Hitting a Nerve

Like most doctors, I have a few patients without insurance.

Raj is a hard-working guy who, like me, has his own business and a family to support. He pays his bills, but really can’t afford insurance.

Recently, he tripped over his dog and suffered a back injury. I tried to manage it conservatively, but things kept getting worse and it became obvious that an MRI was needed. I found a decent place that gave him a cash discount and got the study.

Unfortunately, he had a pretty bad disk herniation with severe canal stenosis and radicular impingement. It was obvious he needed surgery.

He made some calls around the state, looking to get a decent surgical package put together. The best he was able to get, including surgery, anesthesia, and a few hospital days, was $60,000. This didn’t include any costs that might arise from complications.

Raj, like most of us, didn’t have that kind of money lying around. Nor was he going to go to an emergency department to make the rest of us pay for it.

But he also was having increasing problems walking. He and I had a few phone calls trying to find a solution, without any clear ideas.

His answer was to contact his grandparents, who live in India. They were able to get him names of established spine surgeons in the country. He flew there with his MRI disk, saw the surgeon, had a successful operation, and was back home after 10 days. He’s now back at work, without any complications, and doing fine.

Total cost (not including plane fare): $4,000.

I have nothing against the American health care system. I’m a part of it. But I’m left wondering why a successful back surgery would have such a dramatic cost difference between two countries. I’m sure malpractice issues are part of it, but not the whole issue. Are equipment and drug costs lower in India? Labor?

There are probably a lot of factors, which I won’t pretend to understand. But it raises a question. In an era when American medicine is trying to do more with less, what can we learn from other countries? A lot of major breakthroughs are made here that travel elsewhere, but that doesn’t mean we have all the answers.

I may be naive, but if we can learn ways to improve our system by looking elsewhere, we have to. Our patients deserve it.

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

Like most doctors, I have a few patients without insurance.

Raj is a hard-working guy who, like me, has his own business and a family to support. He pays his bills, but really can’t afford insurance.

Recently, he tripped over his dog and suffered a back injury. I tried to manage it conservatively, but things kept getting worse and it became obvious that an MRI was needed. I found a decent place that gave him a cash discount and got the study.

Unfortunately, he had a pretty bad disk herniation with severe canal stenosis and radicular impingement. It was obvious he needed surgery.

He made some calls around the state, looking to get a decent surgical package put together. The best he was able to get, including surgery, anesthesia, and a few hospital days, was $60,000. This didn’t include any costs that might arise from complications.

Raj, like most of us, didn’t have that kind of money lying around. Nor was he going to go to an emergency department to make the rest of us pay for it.

But he also was having increasing problems walking. He and I had a few phone calls trying to find a solution, without any clear ideas.

His answer was to contact his grandparents, who live in India. They were able to get him names of established spine surgeons in the country. He flew there with his MRI disk, saw the surgeon, had a successful operation, and was back home after 10 days. He’s now back at work, without any complications, and doing fine.

Total cost (not including plane fare): $4,000.

I have nothing against the American health care system. I’m a part of it. But I’m left wondering why a successful back surgery would have such a dramatic cost difference between two countries. I’m sure malpractice issues are part of it, but not the whole issue. Are equipment and drug costs lower in India? Labor?

There are probably a lot of factors, which I won’t pretend to understand. But it raises a question. In an era when American medicine is trying to do more with less, what can we learn from other countries? A lot of major breakthroughs are made here that travel elsewhere, but that doesn’t mean we have all the answers.

I may be naive, but if we can learn ways to improve our system by looking elsewhere, we have to. Our patients deserve it.

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

Like most doctors, I have a few patients without insurance.

Raj is a hard-working guy who, like me, has his own business and a family to support. He pays his bills, but really can’t afford insurance.

Recently, he tripped over his dog and suffered a back injury. I tried to manage it conservatively, but things kept getting worse and it became obvious that an MRI was needed. I found a decent place that gave him a cash discount and got the study.

Unfortunately, he had a pretty bad disk herniation with severe canal stenosis and radicular impingement. It was obvious he needed surgery.

He made some calls around the state, looking to get a decent surgical package put together. The best he was able to get, including surgery, anesthesia, and a few hospital days, was $60,000. This didn’t include any costs that might arise from complications.

Raj, like most of us, didn’t have that kind of money lying around. Nor was he going to go to an emergency department to make the rest of us pay for it.

But he also was having increasing problems walking. He and I had a few phone calls trying to find a solution, without any clear ideas.

His answer was to contact his grandparents, who live in India. They were able to get him names of established spine surgeons in the country. He flew there with his MRI disk, saw the surgeon, had a successful operation, and was back home after 10 days. He’s now back at work, without any complications, and doing fine.

Total cost (not including plane fare): $4,000.

I have nothing against the American health care system. I’m a part of it. But I’m left wondering why a successful back surgery would have such a dramatic cost difference between two countries. I’m sure malpractice issues are part of it, but not the whole issue. Are equipment and drug costs lower in India? Labor?

There are probably a lot of factors, which I won’t pretend to understand. But it raises a question. In an era when American medicine is trying to do more with less, what can we learn from other countries? A lot of major breakthroughs are made here that travel elsewhere, but that doesn’t mean we have all the answers.

I may be naive, but if we can learn ways to improve our system by looking elsewhere, we have to. Our patients deserve it.

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

Have you ever used "The Doctor Trick"?

Of course you have. You probably call it something else, though. Like a light saber, it must be used with respect and care. Overuse will render it worthless, but sometimes you don’t have a choice.

"The Doctor Trick" – as a friend in residency called it – is using your title as an excuse to leave.

I remember the first time I did it. It was in residency, and I’d somehow been dragged to a Halloween party I didn’t really want to be at. Not only that, but it had a $15 cover charge. After getting in and realizing that I’d prefer having my fingernails pulled out, I went back to the door. I showed the cashier my hospital ID and receipt indicating I’d been there less than 5 minutes. I told her I’d been called to the hospital for an emergency. She gave me my money back, and I thanked her and left.

Granted, she was under no obligation to do that, but it didn’t hurt to ask. As my dad would say: "The worst they can do is say no."

So I’ve used it here and there over time, typically as an excuse to leave a party, meeting, or pretty much any event where I’m looking for a way out. I’ve never used it to try and get better seats, or a table by the window. To me, that falls on the entitled side, and usually people will say no anyway.

It’s kept in check by knowing that overuse will, like the boy who cried wolf, render it useless. There’s also a fear that abusing it will bring bad karma from the feared "Call Gods" who will punish you next time you’re on.

