Hitting a Nerve

Recently, Ben Stein wrote a column about his visit to a dermatologist, who was, apparently, planning on billing a full new patient charge when all the appointment consisted of was him telling Mr. Stein that he didn’t treat his condition and suggesting he go elsewhere.

Have I ever had visits like that? Sure, a few times a year someone will wander in under the impression I’m a pain specialist, or a neurosurgeon, or whatever. This usually comes out pretty quickly, and when it happens I point them in the right direction and tear up the bill and paperwork. I also dictate a brief note as to what happened, why the visit was ended, and specifically state, "There was no charge for this visit."

Could I bill for it? Of course. Should I? No.

Yes, I know some out there disagree. After all, I did reserve time for this person, and now I lose money on it. My counter is that the same thing happens if a patient gets called into work at the last minute, wakes up violently ill that morning, or has a flat tire on the way to my office. I don’t charge them, either. It’s not right, and I can always use the time to catch up on something else.

I agree – to an extent – with Mr. Stein that there is a "moral-ethical-criminal problem" in modern medical care. He notes that the majority of doctors he’s been to have been fine, but, as in any other field, it only takes a few bad ones to tarnish us all.

All of us likely know a doctor who commits some degree of fraud: overcharging for simple visits, submitting bills on patients he/she never saw, or submitting claims for tests that weren’t done. Obviously, these people shouldn’t be in practice. As Mr. Stein says, they use their license to heal as one to steal.

Sadly, these people don’t see anything wrong with what they’re doing, either. To them it’s just business as usual to submit a level 5 bill for a 10-minute visit, rationalizing it as having to make a living or convincing themselves it was really a 40-minute visit, or whatever. I have no sympathy for them when they get caught.

I still try to be fair, and believe most doctors do, too. Mr. Stein concedes the same point at the end. Unfortunately, as with corrupt politicians, judges, or teachers, it doesn’t take much to hurt the reputation of many.

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

Recently, Ben Stein wrote a column about his visit to a dermatologist, who was, apparently, planning on billing a full new patient charge when all the appointment consisted of was him telling Mr. Stein that he didn’t treat his condition and suggesting he go elsewhere.

Have I ever had visits like that? Sure, a few times a year someone will wander in under the impression I’m a pain specialist, or a neurosurgeon, or whatever. This usually comes out pretty quickly, and when it happens I point them in the right direction and tear up the bill and paperwork. I also dictate a brief note as to what happened, why the visit was ended, and specifically state, "There was no charge for this visit."

Could I bill for it? Of course. Should I? No.

Yes, I know some out there disagree. After all, I did reserve time for this person, and now I lose money on it. My counter is that the same thing happens if a patient gets called into work at the last minute, wakes up violently ill that morning, or has a flat tire on the way to my office. I don’t charge them, either. It’s not right, and I can always use the time to catch up on something else.

I agree – to an extent – with Mr. Stein that there is a "moral-ethical-criminal problem" in modern medical care. He notes that the majority of doctors he’s been to have been fine, but, as in any other field, it only takes a few bad ones to tarnish us all.

All of us likely know a doctor who commits some degree of fraud: overcharging for simple visits, submitting bills on patients he/she never saw, or submitting claims for tests that weren’t done. Obviously, these people shouldn’t be in practice. As Mr. Stein says, they use their license to heal as one to steal.

Sadly, these people don’t see anything wrong with what they’re doing, either. To them it’s just business as usual to submit a level 5 bill for a 10-minute visit, rationalizing it as having to make a living or convincing themselves it was really a 40-minute visit, or whatever. I have no sympathy for them when they get caught.

I still try to be fair, and believe most doctors do, too. Mr. Stein concedes the same point at the end. Unfortunately, as with corrupt politicians, judges, or teachers, it doesn’t take much to hurt the reputation of many.

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

Recently, Ben Stein wrote a column about his visit to a dermatologist, who was, apparently, planning on billing a full new patient charge when all the appointment consisted of was him telling Mr. Stein that he didn’t treat his condition and suggesting he go elsewhere.

Have I ever had visits like that? Sure, a few times a year someone will wander in under the impression I’m a pain specialist, or a neurosurgeon, or whatever. This usually comes out pretty quickly, and when it happens I point them in the right direction and tear up the bill and paperwork. I also dictate a brief note as to what happened, why the visit was ended, and specifically state, "There was no charge for this visit."

Could I bill for it? Of course. Should I? No.

Yes, I know some out there disagree. After all, I did reserve time for this person, and now I lose money on it. My counter is that the same thing happens if a patient gets called into work at the last minute, wakes up violently ill that morning, or has a flat tire on the way to my office. I don’t charge them, either. It’s not right, and I can always use the time to catch up on something else.

I agree – to an extent – with Mr. Stein that there is a "moral-ethical-criminal problem" in modern medical care. He notes that the majority of doctors he’s been to have been fine, but, as in any other field, it only takes a few bad ones to tarnish us all.

All of us likely know a doctor who commits some degree of fraud: overcharging for simple visits, submitting bills on patients he/she never saw, or submitting claims for tests that weren’t done. Obviously, these people shouldn’t be in practice. As Mr. Stein says, they use their license to heal as one to steal.

Sadly, these people don’t see anything wrong with what they’re doing, either. To them it’s just business as usual to submit a level 5 bill for a 10-minute visit, rationalizing it as having to make a living or convincing themselves it was really a 40-minute visit, or whatever. I have no sympathy for them when they get caught.

