Hitting a Nerve

It came in the mail today. I knew it would be here soon, I just didn’t know when. But it’s still a shock. It’s the invitation to my 20-year medical school reunion.

Holy cow! There’s no way it was 20 years ago. I remember it like it was yesterday. For that matter, I remember my first day of medical school. I remember packing up to move from Arizona to Omaha and a million other details. These were events that shaped my life, bringing me to where I am today.

It’s hard to believe it’s been 20 years – even after three kids and 15 years in practice – perhaps because it’s a reminder of my own advancing age. Every trip around the sun seems to get faster.

I flip through the class list. Some of these names I haven’t thought of in 20 years, but I can immediately picture them clearly.

Yes, I’m going to go. Omaha wasn’t the city where I wanted to settle (for that, I came home to Phoenix), but it was still a place I liked. I look at my old apartment building and the Creighton University campus on Google Earth, seeing what’s changed and what hasn’t. I never imagined such a thing as an iPad at the time, and now I use it to "fly" over Omaha, remembering certain places and wondering if restaurants and book stores I used to go to are still there.

I’d like to see my classmates again. My roommate and I were together for 4 years but haven’t been in touch since 1994. In the age of Google, it’s easy to find out where people are these days, but it still doesn’t tell you how they’re doing.

And you miss your classmates. For 4 years, you were a fairly solid unit with them, living on the same schedule, facing the same challenges, studying together, and often going to the same post test parties. It’s hard not to become attached to those around you in that situation. It’s like medical boot camp – drop and recite the Krebs cycle NOW!

I look at old pictures. I was thinner and more idealistic then, still viewing medicine with an almost religious zeal. I still do, but years of running a practice and raising a family knock it down a few notches.

But I’m looking forward to going. I’ll be there, and I hope many others will be, too.

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

It came in the mail today. I knew it would be here soon, I just didn’t know when. But it’s still a shock. It’s the invitation to my 20-year medical school reunion.

Holy cow! There’s no way it was 20 years ago. I remember it like it was yesterday. For that matter, I remember my first day of medical school. I remember packing up to move from Arizona to Omaha and a million other details. These were events that shaped my life, bringing me to where I am today.

It’s hard to believe it’s been 20 years – even after three kids and 15 years in practice – perhaps because it’s a reminder of my own advancing age. Every trip around the sun seems to get faster.

I flip through the class list. Some of these names I haven’t thought of in 20 years, but I can immediately picture them clearly.

Yes, I’m going to go. Omaha wasn’t the city where I wanted to settle (for that, I came home to Phoenix), but it was still a place I liked. I look at my old apartment building and the Creighton University campus on Google Earth, seeing what’s changed and what hasn’t. I never imagined such a thing as an iPad at the time, and now I use it to "fly" over Omaha, remembering certain places and wondering if restaurants and book stores I used to go to are still there.

I’d like to see my classmates again. My roommate and I were together for 4 years but haven’t been in touch since 1994. In the age of Google, it’s easy to find out where people are these days, but it still doesn’t tell you how they’re doing.

And you miss your classmates. For 4 years, you were a fairly solid unit with them, living on the same schedule, facing the same challenges, studying together, and often going to the same post test parties. It’s hard not to become attached to those around you in that situation. It’s like medical boot camp – drop and recite the Krebs cycle NOW!

I look at old pictures. I was thinner and more idealistic then, still viewing medicine with an almost religious zeal. I still do, but years of running a practice and raising a family knock it down a few notches.

But I’m looking forward to going. I’ll be there, and I hope many others will be, too.

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

It came in the mail today. I knew it would be here soon, I just didn’t know when. But it’s still a shock. It’s the invitation to my 20-year medical school reunion.

Holy cow! There’s no way it was 20 years ago. I remember it like it was yesterday. For that matter, I remember my first day of medical school. I remember packing up to move from Arizona to Omaha and a million other details. These were events that shaped my life, bringing me to where I am today.

It’s hard to believe it’s been 20 years – even after three kids and 15 years in practice – perhaps because it’s a reminder of my own advancing age. Every trip around the sun seems to get faster.

I flip through the class list. Some of these names I haven’t thought of in 20 years, but I can immediately picture them clearly.

Yes, I’m going to go. Omaha wasn’t the city where I wanted to settle (for that, I came home to Phoenix), but it was still a place I liked. I look at my old apartment building and the Creighton University campus on Google Earth, seeing what’s changed and what hasn’t. I never imagined such a thing as an iPad at the time, and now I use it to "fly" over Omaha, remembering certain places and wondering if restaurants and book stores I used to go to are still there.

I’d like to see my classmates again. My roommate and I were together for 4 years but haven’t been in touch since 1994. In the age of Google, it’s easy to find out where people are these days, but it still doesn’t tell you how they’re doing.

And you miss your classmates. For 4 years, you were a fairly solid unit with them, living on the same schedule, facing the same challenges, studying together, and often going to the same post test parties. It’s hard not to become attached to those around you in that situation. It’s like medical boot camp – drop and recite the Krebs cycle NOW!

I look at old pictures. I was thinner and more idealistic then, still viewing medicine with an almost religious zeal. I still do, but years of running a practice and raising a family knock it down a few notches.

But I’m looking forward to going. I’ll be there, and I hope many others will be, too.

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

I hate name-dropping. I don’t care who you know or are related to. It won’t get you any better (or worse) care at my office.

A key part of medicine is being impartial. Regardless of whether you’re rich, poor, ugly, attractive, or whatever, I try my best for you.

Granted, this isn’t always entirely possible. Part of human nature is that, consciously or subconsciously, we’re affected in how we view people and act. To the best of my ability, I try to ignore this.

