are incredibly diverse. There’s something out there for every personality type. And that’s excluding all the subspecialties a field gets further broken down to. (In my world there’s movement disorder docs, epileptologists, and stroke-ologists, to name a few.)

When I was in training, an adviser told me that one’s choice of field is as much success as failure. By becoming a neurologist, I’m admitting that I’ve failed to understand pretty much everything else in medicine. On the opposite side, an internist has conceded failure to understand any given organ system in depth.

Most importantly, you don’t care that you’ve failed the rest. This frees you to focus only on what you enjoy and what interests you, and to not worry about anything else.

Using this argument, the best care is from someone who failed everything else. Or, in a better light, who only does one thing, but does it well. No matter how you play it, it’s what works out best for all involved – especially our patients.

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

How did you pick your field?

Neurology, for me, was a combination of personal likes and dislikes. I found it interesting, but also learned I didn’t enjoy most other branches of medicine.

Like other medical students, I went through a series of rotations, gradually crossing things off my list. Eventually, I found that internal medicine fit my personality best, but I didn’t like having to know something about everything. Neurology was a good fit for the way my mind and temperament work. Now, after 16 years in practice, I have no regrets. I still like the job, in spite of having to deal with insurance companies, excessive paperwork, and hospital administrators.

I’m not an adrenaline junkie, living to run in and save lives at the drop of a hat. Nor am I someone who enjoys procedures. I’m the thinking type, and happy to spend my days sitting behind a desk and trying to look smart. I’d have to say I nailed it, my atypical wardrobe notwithstanding.

Medical fields, like cars and music, are incredibly diverse. There’s something out there for every personality type. And that’s excluding all the subspecialties a field gets further broken down to. (In my world there’s movement disorder docs, epileptologists, and stroke-ologists, to name a few.)

When I was in training, an adviser told me that one’s choice of field is as much success as failure. By becoming a neurologist, I’m admitting that I’ve failed to understand pretty much everything else in medicine. On the opposite side, an internist has conceded failure to understand any given organ system in depth.

Most importantly, you don’t care that you’ve failed the rest. This frees you to focus only on what you enjoy and what interests you, and to not worry about anything else.

Using this argument, the best care is from someone who failed everything else. Or, in a better light, who only does one thing, but does it well. No matter how you play it, it’s what works out best for all involved – especially our patients.

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

$11.38. What can you buy for that kind of money?

Not much, realistically: an entrée at a casual restaurant, a shirt on sale at Target, a few cases of Ramen noodles in college.

In my case, it was what (per the Internet) bought my time.

About a year ago, a friendly drug rep asked my secretary if he could bring a pizza for lunch. We don’t do rep lunches, but he’d overheard her telling me she’d forgotten lunch at home and was going to go out to McDonald’s.

He told her he wouldn’t stay to sell anything, so she said “Sure, thank you.” He got a small pizza, dropped it off for her, and left. She had a piece and took the rest home to her kids. I didn’t think much of it, although it was the only time in the last 2 years we’ve gotten anything besides samples from a rep.

I wasn’t planning on checking my Sunshine Act disclosure data, since I don’t see reps beyond signing for samples. But then I heard an old partner of mine had a plastic brain listed under his name ($18.36) by mistake when it had actually been given to another doc with a similar name.

So I logged in, and there it was. I’d accepted $11.38 in “food and beverage” (AKA, the pizza I never ate) from a drug company.

I can’t really dispute it, and it’s not that much money. I doubt anyone will think I’m for sale for such a pithy amount, and no reporter looking for a doctor bribery scandal is going to think it’s a story worth chasing.

I support disclosure. There are clearly many instances where the relationship between physicians and pharma has been abused for financial gains. Kickbacks and bribes are as old as society and will always be with us. Having outside scrutiny of our actions, at least in this instance, is likely good at keeping everyone honest. There will always be ways to cheat, but most of us aren’t looking for them.

But still, it irritates me that this seemingly innocent lunch for my secretary could be taken to mean something else.