I still try to be fair, and believe most doctors do, too. Mr. Stein concedes the same point at the end. Unfortunately, as with corrupt politicians, judges, or teachers, it doesn’t take much to hurt the reputation of many.

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

Do you think about retiring? Of course you do. It’s a goal we all think about years in advance.

In my experience, doctors often have a hard time doing it completely – not for financial reasons, but personal ones. Most of us became doctors because at some point we genuinely liked this sort of thing. (Was "to help people" somewhere on your personal statement? I thought so.) We spend 4-5 years in college to get into medical school, study obsessively through 4 years of medical school, spend anywhere from 3-7 additional years (or more) in training, and then go into practice. By the time we reach retirement age, who we are is so tightly ingrained with what we do that it’s hard to just walk away and separate them.

So, many of us don’t stop. We handle the end of our careers like we handle steroids: a slow, gradual taper. We decrease office hours over time, then shutter a practice, then locum tenens here and there, and finally spend maybe one-half day per week at a VA or community clinic.

My dad was a lawyer, and he was the same way. His office went from a big suite to a subleased room to a post office box. At the end of his life, his practice was down to 1-2 people whose wills or trusts he was still overseeing, but he never gave up his license or considered himself retired. Based on other attorneys I’ve met, I’d say that’s typical. I recently met a financial planner of roughly my age who told me she felt the same way. She thought she might decrease hours, but not shut down right away.

I guess this is a good thing. We all have to work, so it’s good to have a job you enjoy, even if it makes it hard to let go.

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

Do you think about retiring? Of course you do. It’s a goal we all think about years in advance.

In my experience, doctors often have a hard time doing it completely – not for financial reasons, but personal ones. Most of us became doctors because at some point we genuinely liked this sort of thing. (Was "to help people" somewhere on your personal statement? I thought so.) We spend 4-5 years in college to get into medical school, study obsessively through 4 years of medical school, spend anywhere from 3-7 additional years (or more) in training, and then go into practice. By the time we reach retirement age, who we are is so tightly ingrained with what we do that it’s hard to just walk away and separate them.

So, many of us don’t stop. We handle the end of our careers like we handle steroids: a slow, gradual taper. We decrease office hours over time, then shutter a practice, then locum tenens here and there, and finally spend maybe one-half day per week at a VA or community clinic.

My dad was a lawyer, and he was the same way. His office went from a big suite to a subleased room to a post office box. At the end of his life, his practice was down to 1-2 people whose wills or trusts he was still overseeing, but he never gave up his license or considered himself retired. Based on other attorneys I’ve met, I’d say that’s typical. I recently met a financial planner of roughly my age who told me she felt the same way. She thought she might decrease hours, but not shut down right away.

I guess this is a good thing. We all have to work, so it’s good to have a job you enjoy, even if it makes it hard to let go.

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

Do you think about retiring? Of course you do. It’s a goal we all think about years in advance.

In my experience, doctors often have a hard time doing it completely – not for financial reasons, but personal ones. Most of us became doctors because at some point we genuinely liked this sort of thing. (Was "to help people" somewhere on your personal statement? I thought so.) We spend 4-5 years in college to get into medical school, study obsessively through 4 years of medical school, spend anywhere from 3-7 additional years (or more) in training, and then go into practice. By the time we reach retirement age, who we are is so tightly ingrained with what we do that it’s hard to just walk away and separate them.

So, many of us don’t stop. We handle the end of our careers like we handle steroids: a slow, gradual taper. We decrease office hours over time, then shutter a practice, then locum tenens here and there, and finally spend maybe one-half day per week at a VA or community clinic.

My dad was a lawyer, and he was the same way. His office went from a big suite to a subleased room to a post office box. At the end of his life, his practice was down to 1-2 people whose wills or trusts he was still overseeing, but he never gave up his license or considered himself retired. Based on other attorneys I’ve met, I’d say that’s typical. I recently met a financial planner of roughly my age who told me she felt the same way. She thought she might decrease hours, but not shut down right away.

I guess this is a good thing. We all have to work, so it’s good to have a job you enjoy, even if it makes it hard to let go.

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

I think all of us get requests to practice outside our fields. Personally, I always say no.

Like the majority of neurologists out there, I’m not certified in internal medicine. (Why neurology is a residency, and not a fellowship, is due to historical reasons). And I don’t want to practice general medicine.

Of course, that doesn’t stop people from asking. So I get requests for antibiotics to treat sinus infections: "Oh, why not? You’re a doctor, aren’t you?"

There are also more unusual requests for cardiac medications ("Amiodarone?" NO!) or insulin ("But you’re treating my neuropathy – isn’t that part of it?").

Sometimes people ask out of sheer ignorance, figuring a doctor is a doctor. Other times it’s them trying to save time/copay money by hitting me up to do it, hoping that I won’t tell them they need to go see their internist or other specialist (even though that’s exactly what I tell them to do). "But I just KNOW I have a (whatever) infection. Can’t you just call in some (antibiotic du jour)? It’s what always works." Nope.

Most people take my refusal in good stride and understand. Others are angry that I’m going to make them spend money and time on an internist visit. And, rarely, some even leave my practice on the grounds that I’m "not taking care of them."

