Hitting a Nerve

My secretary and I have a pact. I won’t sell her anything, and she won’t sell me anything. Sound strange? You must not have kids.

One of the most irritating rites of the school year is the fundraiser. Your kid goes to a mandatory assembly where a charismatic salesman shows them all kinds of stuff: video game consoles, air rifles, mountain bikes, etc., which they can earn simply by selling merchandise (usually foodstuffs) to raise money for the school.

This drives me (and many parents) nuts. The last thing I want is my kid going door-to-door to sell things. I won’t allow it. Of course, this triggers a riot at home because the kids have been brainwashed into thinking they’re going to be the ones winning the Playstation 17 by selling cookie dough orders.

This is so irritating that at a school meeting I once suggested they simply ask each family to chip in $100 per kid to a school fund once a year, then do away with the fundraisers. The majority of parents agreed with me, but the officials shot my idea down as being "impractical."

So what does this have to do with neurology? Recently, I had to see a doctor. Her office staff was actually trying to sell their kids’ school fundraiser items (candy bars) to patients waiting in the lobby! When I mentioned this to the doctor, she told me she does that once a year for her kids, too.

Does anyone else see this as unprofessional? As a patient, wouldn’t you be worried that not buying something would get you a lower quality of care? Or feel entitled to something more if you did make a purchase?

Likewise, I get letters/calls/faxes from patients asking me to buy things to support their kids’ band/team/whatever. I don’t do this either. No matter how good a cause, I think it’s a bad idea to start. It affects the doctor-patient relationship in ways that may not be tangible but are nonetheless quite real.

I can’t change the school budget issues, and, as much as I’d like to, won’t be able to stop these fundraising-by-brainwashing-kids schemes. But I don’t believe they have any place in a doctor’s office. Their presence changes the relationship between doctor, staff, and patients, but not in ways that are conducive to practicing good medicine.

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

My secretary and I have a pact. I won’t sell her anything, and she won’t sell me anything. Sound strange? You must not have kids.

One of the most irritating rites of the school year is the fundraiser. Your kid goes to a mandatory assembly where a charismatic salesman shows them all kinds of stuff: video game consoles, air rifles, mountain bikes, etc., which they can earn simply by selling merchandise (usually foodstuffs) to raise money for the school.

This drives me (and many parents) nuts. The last thing I want is my kid going door-to-door to sell things. I won’t allow it. Of course, this triggers a riot at home because the kids have been brainwashed into thinking they’re going to be the ones winning the Playstation 17 by selling cookie dough orders.

This is so irritating that at a school meeting I once suggested they simply ask each family to chip in $100 per kid to a school fund once a year, then do away with the fundraisers. The majority of parents agreed with me, but the officials shot my idea down as being "impractical."

So what does this have to do with neurology? Recently, I had to see a doctor. Her office staff was actually trying to sell their kids’ school fundraiser items (candy bars) to patients waiting in the lobby! When I mentioned this to the doctor, she told me she does that once a year for her kids, too.

Does anyone else see this as unprofessional? As a patient, wouldn’t you be worried that not buying something would get you a lower quality of care? Or feel entitled to something more if you did make a purchase?

Likewise, I get letters/calls/faxes from patients asking me to buy things to support their kids’ band/team/whatever. I don’t do this either. No matter how good a cause, I think it’s a bad idea to start. It affects the doctor-patient relationship in ways that may not be tangible but are nonetheless quite real.

I can’t change the school budget issues, and, as much as I’d like to, won’t be able to stop these fundraising-by-brainwashing-kids schemes. But I don’t believe they have any place in a doctor’s office. Their presence changes the relationship between doctor, staff, and patients, but not in ways that are conducive to practicing good medicine.

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

My secretary and I have a pact. I won’t sell her anything, and she won’t sell me anything. Sound strange? You must not have kids.

One of the most irritating rites of the school year is the fundraiser. Your kid goes to a mandatory assembly where a charismatic salesman shows them all kinds of stuff: video game consoles, air rifles, mountain bikes, etc., which they can earn simply by selling merchandise (usually foodstuffs) to raise money for the school.

This drives me (and many parents) nuts. The last thing I want is my kid going door-to-door to sell things. I won’t allow it. Of course, this triggers a riot at home because the kids have been brainwashed into thinking they’re going to be the ones winning the Playstation 17 by selling cookie dough orders.

This is so irritating that at a school meeting I once suggested they simply ask each family to chip in $100 per kid to a school fund once a year, then do away with the fundraisers. The majority of parents agreed with me, but the officials shot my idea down as being "impractical."

So what does this have to do with neurology? Recently, I had to see a doctor. Her office staff was actually trying to sell their kids’ school fundraiser items (candy bars) to patients waiting in the lobby! When I mentioned this to the doctor, she told me she does that once a year for her kids, too.

Does anyone else see this as unprofessional? As a patient, wouldn’t you be worried that not buying something would get you a lower quality of care? Or feel entitled to something more if you did make a purchase?

Likewise, I get letters/calls/faxes from patients asking me to buy things to support their kids’ band/team/whatever. I don’t do this either. No matter how good a cause, I think it’s a bad idea to start. It affects the doctor-patient relationship in ways that may not be tangible but are nonetheless quite real.

I can’t change the school budget issues, and, as much as I’d like to, won’t be able to stop these fundraising-by-brainwashing-kids schemes. But I don’t believe they have any place in a doctor’s office. Their presence changes the relationship between doctor, staff, and patients, but not in ways that are conducive to practicing good medicine.