So, the pizza I didn’t eat becomes an odd milestone in my medical career. I don’t remember when I had my first drug company lunch, but it was likely during my third year of medical school. But now, I, and anyone who wants to look it up, knows when my last one was an $11.38 pizza that I never had on Aug. 29, 2013.

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

$11.38. What can you buy for that kind of money?

Not much, realistically: an entrée at a casual restaurant, a shirt on sale at Target, a few cases of Ramen noodles in college.

In my case, it was what (per the Internet) bought my time.

About a year ago, a friendly drug rep asked my secretary if he could bring a pizza for lunch. We don’t do rep lunches, but he’d overheard her telling me she’d forgotten lunch at home and was going to go out to McDonald’s.

He told her he wouldn’t stay to sell anything, so she said “Sure, thank you.” He got a small pizza, dropped it off for her, and left. She had a piece and took the rest home to her kids. I didn’t think much of it, although it was the only time in the last 2 years we’ve gotten anything besides samples from a rep.

I wasn’t planning on checking my Sunshine Act disclosure data, since I don’t see reps beyond signing for samples. But then I heard an old partner of mine had a plastic brain listed under his name ($18.36) by mistake when it had actually been given to another doc with a similar name.

So I logged in, and there it was. I’d accepted $11.38 in “food and beverage” (AKA, the pizza I never ate) from a drug company.

I can’t really dispute it, and it’s not that much money. I doubt anyone will think I’m for sale for such a pithy amount, and no reporter looking for a doctor bribery scandal is going to think it’s a story worth chasing.

I support disclosure. There are clearly many instances where the relationship between physicians and pharma has been abused for financial gains. Kickbacks and bribes are as old as society and will always be with us. Having outside scrutiny of our actions, at least in this instance, is likely good at keeping everyone honest. There will always be ways to cheat, but most of us aren’t looking for them.

But still, it irritates me that this seemingly innocent lunch for my secretary could be taken to mean something else.

So, the pizza I didn’t eat becomes an odd milestone in my medical career. I don’t remember when I had my first drug company lunch, but it was likely during my third year of medical school. But now, I, and anyone who wants to look it up, knows when my last one was an $11.38 pizza that I never had on Aug. 29, 2013.

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

$11.38. What can you buy for that kind of money?

Not much, realistically: an entrée at a casual restaurant, a shirt on sale at Target, a few cases of Ramen noodles in college.

In my case, it was what (per the Internet) bought my time.

About a year ago, a friendly drug rep asked my secretary if he could bring a pizza for lunch. We don’t do rep lunches, but he’d overheard her telling me she’d forgotten lunch at home and was going to go out to McDonald’s.

He told her he wouldn’t stay to sell anything, so she said “Sure, thank you.” He got a small pizza, dropped it off for her, and left. She had a piece and took the rest home to her kids. I didn’t think much of it, although it was the only time in the last 2 years we’ve gotten anything besides samples from a rep.

I wasn’t planning on checking my Sunshine Act disclosure data, since I don’t see reps beyond signing for samples. But then I heard an old partner of mine had a plastic brain listed under his name ($18.36) by mistake when it had actually been given to another doc with a similar name.

So I logged in, and there it was. I’d accepted $11.38 in “food and beverage” (AKA, the pizza I never ate) from a drug company.

I can’t really dispute it, and it’s not that much money. I doubt anyone will think I’m for sale for such a pithy amount, and no reporter looking for a doctor bribery scandal is going to think it’s a story worth chasing.

I support disclosure. There are clearly many instances where the relationship between physicians and pharma has been abused for financial gains. Kickbacks and bribes are as old as society and will always be with us. Having outside scrutiny of our actions, at least in this instance, is likely good at keeping everyone honest. There will always be ways to cheat, but most of us aren’t looking for them.

But still, it irritates me that this seemingly innocent lunch for my secretary could be taken to mean something else.

So, the pizza I didn’t eat becomes an odd milestone in my medical career. I don’t remember when I had my first drug company lunch, but it was likely during my third year of medical school. But now, I, and anyone who wants to look it up, knows when my last one was an $11.38 pizza that I never had on Aug. 29, 2013.

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

"Do you feel lucky?"

It’s one of Clint Eastwood’s iconic lines (probably a notch below "go ahead, make my day") that wasn’t spoken to a home furnishing. 

