Hitting a Nerve

In the old days, doctors (allegedly) never charged each other. This was labeled "professional courtesy." It’s a nice idea, but really only works when everyone is in a small practice and paying cash.

Today, everyone has insurance, with copays and deductibles. With that comes contracts specifically stating how much money we’re required to collect at the time of service. If one were to bypass them by writing "no copay" on a bill, an insurance company likely would either bill the patient for the uncollected amount or send the doctor a letter saying he or she is in violation of a contract.

I don’t ask for the courtesy myself. My kids have run up a small fortune over time in emergency department bills, radiology charges, and visits to their pediatrician. I fully expect to pay them all, and I do.

On paper, professional courtesy sounds good. But you can also argue it discriminates against nondoctors. Besides, even if you did it, how far should it extend? Immediate family members only? Cousins? Uncles? Aunts? Realistically, a pretty good chunk of the population is distantly related to a doctor. The money adds up over time. To continue being a doctor, I also have to stay in business. And the same goes for the ones my family sees.

Older physicians may be horrified at this approach, but I don’t have an issue with it. I see it as the fairest option: I pay for my family and expect others to do the same. In a perfect world, perhaps medical care would be free for all. But ours is far from it.

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

In the old days, doctors (allegedly) never charged each other. This was labeled "professional courtesy." It’s a nice idea, but really only works when everyone is in a small practice and paying cash.

Today, everyone has insurance, with copays and deductibles. With that comes contracts specifically stating how much money we’re required to collect at the time of service. If one were to bypass them by writing "no copay" on a bill, an insurance company likely would either bill the patient for the uncollected amount or send the doctor a letter saying he or she is in violation of a contract.

I don’t ask for the courtesy myself. My kids have run up a small fortune over time in emergency department bills, radiology charges, and visits to their pediatrician. I fully expect to pay them all, and I do.

On paper, professional courtesy sounds good. But you can also argue it discriminates against nondoctors. Besides, even if you did it, how far should it extend? Immediate family members only? Cousins? Uncles? Aunts? Realistically, a pretty good chunk of the population is distantly related to a doctor. The money adds up over time. To continue being a doctor, I also have to stay in business. And the same goes for the ones my family sees.

Older physicians may be horrified at this approach, but I don’t have an issue with it. I see it as the fairest option: I pay for my family and expect others to do the same. In a perfect world, perhaps medical care would be free for all. But ours is far from it.

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

In the old days, doctors (allegedly) never charged each other. This was labeled "professional courtesy." It’s a nice idea, but really only works when everyone is in a small practice and paying cash.

Today, everyone has insurance, with copays and deductibles. With that comes contracts specifically stating how much money we’re required to collect at the time of service. If one were to bypass them by writing "no copay" on a bill, an insurance company likely would either bill the patient for the uncollected amount or send the doctor a letter saying he or she is in violation of a contract.

I don’t ask for the courtesy myself. My kids have run up a small fortune over time in emergency department bills, radiology charges, and visits to their pediatrician. I fully expect to pay them all, and I do.

On paper, professional courtesy sounds good. But you can also argue it discriminates against nondoctors. Besides, even if you did it, how far should it extend? Immediate family members only? Cousins? Uncles? Aunts? Realistically, a pretty good chunk of the population is distantly related to a doctor. The money adds up over time. To continue being a doctor, I also have to stay in business. And the same goes for the ones my family sees.

Older physicians may be horrified at this approach, but I don’t have an issue with it. I see it as the fairest option: I pay for my family and expect others to do the same. In a perfect world, perhaps medical care would be free for all. But ours is far from it.

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

A few times a week a fax comes to my office, usually from a doctor who doesn’t commonly refer to me. It will include insurance information and a phone number, with a note saying, "Please call patient for an appointment."

We don’t call. My secretary puts the notes in a file for people who haven’t been seen yet, and we move on.

Why don’t we call? We used to. I’m certainly not in the habit of turning away business. What stopped us is that it became a far bigger nightmare than we expected. When my staff called to set up appointments, we found the vast majority of people hadn’t even been told they should see a neurologist. This resulted in my secretary having to deal with panicked individuals demanding to know why they needed to see a neurologist, what their tests showed, and what does a neurologist do, anyway?

In all cases except for the last one, she wasn’t able to answer their questions, which only infuriated them. When we told them to call their internist, it only made things worse.

Some even accused us of lying about getting a fax, and claimed we were just calling people randomly to drum up business. Believe me, we haven’t sunk that low.

So we don’t call anymore. We figure that if patients can answer the phone to make an appointment, they can also dial our number. Other offices may find this to be unfriendly, but we learned our lesson the hard way. At least when people call us themselves, they usually know why they’re being sent.

Communication is perhaps the most critical step in all levels of medicine. It’s best to start off on the right foot with a patient who already has some idea of what to expect.

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

A few times a week a fax comes to my office, usually from a doctor who doesn’t commonly refer to me. It will include insurance information and a phone number, with a note saying, "Please call patient for an appointment."

We don’t call. My secretary puts the notes in a file for people who haven’t been seen yet, and we move on.

Why don’t we call? We used to. I’m certainly not in the habit of turning away business. What stopped us is that it became a far bigger nightmare than we expected. When my staff called to set up appointments, we found the vast majority of people hadn’t even been told they should see a neurologist. This resulted in my secretary having to deal with panicked individuals demanding to know why they needed to see a neurologist, what their tests showed, and what does a neurologist do, anyway?

In all cases except for the last one, she wasn’t able to answer their questions, which only infuriated them. When we told them to call their internist, it only made things worse.

Some even accused us of lying about getting a fax, and claimed we were just calling people randomly to drum up business. Believe me, we haven’t sunk that low.