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

I have an electronic health record ... sort of. I designed my own in 2000, using some off-the-shelf Apple software, gradually modifying it with time and experience. It likely wouldn’t work for most doctors, but in a solo practice, it only has to work for one. I’m perfectly happy with it. It tells me what my schedule is, lets me review my notes and prescriptions, and shows me test results. I also can access it from anywhere.

Does it meet government "meaningful use" criteria? No.

As a result, I, like many other small, financially-limited practices, am scheduled to take a Medicare financial penalty starting in 2015, in spite of the fact that I work hard, provide quality patient care, and have a system that lets me practice on terms that work for me and my patients. It is a system that didn’t cost me a large sum of money that I didn’t have.

That’s why I was relieved to learn of the Electronic Health Records Improvement Act (H.R. 1331), recently introduced by Rep. Diane Black (R-Tenn.). This bill would create a hardship exemption for solo practitioners and those nearing retirement, realizing that those who can least afford to buy a "meaningful use" EHR are only going to be further devastated by cutting their income.

I don’t know if it will pass. It has a long way to go, but hopefully, it will appeal to common sense on both sides of the aisle. Putting small practices out of business only hurts people in general by making it harder for them to find care. This bill is a step in the right direction.

So far, 20 medical associations have stepped forward to support the bill (none thus far in neurology), and I hope that number (and congressional support) continues to grow. Small practices have formed the backbone of American medicine for more than 200 years and still have something to offer.

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

This column, "Hitting a Nerve," appears regularly in Clinical Neurology News.

I have an electronic health record ... sort of. I designed my own in 2000, using some off-the-shelf Apple software, gradually modifying it with time and experience. It likely wouldn’t work for most doctors, but in a solo practice, it only has to work for one. I’m perfectly happy with it. It tells me what my schedule is, lets me review my notes and prescriptions, and shows me test results. I also can access it from anywhere.

Does it meet government "meaningful use" criteria? No.

As a result, I, like many other small, financially-limited practices, am scheduled to take a Medicare financial penalty starting in 2015, in spite of the fact that I work hard, provide quality patient care, and have a system that lets me practice on terms that work for me and my patients. It is a system that didn’t cost me a large sum of money that I didn’t have.

That’s why I was relieved to learn of the Electronic Health Records Improvement Act (H.R. 1331), recently introduced by Rep. Diane Black (R-Tenn.). This bill would create a hardship exemption for solo practitioners and those nearing retirement, realizing that those who can least afford to buy a "meaningful use" EHR are only going to be further devastated by cutting their income.

I don’t know if it will pass. It has a long way to go, but hopefully, it will appeal to common sense on both sides of the aisle. Putting small practices out of business only hurts people in general by making it harder for them to find care. This bill is a step in the right direction.

So far, 20 medical associations have stepped forward to support the bill (none thus far in neurology), and I hope that number (and congressional support) continues to grow. Small practices have formed the backbone of American medicine for more than 200 years and still have something to offer.

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

This column, "Hitting a Nerve," appears regularly in Clinical Neurology News.

I have an electronic health record ... sort of. I designed my own in 2000, using some off-the-shelf Apple software, gradually modifying it with time and experience. It likely wouldn’t work for most doctors, but in a solo practice, it only has to work for one. I’m perfectly happy with it. It tells me what my schedule is, lets me review my notes and prescriptions, and shows me test results. I also can access it from anywhere.

Does it meet government "meaningful use" criteria? No.

As a result, I, like many other small, financially-limited practices, am scheduled to take a Medicare financial penalty starting in 2015, in spite of the fact that I work hard, provide quality patient care, and have a system that lets me practice on terms that work for me and my patients. It is a system that didn’t cost me a large sum of money that I didn’t have.

That’s why I was relieved to learn of the Electronic Health Records Improvement Act (H.R. 1331), recently introduced by Rep. Diane Black (R-Tenn.). This bill would create a hardship exemption for solo practitioners and those nearing retirement, realizing that those who can least afford to buy a "meaningful use" EHR are only going to be further devastated by cutting their income.

I don’t know if it will pass. It has a long way to go, but hopefully, it will appeal to common sense on both sides of the aisle. Putting small practices out of business only hurts people in general by making it harder for them to find care. This bill is a step in the right direction.

So far, 20 medical associations have stepped forward to support the bill (none thus far in neurology), and I hope that number (and congressional support) continues to grow. Small practices have formed the backbone of American medicine for more than 200 years and still have something to offer.

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

This column, "Hitting a Nerve," appears regularly in Clinical Neurology News.

My most hated word in neurology has five letters: D-I-Z-Z-Y.

Very few words are as nonspecific, yet commonly used, as that one. And we hear it all the time. Patients say it. Other doctors (usually non-neurologists) use it. It’s on referral forms, admitting orders, and hospital face sheets.

It tells you nothing, and that’s what drives me nuts. Like any neurologist, I try to break it down. I used to say, "What do you mean by dizzy?" only to find that it led nowhere (beyond the response "You know, like ‘dizzy’"). Now I offer hints, though purists will accuse me of leading the witness.

Sorting it out can be easy or hard, depending on the patient. Is it vertigo? (It’s amazing to me how many other doctors use dizziness and vertigo interchangeably.) Lightheadedness? Imbalance? Or something else entirely? The most frustrating ones are where the patient says either it’s all of those or none of those. It’s even worse when the family is providing the history and just thinks the patient is dizzy, and the patient can’t reliably say.

Medical detective work can be fun, and these times are no exception if you can clarify things in a way that leads you to a reasonable diagnosis (or at least a work-up) and treatment. But not having a clear answer can result in unnecessary tests and medication trials, and will definitely delay finding the cause of the patient’s symptoms.