But it’s still a question many of us think of late on a Friday afternoon just before weekend call gets rolled over to us.

Weekend hospital call, like an approaching storm, brings foreboding and dread. You have no control over the circumstances that are about to whack you. If it’s busy, you’re out of luck. Whatever comes in, you have to deal with it.

I try to ameliorate the pain by using a quote from a residency attending: "It’s not busy, it’s profitable." I also often repeat Dory’s line from "Finding Nemo" – "just keep swimming, just keep swimming" – as I round endlessly.

But humans, by nature, are superstitious creatures. Our ancestors across the globe created pantheons of deities to explain the sun, storms, ocean, and other natural phenomenon they couldn’t control and prayed to them to try to do so.

Now we fear a nebulous group of beings named the "call gods."

It’s always plural, and it’s never been established how many there are or if they have individual names. But they’re feared by all who take hospital call. Amongst physicians, I find they’re universal. Doctors who are Christians, Jews, Hindus, Muslims, atheists ... all know and fear them.

The rules of this medical religion have never been put down and are passed on by verbal tradition. The main theme is that you never, ever, ever do anything to make them angry. This primarily involves not saying things like "it’s quiet so far" or "gee, my phone hasn’t rung all day," for doing so will most assuredly bring their wrath down upon you.

Likewise, even if things are quiet, you never say that until 7:01 on Monday morning, when it’s been rolled back over to your call partner. If someone asks, "how’s your call going?" – even if nothing has happened – you still say "steady" or "hopping" just to avoid challenging the unseen deities.

Of course, the call gods aren’t the only ones we fear. There are specialty-specific, and even procedure-specific, deities. Any neurologist attempting a bedside lumbar puncture on a large person will likely say a quick prayer to the LP gods.

Medicine has come a long way, over time, but even a field with a hefty base in science can’t overcome human nature and our inherent fear of forces beyond our control.

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

"Do you feel lucky?"

It’s one of Clint Eastwood’s iconic lines (probably a notch below "go ahead, make my day") that wasn’t spoken to a home furnishing. 

But it’s still a question many of us think of late on a Friday afternoon just before weekend call gets rolled over to us.

Weekend hospital call, like an approaching storm, brings foreboding and dread. You have no control over the circumstances that are about to whack you. If it’s busy, you’re out of luck. Whatever comes in, you have to deal with it.

I try to ameliorate the pain by using a quote from a residency attending: "It’s not busy, it’s profitable." I also often repeat Dory’s line from "Finding Nemo" – "just keep swimming, just keep swimming" – as I round endlessly.

But humans, by nature, are superstitious creatures. Our ancestors across the globe created pantheons of deities to explain the sun, storms, ocean, and other natural phenomenon they couldn’t control and prayed to them to try to do so.

Now we fear a nebulous group of beings named the "call gods."

It’s always plural, and it’s never been established how many there are or if they have individual names. But they’re feared by all who take hospital call. Amongst physicians, I find they’re universal. Doctors who are Christians, Jews, Hindus, Muslims, atheists ... all know and fear them.

The rules of this medical religion have never been put down and are passed on by verbal tradition. The main theme is that you never, ever, ever do anything to make them angry. This primarily involves not saying things like "it’s quiet so far" or "gee, my phone hasn’t rung all day," for doing so will most assuredly bring their wrath down upon you.

Likewise, even if things are quiet, you never say that until 7:01 on Monday morning, when it’s been rolled back over to your call partner. If someone asks, "how’s your call going?" – even if nothing has happened – you still say "steady" or "hopping" just to avoid challenging the unseen deities.

Of course, the call gods aren’t the only ones we fear. There are specialty-specific, and even procedure-specific, deities. Any neurologist attempting a bedside lumbar puncture on a large person will likely say a quick prayer to the LP gods.

Medicine has come a long way, over time, but even a field with a hefty base in science can’t overcome human nature and our inherent fear of forces beyond our control.

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

"Do you feel lucky?"

It’s one of Clint Eastwood’s iconic lines (probably a notch below "go ahead, make my day") that wasn’t spoken to a home furnishing. 