That said, it still provides a convenient excuse to get out of, or away from, meetings, in-laws, school boards, and other happenings you’d rather avoid.

Membership, as they say, has its privileges.

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

Have you ever used "The Doctor Trick"?

Of course you have. You probably call it something else, though. Like a light saber, it must be used with respect and care. Overuse will render it worthless, but sometimes you don’t have a choice.

"The Doctor Trick" – as a friend in residency called it – is using your title as an excuse to leave.

I remember the first time I did it. It was in residency, and I’d somehow been dragged to a Halloween party I didn’t really want to be at. Not only that, but it had a $15 cover charge. After getting in and realizing that I’d prefer having my fingernails pulled out, I went back to the door. I showed the cashier my hospital ID and receipt indicating I’d been there less than 5 minutes. I told her I’d been called to the hospital for an emergency. She gave me my money back, and I thanked her and left.

Granted, she was under no obligation to do that, but it didn’t hurt to ask. As my dad would say: "The worst they can do is say no."

So I’ve used it here and there over time, typically as an excuse to leave a party, meeting, or pretty much any event where I’m looking for a way out. I’ve never used it to try and get better seats, or a table by the window. To me, that falls on the entitled side, and usually people will say no anyway.

It’s kept in check by knowing that overuse will, like the boy who cried wolf, render it useless. There’s also a fear that abusing it will bring bad karma from the feared "Call Gods" who will punish you next time you’re on.

That said, it still provides a convenient excuse to get out of, or away from, meetings, in-laws, school boards, and other happenings you’d rather avoid.

Membership, as they say, has its privileges.

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

Have you ever used "The Doctor Trick"?

Of course you have. You probably call it something else, though. Like a light saber, it must be used with respect and care. Overuse will render it worthless, but sometimes you don’t have a choice.

"The Doctor Trick" – as a friend in residency called it – is using your title as an excuse to leave.

I remember the first time I did it. It was in residency, and I’d somehow been dragged to a Halloween party I didn’t really want to be at. Not only that, but it had a $15 cover charge. After getting in and realizing that I’d prefer having my fingernails pulled out, I went back to the door. I showed the cashier my hospital ID and receipt indicating I’d been there less than 5 minutes. I told her I’d been called to the hospital for an emergency. She gave me my money back, and I thanked her and left.

Granted, she was under no obligation to do that, but it didn’t hurt to ask. As my dad would say: "The worst they can do is say no."

So I’ve used it here and there over time, typically as an excuse to leave a party, meeting, or pretty much any event where I’m looking for a way out. I’ve never used it to try and get better seats, or a table by the window. To me, that falls on the entitled side, and usually people will say no anyway.

It’s kept in check by knowing that overuse will, like the boy who cried wolf, render it useless. There’s also a fear that abusing it will bring bad karma from the feared "Call Gods" who will punish you next time you’re on.

That said, it still provides a convenient excuse to get out of, or away from, meetings, in-laws, school boards, and other happenings you’d rather avoid.

Membership, as they say, has its privileges.

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

How often do your patients ask about medical marijuana? I suppose it depends on where you live, but here in Arizona, it’s legal. So they ask about using it for migraines, epilepsy, diabetic neuropathy pain, and others. I hear the question from many patients.

How do I answer it? It gets tricky. I have mixed feelings about it, with anecdotal evidence from patients who have tried it, medical journals, and the usual overhyped stories in the lay press. It’s often hard for doctors to see the answer clearly and even more so for patients.

I suspect a lot of the interest comes from the commonly held belief that if it comes from "natural" sources, it has to be better for you than "chemicals." Never mind that what my dog leaves in the backyard is also "natural" or that THC is a chemical. Pretty much everything in the human body (and universe in general) is technically a chemical.

So I tell them I don’t know for sure. At best, it may help them. At worst, it’s an expensive placebo that could lead to other health issues. I explain the treatments I have to offer and that nothing is 100% successful or completely free of side effects – even "natural" products.

I’ve learned that those who’ve decided to use it won’t be dissuaded by my arguments or any amount of equivocal data, so I try to keep an open mind.

I let them make their own decision and document it carefully. If they want to go find a medical dispensary, that’s their call in the end, not mine. I also tell them that, if it doesn’t work, I’ll still be here to do my best to help them. I don’t take offense at their decision, ever.

At our best, doctors are only advisers. We can’t make anyone do anything they don’t want to.

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

How often do your patients ask about medical marijuana? I suppose it depends on where you live, but here in Arizona, it’s legal. So they ask about using it for migraines, epilepsy, diabetic neuropathy pain, and others. I hear the question from many patients.

How do I answer it? It gets tricky. I have mixed feelings about it, with anecdotal evidence from patients who have tried it, medical journals, and the usual overhyped stories in the lay press. It’s often hard for doctors to see the answer clearly and even more so for patients.

I suspect a lot of the interest comes from the commonly held belief that if it comes from "natural" sources, it has to be better for you than "chemicals." Never mind that what my dog leaves in the backyard is also "natural" or that THC is a chemical. Pretty much everything in the human body (and universe in general) is technically a chemical.

So I tell them I don’t know for sure. At best, it may help them. At worst, it’s an expensive placebo that could lead to other health issues. I explain the treatments I have to offer and that nothing is 100% successful or completely free of side effects – even "natural" products.

I’ve learned that those who’ve decided to use it won’t be dissuaded by my arguments or any amount of equivocal data, so I try to keep an open mind.

I let them make their own decision and document it carefully. If they want to go find a medical dispensary, that’s their call in the end, not mine. I also tell them that, if it doesn’t work, I’ll still be here to do my best to help them. I don’t take offense at their decision, ever.

At our best, doctors are only advisers. We can’t make anyone do anything they don’t want to.

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

How often do your patients ask about medical marijuana? I suppose it depends on where you live, but here in Arizona, it’s legal. So they ask about using it for migraines, epilepsy, diabetic neuropathy pain, and others. I hear the question from many patients.

How do I answer it? It gets tricky. I have mixed feelings about it, with anecdotal evidence from patients who have tried it, medical journals, and the usual overhyped stories in the lay press. It’s often hard for doctors to see the answer clearly and even more so for patients.

I suspect a lot of the interest comes from the commonly held belief that if it comes from "natural" sources, it has to be better for you than "chemicals." Never mind that what my dog leaves in the backyard is also "natural" or that THC is a chemical. Pretty much everything in the human body (and universe in general) is technically a chemical.