So we don’t call anymore. We figure that if patients can answer the phone to make an appointment, they can also dial our number. Other offices may find this to be unfriendly, but we learned our lesson the hard way. At least when people call us themselves, they usually know why they’re being sent.

Communication is perhaps the most critical step in all levels of medicine. It’s best to start off on the right foot with a patient who already has some idea of what to expect.

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

A few times a week a fax comes to my office, usually from a doctor who doesn’t commonly refer to me. It will include insurance information and a phone number, with a note saying, "Please call patient for an appointment."

We don’t call. My secretary puts the notes in a file for people who haven’t been seen yet, and we move on.

Why don’t we call? We used to. I’m certainly not in the habit of turning away business. What stopped us is that it became a far bigger nightmare than we expected. When my staff called to set up appointments, we found the vast majority of people hadn’t even been told they should see a neurologist. This resulted in my secretary having to deal with panicked individuals demanding to know why they needed to see a neurologist, what their tests showed, and what does a neurologist do, anyway?

In all cases except for the last one, she wasn’t able to answer their questions, which only infuriated them. When we told them to call their internist, it only made things worse.

Some even accused us of lying about getting a fax, and claimed we were just calling people randomly to drum up business. Believe me, we haven’t sunk that low.

So we don’t call anymore. We figure that if patients can answer the phone to make an appointment, they can also dial our number. Other offices may find this to be unfriendly, but we learned our lesson the hard way. At least when people call us themselves, they usually know why they’re being sent.

Communication is perhaps the most critical step in all levels of medicine. It’s best to start off on the right foot with a patient who already has some idea of what to expect.

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

Last November, several news outlets carried a story about Dr. Russell Dohner of Rushville, Ill.

Dr. Dohner takes no insurances, works 7 days a week, and charges $5 per visit. I respect that. I really do. I wish I could give care to all in need.

The article brought out a lot of comments wondering why all doctors can’t be like him because obviously he cares about patients. Unfortunately, most of the stories about him don’t mention his financial backing until the bottom third of the story – long after most people have stopped reading and moved on to other things. It says he’s primarily supported by a farm that his family owns, allowing him to practice at $5 a person.

If I had enough money to support my family and practice independently, I might do it, too. I like this job. I always have, and hopefully always will.

But the financial reality is that I have kids (Dr. Dohner has none) and a wife (ditto). My two staff members also have families to support, and they can’t work for free, either. So I have to charge people their copays, and bill insurance companies for the balance, and hope I can collect enough to keep my door open. This isn’t just medicine: It’s any business model. No matter how much you love what you do, it’s the rare (and lucky) person who can continue doing it for practically nothing.

Charging for your services isn’t a sign of not caring. It’s a sign of having the same responsibilities that your patients do. In a perfect world, perhaps medical care would be free (or even unnecessary). But our world will never be perfect. And I’ll always have an overhead (both business and personal) to meet. So, to keep caring for patients the best I can, I’ll have to keep charging them.

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

Last November, several news outlets carried a story about Dr. Russell Dohner of Rushville, Ill.

Dr. Dohner takes no insurances, works 7 days a week, and charges $5 per visit. I respect that. I really do. I wish I could give care to all in need.

The article brought out a lot of comments wondering why all doctors can’t be like him because obviously he cares about patients. Unfortunately, most of the stories about him don’t mention his financial backing until the bottom third of the story – long after most people have stopped reading and moved on to other things. It says he’s primarily supported by a farm that his family owns, allowing him to practice at $5 a person.

If I had enough money to support my family and practice independently, I might do it, too. I like this job. I always have, and hopefully always will.

But the financial reality is that I have kids (Dr. Dohner has none) and a wife (ditto). My two staff members also have families to support, and they can’t work for free, either. So I have to charge people their copays, and bill insurance companies for the balance, and hope I can collect enough to keep my door open. This isn’t just medicine: It’s any business model. No matter how much you love what you do, it’s the rare (and lucky) person who can continue doing it for practically nothing.

Charging for your services isn’t a sign of not caring. It’s a sign of having the same responsibilities that your patients do. In a perfect world, perhaps medical care would be free (or even unnecessary). But our world will never be perfect. And I’ll always have an overhead (both business and personal) to meet. So, to keep caring for patients the best I can, I’ll have to keep charging them.

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

Last November, several news outlets carried a story about Dr. Russell Dohner of Rushville, Ill.

Dr. Dohner takes no insurances, works 7 days a week, and charges $5 per visit. I respect that. I really do. I wish I could give care to all in need.

The article brought out a lot of comments wondering why all doctors can’t be like him because obviously he cares about patients. Unfortunately, most of the stories about him don’t mention his financial backing until the bottom third of the story – long after most people have stopped reading and moved on to other things. It says he’s primarily supported by a farm that his family owns, allowing him to practice at $5 a person.

If I had enough money to support my family and practice independently, I might do it, too. I like this job. I always have, and hopefully always will.

But the financial reality is that I have kids (Dr. Dohner has none) and a wife (ditto). My two staff members also have families to support, and they can’t work for free, either. So I have to charge people their copays, and bill insurance companies for the balance, and hope I can collect enough to keep my door open. This isn’t just medicine: It’s any business model. No matter how much you love what you do, it’s the rare (and lucky) person who can continue doing it for practically nothing.

Charging for your services isn’t a sign of not caring. It’s a sign of having the same responsibilities that your patients do. In a perfect world, perhaps medical care would be free (or even unnecessary). But our world will never be perfect. And I’ll always have an overhead (both business and personal) to meet. So, to keep caring for patients the best I can, I’ll have to keep charging them.

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

The electromyography/nerve conduction velocity cuts for 2013 are a serious financial hit for most neurologists. Although the Sustainable Growth Rate formula cuts were halted for another year, their specter still looms for 2014. In addition, the automatic 2% cut to Medicare fees that was averted by the "fiscal cliff" deal will only last through February.

