Hitting a Nerve

Every year, a local magazine publishes its annual "Top Doc" issue. The rankings are based on voting conducted by local physicians.

I’ve been on the list several times over the years. I’m flattered, as anyone would be. But I always worry about patients who put too much faith in these things. I know many good doctors who have never been on the list, and I know some people on the list who are adequate at best.

A handful of people each year come in solely on the magazine’s referral. Most are chronic pain patients, who don’t come back after learning that I don’t have any miracle treatments that their previous doctors didn’t have. My casual sense of fashion also puts them off, as they seem to expect me to be wearing a three-piece suit – with a cape.

Ratings are tricky. Having other doctors do them is likely more reliable than asking patients, but still misses a key point of the doctor-patient relationship: chemistry. The bottom line is that some people click very well together and others don’t. This sort of thing is often hard to predict, and no matter how good a doctor you may be, if patients don’t like you, they probably won’t be back. They also may complain to their internist about you.

I once made it onto a similar list (in a now-defunct throwaway magazine) as the second-best doctor in Scottsdale. (I think the first was a pediatrician.) The rating wasn’t even broken down by specialty, so having a neurologist so high up was unusual. It was, as best I could tell, based on random phone calls made during daytime hours to houses in zip codes surrounding my office. I can only assume it was a remarkably skewed, non-scientific sample, and that many of my patients were home that day. I don\'t remember getting any referrals from that, and the magazine folded within a year.

The only thing I’d say is truly predictable is that after the annual "Top Doc" issue comes out, people call asking for my money: companies selling plaques or statues to commemorate the achievement, financial planners wanting to discuss my portfolio, and the occasional reporter wanting me to comment on a story. I turn them all away. I don’t even hang up my own diplomas, so I have no interest in more tchotchkes. I may not be a financial planner, but in this era I am reluctant to trust others with my money. And I hide from the general media.

In any profession, rating people is never easy. There are a lot of variables, and some things simply can’t be predicted. It’s flattering to be on the lists, but just like betting guides at a sports book, they need to be taken with a grain of salt.

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

Every year, a local magazine publishes its annual "Top Doc" issue. The rankings are based on voting conducted by local physicians.

I’ve been on the list several times over the years. I’m flattered, as anyone would be. But I always worry about patients who put too much faith in these things. I know many good doctors who have never been on the list, and I know some people on the list who are adequate at best.

A handful of people each year come in solely on the magazine’s referral. Most are chronic pain patients, who don’t come back after learning that I don’t have any miracle treatments that their previous doctors didn’t have. My casual sense of fashion also puts them off, as they seem to expect me to be wearing a three-piece suit – with a cape.

Ratings are tricky. Having other doctors do them is likely more reliable than asking patients, but still misses a key point of the doctor-patient relationship: chemistry. The bottom line is that some people click very well together and others don’t. This sort of thing is often hard to predict, and no matter how good a doctor you may be, if patients don’t like you, they probably won’t be back. They also may complain to their internist about you.

I once made it onto a similar list (in a now-defunct throwaway magazine) as the second-best doctor in Scottsdale. (I think the first was a pediatrician.) The rating wasn’t even broken down by specialty, so having a neurologist so high up was unusual. It was, as best I could tell, based on random phone calls made during daytime hours to houses in zip codes surrounding my office. I can only assume it was a remarkably skewed, non-scientific sample, and that many of my patients were home that day. I don\'t remember getting any referrals from that, and the magazine folded within a year.

The only thing I’d say is truly predictable is that after the annual "Top Doc" issue comes out, people call asking for my money: companies selling plaques or statues to commemorate the achievement, financial planners wanting to discuss my portfolio, and the occasional reporter wanting me to comment on a story. I turn them all away. I don’t even hang up my own diplomas, so I have no interest in more tchotchkes. I may not be a financial planner, but in this era I am reluctant to trust others with my money. And I hide from the general media.

In any profession, rating people is never easy. There are a lot of variables, and some things simply can’t be predicted. It’s flattering to be on the lists, but just like betting guides at a sports book, they need to be taken with a grain of salt.

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

Every year, a local magazine publishes its annual "Top Doc" issue. The rankings are based on voting conducted by local physicians.

I’ve been on the list several times over the years. I’m flattered, as anyone would be. But I always worry about patients who put too much faith in these things. I know many good doctors who have never been on the list, and I know some people on the list who are adequate at best.