So I tell them I don’t know for sure. At best, it may help them. At worst, it’s an expensive placebo that could lead to other health issues. I explain the treatments I have to offer and that nothing is 100% successful or completely free of side effects – even "natural" products.

I’ve learned that those who’ve decided to use it won’t be dissuaded by my arguments or any amount of equivocal data, so I try to keep an open mind.

I let them make their own decision and document it carefully. If they want to go find a medical dispensary, that’s their call in the end, not mine. I also tell them that, if it doesn’t work, I’ll still be here to do my best to help them. I don’t take offense at their decision, ever.

At our best, doctors are only advisers. We can’t make anyone do anything they don’t want to.

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

I see other doctors as patients. Granted, other doctors also see me as a patient.

Seeing another doctor always adds an extra layer of challenge to the job. Even if they’re not in my field, I worry they’re secretly criticizing what I’m doing and thinking I’m clueless. Odds are favorable that they did a neurology rotation at some point, and so are at least somewhat familiar with the history and exam.

I suspect other doctors get bigger work-ups than nondoctors. Some of it may be for legal reasons, but I think most of it is that we figure they expect it from us (although, realistically, I’m not looking for a bunch of tests when I go to the doctor). As a result, more MRI scans and labs are ordered to search for both horses and zebras.

I can’t say that I’ve found weird or scary stuff in other doctors any more than what I’ve found in the general population, but somehow I worry more about missing something. Maybe some of it is the feeling that we’re all part of the same family, so I need to take care of brethren. Or a nervous feeling that they’re inwardly rolling their eyes and thinking that I’m an idiot if I don’t order a certain test. It might be more likely that they’re sitting there wondering why the hell anyone would want to be a neurologist because they hated their rotation in it.

When it comes to treatment, similar thoughts come up. Other doctors know the meds – although so does anyone with a smartphone these days – and I worry that, inwardly, they’re secretly criticizing my choice of poison or are going to argue with me about side effects.

Like any doctor, I want to give equal care to all. But human nature means different circumstances can change our mindset, and we have to overcome that. Good or bad, it’s part of the job.

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

I see other doctors as patients. Granted, other doctors also see me as a patient.

Seeing another doctor always adds an extra layer of challenge to the job. Even if they’re not in my field, I worry they’re secretly criticizing what I’m doing and thinking I’m clueless. Odds are favorable that they did a neurology rotation at some point, and so are at least somewhat familiar with the history and exam.

I suspect other doctors get bigger work-ups than nondoctors. Some of it may be for legal reasons, but I think most of it is that we figure they expect it from us (although, realistically, I’m not looking for a bunch of tests when I go to the doctor). As a result, more MRI scans and labs are ordered to search for both horses and zebras.

I can’t say that I’ve found weird or scary stuff in other doctors any more than what I’ve found in the general population, but somehow I worry more about missing something. Maybe some of it is the feeling that we’re all part of the same family, so I need to take care of brethren. Or a nervous feeling that they’re inwardly rolling their eyes and thinking that I’m an idiot if I don’t order a certain test. It might be more likely that they’re sitting there wondering why the hell anyone would want to be a neurologist because they hated their rotation in it.

When it comes to treatment, similar thoughts come up. Other doctors know the meds – although so does anyone with a smartphone these days – and I worry that, inwardly, they’re secretly criticizing my choice of poison or are going to argue with me about side effects.

Like any doctor, I want to give equal care to all. But human nature means different circumstances can change our mindset, and we have to overcome that. Good or bad, it’s part of the job.

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

I see other doctors as patients. Granted, other doctors also see me as a patient.

Seeing another doctor always adds an extra layer of challenge to the job. Even if they’re not in my field, I worry they’re secretly criticizing what I’m doing and thinking I’m clueless. Odds are favorable that they did a neurology rotation at some point, and so are at least somewhat familiar with the history and exam.

I suspect other doctors get bigger work-ups than nondoctors. Some of it may be for legal reasons, but I think most of it is that we figure they expect it from us (although, realistically, I’m not looking for a bunch of tests when I go to the doctor). As a result, more MRI scans and labs are ordered to search for both horses and zebras.

I can’t say that I’ve found weird or scary stuff in other doctors any more than what I’ve found in the general population, but somehow I worry more about missing something. Maybe some of it is the feeling that we’re all part of the same family, so I need to take care of brethren. Or a nervous feeling that they’re inwardly rolling their eyes and thinking that I’m an idiot if I don’t order a certain test. It might be more likely that they’re sitting there wondering why the hell anyone would want to be a neurologist because they hated their rotation in it.

When it comes to treatment, similar thoughts come up. Other doctors know the meds – although so does anyone with a smartphone these days – and I worry that, inwardly, they’re secretly criticizing my choice of poison or are going to argue with me about side effects.

Like any doctor, I want to give equal care to all. But human nature means different circumstances can change our mindset, and we have to overcome that. Good or bad, it’s part of the job.

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

Discharge summaries have become my pet peeve recently.

It’s not uncommon for a patient to be referred to me for outpatient follow-up, or for one of my own patients to be treated where I’m not on staff and then sent back to me afterward. When that occurs, I used to get a copy of the discharge summary to get an idea of what happened. (Note the "used to.") I certainly wouldn’t rely on it entirely, but it was helpful. Not anymore.

The modern discharge summary is worthless and sometimes downright dangerous. It’s often nonspecific and typically full of errors. Not minor errors, either, but big ones. I commonly see patients listed as having had procedures they didn’t undergo, test results that were someone else’s, and diagnoses and medications that aren’t even close.

Here’s a recent example (I’ve removed some information, but this is the basic idea): "The patient was admitted for dizziness. She was seen by neurology and had a brain MRI and labs. Discharge diagnosis is dizziness. Her medications were not changed."

That was it – a few sentences in one paragraph.

How much valuable information did you get from that? Absolutely none. All I see is that I need to get the MRI report and/or films, and possibly the other neurologist’s notes.

In years past, the summary was done by the patient’s own physician, who knew he or she would be referring to it in a few weeks when the patient came in for follow-up. So there was a vested interest in it being thorough and useful.

But today the reports are typically dictated by hospitalists. They may provide good care, but it’s often the case that they just picked up the patient for the first time. They likely have 18 other people to see, five admissions, and three discharge summaries to do and don’t have the time to do more than glance through the H&P and last few scribbled notes. As the day goes on, patients also tend to blur together, causing more errors.