By nature, neurologists try to be precise. We want an exact diagnosis and a clear basis to rest it on. Words like "dizzy" are often maddening, frustrating, and hair thinning.

Just hearing it makes me dizzy.

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

My most hated word in neurology has five letters: D-I-Z-Z-Y.

Very few words are as nonspecific, yet commonly used, as that one. And we hear it all the time. Patients say it. Other doctors (usually non-neurologists) use it. It’s on referral forms, admitting orders, and hospital face sheets.

It tells you nothing, and that’s what drives me nuts. Like any neurologist, I try to break it down. I used to say, "What do you mean by dizzy?" only to find that it led nowhere (beyond the response "You know, like ‘dizzy’"). Now I offer hints, though purists will accuse me of leading the witness.

Sorting it out can be easy or hard, depending on the patient. Is it vertigo? (It’s amazing to me how many other doctors use dizziness and vertigo interchangeably.) Lightheadedness? Imbalance? Or something else entirely? The most frustrating ones are where the patient says either it’s all of those or none of those. It’s even worse when the family is providing the history and just thinks the patient is dizzy, and the patient can’t reliably say.

Medical detective work can be fun, and these times are no exception if you can clarify things in a way that leads you to a reasonable diagnosis (or at least a work-up) and treatment. But not having a clear answer can result in unnecessary tests and medication trials, and will definitely delay finding the cause of the patient’s symptoms.

By nature, neurologists try to be precise. We want an exact diagnosis and a clear basis to rest it on. Words like "dizzy" are often maddening, frustrating, and hair thinning.

Just hearing it makes me dizzy.

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

My most hated word in neurology has five letters: D-I-Z-Z-Y.

Very few words are as nonspecific, yet commonly used, as that one. And we hear it all the time. Patients say it. Other doctors (usually non-neurologists) use it. It’s on referral forms, admitting orders, and hospital face sheets.

It tells you nothing, and that’s what drives me nuts. Like any neurologist, I try to break it down. I used to say, "What do you mean by dizzy?" only to find that it led nowhere (beyond the response "You know, like ‘dizzy’"). Now I offer hints, though purists will accuse me of leading the witness.

Sorting it out can be easy or hard, depending on the patient. Is it vertigo? (It’s amazing to me how many other doctors use dizziness and vertigo interchangeably.) Lightheadedness? Imbalance? Or something else entirely? The most frustrating ones are where the patient says either it’s all of those or none of those. It’s even worse when the family is providing the history and just thinks the patient is dizzy, and the patient can’t reliably say.

Medical detective work can be fun, and these times are no exception if you can clarify things in a way that leads you to a reasonable diagnosis (or at least a work-up) and treatment. But not having a clear answer can result in unnecessary tests and medication trials, and will definitely delay finding the cause of the patient’s symptoms.

By nature, neurologists try to be precise. We want an exact diagnosis and a clear basis to rest it on. Words like "dizzy" are often maddening, frustrating, and hair thinning.

Just hearing it makes me dizzy.

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

"By medicine life may be prolong’d, yet death will seize the doctor too"

–William Shakespeare, in "Cymbeline"

Recently, I had the unpleasant job of diagnosing another physician with amyotrophic lateral sclerosis. It hit home hard, as he and I have referred patients back and forth for years, and we are at similar stages in our lives and careers. I genuinely like him, both as a person and a doctor.

This is unquestionably the most horrible disease we deal with. Its impact is such that, regardless of specialty, all doctors from medical school onward know what those three letters mean.

It’s tragic for anyone, but seems particularly awful when it happens to a fellow physician.

Why is this? I’d venture that there’s a mysterious, unspoken belief that, because we (physicians in general) devote ourselves to helping others, we should be magically immune to the same disorders. I’m not saying this makes sense, but I suspect there’s a remote sense of denial. Like the witch doctors we started out as, the evil spirits we protect others from shouldn’t be able to harm us.

There’s also the tragedy of a life cut short, especially when it’s one lived to serve others. After all the years we spend in training, it seems even worse to see it all end so soon.

I’d argue that there’s also a fear of the unknown. We all hope to avoid another’s tragedy by not doing something risky, like smoking, skydiving, or not wearing a bike helmet. In this respect, I think ALS becomes particularly frightening because there is (with current knowledge) no particular risk factor you can avoid to try and prevent it. The random chance of purely horrible luck is terrifying. No one can say, "Since I don’t do (whatever), it won’t happen to me."

For those of us not directly affected by the tragedy, it still reminds us of our own mortality and how random acts of fate can change our lives so quickly.

Good luck, my friend.

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

"By medicine life may be prolong’d, yet death will seize the doctor too"

–William Shakespeare, in "Cymbeline"

Recently, I had the unpleasant job of diagnosing another physician with amyotrophic lateral sclerosis. It hit home hard, as he and I have referred patients back and forth for years, and we are at similar stages in our lives and careers. I genuinely like him, both as a person and a doctor.

This is unquestionably the most horrible disease we deal with. Its impact is such that, regardless of specialty, all doctors from medical school onward know what those three letters mean.

It’s tragic for anyone, but seems particularly awful when it happens to a fellow physician.

Why is this? I’d venture that there’s a mysterious, unspoken belief that, because we (physicians in general) devote ourselves to helping others, we should be magically immune to the same disorders. I’m not saying this makes sense, but I suspect there’s a remote sense of denial. Like the witch doctors we started out as, the evil spirits we protect others from shouldn’t be able to harm us.

There’s also the tragedy of a life cut short, especially when it’s one lived to serve others. After all the years we spend in training, it seems even worse to see it all end so soon.