But it’s still a question many of us think of late on a Friday afternoon just before weekend call gets rolled over to us.

Weekend hospital call, like an approaching storm, brings foreboding and dread. You have no control over the circumstances that are about to whack you. If it’s busy, you’re out of luck. Whatever comes in, you have to deal with it.

I try to ameliorate the pain by using a quote from a residency attending: "It’s not busy, it’s profitable." I also often repeat Dory’s line from "Finding Nemo" – "just keep swimming, just keep swimming" – as I round endlessly.

But humans, by nature, are superstitious creatures. Our ancestors across the globe created pantheons of deities to explain the sun, storms, ocean, and other natural phenomenon they couldn’t control and prayed to them to try to do so.

Now we fear a nebulous group of beings named the "call gods."

It’s always plural, and it’s never been established how many there are or if they have individual names. But they’re feared by all who take hospital call. Amongst physicians, I find they’re universal. Doctors who are Christians, Jews, Hindus, Muslims, atheists ... all know and fear them.

The rules of this medical religion have never been put down and are passed on by verbal tradition. The main theme is that you never, ever, ever do anything to make them angry. This primarily involves not saying things like "it’s quiet so far" or "gee, my phone hasn’t rung all day," for doing so will most assuredly bring their wrath down upon you.

Likewise, even if things are quiet, you never say that until 7:01 on Monday morning, when it’s been rolled back over to your call partner. If someone asks, "how’s your call going?" – even if nothing has happened – you still say "steady" or "hopping" just to avoid challenging the unseen deities.

Of course, the call gods aren’t the only ones we fear. There are specialty-specific, and even procedure-specific, deities. Any neurologist attempting a bedside lumbar puncture on a large person will likely say a quick prayer to the LP gods.

Medicine has come a long way, over time, but even a field with a hefty base in science can’t overcome human nature and our inherent fear of forces beyond our control.

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

No matter how hard we try to run on-schedule, most patients usually experience some down time in our waiting rooms. So, in the honored tradition of our ancestors, we supply magazines to read.

These days – the era of iPads – many bring their own reading material, but a good percentage still don’t and leaf through the glossies out there.

I try not to subject them to much. You won’t see drug rep pamphlets in my lobby. I get a free subscription to a celebrity gossip rag (thanks, pharma), but it goes straight to recycling on arrival. Many of my patients are seriously ill, and the last thing I want to do is have them read about people who think the worst thing in the world is to have make-up with the wrong foundation color. If professional celebrities want to see real problems, they can hang out at my office, or (better yet) an oncologist’s.

So what do I put out? I get a local parenting magazine, and my mother’s friend donates recent issues of Sunset and Good Housekeeping (thanks, Nancy). People are okay with them.

My dad once got me a big coffee table book about the history of medicine. He found it at a garage sale for 25 cents. On a whim, I put it out, and it’s been surprisingly popular. I even have a patient who makes a note of where he left off when called back, so that he can resume at his next visit.

Six months ago, while straightening up a home bookcase, I found a few "Far Side" collections, and put them out in my lobby. They quickly passed the magazines in popularity, and cemented my already solid reputation as an eccentric.

I don’t know how many other doctors have done this. I’ve heard there’s a doc on the west side of town who only has the complete P.G. Wodehouse "Bertie & Jeeves" series in his lobby. I think that would be perfectly fine, too, but takes longer to read, and I try to minimize waiting room time.

One of my strangest discoveries about private practice is that my most popular lobby magazines aren’t magazines at all. And I found them on my own bookshelf.

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

No matter how hard we try to run on-schedule, most patients usually experience some down time in our waiting rooms. So, in the honored tradition of our ancestors, we supply magazines to read.

These days – the era of iPads – many bring their own reading material, but a good percentage still don’t and leaf through the glossies out there.

I try not to subject them to much. You won’t see drug rep pamphlets in my lobby. I get a free subscription to a celebrity gossip rag (thanks, pharma), but it goes straight to recycling on arrival. Many of my patients are seriously ill, and the last thing I want to do is have them read about people who think the worst thing in the world is to have make-up with the wrong foundation color. If professional celebrities want to see real problems, they can hang out at my office, or (better yet) an oncologist’s.