The hospitalists simply don’t know patients as well as do the outpatient physicians who have been seeing them for years, and so fewer errors will be caught. I admit I’m guilty of turning some of my own patients over to inpatient physicians. All of us are busy. And I’m not knocking hospitalists, who do an often difficult part of medicine. But the loss of communication between these two branches of medicine is a sad loss for all of us – especially for our patients.

Perhaps the most irritating part is the generic statement I see at the bottom of many summaries: "This discharge summary may contain errors and omissions. Please refer to the full chart for complete information." This, sadly, is an admission that the document is worthless (which I doubt will stand up in court). I don’t often have access to the full chart, or time to comb through it in detail, when the patient comes in. Although I wouldn’t put all my faith in the summary, it’s nice when it give me a general idea of what I’m dealing with.

Once, a discharge summary was something useful – a succinct statement of events for the next doctor to use for guidance. Today, it’s become the kitchen mess piled up after a party. No one wants to do it, so a hurried, sloppy job is done, making more work for everyone else later.

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

Discharge summaries have become my pet peeve recently.

It’s not uncommon for a patient to be referred to me for outpatient follow-up, or for one of my own patients to be treated where I’m not on staff and then sent back to me afterward. When that occurs, I used to get a copy of the discharge summary to get an idea of what happened. (Note the "used to.") I certainly wouldn’t rely on it entirely, but it was helpful. Not anymore.

The modern discharge summary is worthless and sometimes downright dangerous. It’s often nonspecific and typically full of errors. Not minor errors, either, but big ones. I commonly see patients listed as having had procedures they didn’t undergo, test results that were someone else’s, and diagnoses and medications that aren’t even close.

Here’s a recent example (I’ve removed some information, but this is the basic idea): "The patient was admitted for dizziness. She was seen by neurology and had a brain MRI and labs. Discharge diagnosis is dizziness. Her medications were not changed."

That was it – a few sentences in one paragraph.

How much valuable information did you get from that? Absolutely none. All I see is that I need to get the MRI report and/or films, and possibly the other neurologist’s notes.

In years past, the summary was done by the patient’s own physician, who knew he or she would be referring to it in a few weeks when the patient came in for follow-up. So there was a vested interest in it being thorough and useful.

But today the reports are typically dictated by hospitalists. They may provide good care, but it’s often the case that they just picked up the patient for the first time. They likely have 18 other people to see, five admissions, and three discharge summaries to do and don’t have the time to do more than glance through the H&P and last few scribbled notes. As the day goes on, patients also tend to blur together, causing more errors.

The hospitalists simply don’t know patients as well as do the outpatient physicians who have been seeing them for years, and so fewer errors will be caught. I admit I’m guilty of turning some of my own patients over to inpatient physicians. All of us are busy. And I’m not knocking hospitalists, who do an often difficult part of medicine. But the loss of communication between these two branches of medicine is a sad loss for all of us – especially for our patients.

Perhaps the most irritating part is the generic statement I see at the bottom of many summaries: "This discharge summary may contain errors and omissions. Please refer to the full chart for complete information." This, sadly, is an admission that the document is worthless (which I doubt will stand up in court). I don’t often have access to the full chart, or time to comb through it in detail, when the patient comes in. Although I wouldn’t put all my faith in the summary, it’s nice when it give me a general idea of what I’m dealing with.

Once, a discharge summary was something useful – a succinct statement of events for the next doctor to use for guidance. Today, it’s become the kitchen mess piled up after a party. No one wants to do it, so a hurried, sloppy job is done, making more work for everyone else later.

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

Discharge summaries have become my pet peeve recently.

It’s not uncommon for a patient to be referred to me for outpatient follow-up, or for one of my own patients to be treated where I’m not on staff and then sent back to me afterward. When that occurs, I used to get a copy of the discharge summary to get an idea of what happened. (Note the "used to.") I certainly wouldn’t rely on it entirely, but it was helpful. Not anymore.

The modern discharge summary is worthless and sometimes downright dangerous. It’s often nonspecific and typically full of errors. Not minor errors, either, but big ones. I commonly see patients listed as having had procedures they didn’t undergo, test results that were someone else’s, and diagnoses and medications that aren’t even close.

Here’s a recent example (I’ve removed some information, but this is the basic idea): "The patient was admitted for dizziness. She was seen by neurology and had a brain MRI and labs. Discharge diagnosis is dizziness. Her medications were not changed."

That was it – a few sentences in one paragraph.

How much valuable information did you get from that? Absolutely none. All I see is that I need to get the MRI report and/or films, and possibly the other neurologist’s notes.

In years past, the summary was done by the patient’s own physician, who knew he or she would be referring to it in a few weeks when the patient came in for follow-up. So there was a vested interest in it being thorough and useful.

But today the reports are typically dictated by hospitalists. They may provide good care, but it’s often the case that they just picked up the patient for the first time. They likely have 18 other people to see, five admissions, and three discharge summaries to do and don’t have the time to do more than glance through the H&P and last few scribbled notes. As the day goes on, patients also tend to blur together, causing more errors.

The hospitalists simply don’t know patients as well as do the outpatient physicians who have been seeing them for years, and so fewer errors will be caught. I admit I’m guilty of turning some of my own patients over to inpatient physicians. All of us are busy. And I’m not knocking hospitalists, who do an often difficult part of medicine. But the loss of communication between these two branches of medicine is a sad loss for all of us – especially for our patients.

Perhaps the most irritating part is the generic statement I see at the bottom of many summaries: "This discharge summary may contain errors and omissions. Please refer to the full chart for complete information." This, sadly, is an admission that the document is worthless (which I doubt will stand up in court). I don’t often have access to the full chart, or time to comb through it in detail, when the patient comes in. Although I wouldn’t put all my faith in the summary, it’s nice when it give me a general idea of what I’m dealing with.

Once, a discharge summary was something useful – a succinct statement of events for the next doctor to use for guidance. Today, it’s become the kitchen mess piled up after a party. No one wants to do it, so a hurried, sloppy job is done, making more work for everyone else later.

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

How often do you fire patients? I do it here and there, maybe a few times a year, but certainly not as often as patients fire me.

Contrary to popular belief, I don’t get some sort of perverse thrill out of it. I am maybe relieved, knowing that I’m (hopefully) done with a difficult relationship. But it’s a pain, always requiring a trip to the post office to send the registered letter. There’s also the fear that they’ll report me to the board for it, and I’ll have to defend my actions. And I certainly can’t guard against the one-sided Yelp reviews.