I like being a neurologist. Stepping outside my little circle can lead to a slippery slope, and the farther you go the more likely it can become a legal issue. If I do it once, people will keep asking, and I don’t want to play that game. I know what I’m good at, and I don’t pretend to be anything else.

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

I think all of us get requests to practice outside our fields. Personally, I always say no.

Like the majority of neurologists out there, I’m not certified in internal medicine. (Why neurology is a residency, and not a fellowship, is due to historical reasons). And I don’t want to practice general medicine.

Of course, that doesn’t stop people from asking. So I get requests for antibiotics to treat sinus infections: "Oh, why not? You’re a doctor, aren’t you?"

There are also more unusual requests for cardiac medications ("Amiodarone?" NO!) or insulin ("But you’re treating my neuropathy – isn’t that part of it?").

Sometimes people ask out of sheer ignorance, figuring a doctor is a doctor. Other times it’s them trying to save time/copay money by hitting me up to do it, hoping that I won’t tell them they need to go see their internist or other specialist (even though that’s exactly what I tell them to do). "But I just KNOW I have a (whatever) infection. Can’t you just call in some (antibiotic du jour)? It’s what always works." Nope.

Most people take my refusal in good stride and understand. Others are angry that I’m going to make them spend money and time on an internist visit. And, rarely, some even leave my practice on the grounds that I’m "not taking care of them."

I like being a neurologist. Stepping outside my little circle can lead to a slippery slope, and the farther you go the more likely it can become a legal issue. If I do it once, people will keep asking, and I don’t want to play that game. I know what I’m good at, and I don’t pretend to be anything else.

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

I think all of us get requests to practice outside our fields. Personally, I always say no.

Like the majority of neurologists out there, I’m not certified in internal medicine. (Why neurology is a residency, and not a fellowship, is due to historical reasons). And I don’t want to practice general medicine.

Of course, that doesn’t stop people from asking. So I get requests for antibiotics to treat sinus infections: "Oh, why not? You’re a doctor, aren’t you?"

There are also more unusual requests for cardiac medications ("Amiodarone?" NO!) or insulin ("But you’re treating my neuropathy – isn’t that part of it?").

Sometimes people ask out of sheer ignorance, figuring a doctor is a doctor. Other times it’s them trying to save time/copay money by hitting me up to do it, hoping that I won’t tell them they need to go see their internist or other specialist (even though that’s exactly what I tell them to do). "But I just KNOW I have a (whatever) infection. Can’t you just call in some (antibiotic du jour)? It’s what always works." Nope.

Most people take my refusal in good stride and understand. Others are angry that I’m going to make them spend money and time on an internist visit. And, rarely, some even leave my practice on the grounds that I’m "not taking care of them."

I like being a neurologist. Stepping outside my little circle can lead to a slippery slope, and the farther you go the more likely it can become a legal issue. If I do it once, people will keep asking, and I don’t want to play that game. I know what I’m good at, and I don’t pretend to be anything else.

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

"Waiter!"

The stereotype of a waiter/waitress as a struggling actor or college student is pretty old. But what if someday it becomes struggling doctors?

I’m not sure that’s too far fetched, either. Medical schools across the country are opening new campuses and expanding, hoping to generate the number of physicians that predictions say will be needed to treat the aging American population (which, I guess, includes me).

But training is another story. The 2% sequestration cuts we’ve had for almost a year include funding for residencies. For neurology, there’s been an additional 5% cut for the National Institute of Neurological Disorders and Stroke. And, of course, more cuts are predicted to come. The long-dead stereotype of the wealthy doctor who works 30 hours a week and spends the rest of his time at the golf course or house in the Caribbean is still so ingrained into the American consciousness that politicians on both sides love to promote it.

The result of these cuts is that while more people may come out of medical school, there will be no residency slots for them. Training program sizes are currently frozen or shrinking. The open slots for any field will go to the top of the class, leaving a large number of new doctors $200,000 in debt and ... waiting tables.

Even when I was in school (the Miocene era) there were a few people who did the "scramble" after match day, frantically trying to find a program with open slots. In my class of 120, I think there were 5. But imagine if the scramble involves a third of a class or more. Realistically, unless things change, there just won’t be enough slots for most of them.

Medical school doesn’t prepare you to practice real medicine. While you may be a doctor, you still don’t have the knowledge or experience from residency. Trying to practice straight out of school is likely going to get someone killed. And I can’t imagine a malpractice company willing to insure you.

Some will take on further debt and go to law school. Others will find work with insurance companies, denying MRIs. Some may even head overseas to countries with less-rigorous licensing requirements. And some of you may meet in a restaurant, hoping for the big call to say there’s a residency opening.

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

"Waiter!"

The stereotype of a waiter/waitress as a struggling actor or college student is pretty old. But what if someday it becomes struggling doctors?

I’m not sure that’s too far fetched, either. Medical schools across the country are opening new campuses and expanding, hoping to generate the number of physicians that predictions say will be needed to treat the aging American population (which, I guess, includes me).

But training is another story. The 2% sequestration cuts we’ve had for almost a year include funding for residencies. For neurology, there’s been an additional 5% cut for the National Institute of Neurological Disorders and Stroke. And, of course, more cuts are predicted to come. The long-dead stereotype of the wealthy doctor who works 30 hours a week and spends the rest of his time at the golf course or house in the Caribbean is still so ingrained into the American consciousness that politicians on both sides love to promote it.