So what do I put out? I get a local parenting magazine, and my mother’s friend donates recent issues of Sunset and Good Housekeeping (thanks, Nancy). People are okay with them.

My dad once got me a big coffee table book about the history of medicine. He found it at a garage sale for 25 cents. On a whim, I put it out, and it’s been surprisingly popular. I even have a patient who makes a note of where he left off when called back, so that he can resume at his next visit.

Six months ago, while straightening up a home bookcase, I found a few "Far Side" collections, and put them out in my lobby. They quickly passed the magazines in popularity, and cemented my already solid reputation as an eccentric.

I don’t know how many other doctors have done this. I’ve heard there’s a doc on the west side of town who only has the complete P.G. Wodehouse "Bertie & Jeeves" series in his lobby. I think that would be perfectly fine, too, but takes longer to read, and I try to minimize waiting room time.

One of my strangest discoveries about private practice is that my most popular lobby magazines aren’t magazines at all. And I found them on my own bookshelf.

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

No matter how hard we try to run on-schedule, most patients usually experience some down time in our waiting rooms. So, in the honored tradition of our ancestors, we supply magazines to read.

These days – the era of iPads – many bring their own reading material, but a good percentage still don’t and leaf through the glossies out there.

I try not to subject them to much. You won’t see drug rep pamphlets in my lobby. I get a free subscription to a celebrity gossip rag (thanks, pharma), but it goes straight to recycling on arrival. Many of my patients are seriously ill, and the last thing I want to do is have them read about people who think the worst thing in the world is to have make-up with the wrong foundation color. If professional celebrities want to see real problems, they can hang out at my office, or (better yet) an oncologist’s.

So what do I put out? I get a local parenting magazine, and my mother’s friend donates recent issues of Sunset and Good Housekeeping (thanks, Nancy). People are okay with them.

My dad once got me a big coffee table book about the history of medicine. He found it at a garage sale for 25 cents. On a whim, I put it out, and it’s been surprisingly popular. I even have a patient who makes a note of where he left off when called back, so that he can resume at his next visit.

Six months ago, while straightening up a home bookcase, I found a few "Far Side" collections, and put them out in my lobby. They quickly passed the magazines in popularity, and cemented my already solid reputation as an eccentric.

I don’t know how many other doctors have done this. I’ve heard there’s a doc on the west side of town who only has the complete P.G. Wodehouse "Bertie & Jeeves" series in his lobby. I think that would be perfectly fine, too, but takes longer to read, and I try to minimize waiting room time.

One of my strangest discoveries about private practice is that my most popular lobby magazines aren’t magazines at all. And I found them on my own bookshelf.

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

What’s in a name? A lot, if you’re a doctor.

"Doctor" is our formal title, although technically it means anyone with a higher educational degree. We’re also called physicians, or healers. In other times, we may have been medicine men, witch doctors, or shamans. Or we may prefer a more specific name based on our chosen field: neurologist, internist, or surgeon, for example.

Recently, though, we’ve had specific (and less flattering) names hung on us – health care providers, primary care physicians, gatekeepers – not to mention the alphabet soup that longer names bring (HCP, PCP).

It kind of puts us in a semantic identity crisis. Especially with all the HCPs out there who aren’t MDs or DOs.

But no matter what title they hang on me, I know what I do. I care for people who need me. I provide treatment for those I can help and support to those I can’t. I hold hands. I write prescriptions. I discuss test results. I talk, and I listen. I fill out forms. I argue with insurance companies. I go home each night and in the morning come back and do it all over again.

Somehow saying I’m an HCP doesn’t seem to do the job description justice.

I remember a residency meeting I attended in the mid-90s. I was in training, and the meeting was held to introduce all the residents to the hospital’s new health plan. The insurance lady running it told us not to use the word "patients" but instead call them "lives." Doctors, in her doublespeak, were "providers" unless you were in internal medicine or family practice, in which case you had the even less flattering name of "gatekeeper."