What tips you over the edge? I consider myself pretty tolerant. In long-standing patients, I’ll generally let the occasional no-show slide. For drug abusers, I’m actually willing to continue with many of them, but will let them know that I’m not going to give them controlled substances anymore. Most of them leave at that point anyway.

I have zero tolerance for malicious behavior. Abuse my staff, and you’re out of here. I’m more willing to put up with someone who’s nasty to me than one who treats my staff the same way.

What other things do I fire them for? Occasionally noncompliance, especially if it’s putting their own safety in danger. Only once have I fired someone for refusing to have tests done. That was after, literally, 5 years of him repeatedly showing up annually to ask me to order them for his symptoms, then never following through and showing up a year later to start over again. At some point, my patience for that type of thing runs out, and I consider myself fairly patient.

Like most doctors, I’ve had more patients fire me than I’ve fired patients. For most, you don’t realize they’re gone. They just never come back. Occasionally, you get a release from another doctor, but more often you don’t.

Rarely, someone sends a nasty letter telling me why they went elsewhere and what they think of my medical skills/fashion sense/office décor ... whatever. The first time I got one of those, it hurt. Nowadays, I just don’t care.

Part of growing up as a doctor is realizing you’ll never make everyone happy or be able to help them all. Trying to do so will only lessen your sanity, so it’s a message best learned early.

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

How often do you fire patients? I do it here and there, maybe a few times a year, but certainly not as often as patients fire me.

Contrary to popular belief, I don’t get some sort of perverse thrill out of it. I am maybe relieved, knowing that I’m (hopefully) done with a difficult relationship. But it’s a pain, always requiring a trip to the post office to send the registered letter. There’s also the fear that they’ll report me to the board for it, and I’ll have to defend my actions. And I certainly can’t guard against the one-sided Yelp reviews.

What tips you over the edge? I consider myself pretty tolerant. In long-standing patients, I’ll generally let the occasional no-show slide. For drug abusers, I’m actually willing to continue with many of them, but will let them know that I’m not going to give them controlled substances anymore. Most of them leave at that point anyway.

I have zero tolerance for malicious behavior. Abuse my staff, and you’re out of here. I’m more willing to put up with someone who’s nasty to me than one who treats my staff the same way.

What other things do I fire them for? Occasionally noncompliance, especially if it’s putting their own safety in danger. Only once have I fired someone for refusing to have tests done. That was after, literally, 5 years of him repeatedly showing up annually to ask me to order them for his symptoms, then never following through and showing up a year later to start over again. At some point, my patience for that type of thing runs out, and I consider myself fairly patient.

Like most doctors, I’ve had more patients fire me than I’ve fired patients. For most, you don’t realize they’re gone. They just never come back. Occasionally, you get a release from another doctor, but more often you don’t.

Rarely, someone sends a nasty letter telling me why they went elsewhere and what they think of my medical skills/fashion sense/office décor ... whatever. The first time I got one of those, it hurt. Nowadays, I just don’t care.

Part of growing up as a doctor is realizing you’ll never make everyone happy or be able to help them all. Trying to do so will only lessen your sanity, so it’s a message best learned early.

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

How often do you fire patients? I do it here and there, maybe a few times a year, but certainly not as often as patients fire me.

Contrary to popular belief, I don’t get some sort of perverse thrill out of it. I am maybe relieved, knowing that I’m (hopefully) done with a difficult relationship. But it’s a pain, always requiring a trip to the post office to send the registered letter. There’s also the fear that they’ll report me to the board for it, and I’ll have to defend my actions. And I certainly can’t guard against the one-sided Yelp reviews.

What tips you over the edge? I consider myself pretty tolerant. In long-standing patients, I’ll generally let the occasional no-show slide. For drug abusers, I’m actually willing to continue with many of them, but will let them know that I’m not going to give them controlled substances anymore. Most of them leave at that point anyway.

I have zero tolerance for malicious behavior. Abuse my staff, and you’re out of here. I’m more willing to put up with someone who’s nasty to me than one who treats my staff the same way.

What other things do I fire them for? Occasionally noncompliance, especially if it’s putting their own safety in danger. Only once have I fired someone for refusing to have tests done. That was after, literally, 5 years of him repeatedly showing up annually to ask me to order them for his symptoms, then never following through and showing up a year later to start over again. At some point, my patience for that type of thing runs out, and I consider myself fairly patient.

Like most doctors, I’ve had more patients fire me than I’ve fired patients. For most, you don’t realize they’re gone. They just never come back. Occasionally, you get a release from another doctor, but more often you don’t.

Rarely, someone sends a nasty letter telling me why they went elsewhere and what they think of my medical skills/fashion sense/office décor ... whatever. The first time I got one of those, it hurt. Nowadays, I just don’t care.

Part of growing up as a doctor is realizing you’ll never make everyone happy or be able to help them all. Trying to do so will only lessen your sanity, so it’s a message best learned early.

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

"What are the side effects?" How many times a day do you get asked that? Plenty, I’m sure. I certainly hear it.

The list of side effects (small print on the product insert) is enormous. No one can possibly cover them in the few minutes we have during a visit, so I just try to hit the ones that are most likely and those that are most serious.

Of course, most patients still go home and look them up. The majority of patients are fine with it, but some immediately develop every side effect imaginable through the power of suggestion. While I’m all for "empowered patients," the Internet is full of both useful and insanely inaccurate information. It’s often hard to tell them apart.

I still get asked for drugs "without any side effects" and try to explain that there is no such thing and never will be. The vagaries of human biochemistry are such that everyone will have a negative reaction to something sooner or later. And it generally can’t be predicted in advance.

I try to reassure people that just because a drug can cause an adverse reaction doesn’t mean that it will. I explain how most side effects were reported in a minority of patients, go over how the data are collected during trials, and so on. Most people are reasonable and understand that there’s a benefit-to-risk calculation we’re making, like anything else.

But some patients are quite adamant that as long as there’s even the slightest chance of them having a side effect, they don’t want to take it. They want help, but won’t let me help them. Those appointments are frustrating and make me wonder why the patient bothered to come in at all. They’re the reason I keep a wand next to my desk.

There is no shortage of treatments for at least some of the many conditions that neurologists treat, but at the same time there is always the chance that side effects will occur. Medicine, like everything else in life, has benefits and risks.

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

"What are the side effects?" How many times a day do you get asked that? Plenty, I’m sure. I certainly hear it.

