Hitting a Nerve

I have a new desk.

In April, I moved offices for the first time in my career. My last office was small, having previously been subleased as a satellite office by the group I started with. When they shut down operations and I stayed, I took it over. This included a small, basic desk. It was nothing fancy, a pressboard student desk.

In the late 1960s, my dad was starting his law practice, and bought a HUGE desk. It was top of the line and cost a few hundred dollars then (no idea what it would be now) – more than he could afford – but he knew it would be the centerpiece for his law practice. So he bought it.

Courtesy Dr. Allan M. Block

He practiced law for almost 40 years at the desk, and then put it in storage for me. I always wanted to use it, but my last office was too small. The desk was too big for the 9-by-9 room I spent almost 15 years working out of.

So when I moved, a room big enough for me and this desk was a key requirement. It was a joy to set it up finally. It even has my dad’s old markings on the bottom to show where to put the screws during assembly. It has eight enormous drawers and a beautiful curved top. The center is darker where his leather blotter covered it for 40 years.

My dad got to see the desk only once in my office, and he was pleased to see it in its second life. With him now gone, my daily time spent at it, although still filled with everyday work, is somehow more special. It is a connection between us. I think of all the hours he put in at it to support his family and am happy to be using it now for mine.

Thank you, dad.

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

I have a new desk.

In April, I moved offices for the first time in my career. My last office was small, having previously been subleased as a satellite office by the group I started with. When they shut down operations and I stayed, I took it over. This included a small, basic desk. It was nothing fancy, a pressboard student desk.

In the late 1960s, my dad was starting his law practice, and bought a HUGE desk. It was top of the line and cost a few hundred dollars then (no idea what it would be now) – more than he could afford – but he knew it would be the centerpiece for his law practice. So he bought it.

Courtesy Dr. Allan M. Block

He practiced law for almost 40 years at the desk, and then put it in storage for me. I always wanted to use it, but my last office was too small. The desk was too big for the 9-by-9 room I spent almost 15 years working out of.

So when I moved, a room big enough for me and this desk was a key requirement. It was a joy to set it up finally. It even has my dad’s old markings on the bottom to show where to put the screws during assembly. It has eight enormous drawers and a beautiful curved top. The center is darker where his leather blotter covered it for 40 years.

My dad got to see the desk only once in my office, and he was pleased to see it in its second life. With him now gone, my daily time spent at it, although still filled with everyday work, is somehow more special. It is a connection between us. I think of all the hours he put in at it to support his family and am happy to be using it now for mine.

Thank you, dad.

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

I have a new desk.

In April, I moved offices for the first time in my career. My last office was small, having previously been subleased as a satellite office by the group I started with. When they shut down operations and I stayed, I took it over. This included a small, basic desk. It was nothing fancy, a pressboard student desk.

In the late 1960s, my dad was starting his law practice, and bought a HUGE desk. It was top of the line and cost a few hundred dollars then (no idea what it would be now) – more than he could afford – but he knew it would be the centerpiece for his law practice. So he bought it.

Courtesy Dr. Allan M. Block

He practiced law for almost 40 years at the desk, and then put it in storage for me. I always wanted to use it, but my last office was too small. The desk was too big for the 9-by-9 room I spent almost 15 years working out of.

So when I moved, a room big enough for me and this desk was a key requirement. It was a joy to set it up finally. It even has my dad’s old markings on the bottom to show where to put the screws during assembly. It has eight enormous drawers and a beautiful curved top. The center is darker where his leather blotter covered it for 40 years.

My dad got to see the desk only once in my office, and he was pleased to see it in its second life. With him now gone, my daily time spent at it, although still filled with everyday work, is somehow more special. It is a connection between us. I think of all the hours he put in at it to support his family and am happy to be using it now for mine.

Thank you, dad.

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

CME drives me nuts. Yes, I know it’s the rules, and the whole idea is to make sure we all keep current on our knowledge, but it’s still a pain in the butt.

I try to do mine in the cracks of everyday life. In solo practice, I don’t have time to go to meetings. So I do all mine on paper or online. My usual method is summer vacation. We go on long driving trips. Since my wife prefers to drive, I just hunker down in my seat with a pile of CME monographs and work my way through them bit by bit.

This year, we didn’t go on a trip, so I’m stuck working it in on weekends and evenings.

I’m sure there’s a better way to do this, but I have no clue what it is. So I take my pile of papers and iPad with me wherever I go, reading things and marking off answers.

I understand the idea behind it. No one wants a doctor with a wealth of experience but a paucity of modern knowledge. Medicine is (and always will be) a changing field. No one can keep up on it entirely. So this is how we’re supposed to prove that we’re trying. How well does it work? I have no idea. Apparently no one has found a better way to do it, though.

So I dutifully do my reading and fill in the circles on the answer sheet because I have to.

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

CME drives me nuts. Yes, I know it’s the rules, and the whole idea is to make sure we all keep current on our knowledge, but it’s still a pain in the butt.

I try to do mine in the cracks of everyday life. In solo practice, I don’t have time to go to meetings. So I do all mine on paper or online. My usual method is summer vacation. We go on long driving trips. Since my wife prefers to drive, I just hunker down in my seat with a pile of CME monographs and work my way through them bit by bit.

This year, we didn’t go on a trip, so I’m stuck working it in on weekends and evenings.

I’m sure there’s a better way to do this, but I have no clue what it is. So I take my pile of papers and iPad with me wherever I go, reading things and marking off answers.