The meeting got increasingly acrimonious, and the insurance lady looked more and more uncomfortable. Finally, a family practice resident named Barb stood up and said, "You can change words all you want, but here’s the truth. We are not providers, or PCPs, or gatekeepers. We are doctors. And we do our best to care for people, even when your company won’t."

Barb stood up, turned on her heel, and walked out with her long skirt swirling. The insurance company lady was obviously angry and left through the exit behind her.

It’s now 20 years later, Barb, and I don’t think anyone could have said it better, then or now. It still holds true.

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

What’s in a name? A lot, if you’re a doctor.

"Doctor" is our formal title, although technically it means anyone with a higher educational degree. We’re also called physicians, or healers. In other times, we may have been medicine men, witch doctors, or shamans. Or we may prefer a more specific name based on our chosen field: neurologist, internist, or surgeon, for example.

Recently, though, we’ve had specific (and less flattering) names hung on us – health care providers, primary care physicians, gatekeepers – not to mention the alphabet soup that longer names bring (HCP, PCP).

It kind of puts us in a semantic identity crisis. Especially with all the HCPs out there who aren’t MDs or DOs.

But no matter what title they hang on me, I know what I do. I care for people who need me. I provide treatment for those I can help and support to those I can’t. I hold hands. I write prescriptions. I discuss test results. I talk, and I listen. I fill out forms. I argue with insurance companies. I go home each night and in the morning come back and do it all over again.

Somehow saying I’m an HCP doesn’t seem to do the job description justice.

I remember a residency meeting I attended in the mid-90s. I was in training, and the meeting was held to introduce all the residents to the hospital’s new health plan. The insurance lady running it told us not to use the word "patients" but instead call them "lives." Doctors, in her doublespeak, were "providers" unless you were in internal medicine or family practice, in which case you had the even less flattering name of "gatekeeper."

The meeting got increasingly acrimonious, and the insurance lady looked more and more uncomfortable. Finally, a family practice resident named Barb stood up and said, "You can change words all you want, but here’s the truth. We are not providers, or PCPs, or gatekeepers. We are doctors. And we do our best to care for people, even when your company won’t."

Barb stood up, turned on her heel, and walked out with her long skirt swirling. The insurance company lady was obviously angry and left through the exit behind her.

It’s now 20 years later, Barb, and I don’t think anyone could have said it better, then or now. It still holds true.

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

What’s in a name? A lot, if you’re a doctor.

"Doctor" is our formal title, although technically it means anyone with a higher educational degree. We’re also called physicians, or healers. In other times, we may have been medicine men, witch doctors, or shamans. Or we may prefer a more specific name based on our chosen field: neurologist, internist, or surgeon, for example.

Recently, though, we’ve had specific (and less flattering) names hung on us – health care providers, primary care physicians, gatekeepers – not to mention the alphabet soup that longer names bring (HCP, PCP).

It kind of puts us in a semantic identity crisis. Especially with all the HCPs out there who aren’t MDs or DOs.

But no matter what title they hang on me, I know what I do. I care for people who need me. I provide treatment for those I can help and support to those I can’t. I hold hands. I write prescriptions. I discuss test results. I talk, and I listen. I fill out forms. I argue with insurance companies. I go home each night and in the morning come back and do it all over again.

Somehow saying I’m an HCP doesn’t seem to do the job description justice.

I remember a residency meeting I attended in the mid-90s. I was in training, and the meeting was held to introduce all the residents to the hospital’s new health plan. The insurance lady running it told us not to use the word "patients" but instead call them "lives." Doctors, in her doublespeak, were "providers" unless you were in internal medicine or family practice, in which case you had the even less flattering name of "gatekeeper."

The meeting got increasingly acrimonious, and the insurance lady looked more and more uncomfortable. Finally, a family practice resident named Barb stood up and said, "You can change words all you want, but here’s the truth. We are not providers, or PCPs, or gatekeepers. We are doctors. And we do our best to care for people, even when your company won’t."

Barb stood up, turned on her heel, and walked out with her long skirt swirling. The insurance company lady was obviously angry and left through the exit behind her.

It’s now 20 years later, Barb, and I don’t think anyone could have said it better, then or now. It still holds true.

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