I’d argue that there’s also a fear of the unknown. We all hope to avoid another’s tragedy by not doing something risky, like smoking, skydiving, or not wearing a bike helmet. In this respect, I think ALS becomes particularly frightening because there is (with current knowledge) no particular risk factor you can avoid to try and prevent it. The random chance of purely horrible luck is terrifying. No one can say, "Since I don’t do (whatever), it won’t happen to me."

For those of us not directly affected by the tragedy, it still reminds us of our own mortality and how random acts of fate can change our lives so quickly.

Good luck, my friend.

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

"By medicine life may be prolong’d, yet death will seize the doctor too"

–William Shakespeare, in "Cymbeline"

Recently, I had the unpleasant job of diagnosing another physician with amyotrophic lateral sclerosis. It hit home hard, as he and I have referred patients back and forth for years, and we are at similar stages in our lives and careers. I genuinely like him, both as a person and a doctor.

This is unquestionably the most horrible disease we deal with. Its impact is such that, regardless of specialty, all doctors from medical school onward know what those three letters mean.

It’s tragic for anyone, but seems particularly awful when it happens to a fellow physician.

Why is this? I’d venture that there’s a mysterious, unspoken belief that, because we (physicians in general) devote ourselves to helping others, we should be magically immune to the same disorders. I’m not saying this makes sense, but I suspect there’s a remote sense of denial. Like the witch doctors we started out as, the evil spirits we protect others from shouldn’t be able to harm us.

There’s also the tragedy of a life cut short, especially when it’s one lived to serve others. After all the years we spend in training, it seems even worse to see it all end so soon.

I’d argue that there’s also a fear of the unknown. We all hope to avoid another’s tragedy by not doing something risky, like smoking, skydiving, or not wearing a bike helmet. In this respect, I think ALS becomes particularly frightening because there is (with current knowledge) no particular risk factor you can avoid to try and prevent it. The random chance of purely horrible luck is terrifying. No one can say, "Since I don’t do (whatever), it won’t happen to me."

For those of us not directly affected by the tragedy, it still reminds us of our own mortality and how random acts of fate can change our lives so quickly.

Good luck, my friend.

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

A neurologic exam involves a number of different elements: strength, coordination, cranial nerves, sensation, reflexes, gait, and a few others.

Certainly, not all of these elements are needed in every circumstance and are often not critical. Nonetheless, we check them, such as vibratory sense in simple migraine patients and carotid auscultation in carpal tunnel syndrome.

Courtesy Cate Storey

Is all of this necessary? Probably not. Do we still do it? Of course. Some of it is for documentation. Part of it is being thorough. (Neurologists, by nature, tend to be a compulsive bunch.) And there’s also habit – once you get into a certain pattern of doing an exam, it becomes a fixed routine.

There’s another intangible that’s rarely talked about: show time and magic. Like our witch doctor ancestors, we also have to make people believe in us. All those degrees on the walls (or lack thereof, in my case) may not convince some, so we pull out our wands. We have a Queen Square hammer instead of a Taylor (a.k.a., Tomahawk). Checking vibratory sense in every migraine patient may not be needed, but it’s a step up from most internists. It shows a patient that we’re looking for details others didn’t think of. It adds an element of mystery and interest to the magic of seeing a subspecialist. And, of course, hopefully convinces them that we’re worth the higher copay.

It might be easier and faster for many things if we just checked a few basic exam features. It likely wouldn’t change our plans in most cases. But it would take some of the luster off our profession and the way patients perceive us.

Even in modern medicine, image plays a big part. And a new curtain rises every time we start seeing a patient.

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

A neurologic exam involves a number of different elements: strength, coordination, cranial nerves, sensation, reflexes, gait, and a few others.

Certainly, not all of these elements are needed in every circumstance and are often not critical. Nonetheless, we check them, such as vibratory sense in simple migraine patients and carotid auscultation in carpal tunnel syndrome.

Courtesy Cate Storey

Is all of this necessary? Probably not. Do we still do it? Of course. Some of it is for documentation. Part of it is being thorough. (Neurologists, by nature, tend to be a compulsive bunch.) And there’s also habit – once you get into a certain pattern of doing an exam, it becomes a fixed routine.

There’s another intangible that’s rarely talked about: show time and magic. Like our witch doctor ancestors, we also have to make people believe in us. All those degrees on the walls (or lack thereof, in my case) may not convince some, so we pull out our wands. We have a Queen Square hammer instead of a Taylor (a.k.a., Tomahawk). Checking vibratory sense in every migraine patient may not be needed, but it’s a step up from most internists. It shows a patient that we’re looking for details others didn’t think of. It adds an element of mystery and interest to the magic of seeing a subspecialist. And, of course, hopefully convinces them that we’re worth the higher copay.

It might be easier and faster for many things if we just checked a few basic exam features. It likely wouldn’t change our plans in most cases. But it would take some of the luster off our profession and the way patients perceive us.

Even in modern medicine, image plays a big part. And a new curtain rises every time we start seeing a patient.

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

A neurologic exam involves a number of different elements: strength, coordination, cranial nerves, sensation, reflexes, gait, and a few others.

Certainly, not all of these elements are needed in every circumstance and are often not critical. Nonetheless, we check them, such as vibratory sense in simple migraine patients and carotid auscultation in carpal tunnel syndrome.

Courtesy Cate Storey

Is all of this necessary? Probably not. Do we still do it? Of course. Some of it is for documentation. Part of it is being thorough. (Neurologists, by nature, tend to be a compulsive bunch.) And there’s also habit – once you get into a certain pattern of doing an exam, it becomes a fixed routine.