I understand the idea behind it. No one wants a doctor with a wealth of experience but a paucity of modern knowledge. Medicine is (and always will be) a changing field. No one can keep up on it entirely. So this is how we’re supposed to prove that we’re trying. How well does it work? I have no idea. Apparently no one has found a better way to do it, though.

So I dutifully do my reading and fill in the circles on the answer sheet because I have to.

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

CME drives me nuts. Yes, I know it’s the rules, and the whole idea is to make sure we all keep current on our knowledge, but it’s still a pain in the butt.

I try to do mine in the cracks of everyday life. In solo practice, I don’t have time to go to meetings. So I do all mine on paper or online. My usual method is summer vacation. We go on long driving trips. Since my wife prefers to drive, I just hunker down in my seat with a pile of CME monographs and work my way through them bit by bit.

This year, we didn’t go on a trip, so I’m stuck working it in on weekends and evenings.

I’m sure there’s a better way to do this, but I have no clue what it is. So I take my pile of papers and iPad with me wherever I go, reading things and marking off answers.

I understand the idea behind it. No one wants a doctor with a wealth of experience but a paucity of modern knowledge. Medicine is (and always will be) a changing field. No one can keep up on it entirely. So this is how we’re supposed to prove that we’re trying. How well does it work? I have no idea. Apparently no one has found a better way to do it, though.

So I dutifully do my reading and fill in the circles on the answer sheet because I have to.

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

Right now my oldest child wants to be an inventor, my next wants to be a teacher, and my last isn’t sure. Granted, they all have a lot of time to decide.

None of them wants to be a doctor. I’m glad.

In seventh grade, I had to interview someone about their job. Like most kids, I picked my dad. He was a lawyer, and so we chatted about his field while a cassette tape slowly turned. At one point, I asked him if he’d recommend law to others, and he said, to my surprise, "no." He elaborated by saying that the field had changed so much since he’d started that he didn’t feel it was a rewarding career anymore.

It’s been 35 years since then, and now I feel the same way.

I once loved medicine. In the idealism of youth, I viewed it as a calling, a chance to help and make a difference in the lives of others. To a large extent, I still feel that way. I like what I do, even though time and reality have dimmed the fires.

But would I recommend this to anyone else? No.

Like Dad said a long time ago, things have changed. I wouldn’t want to walk out of medical school $200,000 (or more) in debt. That puts such a huge shadow over your future – I don’t see it as being worthwhile. I didn’t become a doctor to get rich, but starting out behind the eight-ball is never good.

Medicine isn’t the same. We’re not the old family docs of yore. Our cause is still just, but we’re often vilified for political or legal expediency – or profit. People who know nothing about medicine try to tell us what we can or can’t do. We get stuck in the middle of battles we never wanted to be a part of. Internet and television charlatans are treated like miracle workers.

Through it all, most of us try to do our best for our patients. But over time, it’s the other things that whittle you down. It’s those reasons that make me glad none of my kids is currently interested in doing this job.

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

Right now my oldest child wants to be an inventor, my next wants to be a teacher, and my last isn’t sure. Granted, they all have a lot of time to decide.

None of them wants to be a doctor. I’m glad.

In seventh grade, I had to interview someone about their job. Like most kids, I picked my dad. He was a lawyer, and so we chatted about his field while a cassette tape slowly turned. At one point, I asked him if he’d recommend law to others, and he said, to my surprise, "no." He elaborated by saying that the field had changed so much since he’d started that he didn’t feel it was a rewarding career anymore.

It’s been 35 years since then, and now I feel the same way.

I once loved medicine. In the idealism of youth, I viewed it as a calling, a chance to help and make a difference in the lives of others. To a large extent, I still feel that way. I like what I do, even though time and reality have dimmed the fires.

But would I recommend this to anyone else? No.

Like Dad said a long time ago, things have changed. I wouldn’t want to walk out of medical school $200,000 (or more) in debt. That puts such a huge shadow over your future – I don’t see it as being worthwhile. I didn’t become a doctor to get rich, but starting out behind the eight-ball is never good.

Medicine isn’t the same. We’re not the old family docs of yore. Our cause is still just, but we’re often vilified for political or legal expediency – or profit. People who know nothing about medicine try to tell us what we can or can’t do. We get stuck in the middle of battles we never wanted to be a part of. Internet and television charlatans are treated like miracle workers.

Through it all, most of us try to do our best for our patients. But over time, it’s the other things that whittle you down. It’s those reasons that make me glad none of my kids is currently interested in doing this job.

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

Right now my oldest child wants to be an inventor, my next wants to be a teacher, and my last isn’t sure. Granted, they all have a lot of time to decide.

None of them wants to be a doctor. I’m glad.

In seventh grade, I had to interview someone about their job. Like most kids, I picked my dad. He was a lawyer, and so we chatted about his field while a cassette tape slowly turned. At one point, I asked him if he’d recommend law to others, and he said, to my surprise, "no." He elaborated by saying that the field had changed so much since he’d started that he didn’t feel it was a rewarding career anymore.

It’s been 35 years since then, and now I feel the same way.

I once loved medicine. In the idealism of youth, I viewed it as a calling, a chance to help and make a difference in the lives of others. To a large extent, I still feel that way. I like what I do, even though time and reality have dimmed the fires.

But would I recommend this to anyone else? No.