The hard part is trying not to have a negative reaction to this. I’d say that the instinctive reaction of most docs is the opposite of what the patient is trying to get: a favorable position. When someone drops the "perhaps you’ve heard of my uncle, Senator Smith" line, human nature is more likely to make me instantly dislike that person.

I know I’m not alone, either. Name-droppers are generally seen as "pests." So why do people do it at all? In a medical office, I can only assume it’s because they think it will get them better care.

Maybe it will in some places. There are many medical institutions that are perennially on the lookout for potential donors who want to have a new wing named after them. But my solo practice isn’t one of them.

I promise to provide you the best care I am capable of, regardless of who you’re related to or are friends with. So please keep that information to yourself and let me stay impartial. It makes me a better doctor, and you a better patient.

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

I hate name-dropping. I don’t care who you know or are related to. It won’t get you any better (or worse) care at my office.

A key part of medicine is being impartial. Regardless of whether you’re rich, poor, ugly, attractive, or whatever, I try my best for you.

Granted, this isn’t always entirely possible. Part of human nature is that, consciously or subconsciously, we’re affected in how we view people and act. To the best of my ability, I try to ignore this.

The hard part is trying not to have a negative reaction to this. I’d say that the instinctive reaction of most docs is the opposite of what the patient is trying to get: a favorable position. When someone drops the "perhaps you’ve heard of my uncle, Senator Smith" line, human nature is more likely to make me instantly dislike that person.

I know I’m not alone, either. Name-droppers are generally seen as "pests." So why do people do it at all? In a medical office, I can only assume it’s because they think it will get them better care.

Maybe it will in some places. There are many medical institutions that are perennially on the lookout for potential donors who want to have a new wing named after them. But my solo practice isn’t one of them.

I promise to provide you the best care I am capable of, regardless of who you’re related to or are friends with. So please keep that information to yourself and let me stay impartial. It makes me a better doctor, and you a better patient.

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

I hate name-dropping. I don’t care who you know or are related to. It won’t get you any better (or worse) care at my office.

A key part of medicine is being impartial. Regardless of whether you’re rich, poor, ugly, attractive, or whatever, I try my best for you.

Granted, this isn’t always entirely possible. Part of human nature is that, consciously or subconsciously, we’re affected in how we view people and act. To the best of my ability, I try to ignore this.

The hard part is trying not to have a negative reaction to this. I’d say that the instinctive reaction of most docs is the opposite of what the patient is trying to get: a favorable position. When someone drops the "perhaps you’ve heard of my uncle, Senator Smith" line, human nature is more likely to make me instantly dislike that person.

I know I’m not alone, either. Name-droppers are generally seen as "pests." So why do people do it at all? In a medical office, I can only assume it’s because they think it will get them better care.

Maybe it will in some places. There are many medical institutions that are perennially on the lookout for potential donors who want to have a new wing named after them. But my solo practice isn’t one of them.

I promise to provide you the best care I am capable of, regardless of who you’re related to or are friends with. So please keep that information to yourself and let me stay impartial. It makes me a better doctor, and you a better patient.

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

Medicine must be one of the worst fields for getting a decent amount of rest. It starts (at the latest) with studying late at night in medical school. In residency, we seem to be in a perennial cycle of being on call or post call or trying to catch up on sleep for our next call.

When you become an attending physician, it gets even worse (something you didn’t believe could happen when you were a resident). Now you have a lot more to worry about because the buck stops with you. You get up early to round. You stay late to do dictations and may have to round again. You go home and try to have family time. You go to bed and worry whether you missed anything. As you fall asleep, your pager goes off. You have to return the call and then start over with trying to fall asleep. Then you get up early to round, again.

Most of us turn to caffeine to compensate. My poison of choice is a never-ending cup of tea. Others use coffee or diet cola. The more hardcore among us will use energy drinks or pop caffeine pills. I’m not sure how good these are for you in the long run, but I don’t know any doctors who make it through the day without them.

It’s ironic because, just like telling patients to eat healthy when we don’t, many of us lecture people on the importance of a decent night’s sleep. Sleep medicine as a field has grown rapidly in the last 20 years. And I suspect those doctors are sleep deprived, too.

My wife and I often joke that on weekend mornings, it’s important to make sure we wake up in time to take a nap.

Four hundred years ago, Shakespeare described sleep as that which "knits up the ravell’d sleave of care ... sore labour’s bath, balm of hurt minds, great nature’s second course, chief nourisher in life’s feast." However, in modern medicine it’s one of the rarest commodities.

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

Medicine must be one of the worst fields for getting a decent amount of rest. It starts (at the latest) with studying late at night in medical school. In residency, we seem to be in a perennial cycle of being on call or post call or trying to catch up on sleep for our next call.

When you become an attending physician, it gets even worse (something you didn’t believe could happen when you were a resident). Now you have a lot more to worry about because the buck stops with you. You get up early to round. You stay late to do dictations and may have to round again. You go home and try to have family time. You go to bed and worry whether you missed anything. As you fall asleep, your pager goes off. You have to return the call and then start over with trying to fall asleep. Then you get up early to round, again.

Most of us turn to caffeine to compensate. My poison of choice is a never-ending cup of tea. Others use coffee or diet cola. The more hardcore among us will use energy drinks or pop caffeine pills. I’m not sure how good these are for you in the long run, but I don’t know any doctors who make it through the day without them.

It’s ironic because, just like telling patients to eat healthy when we don’t, many of us lecture people on the importance of a decent night’s sleep. Sleep medicine as a field has grown rapidly in the last 20 years. And I suspect those doctors are sleep deprived, too.