A handful of people each year come in solely on the magazine’s referral. Most are chronic pain patients, who don’t come back after learning that I don’t have any miracle treatments that their previous doctors didn’t have. My casual sense of fashion also puts them off, as they seem to expect me to be wearing a three-piece suit – with a cape.

Ratings are tricky. Having other doctors do them is likely more reliable than asking patients, but still misses a key point of the doctor-patient relationship: chemistry. The bottom line is that some people click very well together and others don’t. This sort of thing is often hard to predict, and no matter how good a doctor you may be, if patients don’t like you, they probably won’t be back. They also may complain to their internist about you.

I once made it onto a similar list (in a now-defunct throwaway magazine) as the second-best doctor in Scottsdale. (I think the first was a pediatrician.) The rating wasn’t even broken down by specialty, so having a neurologist so high up was unusual. It was, as best I could tell, based on random phone calls made during daytime hours to houses in zip codes surrounding my office. I can only assume it was a remarkably skewed, non-scientific sample, and that many of my patients were home that day. I don\'t remember getting any referrals from that, and the magazine folded within a year.

The only thing I’d say is truly predictable is that after the annual "Top Doc" issue comes out, people call asking for my money: companies selling plaques or statues to commemorate the achievement, financial planners wanting to discuss my portfolio, and the occasional reporter wanting me to comment on a story. I turn them all away. I don’t even hang up my own diplomas, so I have no interest in more tchotchkes. I may not be a financial planner, but in this era I am reluctant to trust others with my money. And I hide from the general media.

In any profession, rating people is never easy. There are a lot of variables, and some things simply can’t be predicted. It’s flattering to be on the lists, but just like betting guides at a sports book, they need to be taken with a grain of salt.

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

Back in residency, I needed my glasses prescription checked and went to see a family friend who was an ophthalmologist. On the opposite end of the scale from me, he was nearing retirement, and we discussed medical practice in general.

One comment he made was that the hardest thing to learn to do in medicine was saying no. He related that, when younger, he used to try and do hospital consults when needed, but as the years had gone by, he gradually faded out of them.

Over time, this has really turned out to be true in many ways. When you first start out, you want to make everyone – both patients and other doctors – happy. You need the work, too. You gladly take whatever hospital consults come your way. You fill out boatloads of forms. You do work-ins for any doctor who asks.

Years go by. As your practice grows, so do your time limitations (both personal and professional). You turn away more hospital work (although it pains you to do it). You only do work-ins for a handful of favored physicians.

Patients are always bringing in forms. I used to do a lot of them. Now, for many (at least those that require me to rate physical capabilities), I just send them back with a note saying that I can’t judge this because of the small size of my practice and to instead see someone who does.

I’ve been doing this since 1998. I’ve been an attending for longer than I was in college, medical school, and residency combined. Now, my hospital work is limited to just my established patients who show up at the hospital next door to me. Work-ins? I still do them, but I can count on both hands the number of doctors I’m willing to do them for.

Saying no – to both doctors and patients – becomes easier with time. But it still hurts a little when turning away a new patient. After all, I got into this business to help people, and it bothers me to say "no" when asked to do so. But there are only so many hours in a day, and now I’d rather give the leftover time to my family.

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

Back in residency, I needed my glasses prescription checked and went to see a family friend who was an ophthalmologist. On the opposite end of the scale from me, he was nearing retirement, and we discussed medical practice in general.

One comment he made was that the hardest thing to learn to do in medicine was saying no. He related that, when younger, he used to try and do hospital consults when needed, but as the years had gone by, he gradually faded out of them.

Over time, this has really turned out to be true in many ways. When you first start out, you want to make everyone – both patients and other doctors – happy. You need the work, too. You gladly take whatever hospital consults come your way. You fill out boatloads of forms. You do work-ins for any doctor who asks.

Years go by. As your practice grows, so do your time limitations (both personal and professional). You turn away more hospital work (although it pains you to do it). You only do work-ins for a handful of favored physicians.

Patients are always bringing in forms. I used to do a lot of them. Now, for many (at least those that require me to rate physical capabilities), I just send them back with a note saying that I can’t judge this because of the small size of my practice and to instead see someone who does.