Like Dad said a long time ago, things have changed. I wouldn’t want to walk out of medical school $200,000 (or more) in debt. That puts such a huge shadow over your future – I don’t see it as being worthwhile. I didn’t become a doctor to get rich, but starting out behind the eight-ball is never good.

Medicine isn’t the same. We’re not the old family docs of yore. Our cause is still just, but we’re often vilified for political or legal expediency – or profit. People who know nothing about medicine try to tell us what we can or can’t do. We get stuck in the middle of battles we never wanted to be a part of. Internet and television charlatans are treated like miracle workers.

Through it all, most of us try to do our best for our patients. But over time, it’s the other things that whittle you down. It’s those reasons that make me glad none of my kids is currently interested in doing this job.

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

One of the most infuriating things in a medical practice (or probably anywhere) is when people don’t supervise their kids.

I have nothing against kids. I’m not a pediatrician, but that’s more of a personality thing.

Like any adult neurologist, I don’t see kids, and my office isn’t set up for them. Most parents are aware of this. They either don’t bring them, or when unavoidable, bring stuff to keep them busy: Nintendos, books, iPhone games, etc.

But some assume my office is a day care, and this is a serious problem. I have no idea if my colleagues down the street at the Mayo Clinic have to put up with shenanigans like this, but unfortunately in a typical office practice, it happens too often.

If I step out of the office for something, I’ve had parents do things like handing my examining tools (including fragile things like an ophthalmoscope) to their children to play with or let them look through my desk drawers. Others have allowed their children to randomly run through the halls of my office or even ask my secretary if they can sit at her desk so she can keep them busy. After all, she has a computer. Why can’t their kids play on it? Never mind that she’s constantly scheduling or looking up charts with it.

These same parents also get irate when told no, or are asked to control their kids. I’ve been accused of hating children, being unreasonable, and being unaccommodating.

I’m not in the habit of disciplining other people’s kids. I don’t want someone to do it to mine, and I won’t do it to theirs. In the rare cases when a kid’s behavior makes a visit impossible, I’ve asked people to leave. There are even some patients who I’ve told not to return unless they don’t bring their kids.

Inevitably, this has cost me a few patients and probably gotten me a few bad reviews online. But I really don’t care. Good patient care, not to mention sanity, requires as few distractions as possible. And if I can’t practice good patient care, what’s the point of wasting the patient’s and my own time?

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

One of the most infuriating things in a medical practice (or probably anywhere) is when people don’t supervise their kids.

I have nothing against kids. I’m not a pediatrician, but that’s more of a personality thing.

Like any adult neurologist, I don’t see kids, and my office isn’t set up for them. Most parents are aware of this. They either don’t bring them, or when unavoidable, bring stuff to keep them busy: Nintendos, books, iPhone games, etc.

But some assume my office is a day care, and this is a serious problem. I have no idea if my colleagues down the street at the Mayo Clinic have to put up with shenanigans like this, but unfortunately in a typical office practice, it happens too often.

If I step out of the office for something, I’ve had parents do things like handing my examining tools (including fragile things like an ophthalmoscope) to their children to play with or let them look through my desk drawers. Others have allowed their children to randomly run through the halls of my office or even ask my secretary if they can sit at her desk so she can keep them busy. After all, she has a computer. Why can’t their kids play on it? Never mind that she’s constantly scheduling or looking up charts with it.

These same parents also get irate when told no, or are asked to control their kids. I’ve been accused of hating children, being unreasonable, and being unaccommodating.

I’m not in the habit of disciplining other people’s kids. I don’t want someone to do it to mine, and I won’t do it to theirs. In the rare cases when a kid’s behavior makes a visit impossible, I’ve asked people to leave. There are even some patients who I’ve told not to return unless they don’t bring their kids.

Inevitably, this has cost me a few patients and probably gotten me a few bad reviews online. But I really don’t care. Good patient care, not to mention sanity, requires as few distractions as possible. And if I can’t practice good patient care, what’s the point of wasting the patient’s and my own time?

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

One of the most infuriating things in a medical practice (or probably anywhere) is when people don’t supervise their kids.

I have nothing against kids. I’m not a pediatrician, but that’s more of a personality thing.

Like any adult neurologist, I don’t see kids, and my office isn’t set up for them. Most parents are aware of this. They either don’t bring them, or when unavoidable, bring stuff to keep them busy: Nintendos, books, iPhone games, etc.

But some assume my office is a day care, and this is a serious problem. I have no idea if my colleagues down the street at the Mayo Clinic have to put up with shenanigans like this, but unfortunately in a typical office practice, it happens too often.

If I step out of the office for something, I’ve had parents do things like handing my examining tools (including fragile things like an ophthalmoscope) to their children to play with or let them look through my desk drawers. Others have allowed their children to randomly run through the halls of my office or even ask my secretary if they can sit at her desk so she can keep them busy. After all, she has a computer. Why can’t their kids play on it? Never mind that she’s constantly scheduling or looking up charts with it.

These same parents also get irate when told no, or are asked to control their kids. I’ve been accused of hating children, being unreasonable, and being unaccommodating.

I’m not in the habit of disciplining other people’s kids. I don’t want someone to do it to mine, and I won’t do it to theirs. In the rare cases when a kid’s behavior makes a visit impossible, I’ve asked people to leave. There are even some patients who I’ve told not to return unless they don’t bring their kids.

Inevitably, this has cost me a few patients and probably gotten me a few bad reviews online. But I really don’t care. Good patient care, not to mention sanity, requires as few distractions as possible. And if I can’t practice good patient care, what’s the point of wasting the patient’s and my own time?