My wife and I often joke that on weekend mornings, it’s important to make sure we wake up in time to take a nap.

Four hundred years ago, Shakespeare described sleep as that which "knits up the ravell’d sleave of care ... sore labour’s bath, balm of hurt minds, great nature’s second course, chief nourisher in life’s feast." However, in modern medicine it’s one of the rarest commodities.

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

Medicine must be one of the worst fields for getting a decent amount of rest. It starts (at the latest) with studying late at night in medical school. In residency, we seem to be in a perennial cycle of being on call or post call or trying to catch up on sleep for our next call.

When you become an attending physician, it gets even worse (something you didn’t believe could happen when you were a resident). Now you have a lot more to worry about because the buck stops with you. You get up early to round. You stay late to do dictations and may have to round again. You go home and try to have family time. You go to bed and worry whether you missed anything. As you fall asleep, your pager goes off. You have to return the call and then start over with trying to fall asleep. Then you get up early to round, again.

Most of us turn to caffeine to compensate. My poison of choice is a never-ending cup of tea. Others use coffee or diet cola. The more hardcore among us will use energy drinks or pop caffeine pills. I’m not sure how good these are for you in the long run, but I don’t know any doctors who make it through the day without them.

It’s ironic because, just like telling patients to eat healthy when we don’t, many of us lecture people on the importance of a decent night’s sleep. Sleep medicine as a field has grown rapidly in the last 20 years. And I suspect those doctors are sleep deprived, too.

My wife and I often joke that on weekend mornings, it’s important to make sure we wake up in time to take a nap.

Four hundred years ago, Shakespeare described sleep as that which "knits up the ravell’d sleave of care ... sore labour’s bath, balm of hurt minds, great nature’s second course, chief nourisher in life’s feast." However, in modern medicine it’s one of the rarest commodities.

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

We all have crappy days. Sometimes things just don’t go right.

When that happens, nothing helps turn it around more than a simple "thank you" from a patient. Someone genuinely appreciates what you’re doing for them, and expresses gratitude (in words or writing). The written notes go into what a veterinarian friend of mine calls the "I don’t suck" drawer. I take them out and read them on bad days.

Courtesy Dr. Allan M. Block

Some patients bring gifts. They’re never necessary, but always appreciated. Sometimes it’s food, occasionally a book. One very nice lady always brings a gift card. These are the things that remind you why you came to medicine so many years ago.

During my third year of medical school, I had a rotation at the Omaha Veteran’s Affairs hospital. I spent a lot of time talking to a nice, but sick, old farmer named Lon. He went home after a week, but came back the next day with a bag full of corn from his farm. He wanted me to have it, and said it was to thank me. That was the first time this had ever happened to me, and it felt wonderful.

Last week, a regular patient came in for his annual follow-up. One of those in which the visit is more a friendly chat than a medical talk. I’ve always liked seeing this couple, but this time they’d done something very special: They made me a quilt.

Any gift is nice. But this couple had put extra effort into this, to make it personal to me. And it feels great. It reminds me, again, why I became a doctor. And why I stay here.

Courtesy Dr. Allan M. Block

The front is made out of blue jeans, and the little detail squares were made from a Hawaiian shirt. My patients know my fondness for wearing Aloha garb. They also picked a pattern for the back that resembled an EEG.

Thank you. You guys are awesome.

Most days the good patients outnumber the bad by a huge margin, but just aren’t as vocal. It’s always good to keep that perspective in mind.

And it feels great when thoughtful patients let you know you’re appreciated, regardless of how they say "thank you."

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

We all have crappy days. Sometimes things just don’t go right.

When that happens, nothing helps turn it around more than a simple "thank you" from a patient. Someone genuinely appreciates what you’re doing for them, and expresses gratitude (in words or writing). The written notes go into what a veterinarian friend of mine calls the "I don’t suck" drawer. I take them out and read them on bad days.

Courtesy Dr. Allan M. Block

Some patients bring gifts. They’re never necessary, but always appreciated. Sometimes it’s food, occasionally a book. One very nice lady always brings a gift card. These are the things that remind you why you came to medicine so many years ago.

During my third year of medical school, I had a rotation at the Omaha Veteran’s Affairs hospital. I spent a lot of time talking to a nice, but sick, old farmer named Lon. He went home after a week, but came back the next day with a bag full of corn from his farm. He wanted me to have it, and said it was to thank me. That was the first time this had ever happened to me, and it felt wonderful.

Last week, a regular patient came in for his annual follow-up. One of those in which the visit is more a friendly chat than a medical talk. I’ve always liked seeing this couple, but this time they’d done something very special: They made me a quilt.

Any gift is nice. But this couple had put extra effort into this, to make it personal to me. And it feels great. It reminds me, again, why I became a doctor. And why I stay here.

Courtesy Dr. Allan M. Block

The front is made out of blue jeans, and the little detail squares were made from a Hawaiian shirt. My patients know my fondness for wearing Aloha garb. They also picked a pattern for the back that resembled an EEG.

Thank you. You guys are awesome.

Most days the good patients outnumber the bad by a huge margin, but just aren’t as vocal. It’s always good to keep that perspective in mind.

And it feels great when thoughtful patients let you know you’re appreciated, regardless of how they say "thank you."

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

We all have crappy days. Sometimes things just don’t go right.

When that happens, nothing helps turn it around more than a simple "thank you" from a patient. Someone genuinely appreciates what you’re doing for them, and expresses gratitude (in words or writing). The written notes go into what a veterinarian friend of mine calls the "I don’t suck" drawer. I take them out and read them on bad days.