These cutbacks hurt all of us, but seem particularly onerous for doctors like myself who are in small or even solo practices.

The unpleasant fact that most neurologists (and doctors in general) have to face is this: With the current cuts, it’s impossible to stay in practice by doing what we’re trained to do – see and care for patients. This is similar to restaurants being told that they can only sell food and beverages at below cost. They couldn’t stay open, either.

There are no easy answers. Threatening to drop Medicare is a common sentiment, but realistically it’s not financially possible for most of us. Primary care practices can sometimes get away with it, but in frontline neurology it’s just not possible. The only neurologist I know who tried it closed his doors within a year.

Sadly, it actually pays better to do legal work, such as independent medical exams, than it does to take care of patients. I’ve generally tried to focus on being a doctor, but with these changes I find myself having to take a larger share of legal cases, too.

I try quite hard to be punctual. Double-booking slots certainly would increase revenue, but at what cost? Running behind and inconveniencing patients? Their time is as important as mine. I can’t bring myself to do that.

What about drug company work? I’ve always welcomed the occasional speaking or research job, but these seem to become fewer and farther between as time goes by.

There are always other ways to earn money, but I’m not ready to start doing dermal fillers, running a "MediSpa," or selling overpriced vitamin pills.

And so, like many other small-practice neurologists, I enter 2013 unsure if my business will survive the year. I’m curious to know what other practices are doing.

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

The electromyography/nerve conduction velocity cuts for 2013 are a serious financial hit for most neurologists. Although the Sustainable Growth Rate formula cuts were halted for another year, their specter still looms for 2014. In addition, the automatic 2% cut to Medicare fees that was averted by the "fiscal cliff" deal will only last through February.

These cutbacks hurt all of us, but seem particularly onerous for doctors like myself who are in small or even solo practices.

The unpleasant fact that most neurologists (and doctors in general) have to face is this: With the current cuts, it’s impossible to stay in practice by doing what we’re trained to do – see and care for patients. This is similar to restaurants being told that they can only sell food and beverages at below cost. They couldn’t stay open, either.

There are no easy answers. Threatening to drop Medicare is a common sentiment, but realistically it’s not financially possible for most of us. Primary care practices can sometimes get away with it, but in frontline neurology it’s just not possible. The only neurologist I know who tried it closed his doors within a year.

Sadly, it actually pays better to do legal work, such as independent medical exams, than it does to take care of patients. I’ve generally tried to focus on being a doctor, but with these changes I find myself having to take a larger share of legal cases, too.

I try quite hard to be punctual. Double-booking slots certainly would increase revenue, but at what cost? Running behind and inconveniencing patients? Their time is as important as mine. I can’t bring myself to do that.

What about drug company work? I’ve always welcomed the occasional speaking or research job, but these seem to become fewer and farther between as time goes by.

There are always other ways to earn money, but I’m not ready to start doing dermal fillers, running a "MediSpa," or selling overpriced vitamin pills.

And so, like many other small-practice neurologists, I enter 2013 unsure if my business will survive the year. I’m curious to know what other practices are doing.

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

The electromyography/nerve conduction velocity cuts for 2013 are a serious financial hit for most neurologists. Although the Sustainable Growth Rate formula cuts were halted for another year, their specter still looms for 2014. In addition, the automatic 2% cut to Medicare fees that was averted by the "fiscal cliff" deal will only last through February.

These cutbacks hurt all of us, but seem particularly onerous for doctors like myself who are in small or even solo practices.

The unpleasant fact that most neurologists (and doctors in general) have to face is this: With the current cuts, it’s impossible to stay in practice by doing what we’re trained to do – see and care for patients. This is similar to restaurants being told that they can only sell food and beverages at below cost. They couldn’t stay open, either.

There are no easy answers. Threatening to drop Medicare is a common sentiment, but realistically it’s not financially possible for most of us. Primary care practices can sometimes get away with it, but in frontline neurology it’s just not possible. The only neurologist I know who tried it closed his doors within a year.

Sadly, it actually pays better to do legal work, such as independent medical exams, than it does to take care of patients. I’ve generally tried to focus on being a doctor, but with these changes I find myself having to take a larger share of legal cases, too.

I try quite hard to be punctual. Double-booking slots certainly would increase revenue, but at what cost? Running behind and inconveniencing patients? Their time is as important as mine. I can’t bring myself to do that.

What about drug company work? I’ve always welcomed the occasional speaking or research job, but these seem to become fewer and farther between as time goes by.

There are always other ways to earn money, but I’m not ready to start doing dermal fillers, running a "MediSpa," or selling overpriced vitamin pills.

And so, like many other small-practice neurologists, I enter 2013 unsure if my business will survive the year. I’m curious to know what other practices are doing.

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

Paperwork is never welcome, but it’s a part of this job. There are always forms – MRI approvals, patient disability, drug preauthorizations – a never-ending stream of paper in our allegedly paperless society. I can live with this.

What drives me nuts is unnecessary paperwork, often created for me by a well-meaning patient. My most hated are the multipage Food and Drug Administration forms that show up from time to time.

Let’s take Mrs. Smith, who has multiple sclerosis (MS). She’s on an injectable interferon. After 2 years, she has her first MS relapse since starting it. This is to be expected. Anyone who does this for a living knows that the medications only reduce, but don’t stop, relapses.

Besides calling me, she (for reasons I never understand) decides to notify the manufacturer. Now, Pharma Inc. is stuck with this knowledge and treats it as an adverse drug reaction. I don’t know why, but it does. So now it’s required by the FDA to send me a long form to report the problem. I fill it out and send it in and then get a second one back to clarify an answer from the first form. And so on.