The list of side effects (small print on the product insert) is enormous. No one can possibly cover them in the few minutes we have during a visit, so I just try to hit the ones that are most likely and those that are most serious.

Of course, most patients still go home and look them up. The majority of patients are fine with it, but some immediately develop every side effect imaginable through the power of suggestion. While I’m all for "empowered patients," the Internet is full of both useful and insanely inaccurate information. It’s often hard to tell them apart.

I still get asked for drugs "without any side effects" and try to explain that there is no such thing and never will be. The vagaries of human biochemistry are such that everyone will have a negative reaction to something sooner or later. And it generally can’t be predicted in advance.

I try to reassure people that just because a drug can cause an adverse reaction doesn’t mean that it will. I explain how most side effects were reported in a minority of patients, go over how the data are collected during trials, and so on. Most people are reasonable and understand that there’s a benefit-to-risk calculation we’re making, like anything else.

But some patients are quite adamant that as long as there’s even the slightest chance of them having a side effect, they don’t want to take it. They want help, but won’t let me help them. Those appointments are frustrating and make me wonder why the patient bothered to come in at all. They’re the reason I keep a wand next to my desk.

There is no shortage of treatments for at least some of the many conditions that neurologists treat, but at the same time there is always the chance that side effects will occur. Medicine, like everything else in life, has benefits and risks.

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

"What are the side effects?" How many times a day do you get asked that? Plenty, I’m sure. I certainly hear it.

The list of side effects (small print on the product insert) is enormous. No one can possibly cover them in the few minutes we have during a visit, so I just try to hit the ones that are most likely and those that are most serious.

Of course, most patients still go home and look them up. The majority of patients are fine with it, but some immediately develop every side effect imaginable through the power of suggestion. While I’m all for "empowered patients," the Internet is full of both useful and insanely inaccurate information. It’s often hard to tell them apart.

I still get asked for drugs "without any side effects" and try to explain that there is no such thing and never will be. The vagaries of human biochemistry are such that everyone will have a negative reaction to something sooner or later. And it generally can’t be predicted in advance.

I try to reassure people that just because a drug can cause an adverse reaction doesn’t mean that it will. I explain how most side effects were reported in a minority of patients, go over how the data are collected during trials, and so on. Most people are reasonable and understand that there’s a benefit-to-risk calculation we’re making, like anything else.

But some patients are quite adamant that as long as there’s even the slightest chance of them having a side effect, they don’t want to take it. They want help, but won’t let me help them. Those appointments are frustrating and make me wonder why the patient bothered to come in at all. They’re the reason I keep a wand next to my desk.

There is no shortage of treatments for at least some of the many conditions that neurologists treat, but at the same time there is always the chance that side effects will occur. Medicine, like everything else in life, has benefits and risks.

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

In my area, there are several internists who run cash-pay practices. Only one of them refers to me, and that’s just when he can’t get them to see the Mayo Clinic folks fast enough.

I’m not a cash-only concierge neurologist for a number of reasons I’ve previously mentioned. I don’t really try to cultivate these referrals, and the concierge physicians don’t really want me to see their patients.

Why would I not be bending over backward to get more patients? I take Medicare (and other insurances), so whether you want to pay cash or not, if you’re on Medicare, I can’t accept it. It’s a crime. I can only take what Washington says I can. Maybe that law will change someday, but I doubt it.

So the patient who’s paying $3,000 per year to see Dr. Concierge down the street and cash for every visit after that isn’t financially any more special to me than the guy who’s living on a fixed income and only has Medicare. I get paid the same for both.

About a year ago, a representative from a cash-only practice came by, asking me to be the "designated neurologist" for them. In return, I’d have to agree to the following conditions:

• All patients from them would be seen within 24 hours of calling my office.

• I’d have to give my cell and home phone numbers to all of their patients, so I’d be available. ("Our patients want a lot of hand-holding" is what he said.)

• If needed, I’d meet them on weekends, either at my office or by making house calls, at the patient’s request.

There were a few other requests. I politely said, "No, thank you" and handed his "designated specialist" paperwork back to him.

My practice right now is pretty egalitarian. Uncle Sam pays me the same for your visit regardless of how much money you have or what your social standing is. I also value my privacy and home life. My patients know how to reach the doc on call in an emergency, and know it may not be me.

So, if you’re a concierge physician and don’t feel I’m going the extra mile to get your patients in at the drop of a hat, or to make sure a double-soy latte is ready for them on arrival, I’m sorry. They may be paying you a lot for these perks, but not me. The only thing I have to offer at my practice is the best patient care I can – to all equally.

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

In my area, there are several internists who run cash-pay practices. Only one of them refers to me, and that’s just when he can’t get them to see the Mayo Clinic folks fast enough.

I’m not a cash-only concierge neurologist for a number of reasons I’ve previously mentioned. I don’t really try to cultivate these referrals, and the concierge physicians don’t really want me to see their patients.

Why would I not be bending over backward to get more patients? I take Medicare (and other insurances), so whether you want to pay cash or not, if you’re on Medicare, I can’t accept it. It’s a crime. I can only take what Washington says I can. Maybe that law will change someday, but I doubt it.

So the patient who’s paying $3,000 per year to see Dr. Concierge down the street and cash for every visit after that isn’t financially any more special to me than the guy who’s living on a fixed income and only has Medicare. I get paid the same for both.

About a year ago, a representative from a cash-only practice came by, asking me to be the "designated neurologist" for them. In return, I’d have to agree to the following conditions:

• All patients from them would be seen within 24 hours of calling my office.

• I’d have to give my cell and home phone numbers to all of their patients, so I’d be available. ("Our patients want a lot of hand-holding" is what he said.)

• If needed, I’d meet them on weekends, either at my office or by making house calls, at the patient’s request.

There were a few other requests. I politely said, "No, thank you" and handed his "designated specialist" paperwork back to him.

My practice right now is pretty egalitarian. Uncle Sam pays me the same for your visit regardless of how much money you have or what your social standing is. I also value my privacy and home life. My patients know how to reach the doc on call in an emergency, and know it may not be me.

So, if you’re a concierge physician and don’t feel I’m going the extra mile to get your patients in at the drop of a hat, or to make sure a double-soy latte is ready for them on arrival, I’m sorry. They may be paying you a lot for these perks, but not me. The only thing I have to offer at my practice is the best patient care I can – to all equally.

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

In my area, there are several internists who run cash-pay practices. Only one of them refers to me, and that’s just when he can’t get them to see the Mayo Clinic folks fast enough.