There’s another intangible that’s rarely talked about: show time and magic. Like our witch doctor ancestors, we also have to make people believe in us. All those degrees on the walls (or lack thereof, in my case) may not convince some, so we pull out our wands. We have a Queen Square hammer instead of a Taylor (a.k.a., Tomahawk). Checking vibratory sense in every migraine patient may not be needed, but it’s a step up from most internists. It shows a patient that we’re looking for details others didn’t think of. It adds an element of mystery and interest to the magic of seeing a subspecialist. And, of course, hopefully convinces them that we’re worth the higher copay.

It might be easier and faster for many things if we just checked a few basic exam features. It likely wouldn’t change our plans in most cases. But it would take some of the luster off our profession and the way patients perceive us.

Even in modern medicine, image plays a big part. And a new curtain rises every time we start seeing a patient.

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

I started out with videogames as kid. I had a mid-1970s Odyssey Pong console, then an Atari 2600 (which I still think was the best ever), and few others over time.

I’m not a hardcore gamer. I like games I can play for 2-3 minutes and then move on. I don’t like long storylines, just mild amusement.

When the Wii came out several years ago, I got one about a year after its release. It’s fun. I play it with my kids. But it’s also become a big part of my practice, and it is the only video game system I’ve ever recommended to patients.

In the years since the launch of the Wii, I’ve recommended it to many patients. In particular, the balance exercises on Wii Fit for Parkinson’s disease are excellent. I recommend the bowling and tennis games for patients who used to play to keep active, but now can’t for various reasons. I started suggesting the Wii as an afterthought. I have been surprised how many patients have liked it and found it therapeutic.

Back in training, I never imagined I’d be recommending video games to patients, but times change, as does technology. While they’ll never get the attention a shiny 3T MRI or new deep brain stimulation procedure might, to me video games are still a part of treatment. Just like Sinemet (carbidopa-levodopa), Neurontin (gabapentin), and physical therapy, they have a niche when used on the right patients. (For skeptics, there are studies, for example, in Parkinson’s disease, multiple sclerosis, and gait and posture in Alzheimer’s disease, although I came to the treatment from personal experience.)

I’ve had a few doctors and even patient’s families argue with me about the Wii. I’m not claiming it’s a cure. But if something can help patients get better or keep them in age-appropriate condition, I don’t see any harm in it, especially if they have fun while doing it.

Dr. Block has a solo neurology practice in Scottsdale, Ariz. He has no financial relationship with Nintendo.

[email protected]

I started out with videogames as kid. I had a mid-1970s Odyssey Pong console, then an Atari 2600 (which I still think was the best ever), and few others over time.

I’m not a hardcore gamer. I like games I can play for 2-3 minutes and then move on. I don’t like long storylines, just mild amusement.

When the Wii came out several years ago, I got one about a year after its release. It’s fun. I play it with my kids. But it’s also become a big part of my practice, and it is the only video game system I’ve ever recommended to patients.

In the years since the launch of the Wii, I’ve recommended it to many patients. In particular, the balance exercises on Wii Fit for Parkinson’s disease are excellent. I recommend the bowling and tennis games for patients who used to play to keep active, but now can’t for various reasons. I started suggesting the Wii as an afterthought. I have been surprised how many patients have liked it and found it therapeutic.

Back in training, I never imagined I’d be recommending video games to patients, but times change, as does technology. While they’ll never get the attention a shiny 3T MRI or new deep brain stimulation procedure might, to me video games are still a part of treatment. Just like Sinemet (carbidopa-levodopa), Neurontin (gabapentin), and physical therapy, they have a niche when used on the right patients. (For skeptics, there are studies, for example, in Parkinson’s disease, multiple sclerosis, and gait and posture in Alzheimer’s disease, although I came to the treatment from personal experience.)

I’ve had a few doctors and even patient’s families argue with me about the Wii. I’m not claiming it’s a cure. But if something can help patients get better or keep them in age-appropriate condition, I don’t see any harm in it, especially if they have fun while doing it.

Dr. Block has a solo neurology practice in Scottsdale, Ariz. He has no financial relationship with Nintendo.

[email protected]

I started out with videogames as kid. I had a mid-1970s Odyssey Pong console, then an Atari 2600 (which I still think was the best ever), and few others over time.

I’m not a hardcore gamer. I like games I can play for 2-3 minutes and then move on. I don’t like long storylines, just mild amusement.

When the Wii came out several years ago, I got one about a year after its release. It’s fun. I play it with my kids. But it’s also become a big part of my practice, and it is the only video game system I’ve ever recommended to patients.

In the years since the launch of the Wii, I’ve recommended it to many patients. In particular, the balance exercises on Wii Fit for Parkinson’s disease are excellent. I recommend the bowling and tennis games for patients who used to play to keep active, but now can’t for various reasons. I started suggesting the Wii as an afterthought. I have been surprised how many patients have liked it and found it therapeutic.

Back in training, I never imagined I’d be recommending video games to patients, but times change, as does technology. While they’ll never get the attention a shiny 3T MRI or new deep brain stimulation procedure might, to me video games are still a part of treatment. Just like Sinemet (carbidopa-levodopa), Neurontin (gabapentin), and physical therapy, they have a niche when used on the right patients. (For skeptics, there are studies, for example, in Parkinson’s disease, multiple sclerosis, and gait and posture in Alzheimer’s disease, although I came to the treatment from personal experience.)

I’ve had a few doctors and even patient’s families argue with me about the Wii. I’m not claiming it’s a cure. But if something can help patients get better or keep them in age-appropriate condition, I don’t see any harm in it, especially if they have fun while doing it.