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

Does anyone else out there go to grand rounds? I don’t either.

I’m sure this is still a cherished tradition at academic places. But in the real world of private practice, it’s not.

That’s not to say my nonteaching hospital doesn’t still have them. Occasionally, I see a notice up for some sort of educational gathering. I scan it, but really have no interest in going. Even the opportunity for an hour of free CME doesn’t entice me.

Realistically, I’d rather be at my office, working. An hour spent in a lecture hall is 1 hour more of work I need to do after I get back.

In medical school and residency, you went. You didn’t have a choice. There was always some eagle-eyed attending physician scanning the crowd, making mental notes on who was or wasn’t there. (Yes, Bill and Larry, I’m talking about you.)

I’m not sure I ever got anything out of it, besides coffee and a bagel. In my experience, a lot of it was on some esoteric research that didn’t have any immediately practical applications. There were, of course, exceptions. Sometimes there’d be a good review of a disorder and its treatments that was helpful, but they were the exception rather than the rule. Usually, I just nodded off in the back. Rarely, I’d make my pager chirp, look at it, and leave. (This was such a common trick for everyone that you couldn’t do it too often.)

These days, I find it easier to handpick my own learning material, usually on an iPad, and learn it on my own schedule. This way it’s more relevant and useful to me. And in private practice, that’s what’s important.

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

Does anyone else out there go to grand rounds? I don’t either.

I’m sure this is still a cherished tradition at academic places. But in the real world of private practice, it’s not.

That’s not to say my nonteaching hospital doesn’t still have them. Occasionally, I see a notice up for some sort of educational gathering. I scan it, but really have no interest in going. Even the opportunity for an hour of free CME doesn’t entice me.

Realistically, I’d rather be at my office, working. An hour spent in a lecture hall is 1 hour more of work I need to do after I get back.

In medical school and residency, you went. You didn’t have a choice. There was always some eagle-eyed attending physician scanning the crowd, making mental notes on who was or wasn’t there. (Yes, Bill and Larry, I’m talking about you.)

I’m not sure I ever got anything out of it, besides coffee and a bagel. In my experience, a lot of it was on some esoteric research that didn’t have any immediately practical applications. There were, of course, exceptions. Sometimes there’d be a good review of a disorder and its treatments that was helpful, but they were the exception rather than the rule. Usually, I just nodded off in the back. Rarely, I’d make my pager chirp, look at it, and leave. (This was such a common trick for everyone that you couldn’t do it too often.)

These days, I find it easier to handpick my own learning material, usually on an iPad, and learn it on my own schedule. This way it’s more relevant and useful to me. And in private practice, that’s what’s important.

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

Does anyone else out there go to grand rounds? I don’t either.

I’m sure this is still a cherished tradition at academic places. But in the real world of private practice, it’s not.

That’s not to say my nonteaching hospital doesn’t still have them. Occasionally, I see a notice up for some sort of educational gathering. I scan it, but really have no interest in going. Even the opportunity for an hour of free CME doesn’t entice me.

Realistically, I’d rather be at my office, working. An hour spent in a lecture hall is 1 hour more of work I need to do after I get back.

In medical school and residency, you went. You didn’t have a choice. There was always some eagle-eyed attending physician scanning the crowd, making mental notes on who was or wasn’t there. (Yes, Bill and Larry, I’m talking about you.)

I’m not sure I ever got anything out of it, besides coffee and a bagel. In my experience, a lot of it was on some esoteric research that didn’t have any immediately practical applications. There were, of course, exceptions. Sometimes there’d be a good review of a disorder and its treatments that was helpful, but they were the exception rather than the rule. Usually, I just nodded off in the back. Rarely, I’d make my pager chirp, look at it, and leave. (This was such a common trick for everyone that you couldn’t do it too often.)

These days, I find it easier to handpick my own learning material, usually on an iPad, and learn it on my own schedule. This way it’s more relevant and useful to me. And in private practice, that’s what’s important.

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

Finances are a big part of our lives. We may have become doctors to help people, but we're also supporting families.

The main job, for most of us, is to take care of patients. That's allegedly what we're most appreciated for, so shouldn't it be what pays the bills?

Patient care is still my bread and butter, but here are some dollar figures to think about:

(The following averages are NOT any sort of scientific data. They're based on my own experiences and phone calls to other neurologists.)

• Speaking for a drug company: $750 per hour.
• Legal work: $400 per hour.
• Clinical trials research: $350 per hour.
• Market research: $250 per hour.
• Actually caring for patients: $100 per hour (real money, not the amounts we charge insurance companies, knowing we'll never collect them).

I know that many nondoctors will look at the above and say, "$100 per hour sounds great! These docs should shut up and take it!" Those people, however, are not in the position of also having to pay for rent, malpractice insurance, staff salaries, office supplies, and student loans, each at five to six figures per year.

Do the priorities on this list seem screwed up to anyone else out there? Obviously, clinical research for future medications is important, but does it seem odd that I can make more money for legal work or market research than, say, directly helping people?

You bet. But they do pay more, and so many of us are rapidly gravitating to them as supplemental income. The economics don't give us many other choices. If we want to help patients, we have to be able to keep our practices open.

I think this is sad because, when we all started out applying to medical school, most of us just wanted to care for people. But these days that's the least valued thing we do.

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

Finances are a big part of our lives. We may have become doctors to help people, but we're also supporting families.