The result of these cuts is that while more people may come out of medical school, there will be no residency slots for them. Training program sizes are currently frozen or shrinking. The open slots for any field will go to the top of the class, leaving a large number of new doctors $200,000 in debt and ... waiting tables.

Even when I was in school (the Miocene era) there were a few people who did the "scramble" after match day, frantically trying to find a program with open slots. In my class of 120, I think there were 5. But imagine if the scramble involves a third of a class or more. Realistically, unless things change, there just won’t be enough slots for most of them.

Medical school doesn’t prepare you to practice real medicine. While you may be a doctor, you still don’t have the knowledge or experience from residency. Trying to practice straight out of school is likely going to get someone killed. And I can’t imagine a malpractice company willing to insure you.

Some will take on further debt and go to law school. Others will find work with insurance companies, denying MRIs. Some may even head overseas to countries with less-rigorous licensing requirements. And some of you may meet in a restaurant, hoping for the big call to say there’s a residency opening.

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

"Waiter!"

The stereotype of a waiter/waitress as a struggling actor or college student is pretty old. But what if someday it becomes struggling doctors?

I’m not sure that’s too far fetched, either. Medical schools across the country are opening new campuses and expanding, hoping to generate the number of physicians that predictions say will be needed to treat the aging American population (which, I guess, includes me).

But training is another story. The 2% sequestration cuts we’ve had for almost a year include funding for residencies. For neurology, there’s been an additional 5% cut for the National Institute of Neurological Disorders and Stroke. And, of course, more cuts are predicted to come. The long-dead stereotype of the wealthy doctor who works 30 hours a week and spends the rest of his time at the golf course or house in the Caribbean is still so ingrained into the American consciousness that politicians on both sides love to promote it.

The result of these cuts is that while more people may come out of medical school, there will be no residency slots for them. Training program sizes are currently frozen or shrinking. The open slots for any field will go to the top of the class, leaving a large number of new doctors $200,000 in debt and ... waiting tables.

Even when I was in school (the Miocene era) there were a few people who did the "scramble" after match day, frantically trying to find a program with open slots. In my class of 120, I think there were 5. But imagine if the scramble involves a third of a class or more. Realistically, unless things change, there just won’t be enough slots for most of them.

Medical school doesn’t prepare you to practice real medicine. While you may be a doctor, you still don’t have the knowledge or experience from residency. Trying to practice straight out of school is likely going to get someone killed. And I can’t imagine a malpractice company willing to insure you.

Some will take on further debt and go to law school. Others will find work with insurance companies, denying MRIs. Some may even head overseas to countries with less-rigorous licensing requirements. And some of you may meet in a restaurant, hoping for the big call to say there’s a residency opening.

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

In summer 1975, my mom dropped me and my sister off to see "Bigfoot: The Mysterious Monster." The movie was presented as a documentary to convince you bigfoot was real, even if it meant exaggerating facts and re-enactments and pretty much ignoring the truth. At the age of 10, I believed it, and spent the next several nights wide awake and convinced bigfoot was coming to get me in modern suburbia.

In modern medicine, the rumored side effects of vaccines are the equivalent of bigfoot. Earlier this year, the journal Clinical Infectious Diseases reported that over a 13-year period, vaccines of any kind didn’t cause Guillain-Barré syndrome. But a quick search of Google finds plenty of sites claiming the opposite.

Vaccines and autism are the most fabled example. Despite overwhelming data showing otherwise, this myth persists in modern culture. Buoyed not by scientists and doctors, but by celebrities (yes, Jenny, I’m talking about you) and politics (yes, Rep. Bachmann). Years ago things like this would have been confined to a small group, but not today. The Internet allows rumors to become accepted as facts and gives voice and credibility to those who previously carried signs on street corners. Anyone these days can make an official-looking website and populate it with "facts" that have no basis in reality. And people who use Dr. Google stumble on them, and figure that if it’s on the Internet, it must be real.

As someone who’s spent many years learning to be a doctor, it’s frustrating how many people will ignore my advice, yet listen to that given by a B-list actress or the cashier at the grocery store. And those people aren’t at risk of being sued for it, either.

I am, by nature, a cryptid geek. I would love to someday learn that bigfoot or the Loch Ness monster really exists. But in reality, I don’t believe they do. And, like the boogeyman, the vaccine mythology needs to be seen everywhere as the myth that it is.

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

In summer 1975, my mom dropped me and my sister off to see "Bigfoot: The Mysterious Monster." The movie was presented as a documentary to convince you bigfoot was real, even if it meant exaggerating facts and re-enactments and pretty much ignoring the truth. At the age of 10, I believed it, and spent the next several nights wide awake and convinced bigfoot was coming to get me in modern suburbia.

In modern medicine, the rumored side effects of vaccines are the equivalent of bigfoot. Earlier this year, the journal Clinical Infectious Diseases reported that over a 13-year period, vaccines of any kind didn’t cause Guillain-Barré syndrome. But a quick search of Google finds plenty of sites claiming the opposite.

Vaccines and autism are the most fabled example. Despite overwhelming data showing otherwise, this myth persists in modern culture. Buoyed not by scientists and doctors, but by celebrities (yes, Jenny, I’m talking about you) and politics (yes, Rep. Bachmann). Years ago things like this would have been confined to a small group, but not today. The Internet allows rumors to become accepted as facts and gives voice and credibility to those who previously carried signs on street corners. Anyone these days can make an official-looking website and populate it with "facts" that have no basis in reality. And people who use Dr. Google stumble on them, and figure that if it’s on the Internet, it must be real.