Dr. Block has a solo neurology practice in Scottsdale, Ariz. He has no financial relationship with Nintendo.

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During an elective in my fourth year of medical school, a neurology professor told me how the brain never really turns off reading. He explained this with the example of driving: Heading down a road, you pass signs constantly: traffic signs, billboards, names on buildings, etc. Anything that you look at you automatically read and register.

The only way to not do this is to not see it (I don’t recommend driving blindfolded). The ability to decode symbols into meaningful language becomes such an automatic part of our functioning that we end up screening for what is and isn’t immediately relevant to us (probably a speed limit sign, but not a "waiter wanted" sign [but who knows?]) without even thinking about it.

Likewise, neurologists develop what I call "neurovision." After years of training and clinical experience, it becomes second nature to screen people we pass in the store, restaurant, sidewalk – pretty much anywhere.

It’s impossible NOT to notice things: a slight pill-rolling tremor, an equine gait from a foot drop, a paretic arm from a stroke. Some days, it’s all I can do not to hand out business cards. Granted, this skill has little practical use outside the office (unless you like to approach strangers at restaurants and suggest a higher Sinemet dose), but it makes life more interesting in a weird neuro-nerd sort of way.

Even at family gatherings you notice things – and sometimes check further. An uncle has a slight tremor or hypomimia, and so you check his tone while shaking hands. A cousin seems more forgetful than you remembered, and so you ask seemingly innocuous questions to check cognition.

I’m sure every specialty has a similar skill. I suppose it keeps you on your toes as you go through the days, and I think it’s reassuring to remind yourself that you’re always alert for the things you’re supposed to be.

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

During an elective in my fourth year of medical school, a neurology professor told me how the brain never really turns off reading. He explained this with the example of driving: Heading down a road, you pass signs constantly: traffic signs, billboards, names on buildings, etc. Anything that you look at you automatically read and register.

The only way to not do this is to not see it (I don’t recommend driving blindfolded). The ability to decode symbols into meaningful language becomes such an automatic part of our functioning that we end up screening for what is and isn’t immediately relevant to us (probably a speed limit sign, but not a "waiter wanted" sign [but who knows?]) without even thinking about it.

Likewise, neurologists develop what I call "neurovision." After years of training and clinical experience, it becomes second nature to screen people we pass in the store, restaurant, sidewalk – pretty much anywhere.

It’s impossible NOT to notice things: a slight pill-rolling tremor, an equine gait from a foot drop, a paretic arm from a stroke. Some days, it’s all I can do not to hand out business cards. Granted, this skill has little practical use outside the office (unless you like to approach strangers at restaurants and suggest a higher Sinemet dose), but it makes life more interesting in a weird neuro-nerd sort of way.

Even at family gatherings you notice things – and sometimes check further. An uncle has a slight tremor or hypomimia, and so you check his tone while shaking hands. A cousin seems more forgetful than you remembered, and so you ask seemingly innocuous questions to check cognition.

I’m sure every specialty has a similar skill. I suppose it keeps you on your toes as you go through the days, and I think it’s reassuring to remind yourself that you’re always alert for the things you’re supposed to be.

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

During an elective in my fourth year of medical school, a neurology professor told me how the brain never really turns off reading. He explained this with the example of driving: Heading down a road, you pass signs constantly: traffic signs, billboards, names on buildings, etc. Anything that you look at you automatically read and register.

The only way to not do this is to not see it (I don’t recommend driving blindfolded). The ability to decode symbols into meaningful language becomes such an automatic part of our functioning that we end up screening for what is and isn’t immediately relevant to us (probably a speed limit sign, but not a "waiter wanted" sign [but who knows?]) without even thinking about it.

Likewise, neurologists develop what I call "neurovision." After years of training and clinical experience, it becomes second nature to screen people we pass in the store, restaurant, sidewalk – pretty much anywhere.

It’s impossible NOT to notice things: a slight pill-rolling tremor, an equine gait from a foot drop, a paretic arm from a stroke. Some days, it’s all I can do not to hand out business cards. Granted, this skill has little practical use outside the office (unless you like to approach strangers at restaurants and suggest a higher Sinemet dose), but it makes life more interesting in a weird neuro-nerd sort of way.

Even at family gatherings you notice things – and sometimes check further. An uncle has a slight tremor or hypomimia, and so you check his tone while shaking hands. A cousin seems more forgetful than you remembered, and so you ask seemingly innocuous questions to check cognition.

I’m sure every specialty has a similar skill. I suppose it keeps you on your toes as you go through the days, and I think it’s reassuring to remind yourself that you’re always alert for the things you’re supposed to be.

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

I turn patients away. I don’t do it all the time, but once a week or so. Calling with an unusually complex case? Not me. Been through multiple other neurologists without luck? Nope. Have a rare disease that I’ve never seen? I’m not your man. Sorry.

My secretary knows my preferences very well and often checks with me before scheduling someone. If there are still questions she’ll have them send records for me to review.

I’m never looking to turn away business or people who need help, but I also know my limitations. If I can’t help someone, or if they have a rare and/or complicated disorder that’s out of my league, why waste their time and mine? I’m at least lucky enough to practice in a city that has two major neurology tertiary care centers, and my staff gives out their phone numbers when needed.

I hear other doctors try to justify these things, often on financial grounds: "I’ll get an EEG/EMG/whatever" out of it. In almost all of these cases, the patient has already had the tests from previous physicians (sometimes multiple times), and to me, repeating them is often an exercise in futility.

My office website says that I’m a general neurologist who’s a "jack-of-all-trades, and master of none." I try to live by that ideal. If I can’t help a patient, I think it’s more important that they be directed to someone who can than waste their time with me.