The main job, for most of us, is to take care of patients. That's allegedly what we're most appreciated for, so shouldn't it be what pays the bills?

Patient care is still my bread and butter, but here are some dollar figures to think about:

(The following averages are NOT any sort of scientific data. They're based on my own experiences and phone calls to other neurologists.)

• Speaking for a drug company: $750 per hour.
• Legal work: $400 per hour.
• Clinical trials research: $350 per hour.
• Market research: $250 per hour.
• Actually caring for patients: $100 per hour (real money, not the amounts we charge insurance companies, knowing we'll never collect them).

I know that many nondoctors will look at the above and say, "$100 per hour sounds great! These docs should shut up and take it!" Those people, however, are not in the position of also having to pay for rent, malpractice insurance, staff salaries, office supplies, and student loans, each at five to six figures per year.

Do the priorities on this list seem screwed up to anyone else out there? Obviously, clinical research for future medications is important, but does it seem odd that I can make more money for legal work or market research than, say, directly helping people?

You bet. But they do pay more, and so many of us are rapidly gravitating to them as supplemental income. The economics don't give us many other choices. If we want to help patients, we have to be able to keep our practices open.

I think this is sad because, when we all started out applying to medical school, most of us just wanted to care for people. But these days that's the least valued thing we do.

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

Finances are a big part of our lives. We may have become doctors to help people, but we're also supporting families.

The main job, for most of us, is to take care of patients. That's allegedly what we're most appreciated for, so shouldn't it be what pays the bills?

Patient care is still my bread and butter, but here are some dollar figures to think about:

(The following averages are NOT any sort of scientific data. They're based on my own experiences and phone calls to other neurologists.)

• Speaking for a drug company: $750 per hour.
• Legal work: $400 per hour.
• Clinical trials research: $350 per hour.
• Market research: $250 per hour.
• Actually caring for patients: $100 per hour (real money, not the amounts we charge insurance companies, knowing we'll never collect them).

I know that many nondoctors will look at the above and say, "$100 per hour sounds great! These docs should shut up and take it!" Those people, however, are not in the position of also having to pay for rent, malpractice insurance, staff salaries, office supplies, and student loans, each at five to six figures per year.

Do the priorities on this list seem screwed up to anyone else out there? Obviously, clinical research for future medications is important, but does it seem odd that I can make more money for legal work or market research than, say, directly helping people?

You bet. But they do pay more, and so many of us are rapidly gravitating to them as supplemental income. The economics don't give us many other choices. If we want to help patients, we have to be able to keep our practices open.

I think this is sad because, when we all started out applying to medical school, most of us just wanted to care for people. But these days that's the least valued thing we do.

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

I send letters to other doctors, pretty religiously. I know this isn’t required, and some have stopped doing it.

To me, though, it isn’t just a courtesy. It’s good patient care. If an internist referred a patient to me, I assume they’d want to know what I think, what tests I’m ordering (and what they showed), and what, if any, treatments I’m prescribing. They’re also going to want to know this from me, and not the patient, whose recollection may not be accurate ("he ordered tests and gave me a white pill").

It saves money. I make sure test results from my orders are sent to them, so things don’t get duplicated and they’re up to date on my findings. Likewise, I hope they’ll copy me with relevant records.

It improves safety. Most of a patient’s medications are going to come from their internist, so it’s important they know what I’m prescribing. Drug interactions can be a serious problem.

Realistically, I’m not expecting anyone to read my entire note. I think most (like me) skip to the impression. That’s okay. The point is to know what others are doing. We’re all supposed to be working together to help Mrs. Smith get better, aren’t we? That’s not easy when you have no idea what’s going on elsewhere on the field.

One particular irritant I have is a major neurologic center in my town. Every now and then I have an unusually complex case and refer patients there for a second opinion ... and never hear back.

This drives me nuts. Sometimes the patients return to me, and to figure out what was done, I have to send over a release for records, which can take a week or two to get back. I’m also curious, for my own education, to know what they thought and what the final diagnosis was. Learning about the cases I didn’t figure out helps make me a better doctor.

Communication is a critical feature of our species. And, among doctors, I believe it leads to better patient care. I hope that my obsession with it is good for all involved, and I wish others felt the same way.

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

I send letters to other doctors, pretty religiously. I know this isn’t required, and some have stopped doing it.

To me, though, it isn’t just a courtesy. It’s good patient care. If an internist referred a patient to me, I assume they’d want to know what I think, what tests I’m ordering (and what they showed), and what, if any, treatments I’m prescribing. They’re also going to want to know this from me, and not the patient, whose recollection may not be accurate ("he ordered tests and gave me a white pill").

It saves money. I make sure test results from my orders are sent to them, so things don’t get duplicated and they’re up to date on my findings. Likewise, I hope they’ll copy me with relevant records.

It improves safety. Most of a patient’s medications are going to come from their internist, so it’s important they know what I’m prescribing. Drug interactions can be a serious problem.

Realistically, I’m not expecting anyone to read my entire note. I think most (like me) skip to the impression. That’s okay. The point is to know what others are doing. We’re all supposed to be working together to help Mrs. Smith get better, aren’t we? That’s not easy when you have no idea what’s going on elsewhere on the field.

One particular irritant I have is a major neurologic center in my town. Every now and then I have an unusually complex case and refer patients there for a second opinion ... and never hear back.

This drives me nuts. Sometimes the patients return to me, and to figure out what was done, I have to send over a release for records, which can take a week or two to get back. I’m also curious, for my own education, to know what they thought and what the final diagnosis was. Learning about the cases I didn’t figure out helps make me a better doctor.