As someone who’s spent many years learning to be a doctor, it’s frustrating how many people will ignore my advice, yet listen to that given by a B-list actress or the cashier at the grocery store. And those people aren’t at risk of being sued for it, either.

I am, by nature, a cryptid geek. I would love to someday learn that bigfoot or the Loch Ness monster really exists. But in reality, I don’t believe they do. And, like the boogeyman, the vaccine mythology needs to be seen everywhere as the myth that it is.

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

In summer 1975, my mom dropped me and my sister off to see "Bigfoot: The Mysterious Monster." The movie was presented as a documentary to convince you bigfoot was real, even if it meant exaggerating facts and re-enactments and pretty much ignoring the truth. At the age of 10, I believed it, and spent the next several nights wide awake and convinced bigfoot was coming to get me in modern suburbia.

In modern medicine, the rumored side effects of vaccines are the equivalent of bigfoot. Earlier this year, the journal Clinical Infectious Diseases reported that over a 13-year period, vaccines of any kind didn’t cause Guillain-Barré syndrome. But a quick search of Google finds plenty of sites claiming the opposite.

Vaccines and autism are the most fabled example. Despite overwhelming data showing otherwise, this myth persists in modern culture. Buoyed not by scientists and doctors, but by celebrities (yes, Jenny, I’m talking about you) and politics (yes, Rep. Bachmann). Years ago things like this would have been confined to a small group, but not today. The Internet allows rumors to become accepted as facts and gives voice and credibility to those who previously carried signs on street corners. Anyone these days can make an official-looking website and populate it with "facts" that have no basis in reality. And people who use Dr. Google stumble on them, and figure that if it’s on the Internet, it must be real.

As someone who’s spent many years learning to be a doctor, it’s frustrating how many people will ignore my advice, yet listen to that given by a B-list actress or the cashier at the grocery store. And those people aren’t at risk of being sued for it, either.

I am, by nature, a cryptid geek. I would love to someday learn that bigfoot or the Loch Ness monster really exists. But in reality, I don’t believe they do. And, like the boogeyman, the vaccine mythology needs to be seen everywhere as the myth that it is.

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

I don’t do conferences. I don’t care how much continuing medical education credit I get or how exotic the location is. I just don’t care.

I get ads for them all the time, too: head trauma, stroke review, modern headache management, epilepsy 2013, and so on. I do my reading at home and cram CME in where I can.

Solo practice is an "eat what you kill" world. If I’m not seeing patients, I’m not getting paid. So I have a very strong incentive not to leave my office. If I’m going to take time off and spend money to travel, I want to enjoy it with my family, not cooped up in a conference room with other neurologists. Besides, like most doctors, I’m conditioned to nod off as soon as the slides start.

I’m not into networking, either. I’m in solo practice to avoid other neurologists. Why on Earth would I want to spend money to hang out with a group of them? I don’t need call coverage or anyone to collaborate with on research or to argue with (I have my kids for that).

Also, travel isn’t cheap. Going to the American Academy of Neurology meeting next April? Registration is a few hundred bucks. More if you actually want to attend many of the education classes. Of course, I’m in Arizona, and the meeting is in Philly. So I have to factor in plane fare, then a hotel room for 3-7 nights (depending on how long I stay), meals, taxis ... It adds up fast. Unless you’ve got an institution paying, it can be steep. On top of it all (at least in my world), the costs include how much I’m NOT earning from being out of the office.

The fact that it’s a business tax deduction doesn’t matter to me. In solo practice, I am the business. Anything spent, regardless of tax status, still comes out of my salary when it’s all over.

So I stay at my office and limit travel to being with my family. After all, they are whom I really work for.

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

I don’t do conferences. I don’t care how much continuing medical education credit I get or how exotic the location is. I just don’t care.

I get ads for them all the time, too: head trauma, stroke review, modern headache management, epilepsy 2013, and so on. I do my reading at home and cram CME in where I can.

Solo practice is an "eat what you kill" world. If I’m not seeing patients, I’m not getting paid. So I have a very strong incentive not to leave my office. If I’m going to take time off and spend money to travel, I want to enjoy it with my family, not cooped up in a conference room with other neurologists. Besides, like most doctors, I’m conditioned to nod off as soon as the slides start.

I’m not into networking, either. I’m in solo practice to avoid other neurologists. Why on Earth would I want to spend money to hang out with a group of them? I don’t need call coverage or anyone to collaborate with on research or to argue with (I have my kids for that).

Also, travel isn’t cheap. Going to the American Academy of Neurology meeting next April? Registration is a few hundred bucks. More if you actually want to attend many of the education classes. Of course, I’m in Arizona, and the meeting is in Philly. So I have to factor in plane fare, then a hotel room for 3-7 nights (depending on how long I stay), meals, taxis ... It adds up fast. Unless you’ve got an institution paying, it can be steep. On top of it all (at least in my world), the costs include how much I’m NOT earning from being out of the office.

The fact that it’s a business tax deduction doesn’t matter to me. In solo practice, I am the business. Anything spent, regardless of tax status, still comes out of my salary when it’s all over.

So I stay at my office and limit travel to being with my family. After all, they are whom I really work for.