I still try to consider patient care above other factors. If seeing me is just going to delay someone from getting the care they need, why bother?

Dr. Block has a solo neurology practice in Scottsdale, Ariz. E-mail him at [email protected].

I turn patients away. I don’t do it all the time, but once a week or so. Calling with an unusually complex case? Not me. Been through multiple other neurologists without luck? Nope. Have a rare disease that I’ve never seen? I’m not your man. Sorry.

My secretary knows my preferences very well and often checks with me before scheduling someone. If there are still questions she’ll have them send records for me to review.

I’m never looking to turn away business or people who need help, but I also know my limitations. If I can’t help someone, or if they have a rare and/or complicated disorder that’s out of my league, why waste their time and mine? I’m at least lucky enough to practice in a city that has two major neurology tertiary care centers, and my staff gives out their phone numbers when needed.

I hear other doctors try to justify these things, often on financial grounds: "I’ll get an EEG/EMG/whatever" out of it. In almost all of these cases, the patient has already had the tests from previous physicians (sometimes multiple times), and to me, repeating them is often an exercise in futility.

My office website says that I’m a general neurologist who’s a "jack-of-all-trades, and master of none." I try to live by that ideal. If I can’t help a patient, I think it’s more important that they be directed to someone who can than waste their time with me.

I still try to consider patient care above other factors. If seeing me is just going to delay someone from getting the care they need, why bother?

Dr. Block has a solo neurology practice in Scottsdale, Ariz. E-mail him at [email protected].

I turn patients away. I don’t do it all the time, but once a week or so. Calling with an unusually complex case? Not me. Been through multiple other neurologists without luck? Nope. Have a rare disease that I’ve never seen? I’m not your man. Sorry.

My secretary knows my preferences very well and often checks with me before scheduling someone. If there are still questions she’ll have them send records for me to review.

I’m never looking to turn away business or people who need help, but I also know my limitations. If I can’t help someone, or if they have a rare and/or complicated disorder that’s out of my league, why waste their time and mine? I’m at least lucky enough to practice in a city that has two major neurology tertiary care centers, and my staff gives out their phone numbers when needed.

I hear other doctors try to justify these things, often on financial grounds: "I’ll get an EEG/EMG/whatever" out of it. In almost all of these cases, the patient has already had the tests from previous physicians (sometimes multiple times), and to me, repeating them is often an exercise in futility.

My office website says that I’m a general neurologist who’s a "jack-of-all-trades, and master of none." I try to live by that ideal. If I can’t help a patient, I think it’s more important that they be directed to someone who can than waste their time with me.

I still try to consider patient care above other factors. If seeing me is just going to delay someone from getting the care they need, why bother?

Dr. Block has a solo neurology practice in Scottsdale, Ariz. E-mail him at [email protected].

In his State of the Union address, President Obama obliquely referred to the Brain Activity Map project, which is now confirmed to be in its planning stages. It is an ambitious initiative, lasting (at least) 10 years, to map the structure and functions of the human brain in great detail.

I hope the project goes through as planned. Although the brain is arguably the most critical part of what makes us human, it’s often a forgotten stepchild in public forums. Medical dramas often dominate the TV schedule, but the only one to center around the brain ("3 lbs" on CBS) lasted for only three episodes over a 2-week period in 2006.

We tend to focus more on disease terms – Alzheimer’s or Parkinson’s – than the organ involved itself. But in order to find more effective treatments, we need to understand what’s underlying them. Without knowing how it works, we can’t fix it.

Certainly, knowledge about the brain is at its most advanced point ever, but a central effort certainly would help further it. Like space exploration, some things are simply too big for the private sector to handle alone.

It’s been over 20 years since President George H.W. Bush proclaimed the 1990s as the "Decade of the Brain." A tremendous amount of knowledge has since been gained, but the workings of the cerebrum still remain largely mysterious.

The Human Genome Project, as often noted, turned into both an economic and medical boon. It returned a significant net on its financial investment and led to new disease treatments that weren’t imagined 20-30 years ago. We can only hope the brain project will do the same. And, perhaps, bring more awareness to the tissues that led us out of the cave.

Dr. Block has a solo neurology practice in Scottsdale, Ariz. E-mail him at [email protected].

In his State of the Union address, President Obama obliquely referred to the Brain Activity Map project, which is now confirmed to be in its planning stages. It is an ambitious initiative, lasting (at least) 10 years, to map the structure and functions of the human brain in great detail.

I hope the project goes through as planned. Although the brain is arguably the most critical part of what makes us human, it’s often a forgotten stepchild in public forums. Medical dramas often dominate the TV schedule, but the only one to center around the brain ("3 lbs" on CBS) lasted for only three episodes over a 2-week period in 2006.

We tend to focus more on disease terms – Alzheimer’s or Parkinson’s – than the organ involved itself. But in order to find more effective treatments, we need to understand what’s underlying them. Without knowing how it works, we can’t fix it.

Certainly, knowledge about the brain is at its most advanced point ever, but a central effort certainly would help further it. Like space exploration, some things are simply too big for the private sector to handle alone.

It’s been over 20 years since President George H.W. Bush proclaimed the 1990s as the "Decade of the Brain." A tremendous amount of knowledge has since been gained, but the workings of the cerebrum still remain largely mysterious.

The Human Genome Project, as often noted, turned into both an economic and medical boon. It returned a significant net on its financial investment and led to new disease treatments that weren’t imagined 20-30 years ago. We can only hope the brain project will do the same. And, perhaps, bring more awareness to the tissues that led us out of the cave.