I’m not a cash-only concierge neurologist for a number of reasons I’ve previously mentioned. I don’t really try to cultivate these referrals, and the concierge physicians don’t really want me to see their patients.

Why would I not be bending over backward to get more patients? I take Medicare (and other insurances), so whether you want to pay cash or not, if you’re on Medicare, I can’t accept it. It’s a crime. I can only take what Washington says I can. Maybe that law will change someday, but I doubt it.

So the patient who’s paying $3,000 per year to see Dr. Concierge down the street and cash for every visit after that isn’t financially any more special to me than the guy who’s living on a fixed income and only has Medicare. I get paid the same for both.

About a year ago, a representative from a cash-only practice came by, asking me to be the "designated neurologist" for them. In return, I’d have to agree to the following conditions:

• All patients from them would be seen within 24 hours of calling my office.

• I’d have to give my cell and home phone numbers to all of their patients, so I’d be available. ("Our patients want a lot of hand-holding" is what he said.)

• If needed, I’d meet them on weekends, either at my office or by making house calls, at the patient’s request.

There were a few other requests. I politely said, "No, thank you" and handed his "designated specialist" paperwork back to him.

My practice right now is pretty egalitarian. Uncle Sam pays me the same for your visit regardless of how much money you have or what your social standing is. I also value my privacy and home life. My patients know how to reach the doc on call in an emergency, and know it may not be me.

So, if you’re a concierge physician and don’t feel I’m going the extra mile to get your patients in at the drop of a hat, or to make sure a double-soy latte is ready for them on arrival, I’m sorry. They may be paying you a lot for these perks, but not me. The only thing I have to offer at my practice is the best patient care I can – to all equally.

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

"I’m sorry."

I say that a lot – probably a few times an hour. I say it if I’m 2 minutes late taking a patient back, when a patient complains that the MRI was too loud, that a medication didn’t help, that I poked too hard with the pin while testing sensation, when a patient is unhappy that we don’t take American Express, or pretty much anything.

It’s a common phrase, meant to express care and concern and to smooth out the fabric of human social relationships.

A total of 37 states have some form of a medical malpractice "apology law" that allows physicians to apologize after something goes wrong without the apology being used against them in court. Thirteen states do not have an apology law (Alabama, Alaska, Arkansas, Illinois, Kansas, Kentucky, Minnesota, Mississippi, Nevada, New Mexico, New York, Rhode Island, and Wisconsin).

When a case goes bad we all feel awful about it, regardless of whether or not it’s our fault. These include the patient with symptomatic carotid stenosis we referred for surgery who then had a stroke on the operating table, the multiple sclerosis patient with a downhill course regardless of what medication we use, and the young person with speech problems who turns out to have a glioma.

We’ve all seen similar outcomes and feel bad for the patients. We do our best, but things beyond our control happen. Unfortunately, this is part of medicine. At the end of the day, we can only hope to have had more good outcomes than bad, but the bad ones are still unavoidable. Luck, chance, biology, aging, and human fallibility all work against us sometimes.

When things go wrong, it’s normal to say "I’m sorry," because we are concerned and do care and wish it had happened otherwise for the sake of someone who came to us seeking help.

To me, it seems wrong that expressing such feelings can be seen as an admission of guilt. It sounds more like part of the Miranda rights: "Anything you say can and will be used against you in a court of law." 

Being afraid to apologize can make a bad situation even worse. Not expressing condolences makes a doctor appear aloof, uncaring, and arrogant.

Communication between a doctor, the patient, and his or her family under difficult circumstances is never easy, and having a simple apology subject to legal action only makes it worse. The medical relationship works best when it is open and honest – the way it should be everywhere.

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

"I’m sorry."

I say that a lot – probably a few times an hour. I say it if I’m 2 minutes late taking a patient back, when a patient complains that the MRI was too loud, that a medication didn’t help, that I poked too hard with the pin while testing sensation, when a patient is unhappy that we don’t take American Express, or pretty much anything.

It’s a common phrase, meant to express care and concern and to smooth out the fabric of human social relationships.

A total of 37 states have some form of a medical malpractice "apology law" that allows physicians to apologize after something goes wrong without the apology being used against them in court. Thirteen states do not have an apology law (Alabama, Alaska, Arkansas, Illinois, Kansas, Kentucky, Minnesota, Mississippi, Nevada, New Mexico, New York, Rhode Island, and Wisconsin).

When a case goes bad we all feel awful about it, regardless of whether or not it’s our fault. These include the patient with symptomatic carotid stenosis we referred for surgery who then had a stroke on the operating table, the multiple sclerosis patient with a downhill course regardless of what medication we use, and the young person with speech problems who turns out to have a glioma.

We’ve all seen similar outcomes and feel bad for the patients. We do our best, but things beyond our control happen. Unfortunately, this is part of medicine. At the end of the day, we can only hope to have had more good outcomes than bad, but the bad ones are still unavoidable. Luck, chance, biology, aging, and human fallibility all work against us sometimes.

When things go wrong, it’s normal to say "I’m sorry," because we are concerned and do care and wish it had happened otherwise for the sake of someone who came to us seeking help.

To me, it seems wrong that expressing such feelings can be seen as an admission of guilt. It sounds more like part of the Miranda rights: "Anything you say can and will be used against you in a court of law." 

Being afraid to apologize can make a bad situation even worse. Not expressing condolences makes a doctor appear aloof, uncaring, and arrogant.

Communication between a doctor, the patient, and his or her family under difficult circumstances is never easy, and having a simple apology subject to legal action only makes it worse. The medical relationship works best when it is open and honest – the way it should be everywhere.

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

"I’m sorry."

I say that a lot – probably a few times an hour. I say it if I’m 2 minutes late taking a patient back, when a patient complains that the MRI was too loud, that a medication didn’t help, that I poked too hard with the pin while testing sensation, when a patient is unhappy that we don’t take American Express, or pretty much anything.

It’s a common phrase, meant to express care and concern and to smooth out the fabric of human social relationships.

A total of 37 states have some form of a medical malpractice "apology law" that allows physicians to apologize after something goes wrong without the apology being used against them in court. Thirteen states do not have an apology law (Alabama, Alaska, Arkansas, Illinois, Kansas, Kentucky, Minnesota, Mississippi, Nevada, New Mexico, New York, Rhode Island, and Wisconsin).