Communication is a critical feature of our species. And, among doctors, I believe it leads to better patient care. I hope that my obsession with it is good for all involved, and I wish others felt the same way.

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

I send letters to other doctors, pretty religiously. I know this isn’t required, and some have stopped doing it.

To me, though, it isn’t just a courtesy. It’s good patient care. If an internist referred a patient to me, I assume they’d want to know what I think, what tests I’m ordering (and what they showed), and what, if any, treatments I’m prescribing. They’re also going to want to know this from me, and not the patient, whose recollection may not be accurate ("he ordered tests and gave me a white pill").

It saves money. I make sure test results from my orders are sent to them, so things don’t get duplicated and they’re up to date on my findings. Likewise, I hope they’ll copy me with relevant records.

It improves safety. Most of a patient’s medications are going to come from their internist, so it’s important they know what I’m prescribing. Drug interactions can be a serious problem.

Realistically, I’m not expecting anyone to read my entire note. I think most (like me) skip to the impression. That’s okay. The point is to know what others are doing. We’re all supposed to be working together to help Mrs. Smith get better, aren’t we? That’s not easy when you have no idea what’s going on elsewhere on the field.

One particular irritant I have is a major neurologic center in my town. Every now and then I have an unusually complex case and refer patients there for a second opinion ... and never hear back.

This drives me nuts. Sometimes the patients return to me, and to figure out what was done, I have to send over a release for records, which can take a week or two to get back. I’m also curious, for my own education, to know what they thought and what the final diagnosis was. Learning about the cases I didn’t figure out helps make me a better doctor.

Communication is a critical feature of our species. And, among doctors, I believe it leads to better patient care. I hope that my obsession with it is good for all involved, and I wish others felt the same way.

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

I see anywhere from 7 to 21 patients a day, depending on the mix of new ones, follow-ups, and electromyographs. I don’t break for lunch. But I’m told that’s not enough.

Like most doctors, I’ve been reading about ways to increase revenue. A common theme is to see more patients, with some suggesting as many as 10 per hour.

In some fields, like pediatrics, this may be doable. But in neurology? I just don’t see it. No one likes being rushed at the doctor’s office, especially when they have a complex issue and a lot of questions.

I admit that my schedule is not as busy as others. I try to allow extra time, hoping it averages out over the course of the day. I hate running behind, and don’t like the stereotype of patients waiting for hours reading moldy magazines. Yes, there are still unexpected emergencies, but overbooking is probably the most common reason for falling behind.

Right now I have no plans to cram people in. Making them angry will only hurt my practice in the long run. It will result in bad feedback to my referral sources and bad ratings on Yelp. Not only that, but if you’re also billing level four and five for a 6-minute visit that’s only going to invite an audit down the road.

Trying to hurry through the schedule isn’t good for patient care or doctor sanity. Too many things can be missed.

At the end of the day, I want to feel that I did my very best for my patients. This includes taking the time to listen and answer questions. I don’t see how that’s possible spending only 6 minutes with each one.

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

I see anywhere from 7 to 21 patients a day, depending on the mix of new ones, follow-ups, and electromyographs. I don’t break for lunch. But I’m told that’s not enough.

Like most doctors, I’ve been reading about ways to increase revenue. A common theme is to see more patients, with some suggesting as many as 10 per hour.

In some fields, like pediatrics, this may be doable. But in neurology? I just don’t see it. No one likes being rushed at the doctor’s office, especially when they have a complex issue and a lot of questions.

I admit that my schedule is not as busy as others. I try to allow extra time, hoping it averages out over the course of the day. I hate running behind, and don’t like the stereotype of patients waiting for hours reading moldy magazines. Yes, there are still unexpected emergencies, but overbooking is probably the most common reason for falling behind.

Right now I have no plans to cram people in. Making them angry will only hurt my practice in the long run. It will result in bad feedback to my referral sources and bad ratings on Yelp. Not only that, but if you’re also billing level four and five for a 6-minute visit that’s only going to invite an audit down the road.

Trying to hurry through the schedule isn’t good for patient care or doctor sanity. Too many things can be missed.

At the end of the day, I want to feel that I did my very best for my patients. This includes taking the time to listen and answer questions. I don’t see how that’s possible spending only 6 minutes with each one.

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

I see anywhere from 7 to 21 patients a day, depending on the mix of new ones, follow-ups, and electromyographs. I don’t break for lunch. But I’m told that’s not enough.

Like most doctors, I’ve been reading about ways to increase revenue. A common theme is to see more patients, with some suggesting as many as 10 per hour.

In some fields, like pediatrics, this may be doable. But in neurology? I just don’t see it. No one likes being rushed at the doctor’s office, especially when they have a complex issue and a lot of questions.

I admit that my schedule is not as busy as others. I try to allow extra time, hoping it averages out over the course of the day. I hate running behind, and don’t like the stereotype of patients waiting for hours reading moldy magazines. Yes, there are still unexpected emergencies, but overbooking is probably the most common reason for falling behind.

Right now I have no plans to cram people in. Making them angry will only hurt my practice in the long run. It will result in bad feedback to my referral sources and bad ratings on Yelp. Not only that, but if you’re also billing level four and five for a 6-minute visit that’s only going to invite an audit down the road.

Trying to hurry through the schedule isn’t good for patient care or doctor sanity. Too many things can be missed.