I’ve been doing this since 1998. I’ve been an attending for longer than I was in college, medical school, and residency combined. Now, my hospital work is limited to just my established patients who show up at the hospital next door to me. Work-ins? I still do them, but I can count on both hands the number of doctors I’m willing to do them for.

Saying no – to both doctors and patients – becomes easier with time. But it still hurts a little when turning away a new patient. After all, I got into this business to help people, and it bothers me to say "no" when asked to do so. But there are only so many hours in a day, and now I’d rather give the leftover time to my family.

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

Back in residency, I needed my glasses prescription checked and went to see a family friend who was an ophthalmologist. On the opposite end of the scale from me, he was nearing retirement, and we discussed medical practice in general.

One comment he made was that the hardest thing to learn to do in medicine was saying no. He related that, when younger, he used to try and do hospital consults when needed, but as the years had gone by, he gradually faded out of them.

Over time, this has really turned out to be true in many ways. When you first start out, you want to make everyone – both patients and other doctors – happy. You need the work, too. You gladly take whatever hospital consults come your way. You fill out boatloads of forms. You do work-ins for any doctor who asks.

Years go by. As your practice grows, so do your time limitations (both personal and professional). You turn away more hospital work (although it pains you to do it). You only do work-ins for a handful of favored physicians.

Patients are always bringing in forms. I used to do a lot of them. Now, for many (at least those that require me to rate physical capabilities), I just send them back with a note saying that I can’t judge this because of the small size of my practice and to instead see someone who does.

I’ve been doing this since 1998. I’ve been an attending for longer than I was in college, medical school, and residency combined. Now, my hospital work is limited to just my established patients who show up at the hospital next door to me. Work-ins? I still do them, but I can count on both hands the number of doctors I’m willing to do them for.

Saying no – to both doctors and patients – becomes easier with time. But it still hurts a little when turning away a new patient. After all, I got into this business to help people, and it bothers me to say "no" when asked to do so. But there are only so many hours in a day, and now I’d rather give the leftover time to my family.

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

No-show patients who don’t come for an appointment – leaving you with an empty time slot – are one of the most frustrating things we deal with.

There are plenty of good reasons to no-show: flat tires, illness, and last-minute things at work. I don’t mind those too much, especially when patients have the decency to call in, even at the last minute or afterward, to apologize and let me know. Those things happen to all of us. Sometimes even the fault is with our scheduling and not the patient.

But the really frustrating ones are the ones who just don’t show up, especially when they’re new patients and you’ve booked out an hour.

I can always use the time. Certainly, there’s never any shortage of stuff in a modern practice: dictations to be done, test results to review, refills to okay, and the endless forms of varying types. But it still doesn’t change the fact that it’s an hour you’re taking a financial loss on. My wife uses the phrase that "butts in seats" is what pays the bills in an office practice, and I can’t argue with that.

Predictably, I’m not very forgiving toward them. An established patient who forgets an appointment here and there I generally don’t punish, but a new one without a damn good reason gets my wrath. Most never call in, but the ones that do I usually won’t reschedule.

When I first started out I took 20 or so different insurance companies. After a few years I did an analysis, and found one insurance company accounted for nearly 50% of my no-shows. I dropped it, and this brought down the rate quite a bit. But they still happen and are unavoidable.

Even so, there are some days where a confluence of no-shows can leave you with an empty schedule, scratching your head and trying to use the extra time productively (as opposed to watching Monty Python on YouTube).

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

No-show patients who don’t come for an appointment – leaving you with an empty time slot – are one of the most frustrating things we deal with.

There are plenty of good reasons to no-show: flat tires, illness, and last-minute things at work. I don’t mind those too much, especially when patients have the decency to call in, even at the last minute or afterward, to apologize and let me know. Those things happen to all of us. Sometimes even the fault is with our scheduling and not the patient.

But the really frustrating ones are the ones who just don’t show up, especially when they’re new patients and you’ve booked out an hour.

I can always use the time. Certainly, there’s never any shortage of stuff in a modern practice: dictations to be done, test results to review, refills to okay, and the endless forms of varying types. But it still doesn’t change the fact that it’s an hour you’re taking a financial loss on. My wife uses the phrase that "butts in seats" is what pays the bills in an office practice, and I can’t argue with that.

Predictably, I’m not very forgiving toward them. An established patient who forgets an appointment here and there I generally don’t punish, but a new one without a damn good reason gets my wrath. Most never call in, but the ones that do I usually won’t reschedule.