Ignoring the forms won’t get you anywhere. They keep mailing them and calling until you return them. For MS drugs, this has happened twice to me in the last few months, with similar stories.

A patient gets a common (and well-documented) side effect, like chest pain after taking a triptan, and decides to report it to the manufacturer, which treats it like something previously unknown and sends me the dreaded paperwork looking for more information. Dispatching the paperwork quickly by writing, "It’s a triptan. This is what they do!" is not an acceptable answer. Trust me, I tried it.

Years ago, I saw a patient who took an overdose of a drug that is well known to cause seizures. Of course, he had a seizure. A friend of mine worked for the drug’s manufacturer at the time (although in another division), and I mentioned the story to him in a passing conversation about my weekend on call.

This was a big mistake, as he was then obliged to report it to his company, which of course sent me a 14-page form looking for more details than I had any idea of. So, with my lesson learned, now I don’t mention any of his current company’s products to him. It’s safer that way.

I have nothing against gathering new drug data or the paperwork that is involved. But to gather information that’s already well established? That’s a waste of everyone’s time.

Paperwork is never welcome, but it’s a part of this job. There are always forms – MRI approvals, patient disability, drug preauthorizations – a never-ending stream of paper in our allegedly paperless society. I can live with this.

What drives me nuts is unnecessary paperwork, often created for me by a well-meaning patient. My most hated are the multipage Food and Drug Administration forms that show up from time to time.

Let’s take Mrs. Smith, who has multiple sclerosis (MS). She’s on an injectable interferon. After 2 years, she has her first MS relapse since starting it. This is to be expected. Anyone who does this for a living knows that the medications only reduce, but don’t stop, relapses.

Besides calling me, she (for reasons I never understand) decides to notify the manufacturer. Now, Pharma Inc. is stuck with this knowledge and treats it as an adverse drug reaction. I don’t know why, but it does. So now it’s required by the FDA to send me a long form to report the problem. I fill it out and send it in and then get a second one back to clarify an answer from the first form. And so on.

Ignoring the forms won’t get you anywhere. They keep mailing them and calling until you return them. For MS drugs, this has happened twice to me in the last few months, with similar stories.

A patient gets a common (and well-documented) side effect, like chest pain after taking a triptan, and decides to report it to the manufacturer, which treats it like something previously unknown and sends me the dreaded paperwork looking for more information. Dispatching the paperwork quickly by writing, "It’s a triptan. This is what they do!" is not an acceptable answer. Trust me, I tried it.

Years ago, I saw a patient who took an overdose of a drug that is well known to cause seizures. Of course, he had a seizure. A friend of mine worked for the drug’s manufacturer at the time (although in another division), and I mentioned the story to him in a passing conversation about my weekend on call.

This was a big mistake, as he was then obliged to report it to his company, which of course sent me a 14-page form looking for more details than I had any idea of. So, with my lesson learned, now I don’t mention any of his current company’s products to him. It’s safer that way.

I have nothing against gathering new drug data or the paperwork that is involved. But to gather information that’s already well established? That’s a waste of everyone’s time.

Paperwork is never welcome, but it’s a part of this job. There are always forms – MRI approvals, patient disability, drug preauthorizations – a never-ending stream of paper in our allegedly paperless society. I can live with this.

What drives me nuts is unnecessary paperwork, often created for me by a well-meaning patient. My most hated are the multipage Food and Drug Administration forms that show up from time to time.

Let’s take Mrs. Smith, who has multiple sclerosis (MS). She’s on an injectable interferon. After 2 years, she has her first MS relapse since starting it. This is to be expected. Anyone who does this for a living knows that the medications only reduce, but don’t stop, relapses.

Besides calling me, she (for reasons I never understand) decides to notify the manufacturer. Now, Pharma Inc. is stuck with this knowledge and treats it as an adverse drug reaction. I don’t know why, but it does. So now it’s required by the FDA to send me a long form to report the problem. I fill it out and send it in and then get a second one back to clarify an answer from the first form. And so on.

Ignoring the forms won’t get you anywhere. They keep mailing them and calling until you return them. For MS drugs, this has happened twice to me in the last few months, with similar stories.

A patient gets a common (and well-documented) side effect, like chest pain after taking a triptan, and decides to report it to the manufacturer, which treats it like something previously unknown and sends me the dreaded paperwork looking for more information. Dispatching the paperwork quickly by writing, "It’s a triptan. This is what they do!" is not an acceptable answer. Trust me, I tried it.

Years ago, I saw a patient who took an overdose of a drug that is well known to cause seizures. Of course, he had a seizure. A friend of mine worked for the drug’s manufacturer at the time (although in another division), and I mentioned the story to him in a passing conversation about my weekend on call.

This was a big mistake, as he was then obliged to report it to his company, which of course sent me a 14-page form looking for more details than I had any idea of. So, with my lesson learned, now I don’t mention any of his current company’s products to him. It’s safer that way.

I have nothing against gathering new drug data or the paperwork that is involved. But to gather information that’s already well established? That’s a waste of everyone’s time.

From the starting gun each day, there’s a never-ending stream of electrons flying between my secretary, assistant, and me – ongoing exchanges about test results, refill requests, patient calls, etc. If I’m away from the office, I answer them on my phone, but I always answer.

After hours my iPhone is the connection to the practice. Patient calls route to me when we’re closed. If my assistant is working late, I answer her questions as they come in.

Last week, one of my kids had to leave school due to illness, and the call (fortunately) came in when I had an empty hour in the schedule. So I went to get him.

While driving to his school, I suddenly realized I’d left the phone on my desk. It was a strange feeling. For the first time since opening my practice, I can’t remember being more than a few feet from my phone. A million thoughts raced through my head: What if an urgent call comes in? What if an ER needs to reach me? What if I have a wreck and can’t reach anyone? Should I go back for it?