At the end of the day, I want to feel that I did my very best for my patients. This includes taking the time to listen and answer questions. I don’t see how that’s possible spending only 6 minutes with each one.

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

The buzz phrase in medicine these days is "cash pay." You see it everywhere: in online physician forums, in the pages of medical magazines, and in brochures mailed to the office. Presumably, the idea is that if we all went to a cash-only system it would fix the ills of modern medicine.

I don’t know if it would or not, but I do think every private practice doc has at least kicked the idea around, including me.

I’d love to go cash only. I think it would make everyone’s life easier, both mine and the patients’. I have no idea what my realistic rates would be, but I know they’d be less than the inflated amounts we all charge insurances (knowing that we’ll see maybe half of what we charge, if we’re lucky).

I’m also not sure how well it would work for a specialist. Unlike internists, not all patients are with us for the long haul. Some certainly are, but many we may see just a few times before solving whatever ails them.

The other issue is competition. Cash pay offers a lot of incentives for fairness and transparency in pricing, but (at least in neurology) it flies out the window if you’re the only one doing it. In my immediate area there are seven other neurologists, all of whom take insurance. If I were to suddenly go cash only, I’m pretty sure most patients would quickly migrate elsewhere. Paying a $25 copay down the street is going to outweigh loyalty to me for most of them. Sure, there will be some who will stay with me, but realistically, it’s not likely to be enough to keep my door open. And by the time you’ve figured out if it’s going to work, it’s too late to go back if you guessed wrong.

I know only one other neurologist who tried opening a cash-only general neurology practice. He lasted slightly less than 5 months before frantically trying to get on every insurance plan he could. He folded after 2 years, unable to pay off the debt he’d accumulated in trying to start up.

Another way to do cash only is if you have some special skill that attracts people, such as being world famous at something or the only doc in your area that does a specific procedure. Then you might have a marketing angle. But for most of us it would probably settle out to a practice full of wealthy migraineurs and chronic pain patients. And I don’t want that.

So, without any better ideas right now, I plug along with the insurance companies, hoping (but not particularly hopeful) that things will improve.

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

The buzz phrase in medicine these days is "cash pay." You see it everywhere: in online physician forums, in the pages of medical magazines, and in brochures mailed to the office. Presumably, the idea is that if we all went to a cash-only system it would fix the ills of modern medicine.

I don’t know if it would or not, but I do think every private practice doc has at least kicked the idea around, including me.

I’d love to go cash only. I think it would make everyone’s life easier, both mine and the patients’. I have no idea what my realistic rates would be, but I know they’d be less than the inflated amounts we all charge insurances (knowing that we’ll see maybe half of what we charge, if we’re lucky).

I’m also not sure how well it would work for a specialist. Unlike internists, not all patients are with us for the long haul. Some certainly are, but many we may see just a few times before solving whatever ails them.

The other issue is competition. Cash pay offers a lot of incentives for fairness and transparency in pricing, but (at least in neurology) it flies out the window if you’re the only one doing it. In my immediate area there are seven other neurologists, all of whom take insurance. If I were to suddenly go cash only, I’m pretty sure most patients would quickly migrate elsewhere. Paying a $25 copay down the street is going to outweigh loyalty to me for most of them. Sure, there will be some who will stay with me, but realistically, it’s not likely to be enough to keep my door open. And by the time you’ve figured out if it’s going to work, it’s too late to go back if you guessed wrong.

I know only one other neurologist who tried opening a cash-only general neurology practice. He lasted slightly less than 5 months before frantically trying to get on every insurance plan he could. He folded after 2 years, unable to pay off the debt he’d accumulated in trying to start up.

Another way to do cash only is if you have some special skill that attracts people, such as being world famous at something or the only doc in your area that does a specific procedure. Then you might have a marketing angle. But for most of us it would probably settle out to a practice full of wealthy migraineurs and chronic pain patients. And I don’t want that.

So, without any better ideas right now, I plug along with the insurance companies, hoping (but not particularly hopeful) that things will improve.

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

The buzz phrase in medicine these days is "cash pay." You see it everywhere: in online physician forums, in the pages of medical magazines, and in brochures mailed to the office. Presumably, the idea is that if we all went to a cash-only system it would fix the ills of modern medicine.

I don’t know if it would or not, but I do think every private practice doc has at least kicked the idea around, including me.

I’d love to go cash only. I think it would make everyone’s life easier, both mine and the patients’. I have no idea what my realistic rates would be, but I know they’d be less than the inflated amounts we all charge insurances (knowing that we’ll see maybe half of what we charge, if we’re lucky).

I’m also not sure how well it would work for a specialist. Unlike internists, not all patients are with us for the long haul. Some certainly are, but many we may see just a few times before solving whatever ails them.

The other issue is competition. Cash pay offers a lot of incentives for fairness and transparency in pricing, but (at least in neurology) it flies out the window if you’re the only one doing it. In my immediate area there are seven other neurologists, all of whom take insurance. If I were to suddenly go cash only, I’m pretty sure most patients would quickly migrate elsewhere. Paying a $25 copay down the street is going to outweigh loyalty to me for most of them. Sure, there will be some who will stay with me, but realistically, it’s not likely to be enough to keep my door open. And by the time you’ve figured out if it’s going to work, it’s too late to go back if you guessed wrong.

I know only one other neurologist who tried opening a cash-only general neurology practice. He lasted slightly less than 5 months before frantically trying to get on every insurance plan he could. He folded after 2 years, unable to pay off the debt he’d accumulated in trying to start up.