Courtesy Dr. Allan M. Block

Some patients bring gifts. They’re never necessary, but always appreciated. Sometimes it’s food, occasionally a book. One very nice lady always brings a gift card. These are the things that remind you why you came to medicine so many years ago.

During my third year of medical school, I had a rotation at the Omaha Veteran’s Affairs hospital. I spent a lot of time talking to a nice, but sick, old farmer named Lon. He went home after a week, but came back the next day with a bag full of corn from his farm. He wanted me to have it, and said it was to thank me. That was the first time this had ever happened to me, and it felt wonderful.

Last week, a regular patient came in for his annual follow-up. One of those in which the visit is more a friendly chat than a medical talk. I’ve always liked seeing this couple, but this time they’d done something very special: They made me a quilt.

Any gift is nice. But this couple had put extra effort into this, to make it personal to me. And it feels great. It reminds me, again, why I became a doctor. And why I stay here.

Courtesy Dr. Allan M. Block

The front is made out of blue jeans, and the little detail squares were made from a Hawaiian shirt. My patients know my fondness for wearing Aloha garb. They also picked a pattern for the back that resembled an EEG.

Thank you. You guys are awesome.

Most days the good patients outnumber the bad by a huge margin, but just aren’t as vocal. It’s always good to keep that perspective in mind.

And it feels great when thoughtful patients let you know you’re appreciated, regardless of how they say "thank you."

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

How’s your patter? Mine has been so well rehearsed it’s become second nature.

What do I mean by patter? It’s the background dialogue of an appointment. The small talk you make during the exam. The stock phrases and canned jokes to reduce tension and get people to feel more comfortable. It can be jokes about kids, the parking at your building, maybe some self-deprecating humor about my lack of fashion sense ... They may all seem like little things, but patter is critical to developing a relationship with a patient. It’s outside the framework of the routine history and exam, but every bit as important.

Helping patients feel at ease with you isn’t taught in medical school, more something that comes with experience. If they’re terrified over the visit, keeping them that way isn’t going to help you get details of what ails them.

So we use what I call "patter" – small talk to fill in the cracks of the visit. Asking about families, how long they’ve lived here, if they had trouble finding my office, etc., adds a human dimension to the visit. If the patient becomes more comfortable, hopefully you’ll be able to get better clues to figure out the case.

Seeing a new doctor is always a stressful event for most, and if it’s to see specialist, like myself, it means something is going on that the regular internist hasn’t been able to solve. That alone ups the anxiety level a bit. Unless you have a way to defuse patients, they may be too nervous to give you a good history, or forget simple details you need. Even talking about something simple, like Phoenix’s notoriously hot weather, can be a boon to getting a better history.

It becomes a work in progress during each patient’s visit, depending on how they respond, and then is quietly filed away in your mind for the next visit.

So, how’s your patter? The next show starts several times a day.

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

How’s your patter? Mine has been so well rehearsed it’s become second nature.

What do I mean by patter? It’s the background dialogue of an appointment. The small talk you make during the exam. The stock phrases and canned jokes to reduce tension and get people to feel more comfortable. It can be jokes about kids, the parking at your building, maybe some self-deprecating humor about my lack of fashion sense ... They may all seem like little things, but patter is critical to developing a relationship with a patient. It’s outside the framework of the routine history and exam, but every bit as important.

Helping patients feel at ease with you isn’t taught in medical school, more something that comes with experience. If they’re terrified over the visit, keeping them that way isn’t going to help you get details of what ails them.

So we use what I call "patter" – small talk to fill in the cracks of the visit. Asking about families, how long they’ve lived here, if they had trouble finding my office, etc., adds a human dimension to the visit. If the patient becomes more comfortable, hopefully you’ll be able to get better clues to figure out the case.

Seeing a new doctor is always a stressful event for most, and if it’s to see specialist, like myself, it means something is going on that the regular internist hasn’t been able to solve. That alone ups the anxiety level a bit. Unless you have a way to defuse patients, they may be too nervous to give you a good history, or forget simple details you need. Even talking about something simple, like Phoenix’s notoriously hot weather, can be a boon to getting a better history.

It becomes a work in progress during each patient’s visit, depending on how they respond, and then is quietly filed away in your mind for the next visit.

So, how’s your patter? The next show starts several times a day.

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

How’s your patter? Mine has been so well rehearsed it’s become second nature.

What do I mean by patter? It’s the background dialogue of an appointment. The small talk you make during the exam. The stock phrases and canned jokes to reduce tension and get people to feel more comfortable. It can be jokes about kids, the parking at your building, maybe some self-deprecating humor about my lack of fashion sense ... They may all seem like little things, but patter is critical to developing a relationship with a patient. It’s outside the framework of the routine history and exam, but every bit as important.

Helping patients feel at ease with you isn’t taught in medical school, more something that comes with experience. If they’re terrified over the visit, keeping them that way isn’t going to help you get details of what ails them.

So we use what I call "patter" – small talk to fill in the cracks of the visit. Asking about families, how long they’ve lived here, if they had trouble finding my office, etc., adds a human dimension to the visit. If the patient becomes more comfortable, hopefully you’ll be able to get better clues to figure out the case.

Seeing a new doctor is always a stressful event for most, and if it’s to see specialist, like myself, it means something is going on that the regular internist hasn’t been able to solve. That alone ups the anxiety level a bit. Unless you have a way to defuse patients, they may be too nervous to give you a good history, or forget simple details you need. Even talking about something simple, like Phoenix’s notoriously hot weather, can be a boon to getting a better history.

It becomes a work in progress during each patient’s visit, depending on how they respond, and then is quietly filed away in your mind for the next visit.

So, how’s your patter? The next show starts several times a day.