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

I don’t do conferences. I don’t care how much continuing medical education credit I get or how exotic the location is. I just don’t care.

I get ads for them all the time, too: head trauma, stroke review, modern headache management, epilepsy 2013, and so on. I do my reading at home and cram CME in where I can.

Solo practice is an "eat what you kill" world. If I’m not seeing patients, I’m not getting paid. So I have a very strong incentive not to leave my office. If I’m going to take time off and spend money to travel, I want to enjoy it with my family, not cooped up in a conference room with other neurologists. Besides, like most doctors, I’m conditioned to nod off as soon as the slides start.

I’m not into networking, either. I’m in solo practice to avoid other neurologists. Why on Earth would I want to spend money to hang out with a group of them? I don’t need call coverage or anyone to collaborate with on research or to argue with (I have my kids for that).

Also, travel isn’t cheap. Going to the American Academy of Neurology meeting next April? Registration is a few hundred bucks. More if you actually want to attend many of the education classes. Of course, I’m in Arizona, and the meeting is in Philly. So I have to factor in plane fare, then a hotel room for 3-7 nights (depending on how long I stay), meals, taxis ... It adds up fast. Unless you’ve got an institution paying, it can be steep. On top of it all (at least in my world), the costs include how much I’m NOT earning from being out of the office.

The fact that it’s a business tax deduction doesn’t matter to me. In solo practice, I am the business. Anything spent, regardless of tax status, still comes out of my salary when it’s all over.

So I stay at my office and limit travel to being with my family. After all, they are whom I really work for.

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

Neurology, like most of medicine, has different disease prevalences as the seasons change.

In Phoenix, for example, July-August is migraine season. When the monsoons roll in the afternoon several times a week, my office phones ring merrily with requests for early triptan refills and medication changes.

In December, you may think of Hanukkah, Christmas, eggnog, gifts, latkes ... but at my office I think of seizures.

The calls start around Thanksgiving and continue until after New Years. Breakthrough seizures become common. People travel and leave their pills at home (calling scrips to out-of-state pharmacies is a holiday ritual here). They go to parties and are up late, and forget to take their pills. Or simply the combination of more frequent alcohol use, holiday stress, and sleep deprivation does the trick.

This time of year, with kids out on breaks, family trips, visiting relatives, parties, and shopping, always makes those "well, you’ll have to stop driving until ..." discussions even uglier.

After years of experience, I try to warn people in advance. At routine appointments I tell them that the holiday spirit (or spirits) aren’t conducive to medication compliance and discuss ways of remembering to take pills. Usually it works, but there is always someone caught up in the season of travel, sleep deprivation, and stress who forgets.

And so, as the (not particularly cold) Phoenix winter comes, my staff and I prepare for neurology’s peculiar rite of winter.

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

Neurology, like most of medicine, has different disease prevalences as the seasons change.

In Phoenix, for example, July-August is migraine season. When the monsoons roll in the afternoon several times a week, my office phones ring merrily with requests for early triptan refills and medication changes.

In December, you may think of Hanukkah, Christmas, eggnog, gifts, latkes ... but at my office I think of seizures.

The calls start around Thanksgiving and continue until after New Years. Breakthrough seizures become common. People travel and leave their pills at home (calling scrips to out-of-state pharmacies is a holiday ritual here). They go to parties and are up late, and forget to take their pills. Or simply the combination of more frequent alcohol use, holiday stress, and sleep deprivation does the trick.

This time of year, with kids out on breaks, family trips, visiting relatives, parties, and shopping, always makes those "well, you’ll have to stop driving until ..." discussions even uglier.

After years of experience, I try to warn people in advance. At routine appointments I tell them that the holiday spirit (or spirits) aren’t conducive to medication compliance and discuss ways of remembering to take pills. Usually it works, but there is always someone caught up in the season of travel, sleep deprivation, and stress who forgets.

And so, as the (not particularly cold) Phoenix winter comes, my staff and I prepare for neurology’s peculiar rite of winter.

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

Neurology, like most of medicine, has different disease prevalences as the seasons change.

In Phoenix, for example, July-August is migraine season. When the monsoons roll in the afternoon several times a week, my office phones ring merrily with requests for early triptan refills and medication changes.

In December, you may think of Hanukkah, Christmas, eggnog, gifts, latkes ... but at my office I think of seizures.

The calls start around Thanksgiving and continue until after New Years. Breakthrough seizures become common. People travel and leave their pills at home (calling scrips to out-of-state pharmacies is a holiday ritual here). They go to parties and are up late, and forget to take their pills. Or simply the combination of more frequent alcohol use, holiday stress, and sleep deprivation does the trick.

This time of year, with kids out on breaks, family trips, visiting relatives, parties, and shopping, always makes those "well, you’ll have to stop driving until ..." discussions even uglier.

After years of experience, I try to warn people in advance. At routine appointments I tell them that the holiday spirit (or spirits) aren’t conducive to medication compliance and discuss ways of remembering to take pills. Usually it works, but there is always someone caught up in the season of travel, sleep deprivation, and stress who forgets.

And so, as the (not particularly cold) Phoenix winter comes, my staff and I prepare for neurology’s peculiar rite of winter.

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

On a recent visit to a medical school, I watched the usual parade of residents and medical students go by in the typical flock of white coats on rounds. Been there, done that.