Dr. Block has a solo neurology practice in Scottsdale, Ariz. E-mail him at [email protected].

In his State of the Union address, President Obama obliquely referred to the Brain Activity Map project, which is now confirmed to be in its planning stages. It is an ambitious initiative, lasting (at least) 10 years, to map the structure and functions of the human brain in great detail.

I hope the project goes through as planned. Although the brain is arguably the most critical part of what makes us human, it’s often a forgotten stepchild in public forums. Medical dramas often dominate the TV schedule, but the only one to center around the brain ("3 lbs" on CBS) lasted for only three episodes over a 2-week period in 2006.

We tend to focus more on disease terms – Alzheimer’s or Parkinson’s – than the organ involved itself. But in order to find more effective treatments, we need to understand what’s underlying them. Without knowing how it works, we can’t fix it.

Certainly, knowledge about the brain is at its most advanced point ever, but a central effort certainly would help further it. Like space exploration, some things are simply too big for the private sector to handle alone.

It’s been over 20 years since President George H.W. Bush proclaimed the 1990s as the "Decade of the Brain." A tremendous amount of knowledge has since been gained, but the workings of the cerebrum still remain largely mysterious.

The Human Genome Project, as often noted, turned into both an economic and medical boon. It returned a significant net on its financial investment and led to new disease treatments that weren’t imagined 20-30 years ago. We can only hope the brain project will do the same. And, perhaps, bring more awareness to the tissues that led us out of the cave.

Dr. Block has a solo neurology practice in Scottsdale, Ariz. E-mail him at [email protected].

I’m an on-time nut. I’ve never understood doctors who routinely run way behind schedule. At my first job there were one to two guys who were notorious for waits in the 2- to 3-hour range.

I’m a fanatic. My schedule is structured to allow a decent amount of time for patients, and I work on other things (drug refills, nurses’ questions, test results) in the extra minutes where they happen. Granted, there are still rare emergencies (having to run to the hospital, or an unexpected patient issue) that are beyond my control, but most days I’m able to keep things running on time (give or take 5 minutes). If patients show up early, and I have time to see them, I see them. The extra time will always be needed later for something else.

From watching other doctors during training and at my first job, I came away feeling that the majority of running behind was preventable, and was primarily caused by a handful of factors:

• Time spent chatting with staff/colleagues about nonmedical issues (weekend camping, politics, last night’s baseball game).

• Cramming in far more patients in the schedule than can realistically be seen.

• Endlessly adding on anyone who calls in demanding to be seen that day.

• Other personal junk: phone calls, surfing the Internet, etc.

There will always be emergencies and circumstances we can’t control that interfere with our schedules. But after 14 years of running pretty close to on time, I’m glad that I keep my day controlled. I like it, the patients like it, and having predictable hours is nice. I like knowing what time I can leave each day, and then doing it.

Dr. Block has a solo neurology practice in Scottsdale, Ariz. E-mail him at [email protected].

I’m an on-time nut. I’ve never understood doctors who routinely run way behind schedule. At my first job there were one to two guys who were notorious for waits in the 2- to 3-hour range.

I’m a fanatic. My schedule is structured to allow a decent amount of time for patients, and I work on other things (drug refills, nurses’ questions, test results) in the extra minutes where they happen. Granted, there are still rare emergencies (having to run to the hospital, or an unexpected patient issue) that are beyond my control, but most days I’m able to keep things running on time (give or take 5 minutes). If patients show up early, and I have time to see them, I see them. The extra time will always be needed later for something else.

From watching other doctors during training and at my first job, I came away feeling that the majority of running behind was preventable, and was primarily caused by a handful of factors:

• Time spent chatting with staff/colleagues about nonmedical issues (weekend camping, politics, last night’s baseball game).

• Cramming in far more patients in the schedule than can realistically be seen.

• Endlessly adding on anyone who calls in demanding to be seen that day.

• Other personal junk: phone calls, surfing the Internet, etc.

There will always be emergencies and circumstances we can’t control that interfere with our schedules. But after 14 years of running pretty close to on time, I’m glad that I keep my day controlled. I like it, the patients like it, and having predictable hours is nice. I like knowing what time I can leave each day, and then doing it.

Dr. Block has a solo neurology practice in Scottsdale, Ariz. E-mail him at [email protected].

I’m an on-time nut. I’ve never understood doctors who routinely run way behind schedule. At my first job there were one to two guys who were notorious for waits in the 2- to 3-hour range.

I’m a fanatic. My schedule is structured to allow a decent amount of time for patients, and I work on other things (drug refills, nurses’ questions, test results) in the extra minutes where they happen. Granted, there are still rare emergencies (having to run to the hospital, or an unexpected patient issue) that are beyond my control, but most days I’m able to keep things running on time (give or take 5 minutes). If patients show up early, and I have time to see them, I see them. The extra time will always be needed later for something else.

From watching other doctors during training and at my first job, I came away feeling that the majority of running behind was preventable, and was primarily caused by a handful of factors:

• Time spent chatting with staff/colleagues about nonmedical issues (weekend camping, politics, last night’s baseball game).

• Cramming in far more patients in the schedule than can realistically be seen.

• Endlessly adding on anyone who calls in demanding to be seen that day.

• Other personal junk: phone calls, surfing the Internet, etc.

There will always be emergencies and circumstances we can’t control that interfere with our schedules. But after 14 years of running pretty close to on time, I’m glad that I keep my day controlled. I like it, the patients like it, and having predictable hours is nice. I like knowing what time I can leave each day, and then doing it.

Dr. Block has a solo neurology practice in Scottsdale, Ariz. E-mail him at [email protected].