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

I prefer simple things, but that hasn’t always been the case. There was a time when I, and probably most doctors, enjoyed the complex cases and the intellectual detective work they involved. Neurology has a well-deserved reputation of being a thinking person’s field.

The challenging patients, especially during training, are what makes many of us tick. We look for subtle clues in the history and exam, comb through lab and radiology reports to see if anything was missed, and search databases for similar cases. This is the process that is critical to becoming a doctor, and learning it is a key step in medical school and residency.

You get to be a combination of Sherlock Holmes and Gregory House. Nothing can stoke your ego like nailing a difficult diagnosis, but not any more, at least to me.

As the years go by, I prefer my life simple. It doesn’t mean that I don’t occasionally enjoy the complex cases or have lost my ability to handle them.

It’s recognition of how life and the practice of medicine change you. At this point in my solo-practice career, I have responsibilities outside of my practice: kids to shuttle around, work to be done at home, and forms to complete.

Over time you realize that the simple cases and the complex ones both (generally) pay the same amount, yet the latter take far more time. This is a sad truth of modern medicine. The intellectual interest becomes replaced by the more immediate needs of financially supporting a practice.

Determining if a patient has oculopharyngeal muscular dystrophy or Kufs disease is certainly fascinating to work-up and then to manage, but I’ll take carpal tunnel syndrome over either, every time.

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

I prefer simple things, but that hasn’t always been the case. There was a time when I, and probably most doctors, enjoyed the complex cases and the intellectual detective work they involved. Neurology has a well-deserved reputation of being a thinking person’s field.

The challenging patients, especially during training, are what makes many of us tick. We look for subtle clues in the history and exam, comb through lab and radiology reports to see if anything was missed, and search databases for similar cases. This is the process that is critical to becoming a doctor, and learning it is a key step in medical school and residency.

You get to be a combination of Sherlock Holmes and Gregory House. Nothing can stoke your ego like nailing a difficult diagnosis, but not any more, at least to me.

As the years go by, I prefer my life simple. It doesn’t mean that I don’t occasionally enjoy the complex cases or have lost my ability to handle them.

It’s recognition of how life and the practice of medicine change you. At this point in my solo-practice career, I have responsibilities outside of my practice: kids to shuttle around, work to be done at home, and forms to complete.

Over time you realize that the simple cases and the complex ones both (generally) pay the same amount, yet the latter take far more time. This is a sad truth of modern medicine. The intellectual interest becomes replaced by the more immediate needs of financially supporting a practice.

Determining if a patient has oculopharyngeal muscular dystrophy or Kufs disease is certainly fascinating to work-up and then to manage, but I’ll take carpal tunnel syndrome over either, every time.

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

I prefer simple things, but that hasn’t always been the case. There was a time when I, and probably most doctors, enjoyed the complex cases and the intellectual detective work they involved. Neurology has a well-deserved reputation of being a thinking person’s field.

The challenging patients, especially during training, are what makes many of us tick. We look for subtle clues in the history and exam, comb through lab and radiology reports to see if anything was missed, and search databases for similar cases. This is the process that is critical to becoming a doctor, and learning it is a key step in medical school and residency.

You get to be a combination of Sherlock Holmes and Gregory House. Nothing can stoke your ego like nailing a difficult diagnosis, but not any more, at least to me.

As the years go by, I prefer my life simple. It doesn’t mean that I don’t occasionally enjoy the complex cases or have lost my ability to handle them.

It’s recognition of how life and the practice of medicine change you. At this point in my solo-practice career, I have responsibilities outside of my practice: kids to shuttle around, work to be done at home, and forms to complete.

Over time you realize that the simple cases and the complex ones both (generally) pay the same amount, yet the latter take far more time. This is a sad truth of modern medicine. The intellectual interest becomes replaced by the more immediate needs of financially supporting a practice.

Determining if a patient has oculopharyngeal muscular dystrophy or Kufs disease is certainly fascinating to work-up and then to manage, but I’ll take carpal tunnel syndrome over either, every time.

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

I hate having to pull a driver’s license – a lot.

Patients often believe I get some perverse pleasure out of it or that I do it to "get even" with them for some reason, but I don’t.

Like most neurologists, I don’t take this lightly. If I’ve gone to the length to fill out the paperwork and notify the state that you shouldn’t be driving, it means you’ve given me a really good reason.

Here in Arizona we operate on the honor system. So if I have to suggest revoking a seizure patient’s license, it means I’ve clearly caught them driving after I’ve told them not to.

Dementia patients are trickier, with more shades of gray than simple black or white. I tend to err on the side of caution and tell them to stop driving when I become concerned. If they won’t stop or refuse to take a behind-the-wheel test, then I notify the state.

The scariest patients are those without insight into their impairments and either no family to work with or a family that’s indifferent. There are no easy answers in those cases because the patient will likely be oblivious to the fact that his license has been taken away and will not stop driving.

I feel bad about taking away a license. In modern society, the ability to safely operate a car is independence for many. My city isn’t notable for being easy to walk around or for having an exceptionally easy public transportation system.

But I still do it. My criterion, besides state law, comes down to what I call the "kid question": Do I want this person out on the road, knowing that my children are riding around on it, too?

And if the answer is no, it’s time to reach for the department of motor vehicles form.

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

I hate having to pull a driver’s license – a lot.

Patients often believe I get some perverse pleasure out of it or that I do it to "get even" with them for some reason, but I don’t.

Like most neurologists, I don’t take this lightly. If I’ve gone to the length to fill out the paperwork and notify the state that you shouldn’t be driving, it means you’ve given me a really good reason.