After about 10 seconds, I continued on my way. I wasn’t on call for the hospital. My assistant, after 15 years of this, knows when to direct someone to the ER. If I have a wreck someone else will have a phone there. It was highly unlikely that anything would happen to require my immediate attention in 20 minutes. And nothing did. I received two e-mails while I was gone, both on routine issues.

I was never a phone person when I was younger. I didn’t get my first cell phone until the day I started in practice in 1998. I didn’t get a phone that could do e-mail until July of last year.

But once you’re acclimated, it’s amazing how hard it is not to have it around. I’m not sure if that’s good or bad, but it is what it is – a genie that isn’t going back in its bottle.

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

From the starting gun each day, there’s a never-ending stream of electrons flying between my secretary, assistant, and me – ongoing exchanges about test results, refill requests, patient calls, etc. If I’m away from the office, I answer them on my phone, but I always answer.

After hours my iPhone is the connection to the practice. Patient calls route to me when we’re closed. If my assistant is working late, I answer her questions as they come in.

Last week, one of my kids had to leave school due to illness, and the call (fortunately) came in when I had an empty hour in the schedule. So I went to get him.

While driving to his school, I suddenly realized I’d left the phone on my desk. It was a strange feeling. For the first time since opening my practice, I can’t remember being more than a few feet from my phone. A million thoughts raced through my head: What if an urgent call comes in? What if an ER needs to reach me? What if I have a wreck and can’t reach anyone? Should I go back for it?

After about 10 seconds, I continued on my way. I wasn’t on call for the hospital. My assistant, after 15 years of this, knows when to direct someone to the ER. If I have a wreck someone else will have a phone there. It was highly unlikely that anything would happen to require my immediate attention in 20 minutes. And nothing did. I received two e-mails while I was gone, both on routine issues.

I was never a phone person when I was younger. I didn’t get my first cell phone until the day I started in practice in 1998. I didn’t get a phone that could do e-mail until July of last year.

But once you’re acclimated, it’s amazing how hard it is not to have it around. I’m not sure if that’s good or bad, but it is what it is – a genie that isn’t going back in its bottle.

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

From the starting gun each day, there’s a never-ending stream of electrons flying between my secretary, assistant, and me – ongoing exchanges about test results, refill requests, patient calls, etc. If I’m away from the office, I answer them on my phone, but I always answer.

After hours my iPhone is the connection to the practice. Patient calls route to me when we’re closed. If my assistant is working late, I answer her questions as they come in.

Last week, one of my kids had to leave school due to illness, and the call (fortunately) came in when I had an empty hour in the schedule. So I went to get him.

While driving to his school, I suddenly realized I’d left the phone on my desk. It was a strange feeling. For the first time since opening my practice, I can’t remember being more than a few feet from my phone. A million thoughts raced through my head: What if an urgent call comes in? What if an ER needs to reach me? What if I have a wreck and can’t reach anyone? Should I go back for it?

After about 10 seconds, I continued on my way. I wasn’t on call for the hospital. My assistant, after 15 years of this, knows when to direct someone to the ER. If I have a wreck someone else will have a phone there. It was highly unlikely that anything would happen to require my immediate attention in 20 minutes. And nothing did. I received two e-mails while I was gone, both on routine issues.

I was never a phone person when I was younger. I didn’t get my first cell phone until the day I started in practice in 1998. I didn’t get a phone that could do e-mail until July of last year.

But once you’re acclimated, it’s amazing how hard it is not to have it around. I’m not sure if that’s good or bad, but it is what it is – a genie that isn’t going back in its bottle.

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

Friday, Dec. 14, was just another routine day at my office. I had a lighter schedule than usual (which always seems to happen as Christmas approaches), test reports to review, and medications to refill.

Sometime just before the first patient came in, a news bulletin crossed my computer screen about a possible gun incident at a school in Connecticut. I forwarded it on to a few friends, but didn’t think much about it at the time. Becoming numb to random gun violence is an unfortunate part of American life.

I went on with my day. I saw patients. MRI reports were dropped off. I reviewed them, made decisions, and e-mailed my nurse as to what to tell patients. People called in to report side effects, migraines, seizures, and I made changes as needed. I saw more patients.

As the hours went by, more reports came in, each more horrific than the last. At some point it became hard to focus on the patients, but you have to.

You resist the urge to text your kids to make sure they’re okay. Or go get them and take them home. You think about how horrible it must be to be a parent in these situations. You hope it never happens to you. And through it all I refilled scrips for Imitrex, Plavix, and Lamictal, looked at lab results, and went ahead with the daily business of a medical office.

At the end of the day, the final toll was in: 28 dead (including the shooter), 20 of them young children. Even in a land where shootings aren’t even news anymore, this one cracked through. An entire first-grade class wiped out. Christmas presents waiting in attics, never to be opened. A searing image of a young woman in tears, holding a cell phone.

It was 4 o’clock on a Friday afternoon. My last patient was done. My secretary and I shut down the computers, rolled the phones, and left. Both of us had to pick up our kids from school. For us, it was just a normal day. Something to be more thankful for than ever.

And at the same time, the feeling of horror and sorrow is there, for those affected. I wish that I could do something – anything – to turn back the clock and have made Dec. 14 just another boring day for parents in Connecticut, too. But there is the helplessness of knowing I can’t, and that nothing will change.

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

Friday, Dec. 14, was just another routine day at my office. I had a lighter schedule than usual (which always seems to happen as Christmas approaches), test reports to review, and medications to refill.

Sometime just before the first patient came in, a news bulletin crossed my computer screen about a possible gun incident at a school in Connecticut. I forwarded it on to a few friends, but didn’t think much about it at the time. Becoming numb to random gun violence is an unfortunate part of American life.