Another way to do cash only is if you have some special skill that attracts people, such as being world famous at something or the only doc in your area that does a specific procedure. Then you might have a marketing angle. But for most of us it would probably settle out to a practice full of wealthy migraineurs and chronic pain patients. And I don’t want that.

So, without any better ideas right now, I plug along with the insurance companies, hoping (but not particularly hopeful) that things will improve.

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

One of the biggest challenges I (and I suspect many) neurologists face is treating Parkinson’s disease in patients with a history of melanoma.

This is always tricky. Every medicine used for the condition has warnings about it, but on the other hand, we also want to help these people.

This is confounded by the fact that there clearly is an increased risk of melanoma with Parkinson’s disease alone. But you can’t tell patients with a history of melanoma not to get Parkinson’s disease and vice versa.

Our only real control here is what medications we prescribe. Data now suggest that medications have nothing to do with the risk of melanoma, but how well would that stand up in court? The labeling for most Parkinson’s medications clearly lists melanoma as a contraindication, and I don’t see anyone willing to sink the money needed to get that taken off anytime soon.

A tenet of medicine is "do no harm." We all try to live by that. But which is more harmful? Putting a patient at risk of a (relatively) incurable cancer? Or letting them suffer, day by day, of a degenerative illness when effective treatments are just a prescription pad away?

I don’t know what the right answer is. I try to explain all the angles to patients as best I can, and let them make an informed decision. But at the end of the day I still worry. I worry about them. I worry about their families. I worry about lawsuits.

The situation gets worse if they DO develop a melanoma. The knee-jerk response is to stop their Parkinson’s medications, with immediate (sometimes disabling) worsening of their tremor, balance, and other symptoms. But is that the right thing to do?

The relationship between Parkinson’s disease, its treatment, and melanoma remains murky even today. But the association is there, and no one wants to guess wrong. We’re all trying to do our best for the patient, but the definition of what’s best varies from person to person.

The lack of a crystal ball in medicine is a real problem. The most we can do some days is educate the patient, work with them as best we can, and hope things work out in their favor.

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

One of the biggest challenges I (and I suspect many) neurologists face is treating Parkinson’s disease in patients with a history of melanoma.

This is always tricky. Every medicine used for the condition has warnings about it, but on the other hand, we also want to help these people.

This is confounded by the fact that there clearly is an increased risk of melanoma with Parkinson’s disease alone. But you can’t tell patients with a history of melanoma not to get Parkinson’s disease and vice versa.

Our only real control here is what medications we prescribe. Data now suggest that medications have nothing to do with the risk of melanoma, but how well would that stand up in court? The labeling for most Parkinson’s medications clearly lists melanoma as a contraindication, and I don’t see anyone willing to sink the money needed to get that taken off anytime soon.

A tenet of medicine is "do no harm." We all try to live by that. But which is more harmful? Putting a patient at risk of a (relatively) incurable cancer? Or letting them suffer, day by day, of a degenerative illness when effective treatments are just a prescription pad away?

I don’t know what the right answer is. I try to explain all the angles to patients as best I can, and let them make an informed decision. But at the end of the day I still worry. I worry about them. I worry about their families. I worry about lawsuits.

The situation gets worse if they DO develop a melanoma. The knee-jerk response is to stop their Parkinson’s medications, with immediate (sometimes disabling) worsening of their tremor, balance, and other symptoms. But is that the right thing to do?

The relationship between Parkinson’s disease, its treatment, and melanoma remains murky even today. But the association is there, and no one wants to guess wrong. We’re all trying to do our best for the patient, but the definition of what’s best varies from person to person.

The lack of a crystal ball in medicine is a real problem. The most we can do some days is educate the patient, work with them as best we can, and hope things work out in their favor.

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

One of the biggest challenges I (and I suspect many) neurologists face is treating Parkinson’s disease in patients with a history of melanoma.

This is always tricky. Every medicine used for the condition has warnings about it, but on the other hand, we also want to help these people.

This is confounded by the fact that there clearly is an increased risk of melanoma with Parkinson’s disease alone. But you can’t tell patients with a history of melanoma not to get Parkinson’s disease and vice versa.

Our only real control here is what medications we prescribe. Data now suggest that medications have nothing to do with the risk of melanoma, but how well would that stand up in court? The labeling for most Parkinson’s medications clearly lists melanoma as a contraindication, and I don’t see anyone willing to sink the money needed to get that taken off anytime soon.

A tenet of medicine is "do no harm." We all try to live by that. But which is more harmful? Putting a patient at risk of a (relatively) incurable cancer? Or letting them suffer, day by day, of a degenerative illness when effective treatments are just a prescription pad away?

I don’t know what the right answer is. I try to explain all the angles to patients as best I can, and let them make an informed decision. But at the end of the day I still worry. I worry about them. I worry about their families. I worry about lawsuits.

The situation gets worse if they DO develop a melanoma. The knee-jerk response is to stop their Parkinson’s medications, with immediate (sometimes disabling) worsening of their tremor, balance, and other symptoms. But is that the right thing to do?

The relationship between Parkinson’s disease, its treatment, and melanoma remains murky even today. But the association is there, and no one wants to guess wrong. We’re all trying to do our best for the patient, but the definition of what’s best varies from person to person.

The lack of a crystal ball in medicine is a real problem. The most we can do some days is educate the patient, work with them as best we can, and hope things work out in their favor.

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