Here in Arizona we operate on the honor system. So if I have to suggest revoking a seizure patient’s license, it means I’ve clearly caught them driving after I’ve told them not to.

Dementia patients are trickier, with more shades of gray than simple black or white. I tend to err on the side of caution and tell them to stop driving when I become concerned. If they won’t stop or refuse to take a behind-the-wheel test, then I notify the state.

The scariest patients are those without insight into their impairments and either no family to work with or a family that’s indifferent. There are no easy answers in those cases because the patient will likely be oblivious to the fact that his license has been taken away and will not stop driving.

I feel bad about taking away a license. In modern society, the ability to safely operate a car is independence for many. My city isn’t notable for being easy to walk around or for having an exceptionally easy public transportation system.

But I still do it. My criterion, besides state law, comes down to what I call the "kid question": Do I want this person out on the road, knowing that my children are riding around on it, too?

And if the answer is no, it’s time to reach for the department of motor vehicles form.

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

I hate having to pull a driver’s license – a lot.

Patients often believe I get some perverse pleasure out of it or that I do it to "get even" with them for some reason, but I don’t.

Like most neurologists, I don’t take this lightly. If I’ve gone to the length to fill out the paperwork and notify the state that you shouldn’t be driving, it means you’ve given me a really good reason.

Here in Arizona we operate on the honor system. So if I have to suggest revoking a seizure patient’s license, it means I’ve clearly caught them driving after I’ve told them not to.

Dementia patients are trickier, with more shades of gray than simple black or white. I tend to err on the side of caution and tell them to stop driving when I become concerned. If they won’t stop or refuse to take a behind-the-wheel test, then I notify the state.

The scariest patients are those without insight into their impairments and either no family to work with or a family that’s indifferent. There are no easy answers in those cases because the patient will likely be oblivious to the fact that his license has been taken away and will not stop driving.

I feel bad about taking away a license. In modern society, the ability to safely operate a car is independence for many. My city isn’t notable for being easy to walk around or for having an exceptionally easy public transportation system.

But I still do it. My criterion, besides state law, comes down to what I call the "kid question": Do I want this person out on the road, knowing that my children are riding around on it, too?

And if the answer is no, it’s time to reach for the department of motor vehicles form.

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

Recently, I wrote a column on my hatred of the phrase "mini-strokes." And today, I guess I had one (at least as they are often described by my patients).

While catching up on dictation, I meant to type "please forward her labs." For whatever reason, as I tapped away, I accidentally wrote "place" instead of "please."

I knew it was the wrong word and realized it by the third letter, but in the fraction of a second it took to see it, my left fingers finished typing "place" before I could stop them, as if they were on their own. So I deleted the word, retyped it, and went on with my letter.

It was a pretty minor thing. We all do it here and there while typing.

But it’s amazing how many patients will mention such a simple thing to a doctor or go to the emergency department for it. This is, to some extent, our own fault. Organizations heavily publicize "stroke warning signs," which include clumsiness, weakness, and confusion. How you interpret them is going to vary.

What if you’d heard the same complaint in the office? A patient comes in with the same story, presented in terms of "I knew what I wanted to type, but couldn’t make the words come out" or "I couldn’t make my left hand hit the correct keys."

What would you do? Would you write it off as "one of those things" or "we all do that sometimes" (like I did) or would you work it up? Given the nature of our profession, and the risk of a malpractice suit, you’d probably work it up.

How far would this take you? A brain MRI, and likely either a magnetic resonance angiography or a carotid Doppler. You’d probably tack on an echocardiogram for good measure. The more aggressive among us may do a TEE [transesophageal echocardiogram], EEG, and hypercoagulable work-up.

At this point, the mistyped word (or "mini-stroke") has cost at least $5,000 in tests, not to mention the patient’s time off from work to get it all done.

And, of course, we’d also start a daily aspirin. But wait, I already take a daily aspirin. So should I start Plavix? Or Aggrenox? Or Coumadin?

What would you do when your thoroughness finds something incidental? A thyroid nodule seen on carotid Doppler? That will need labs and maybe a needle biopsy. A small aneurysm or meningioma? Those will need annual follow-up studies. A patent foramen ovale? There’s already a 25% chance of finding that right off the top. Are you going to send the patient for a closure? After all, you can’t definitively prove he didn’t have a transient ischemic attack ...

There’s no easy answer here. We try to find a balance between being practical and being competent, with the threat of malpractice sometimes leading us to overkill.

I’m sure some out there will criticize me for trying to be my own doctor by ignoring the "mini-stroke" typing issue. But I’ll hope it’s within the range of everyday human errors (and continue daily aspirin).

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

Recently, I wrote a column on my hatred of the phrase "mini-strokes." And today, I guess I had one (at least as they are often described by my patients).

While catching up on dictation, I meant to type "please forward her labs." For whatever reason, as I tapped away, I accidentally wrote "place" instead of "please."

I knew it was the wrong word and realized it by the third letter, but in the fraction of a second it took to see it, my left fingers finished typing "place" before I could stop them, as if they were on their own. So I deleted the word, retyped it, and went on with my letter.

It was a pretty minor thing. We all do it here and there while typing.

But it’s amazing how many patients will mention such a simple thing to a doctor or go to the emergency department for it. This is, to some extent, our own fault. Organizations heavily publicize "stroke warning signs," which include clumsiness, weakness, and confusion. How you interpret them is going to vary.

What if you’d heard the same complaint in the office? A patient comes in with the same story, presented in terms of "I knew what I wanted to type, but couldn’t make the words come out" or "I couldn’t make my left hand hit the correct keys."