But what surprised me was how little they carried (which you’d think I’d be used to). When I was a medical student, my pockets were crammed full of books:

• A pocket pharmacopoeia.

• Washington Manual of Medical Therapeutics.

• An antibiotic use pamphlet.

• Handbook of Radiology.

• The House Officer’s Guide.

• On Call Reference.

I think a reason most medical students were so thin (besides living on ramen, tuna, and coffee) is the exercise we’d get wearing a coat that weighed more than we did. Not to mention the clipboard I carried everywhere to frantically scribble notes, reminders, and clinical pearls on.

But those aren’t necessary any more. Now that world-changing invention, the smartphone, has replaced all. In just 5 ounces of metal and glass you have all these books, and more. Questions you don’t know can be Googled (provided the attending doesn’t see you). Notes and reminders can be typed on the fly. Medical students may not get as much exercise on rounds, but on the other hand, they are less likely to suffer back injuries.

I’m not whining about this at all. I’m quite fond of it. Even as an attending, it’s much easier to have all my references in one convenient place. The Physicians’ Desk Reference is likely the biggest and heaviest book in medicine, and it’s nice to be rid of it – not to mention all the trees we’re saving by using the electronic gadgets.

Now I just need to find another way to exercise.

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

On a recent visit to a medical school, I watched the usual parade of residents and medical students go by in the typical flock of white coats on rounds. Been there, done that.

But what surprised me was how little they carried (which you’d think I’d be used to). When I was a medical student, my pockets were crammed full of books:

• A pocket pharmacopoeia.

• Washington Manual of Medical Therapeutics.

• An antibiotic use pamphlet.

• Handbook of Radiology.

• The House Officer’s Guide.

• On Call Reference.

I think a reason most medical students were so thin (besides living on ramen, tuna, and coffee) is the exercise we’d get wearing a coat that weighed more than we did. Not to mention the clipboard I carried everywhere to frantically scribble notes, reminders, and clinical pearls on.

But those aren’t necessary any more. Now that world-changing invention, the smartphone, has replaced all. In just 5 ounces of metal and glass you have all these books, and more. Questions you don’t know can be Googled (provided the attending doesn’t see you). Notes and reminders can be typed on the fly. Medical students may not get as much exercise on rounds, but on the other hand, they are less likely to suffer back injuries.

I’m not whining about this at all. I’m quite fond of it. Even as an attending, it’s much easier to have all my references in one convenient place. The Physicians’ Desk Reference is likely the biggest and heaviest book in medicine, and it’s nice to be rid of it – not to mention all the trees we’re saving by using the electronic gadgets.

Now I just need to find another way to exercise.

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

On a recent visit to a medical school, I watched the usual parade of residents and medical students go by in the typical flock of white coats on rounds. Been there, done that.

But what surprised me was how little they carried (which you’d think I’d be used to). When I was a medical student, my pockets were crammed full of books:

• A pocket pharmacopoeia.

• Washington Manual of Medical Therapeutics.

• An antibiotic use pamphlet.

• Handbook of Radiology.

• The House Officer’s Guide.

• On Call Reference.

I think a reason most medical students were so thin (besides living on ramen, tuna, and coffee) is the exercise we’d get wearing a coat that weighed more than we did. Not to mention the clipboard I carried everywhere to frantically scribble notes, reminders, and clinical pearls on.

But those aren’t necessary any more. Now that world-changing invention, the smartphone, has replaced all. In just 5 ounces of metal and glass you have all these books, and more. Questions you don’t know can be Googled (provided the attending doesn’t see you). Notes and reminders can be typed on the fly. Medical students may not get as much exercise on rounds, but on the other hand, they are less likely to suffer back injuries.

I’m not whining about this at all. I’m quite fond of it. Even as an attending, it’s much easier to have all my references in one convenient place. The Physicians’ Desk Reference is likely the biggest and heaviest book in medicine, and it’s nice to be rid of it – not to mention all the trees we’re saving by using the electronic gadgets.

Now I just need to find another way to exercise.

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

I like it here. I’m not saying America, Arizona, or Americans are perfect – far from it. But realistically, there’s no country on Earth that is. I was born here, and I like my practice.

Occasionally, I get letters from companies suggesting I relocate overseas to "doctor-friendly" countries. They claim to offer better salaries, better lifestyles, etc. They also suggest that my patients will follow me for medical tourism.

I have nothing against physicians who move. Some jobs certainly aren’t worth staying for, or there are family reasons, or whatever. But I have no desire to move to a different country.

One of my favorite books is "I Had Trouble in Getting to Solla Sollew" by Dr. Seuss. In it, the hero keeps trying to find a place that has no troubles, only to discover that everywhere he goes has its own set of problems, just different from the previous place. So, at the end, he returns home. He realizes that every place has good and bad, and it’s a question of accepting the bad parts and doing your best to deal with them.

For myself, I’m happy where I am. I have no interest in moving to another country in search of Solla Sollew. Dr. Seuss told me it doesn’t exist, and life has proven him correct.

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

I like it here. I’m not saying America, Arizona, or Americans are perfect – far from it. But realistically, there’s no country on Earth that is. I was born here, and I like my practice.

Occasionally, I get letters from companies suggesting I relocate overseas to "doctor-friendly" countries. They claim to offer better salaries, better lifestyles, etc. They also suggest that my patients will follow me for medical tourism.