I went on with my day. I saw patients. MRI reports were dropped off. I reviewed them, made decisions, and e-mailed my nurse as to what to tell patients. People called in to report side effects, migraines, seizures, and I made changes as needed. I saw more patients.

As the hours went by, more reports came in, each more horrific than the last. At some point it became hard to focus on the patients, but you have to.

You resist the urge to text your kids to make sure they’re okay. Or go get them and take them home. You think about how horrible it must be to be a parent in these situations. You hope it never happens to you. And through it all I refilled scrips for Imitrex, Plavix, and Lamictal, looked at lab results, and went ahead with the daily business of a medical office.

At the end of the day, the final toll was in: 28 dead (including the shooter), 20 of them young children. Even in a land where shootings aren’t even news anymore, this one cracked through. An entire first-grade class wiped out. Christmas presents waiting in attics, never to be opened. A searing image of a young woman in tears, holding a cell phone.

It was 4 o’clock on a Friday afternoon. My last patient was done. My secretary and I shut down the computers, rolled the phones, and left. Both of us had to pick up our kids from school. For us, it was just a normal day. Something to be more thankful for than ever.

And at the same time, the feeling of horror and sorrow is there, for those affected. I wish that I could do something – anything – to turn back the clock and have made Dec. 14 just another boring day for parents in Connecticut, too. But there is the helplessness of knowing I can’t, and that nothing will change.

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

Friday, Dec. 14, was just another routine day at my office. I had a lighter schedule than usual (which always seems to happen as Christmas approaches), test reports to review, and medications to refill.

Sometime just before the first patient came in, a news bulletin crossed my computer screen about a possible gun incident at a school in Connecticut. I forwarded it on to a few friends, but didn’t think much about it at the time. Becoming numb to random gun violence is an unfortunate part of American life.

I went on with my day. I saw patients. MRI reports were dropped off. I reviewed them, made decisions, and e-mailed my nurse as to what to tell patients. People called in to report side effects, migraines, seizures, and I made changes as needed. I saw more patients.

As the hours went by, more reports came in, each more horrific than the last. At some point it became hard to focus on the patients, but you have to.

You resist the urge to text your kids to make sure they’re okay. Or go get them and take them home. You think about how horrible it must be to be a parent in these situations. You hope it never happens to you. And through it all I refilled scrips for Imitrex, Plavix, and Lamictal, looked at lab results, and went ahead with the daily business of a medical office.

At the end of the day, the final toll was in: 28 dead (including the shooter), 20 of them young children. Even in a land where shootings aren’t even news anymore, this one cracked through. An entire first-grade class wiped out. Christmas presents waiting in attics, never to be opened. A searing image of a young woman in tears, holding a cell phone.

It was 4 o’clock on a Friday afternoon. My last patient was done. My secretary and I shut down the computers, rolled the phones, and left. Both of us had to pick up our kids from school. For us, it was just a normal day. Something to be more thankful for than ever.

And at the same time, the feeling of horror and sorrow is there, for those affected. I wish that I could do something – anything – to turn back the clock and have made Dec. 14 just another boring day for parents in Connecticut, too. But there is the helplessness of knowing I can’t, and that nothing will change.

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

Recently, I encountered a physician who was surprised that other doctors hadn’t voted the same way he did in the election. He felt that one candidate had been so clearly the obvious choice for physicians that it didn’t make sense that others voted differently.

Generalizations like this are always difficult for me to understand. Perhaps the most remarkable thing about the human brain is how, in spite of it looking quite similar between humans, it produces such strikingly different individuals.

To say all doctors should agree is no different from saying everyone in a certain ethnic group, or religious background, or geographical region should agree. Obviously, if people did all agree, there would be no need for elections at all.

Physicians, like accountants, construction workers, lawyers, teachers, firemen, and nurses, are people from many walks of life. Most of us are in it to help people, but we often disagree on what the best ways are to do so. You’ll see these differences manifest at tumor boards, grand rounds, and nurses stations. So why is it a surprise that they appear in political views, too?

I tend to believe that this diversity is good (as is a polite respect for the opinions of others) because it often leads to finding the best solution using ideas from both sides. In most things, no one is absolutely right or wrong. People – doctors included – are a remarkably heterogeneous group in behaviors and opinions. One paintbrush will never cover all of them, nor should it.

That, like so many other things in our lives, is human nature. And years of medical training will (hopefully) never take that away. I think that’s a good thing.

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

Recently, I encountered a physician who was surprised that other doctors hadn’t voted the same way he did in the election. He felt that one candidate had been so clearly the obvious choice for physicians that it didn’t make sense that others voted differently.

Generalizations like this are always difficult for me to understand. Perhaps the most remarkable thing about the human brain is how, in spite of it looking quite similar between humans, it produces such strikingly different individuals.

To say all doctors should agree is no different from saying everyone in a certain ethnic group, or religious background, or geographical region should agree. Obviously, if people did all agree, there would be no need for elections at all.

Physicians, like accountants, construction workers, lawyers, teachers, firemen, and nurses, are people from many walks of life. Most of us are in it to help people, but we often disagree on what the best ways are to do so. You’ll see these differences manifest at tumor boards, grand rounds, and nurses stations. So why is it a surprise that they appear in political views, too?

I tend to believe that this diversity is good (as is a polite respect for the opinions of others) because it often leads to finding the best solution using ideas from both sides. In most things, no one is absolutely right or wrong. People – doctors included – are a remarkably heterogeneous group in behaviors and opinions. One paintbrush will never cover all of them, nor should it.

That, like so many other things in our lives, is human nature. And years of medical training will (hopefully) never take that away. I think that’s a good thing.