When a case goes bad we all feel awful about it, regardless of whether or not it’s our fault. These include the patient with symptomatic carotid stenosis we referred for surgery who then had a stroke on the operating table, the multiple sclerosis patient with a downhill course regardless of what medication we use, and the young person with speech problems who turns out to have a glioma.

We’ve all seen similar outcomes and feel bad for the patients. We do our best, but things beyond our control happen. Unfortunately, this is part of medicine. At the end of the day, we can only hope to have had more good outcomes than bad, but the bad ones are still unavoidable. Luck, chance, biology, aging, and human fallibility all work against us sometimes.

When things go wrong, it’s normal to say "I’m sorry," because we are concerned and do care and wish it had happened otherwise for the sake of someone who came to us seeking help.

To me, it seems wrong that expressing such feelings can be seen as an admission of guilt. It sounds more like part of the Miranda rights: "Anything you say can and will be used against you in a court of law." 

Being afraid to apologize can make a bad situation even worse. Not expressing condolences makes a doctor appear aloof, uncaring, and arrogant.

Communication between a doctor, the patient, and his or her family under difficult circumstances is never easy, and having a simple apology subject to legal action only makes it worse. The medical relationship works best when it is open and honest – the way it should be everywhere.

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

How often have you read "Neighbor Rosicky" by Willa Cather?

Really? You should. It’ll take maybe an hour, at most. You can likely find it free online.

It was an assignment for a college literature class I took in 1987. A lot of the things we read weren’t particularly memorable, but this one grabbed me. It’s a simple story about life, aging, and family, partially told through the eyes of a young doctor. At the same time it has both very little and a lot to do with being a doctor. It wasn’t my sole inspiration to become one, but it struck a chord that made me feel like it was the right thing for me.

At its heart and soul, it’s why, I believe, many of us become doctors. In the modern era, it’s also likely more fantasy than reality. But the basic theme is there: helping patients who genuinely need you and who appreciate what you do for them, even when the news isn’t good.

I’m sure there are still areas (though not many in the Western world) where medicine is more like the story. Besides, neurology is a pretty tech-dependent field. We couldn’t do our job without advanced imaging, electroencephalography, electromyography and nerve conduction velocity testing, etc.

But we still care for patients. For all the labels that get put on us (practitioners, providers, defendants, etc.) what we do now is still what the shamans did ages ago: try to help sick people with the tools that are available to us. And that, at the center of things, is what being a doctor is about.

It’s an idea that’s easy to lose sight of these days, with the endless forms for medication and test authorizations; news articles about how we’re overpaid, underpaid, inebriated, suicidal, or dangerous; and where there’s an emphasis on patient satisfaction that doesn’t necessarily involve clinical outcomes ("my migraines are better, but I was disappointed I wasn’t offered a beverage while waiting for the doctor").

So, I keep a copy of "Neighbor Rosicky" on my Kindle, and read it when I need to remind myself why I like this job. Sometimes even grateful patients forget to say thank you, and it’s good to remember that we are, for the most part, appreciated.

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

How often have you read "Neighbor Rosicky" by Willa Cather?

Really? You should. It’ll take maybe an hour, at most. You can likely find it free online.

It was an assignment for a college literature class I took in 1987. A lot of the things we read weren’t particularly memorable, but this one grabbed me. It’s a simple story about life, aging, and family, partially told through the eyes of a young doctor. At the same time it has both very little and a lot to do with being a doctor. It wasn’t my sole inspiration to become one, but it struck a chord that made me feel like it was the right thing for me.

At its heart and soul, it’s why, I believe, many of us become doctors. In the modern era, it’s also likely more fantasy than reality. But the basic theme is there: helping patients who genuinely need you and who appreciate what you do for them, even when the news isn’t good.

I’m sure there are still areas (though not many in the Western world) where medicine is more like the story. Besides, neurology is a pretty tech-dependent field. We couldn’t do our job without advanced imaging, electroencephalography, electromyography and nerve conduction velocity testing, etc.

But we still care for patients. For all the labels that get put on us (practitioners, providers, defendants, etc.) what we do now is still what the shamans did ages ago: try to help sick people with the tools that are available to us. And that, at the center of things, is what being a doctor is about.

It’s an idea that’s easy to lose sight of these days, with the endless forms for medication and test authorizations; news articles about how we’re overpaid, underpaid, inebriated, suicidal, or dangerous; and where there’s an emphasis on patient satisfaction that doesn’t necessarily involve clinical outcomes ("my migraines are better, but I was disappointed I wasn’t offered a beverage while waiting for the doctor").

So, I keep a copy of "Neighbor Rosicky" on my Kindle, and read it when I need to remind myself why I like this job. Sometimes even grateful patients forget to say thank you, and it’s good to remember that we are, for the most part, appreciated.

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

How often have you read "Neighbor Rosicky" by Willa Cather?

Really? You should. It’ll take maybe an hour, at most. You can likely find it free online.

It was an assignment for a college literature class I took in 1987. A lot of the things we read weren’t particularly memorable, but this one grabbed me. It’s a simple story about life, aging, and family, partially told through the eyes of a young doctor. At the same time it has both very little and a lot to do with being a doctor. It wasn’t my sole inspiration to become one, but it struck a chord that made me feel like it was the right thing for me.

At its heart and soul, it’s why, I believe, many of us become doctors. In the modern era, it’s also likely more fantasy than reality. But the basic theme is there: helping patients who genuinely need you and who appreciate what you do for them, even when the news isn’t good.

I’m sure there are still areas (though not many in the Western world) where medicine is more like the story. Besides, neurology is a pretty tech-dependent field. We couldn’t do our job without advanced imaging, electroencephalography, electromyography and nerve conduction velocity testing, etc.

But we still care for patients. For all the labels that get put on us (practitioners, providers, defendants, etc.) what we do now is still what the shamans did ages ago: try to help sick people with the tools that are available to us. And that, at the center of things, is what being a doctor is about.

It’s an idea that’s easy to lose sight of these days, with the endless forms for medication and test authorizations; news articles about how we’re overpaid, underpaid, inebriated, suicidal, or dangerous; and where there’s an emphasis on patient satisfaction that doesn’t necessarily involve clinical outcomes ("my migraines are better, but I was disappointed I wasn’t offered a beverage while waiting for the doctor").

So, I keep a copy of "Neighbor Rosicky" on my Kindle, and read it when I need to remind myself why I like this job. Sometimes even grateful patients forget to say thank you, and it’s good to remember that we are, for the most part, appreciated.

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