I have nothing against physicians who move. Some jobs certainly aren’t worth staying for, or there are family reasons, or whatever. But I have no desire to move to a different country.

One of my favorite books is "I Had Trouble in Getting to Solla Sollew" by Dr. Seuss. In it, the hero keeps trying to find a place that has no troubles, only to discover that everywhere he goes has its own set of problems, just different from the previous place. So, at the end, he returns home. He realizes that every place has good and bad, and it’s a question of accepting the bad parts and doing your best to deal with them.

For myself, I’m happy where I am. I have no interest in moving to another country in search of Solla Sollew. Dr. Seuss told me it doesn’t exist, and life has proven him correct.

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

I like it here. I’m not saying America, Arizona, or Americans are perfect – far from it. But realistically, there’s no country on Earth that is. I was born here, and I like my practice.

Occasionally, I get letters from companies suggesting I relocate overseas to "doctor-friendly" countries. They claim to offer better salaries, better lifestyles, etc. They also suggest that my patients will follow me for medical tourism.

I have nothing against physicians who move. Some jobs certainly aren’t worth staying for, or there are family reasons, or whatever. But I have no desire to move to a different country.

One of my favorite books is "I Had Trouble in Getting to Solla Sollew" by Dr. Seuss. In it, the hero keeps trying to find a place that has no troubles, only to discover that everywhere he goes has its own set of problems, just different from the previous place. So, at the end, he returns home. He realizes that every place has good and bad, and it’s a question of accepting the bad parts and doing your best to deal with them.

For myself, I’m happy where I am. I have no interest in moving to another country in search of Solla Sollew. Dr. Seuss told me it doesn’t exist, and life has proven him correct.

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

At a carnival last year, my kids won a magic wand and gave it to me.

For a while it sat on a bookshelf at home, along with a clay snowman and decorated picture frame they’d given me. It was one of those things that I had no idea what to do with, but was afraid to get rid of for fear of hurting their feelings.

Courtesy Allan M. Block

About a month later, I was dealing with a young lady who wanted me to make her better, but didn’t want to take any medications or try treatment of any sort. In her own words, she "just wanted to get fixed." (Fortunately for her, I’m not a veterinarian.)

She left my office, with both of us frustrated – I, because she wouldn’t let me help her, and she, because in her mind I couldn’t offer her what she wanted: a magic cure.

That evening, it occurred to me that she would have been the perfect subject for my magic wand. The next morning I hung it up in my office, where it’s remained since.

It even lights up when I press the button.

So now, I have a treatment option. At no additional charge and covered by all insurance plans, I wave a magic wand. Granted, it has absolutely no capabilities to evaluate or treat, but it often gets my point across.

Now, when people want me to figure things out without doing tests, or want me to make them better without medication or physical therapy, I offer them the wand. Initially, I was afraid it would make people angry, but have since found it surprisingly effective at getting my point across: There is no magic in medicine, and I need their help to help them.

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

At a carnival last year, my kids won a magic wand and gave it to me.

For a while it sat on a bookshelf at home, along with a clay snowman and decorated picture frame they’d given me. It was one of those things that I had no idea what to do with, but was afraid to get rid of for fear of hurting their feelings.

Courtesy Allan M. Block

About a month later, I was dealing with a young lady who wanted me to make her better, but didn’t want to take any medications or try treatment of any sort. In her own words, she "just wanted to get fixed." (Fortunately for her, I’m not a veterinarian.)

She left my office, with both of us frustrated – I, because she wouldn’t let me help her, and she, because in her mind I couldn’t offer her what she wanted: a magic cure.

That evening, it occurred to me that she would have been the perfect subject for my magic wand. The next morning I hung it up in my office, where it’s remained since.

It even lights up when I press the button.

So now, I have a treatment option. At no additional charge and covered by all insurance plans, I wave a magic wand. Granted, it has absolutely no capabilities to evaluate or treat, but it often gets my point across.

Now, when people want me to figure things out without doing tests, or want me to make them better without medication or physical therapy, I offer them the wand. Initially, I was afraid it would make people angry, but have since found it surprisingly effective at getting my point across: There is no magic in medicine, and I need their help to help them.

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

At a carnival last year, my kids won a magic wand and gave it to me.

For a while it sat on a bookshelf at home, along with a clay snowman and decorated picture frame they’d given me. It was one of those things that I had no idea what to do with, but was afraid to get rid of for fear of hurting their feelings.

Courtesy Allan M. Block

About a month later, I was dealing with a young lady who wanted me to make her better, but didn’t want to take any medications or try treatment of any sort. In her own words, she "just wanted to get fixed." (Fortunately for her, I’m not a veterinarian.)

She left my office, with both of us frustrated – I, because she wouldn’t let me help her, and she, because in her mind I couldn’t offer her what she wanted: a magic cure.

That evening, it occurred to me that she would have been the perfect subject for my magic wand. The next morning I hung it up in my office, where it’s remained since.

It even lights up when I press the button.

So now, I have a treatment option. At no additional charge and covered by all insurance plans, I wave a magic wand. Granted, it has absolutely no capabilities to evaluate or treat, but it often gets my point across.

Now, when people want me to figure things out without doing tests, or want me to make them better without medication or physical therapy, I offer them the wand. Initially, I was afraid it would make people angry, but have since found it surprisingly effective at getting my point across: There is no magic in medicine, and I need their help to help them.

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