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

Recently, I encountered a physician who was surprised that other doctors hadn’t voted the same way he did in the election. He felt that one candidate had been so clearly the obvious choice for physicians that it didn’t make sense that others voted differently.

Generalizations like this are always difficult for me to understand. Perhaps the most remarkable thing about the human brain is how, in spite of it looking quite similar between humans, it produces such strikingly different individuals.

To say all doctors should agree is no different from saying everyone in a certain ethnic group, or religious background, or geographical region should agree. Obviously, if people did all agree, there would be no need for elections at all.

Physicians, like accountants, construction workers, lawyers, teachers, firemen, and nurses, are people from many walks of life. Most of us are in it to help people, but we often disagree on what the best ways are to do so. You’ll see these differences manifest at tumor boards, grand rounds, and nurses stations. So why is it a surprise that they appear in political views, too?

I tend to believe that this diversity is good (as is a polite respect for the opinions of others) because it often leads to finding the best solution using ideas from both sides. In most things, no one is absolutely right or wrong. People – doctors included – are a remarkably heterogeneous group in behaviors and opinions. One paintbrush will never cover all of them, nor should it.

That, like so many other things in our lives, is human nature. And years of medical training will (hopefully) never take that away. I think that’s a good thing.

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

Last week I talked about combination pills. But they aren’t the only drug company issue that irritates me.

Alphabet letters are cheap, except in pharmaceuticals. Here the most expensive combinations are XR, ER, CR, XL, SR, and a few others.

Most patients can remember to take their medications twice a day (three times a day, I admit, can be an issue). But that hasn’t stopped drug companies from trying to mine gold out of these letters.

Many drugs are twice-daily. And it’s almost a sure bet that when their patent life dwindles down to a few months, the parent company will introduce a once-daily variant with one of these letter combinations tacked on to the name. Of course, this involves a significant price-hike over the generic b.i.d. form.

Just like other "convenience pills," this quickly becomes a financial issue. I always have plenty of samples to give out, but sooner or later a real scrip has to be called in, and that’s when the guano hits the fan. The scrip gets rejected because the insurance company won’t pay for it, the patient is horrified by the cash price and won’t pay for it, and those little copay cards don’t help as much as the drug reps claim (they’re also, in my experience, thoroughly hated by pharmacists).

As with combo pills that I’ve written about previously, QD dosing is nice, but not take-out-a-second-mortgage-to-pay-for-it nice. In these cases, the patient inevitably goes with the b.i.d. generic. The samples become a gateway to try the drug, but sooner or later the real scrip will be for the generic b.i.d. form.

I’m aware that these types of pills are easier to bring to market than an all-new agent. They get marketed with all sorts of hoopla as some sort of miracle breakthrough, but anyone on the prescribing side of the business can see that they’re just repackaging an older drug to squeeze a few more dollars out if it. And, as always, I find myself wondering if the fortune blown on bringing this to market couldn’t have been better spent on something truly new and useful.

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

Last week I talked about combination pills. But they aren’t the only drug company issue that irritates me.

Alphabet letters are cheap, except in pharmaceuticals. Here the most expensive combinations are XR, ER, CR, XL, SR, and a few others.

Most patients can remember to take their medications twice a day (three times a day, I admit, can be an issue). But that hasn’t stopped drug companies from trying to mine gold out of these letters.

Many drugs are twice-daily. And it’s almost a sure bet that when their patent life dwindles down to a few months, the parent company will introduce a once-daily variant with one of these letter combinations tacked on to the name. Of course, this involves a significant price-hike over the generic b.i.d. form.

Just like other "convenience pills," this quickly becomes a financial issue. I always have plenty of samples to give out, but sooner or later a real scrip has to be called in, and that’s when the guano hits the fan. The scrip gets rejected because the insurance company won’t pay for it, the patient is horrified by the cash price and won’t pay for it, and those little copay cards don’t help as much as the drug reps claim (they’re also, in my experience, thoroughly hated by pharmacists).

As with combo pills that I’ve written about previously, QD dosing is nice, but not take-out-a-second-mortgage-to-pay-for-it nice. In these cases, the patient inevitably goes with the b.i.d. generic. The samples become a gateway to try the drug, but sooner or later the real scrip will be for the generic b.i.d. form.

I’m aware that these types of pills are easier to bring to market than an all-new agent. They get marketed with all sorts of hoopla as some sort of miracle breakthrough, but anyone on the prescribing side of the business can see that they’re just repackaging an older drug to squeeze a few more dollars out if it. And, as always, I find myself wondering if the fortune blown on bringing this to market couldn’t have been better spent on something truly new and useful.

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

Last week I talked about combination pills. But they aren’t the only drug company issue that irritates me.

Alphabet letters are cheap, except in pharmaceuticals. Here the most expensive combinations are XR, ER, CR, XL, SR, and a few others.

Most patients can remember to take their medications twice a day (three times a day, I admit, can be an issue). But that hasn’t stopped drug companies from trying to mine gold out of these letters.

Many drugs are twice-daily. And it’s almost a sure bet that when their patent life dwindles down to a few months, the parent company will introduce a once-daily variant with one of these letter combinations tacked on to the name. Of course, this involves a significant price-hike over the generic b.i.d. form.

Just like other "convenience pills," this quickly becomes a financial issue. I always have plenty of samples to give out, but sooner or later a real scrip has to be called in, and that’s when the guano hits the fan. The scrip gets rejected because the insurance company won’t pay for it, the patient is horrified by the cash price and won’t pay for it, and those little copay cards don’t help as much as the drug reps claim (they’re also, in my experience, thoroughly hated by pharmacists).

As with combo pills that I’ve written about previously, QD dosing is nice, but not take-out-a-second-mortgage-to-pay-for-it nice. In these cases, the patient inevitably goes with the b.i.d. generic. The samples become a gateway to try the drug, but sooner or later the real scrip will be for the generic b.i.d. form.