What would you do? Would you write it off as "one of those things" or "we all do that sometimes" (like I did) or would you work it up? Given the nature of our profession, and the risk of a malpractice suit, you’d probably work it up.

How far would this take you? A brain MRI, and likely either a magnetic resonance angiography or a carotid Doppler. You’d probably tack on an echocardiogram for good measure. The more aggressive among us may do a TEE [transesophageal echocardiogram], EEG, and hypercoagulable work-up.

At this point, the mistyped word (or "mini-stroke") has cost at least $5,000 in tests, not to mention the patient’s time off from work to get it all done.

And, of course, we’d also start a daily aspirin. But wait, I already take a daily aspirin. So should I start Plavix? Or Aggrenox? Or Coumadin?

What would you do when your thoroughness finds something incidental? A thyroid nodule seen on carotid Doppler? That will need labs and maybe a needle biopsy. A small aneurysm or meningioma? Those will need annual follow-up studies. A patent foramen ovale? There’s already a 25% chance of finding that right off the top. Are you going to send the patient for a closure? After all, you can’t definitively prove he didn’t have a transient ischemic attack ...

There’s no easy answer here. We try to find a balance between being practical and being competent, with the threat of malpractice sometimes leading us to overkill.

I’m sure some out there will criticize me for trying to be my own doctor by ignoring the "mini-stroke" typing issue. But I’ll hope it’s within the range of everyday human errors (and continue daily aspirin).

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

Recently, I wrote a column on my hatred of the phrase "mini-strokes." And today, I guess I had one (at least as they are often described by my patients).

While catching up on dictation, I meant to type "please forward her labs." For whatever reason, as I tapped away, I accidentally wrote "place" instead of "please."

I knew it was the wrong word and realized it by the third letter, but in the fraction of a second it took to see it, my left fingers finished typing "place" before I could stop them, as if they were on their own. So I deleted the word, retyped it, and went on with my letter.

It was a pretty minor thing. We all do it here and there while typing.

But it’s amazing how many patients will mention such a simple thing to a doctor or go to the emergency department for it. This is, to some extent, our own fault. Organizations heavily publicize "stroke warning signs," which include clumsiness, weakness, and confusion. How you interpret them is going to vary.

What if you’d heard the same complaint in the office? A patient comes in with the same story, presented in terms of "I knew what I wanted to type, but couldn’t make the words come out" or "I couldn’t make my left hand hit the correct keys."

What would you do? Would you write it off as "one of those things" or "we all do that sometimes" (like I did) or would you work it up? Given the nature of our profession, and the risk of a malpractice suit, you’d probably work it up.

How far would this take you? A brain MRI, and likely either a magnetic resonance angiography or a carotid Doppler. You’d probably tack on an echocardiogram for good measure. The more aggressive among us may do a TEE [transesophageal echocardiogram], EEG, and hypercoagulable work-up.

At this point, the mistyped word (or "mini-stroke") has cost at least $5,000 in tests, not to mention the patient’s time off from work to get it all done.

And, of course, we’d also start a daily aspirin. But wait, I already take a daily aspirin. So should I start Plavix? Or Aggrenox? Or Coumadin?

What would you do when your thoroughness finds something incidental? A thyroid nodule seen on carotid Doppler? That will need labs and maybe a needle biopsy. A small aneurysm or meningioma? Those will need annual follow-up studies. A patent foramen ovale? There’s already a 25% chance of finding that right off the top. Are you going to send the patient for a closure? After all, you can’t definitively prove he didn’t have a transient ischemic attack ...

There’s no easy answer here. We try to find a balance between being practical and being competent, with the threat of malpractice sometimes leading us to overkill.

I’m sure some out there will criticize me for trying to be my own doctor by ignoring the "mini-stroke" typing issue. But I’ll hope it’s within the range of everyday human errors (and continue daily aspirin).

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

My secretary recently refused to schedule a patient to see me. You might think I’d be angry about it, but I wasn’t.

She and I have been together since 2004. She’s seen me at my best and worst. And she knows the rare personality types that will not like me at all: argumentative, belligerent, pushy, demanding of special treatment. She tells them to go elsewhere. There’s no shortage of neurologists in this town.

This is actually a good thing. It saves both me and those patients time and frustration. They don’t have to be horrified when they discover that I wear shorts to the office or that I won’t prescribe boatloads of narcotics for the hell of it. They don’t have to bother with leaving the office midappointment when they realize that my personality/decor/whatever doesn’t work for them.

Some might say it’s better to get the billing, but I disagree. I’d rather have an empty hour on occasion than an acrimonious one. The former can be used for another patient or catching up on the endless array of papers and reports that compose a modern neurology practice.

This job is tough enough as it is. Having a patient that you can’t work with only makes it harder, and isn’t worth the frustration for either of us.

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

My secretary recently refused to schedule a patient to see me. You might think I’d be angry about it, but I wasn’t.

She and I have been together since 2004. She’s seen me at my best and worst. And she knows the rare personality types that will not like me at all: argumentative, belligerent, pushy, demanding of special treatment. She tells them to go elsewhere. There’s no shortage of neurologists in this town.

This is actually a good thing. It saves both me and those patients time and frustration. They don’t have to be horrified when they discover that I wear shorts to the office or that I won’t prescribe boatloads of narcotics for the hell of it. They don’t have to bother with leaving the office midappointment when they realize that my personality/decor/whatever doesn’t work for them.

Some might say it’s better to get the billing, but I disagree. I’d rather have an empty hour on occasion than an acrimonious one. The former can be used for another patient or catching up on the endless array of papers and reports that compose a modern neurology practice.

This job is tough enough as it is. Having a patient that you can’t work with only makes it harder, and isn’t worth the frustration for either of us.