I’m aware that these types of pills are easier to bring to market than an all-new agent. They get marketed with all sorts of hoopla as some sort of miracle breakthrough, but anyone on the prescribing side of the business can see that they’re just repackaging an older drug to squeeze a few more dollars out if it. And, as always, I find myself wondering if the fortune blown on bringing this to market couldn’t have been better spent on something truly new and useful.

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

Drug companies bring all kinds of miracles to our lives, but it amazes me how many dollars are spent on things that (at least to me) seem to have no profit potential.

My personal peeve is "convenience pills." Recently, I read a news item about a company developing a combination tablet with omeprazole and aspirin – in one pill.

I’m not a marketing person, so I really don’t understand this. Both drugs are available over the counter for pennies per day, and here someone wants to put them in one pill and charge extra for it.

©PhotoDisk

This isn’t the first time it’s been done. Duexis (ibuprofen plus famotidine) is one of several out there. You’d think that finding a new drug would be the goal, rather than recycling new ones. Giving us plenty of samples to start patients on (and those copay cards) doesn’t change the fact that the drug won’t be covered by insurance, and in a week we’ll tell the patient to just buy the individual components.

The people behind these often use the phrase "pill burden" referring to the apparently horrendous difficulties posed by having to take two pills instead of one. I have no idea where they get this idea. Yes, it sounds nice on the surface, but not "costs-$35-more-a-month" nice. Most of my patients are just fine with taking two pills at once, as am I.

I understand the reason they do this: It’s cheaper to reformulate and market drugs that already have been developed and have years of data behind them. This cuts down dramatically on R&D costs. But you still have to sink a fortune into clinical trials, getting Food and Drug Administration approval, and marketing. At the end of all that, I have no idea how they can make a profit when competing with already available generics.

My personality type is such that I don’t argue with the drug reps who come to my office. They didn’t bring it to market. They’re doing their job, just like I’m doing mine. I suspect they know how useless the drug is but (as I often do) remind themselves that they have a family to support.

It’s a free country, and I know you can sell whatever you want (with FDA approval). But I don’t understand what financial incentives there are for companies to do this pharmaceutical recycling. And I probably never will.

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

Drug companies bring all kinds of miracles to our lives, but it amazes me how many dollars are spent on things that (at least to me) seem to have no profit potential.

My personal peeve is "convenience pills." Recently, I read a news item about a company developing a combination tablet with omeprazole and aspirin – in one pill.

I’m not a marketing person, so I really don’t understand this. Both drugs are available over the counter for pennies per day, and here someone wants to put them in one pill and charge extra for it.

©PhotoDisk

This isn’t the first time it’s been done. Duexis (ibuprofen plus famotidine) is one of several out there. You’d think that finding a new drug would be the goal, rather than recycling new ones. Giving us plenty of samples to start patients on (and those copay cards) doesn’t change the fact that the drug won’t be covered by insurance, and in a week we’ll tell the patient to just buy the individual components.

The people behind these often use the phrase "pill burden" referring to the apparently horrendous difficulties posed by having to take two pills instead of one. I have no idea where they get this idea. Yes, it sounds nice on the surface, but not "costs-$35-more-a-month" nice. Most of my patients are just fine with taking two pills at once, as am I.

I understand the reason they do this: It’s cheaper to reformulate and market drugs that already have been developed and have years of data behind them. This cuts down dramatically on R&D costs. But you still have to sink a fortune into clinical trials, getting Food and Drug Administration approval, and marketing. At the end of all that, I have no idea how they can make a profit when competing with already available generics.

My personality type is such that I don’t argue with the drug reps who come to my office. They didn’t bring it to market. They’re doing their job, just like I’m doing mine. I suspect they know how useless the drug is but (as I often do) remind themselves that they have a family to support.

It’s a free country, and I know you can sell whatever you want (with FDA approval). But I don’t understand what financial incentives there are for companies to do this pharmaceutical recycling. And I probably never will.

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

Drug companies bring all kinds of miracles to our lives, but it amazes me how many dollars are spent on things that (at least to me) seem to have no profit potential.

My personal peeve is "convenience pills." Recently, I read a news item about a company developing a combination tablet with omeprazole and aspirin – in one pill.

I’m not a marketing person, so I really don’t understand this. Both drugs are available over the counter for pennies per day, and here someone wants to put them in one pill and charge extra for it.

©PhotoDisk

This isn’t the first time it’s been done. Duexis (ibuprofen plus famotidine) is one of several out there. You’d think that finding a new drug would be the goal, rather than recycling new ones. Giving us plenty of samples to start patients on (and those copay cards) doesn’t change the fact that the drug won’t be covered by insurance, and in a week we’ll tell the patient to just buy the individual components.

The people behind these often use the phrase "pill burden" referring to the apparently horrendous difficulties posed by having to take two pills instead of one. I have no idea where they get this idea. Yes, it sounds nice on the surface, but not "costs-$35-more-a-month" nice. Most of my patients are just fine with taking two pills at once, as am I.

I understand the reason they do this: It’s cheaper to reformulate and market drugs that already have been developed and have years of data behind them. This cuts down dramatically on R&D costs. But you still have to sink a fortune into clinical trials, getting Food and Drug Administration approval, and marketing. At the end of all that, I have no idea how they can make a profit when competing with already available generics.

My personality type is such that I don’t argue with the drug reps who come to my office. They didn’t bring it to market. They’re doing their job, just like I’m doing mine. I suspect they know how useless the drug is but (as I often do) remind themselves that they have a family to support.

It’s a free country, and I know you can sell whatever you want (with FDA approval). But I don’t understand what financial incentives there are for companies to do this pharmaceutical recycling. And I probably never will.

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