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

My secretary recently refused to schedule a patient to see me. You might think I’d be angry about it, but I wasn’t.

She and I have been together since 2004. She’s seen me at my best and worst. And she knows the rare personality types that will not like me at all: argumentative, belligerent, pushy, demanding of special treatment. She tells them to go elsewhere. There’s no shortage of neurologists in this town.

This is actually a good thing. It saves both me and those patients time and frustration. They don’t have to be horrified when they discover that I wear shorts to the office or that I won’t prescribe boatloads of narcotics for the hell of it. They don’t have to bother with leaving the office midappointment when they realize that my personality/decor/whatever doesn’t work for them.

Some might say it’s better to get the billing, but I disagree. I’d rather have an empty hour on occasion than an acrimonious one. The former can be used for another patient or catching up on the endless array of papers and reports that compose a modern neurology practice.

This job is tough enough as it is. Having a patient that you can’t work with only makes it harder, and isn’t worth the frustration for either of us.

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

A few weeks ago, I wrote about my hatred of the word "dizzy." Today, I’m going to address another term that drives me nuts: mini-stroke. Patients come to me and describe the events these ways:

• "I went to the ER. They said I had a mini-stroke."

• "Dr. Smith said my MRI showed mini-strokes."

• "I had a bunch of mini-strokes yesterday."

So what is a mini-stroke? I think a lot of people use it interchangeably with transient ischemic attack (TIA). I can’t stand that. A stroke is like being pregnant: You either are or you aren’t. In my mind, there’s no such thing as "semi-pregnant" any more than there is a mini-stroke. A TIA is not a stroke. They may be similar, but they’re NOT the same, and using mini-stroke for something that isn’t one is misleading.

Other people use the phrase to mean the nonspecific white matter changes seen on MRI, which our species collects like tree rings over time. I’m not convinced they deserve the distinction of being labeled as "strokes," either.

Another group of people may use it to mean pretty much any sort of transient neurologic phenomenon:

• "When I woke up the fingers were tingling. I shook them out, and they got better. I think it was a mini-stroke."

• "My nose was numb after I went jogging yesterday. My wife said it might a mini-stroke."

• "My doctor says all my weird thoughts might be mini-strokes, and told me to come here."

Dizzy is so entrenched in the English language that I know we’ll never be rid of it. But, this one, I can see some hope for. I’d think that education, geared to primary care doctors and the general public, would help.

But, on the other hand, it’s probably better to leave it as it is. Mini-strokes in all forms are a good source of referrals, and who wants to stop that?

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

A few weeks ago, I wrote about my hatred of the word "dizzy." Today, I’m going to address another term that drives me nuts: mini-stroke. Patients come to me and describe the events these ways:

• "I went to the ER. They said I had a mini-stroke."

• "Dr. Smith said my MRI showed mini-strokes."

• "I had a bunch of mini-strokes yesterday."

So what is a mini-stroke? I think a lot of people use it interchangeably with transient ischemic attack (TIA). I can’t stand that. A stroke is like being pregnant: You either are or you aren’t. In my mind, there’s no such thing as "semi-pregnant" any more than there is a mini-stroke. A TIA is not a stroke. They may be similar, but they’re NOT the same, and using mini-stroke for something that isn’t one is misleading.

Other people use the phrase to mean the nonspecific white matter changes seen on MRI, which our species collects like tree rings over time. I’m not convinced they deserve the distinction of being labeled as "strokes," either.

Another group of people may use it to mean pretty much any sort of transient neurologic phenomenon:

• "When I woke up the fingers were tingling. I shook them out, and they got better. I think it was a mini-stroke."

• "My nose was numb after I went jogging yesterday. My wife said it might a mini-stroke."

• "My doctor says all my weird thoughts might be mini-strokes, and told me to come here."

Dizzy is so entrenched in the English language that I know we’ll never be rid of it. But, this one, I can see some hope for. I’d think that education, geared to primary care doctors and the general public, would help.

But, on the other hand, it’s probably better to leave it as it is. Mini-strokes in all forms are a good source of referrals, and who wants to stop that?

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

A few weeks ago, I wrote about my hatred of the word "dizzy." Today, I’m going to address another term that drives me nuts: mini-stroke. Patients come to me and describe the events these ways:

• "I went to the ER. They said I had a mini-stroke."

• "Dr. Smith said my MRI showed mini-strokes."

• "I had a bunch of mini-strokes yesterday."

So what is a mini-stroke? I think a lot of people use it interchangeably with transient ischemic attack (TIA). I can’t stand that. A stroke is like being pregnant: You either are or you aren’t. In my mind, there’s no such thing as "semi-pregnant" any more than there is a mini-stroke. A TIA is not a stroke. They may be similar, but they’re NOT the same, and using mini-stroke for something that isn’t one is misleading.

Other people use the phrase to mean the nonspecific white matter changes seen on MRI, which our species collects like tree rings over time. I’m not convinced they deserve the distinction of being labeled as "strokes," either.

Another group of people may use it to mean pretty much any sort of transient neurologic phenomenon:

• "When I woke up the fingers were tingling. I shook them out, and they got better. I think it was a mini-stroke."

• "My nose was numb after I went jogging yesterday. My wife said it might a mini-stroke."

• "My doctor says all my weird thoughts might be mini-strokes, and told me to come here."

Dizzy is so entrenched in the English language that I know we’ll never be rid of it. But, this one, I can see some hope for. I’d think that education, geared to primary care doctors and the general public, would help.

But, on the other hand, it’s probably better to leave it as it is. Mini-strokes in all forms are a good source of referrals, and who wants to stop that?

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