When I first started out I took 20 or so different insurance companies. After a few years I did an analysis, and found one insurance company accounted for nearly 50% of my no-shows. I dropped it, and this brought down the rate quite a bit. But they still happen and are unavoidable.

Even so, there are some days where a confluence of no-shows can leave you with an empty schedule, scratching your head and trying to use the extra time productively (as opposed to watching Monty Python on YouTube).

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

No-show patients who don’t come for an appointment – leaving you with an empty time slot – are one of the most frustrating things we deal with.

There are plenty of good reasons to no-show: flat tires, illness, and last-minute things at work. I don’t mind those too much, especially when patients have the decency to call in, even at the last minute or afterward, to apologize and let me know. Those things happen to all of us. Sometimes even the fault is with our scheduling and not the patient.

But the really frustrating ones are the ones who just don’t show up, especially when they’re new patients and you’ve booked out an hour.

I can always use the time. Certainly, there’s never any shortage of stuff in a modern practice: dictations to be done, test results to review, refills to okay, and the endless forms of varying types. But it still doesn’t change the fact that it’s an hour you’re taking a financial loss on. My wife uses the phrase that "butts in seats" is what pays the bills in an office practice, and I can’t argue with that.

Predictably, I’m not very forgiving toward them. An established patient who forgets an appointment here and there I generally don’t punish, but a new one without a damn good reason gets my wrath. Most never call in, but the ones that do I usually won’t reschedule.

When I first started out I took 20 or so different insurance companies. After a few years I did an analysis, and found one insurance company accounted for nearly 50% of my no-shows. I dropped it, and this brought down the rate quite a bit. But they still happen and are unavoidable.

Even so, there are some days where a confluence of no-shows can leave you with an empty schedule, scratching your head and trying to use the extra time productively (as opposed to watching Monty Python on YouTube).

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

I try very hard not to discuss politics with patients. Politics are always flammable.

I respect everyone’s right to an opinion, and certainly don’t treat them any different, regardless of what it is. But, in my experience, it’s simply best not to know.

So when patients ask me who I’m voting for, I generally tell them I don’t discuss such issues in my practice. Some doctors will say I’m missing an opportunity to educate them about important issues, such as the Patient Protection and Affordable Care Act, but I take the view that such isn’t my job.

I’m here to provide medical care and education about their condition. Discussions about politics, no matter how well intended, can often lead beyond polite disagreements to anger or resentment – elements that are never good things in the doctor-patient relationship.

When I was a younger doctor, once a week I’d work at a prisoner clinic. It was strictly forbidden to ask what the person was in for, on the same grounds: If it was, say, a child molester, would that alter the care you’d provide? Maybe, maybe not. We are all human, and it’s not easy to remain objective when dealing with someone who might disgust you.

Objectivity is a critical element in patient care. It’s the same reason we (generally) try not to treat family members or friends. Once you lose it, the relationship can’t be returned to its previous level. So it’s best not to start at all.

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

I try very hard not to discuss politics with patients. Politics are always flammable.

I respect everyone’s right to an opinion, and certainly don’t treat them any different, regardless of what it is. But, in my experience, it’s simply best not to know.

So when patients ask me who I’m voting for, I generally tell them I don’t discuss such issues in my practice. Some doctors will say I’m missing an opportunity to educate them about important issues, such as the Patient Protection and Affordable Care Act, but I take the view that such isn’t my job.

I’m here to provide medical care and education about their condition. Discussions about politics, no matter how well intended, can often lead beyond polite disagreements to anger or resentment – elements that are never good things in the doctor-patient relationship.

When I was a younger doctor, once a week I’d work at a prisoner clinic. It was strictly forbidden to ask what the person was in for, on the same grounds: If it was, say, a child molester, would that alter the care you’d provide? Maybe, maybe not. We are all human, and it’s not easy to remain objective when dealing with someone who might disgust you.

Objectivity is a critical element in patient care. It’s the same reason we (generally) try not to treat family members or friends. Once you lose it, the relationship can’t be returned to its previous level. So it’s best not to start at all.

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

I try very hard not to discuss politics with patients. Politics are always flammable.

I respect everyone’s right to an opinion, and certainly don’t treat them any different, regardless of what it is. But, in my experience, it’s simply best not to know.

So when patients ask me who I’m voting for, I generally tell them I don’t discuss such issues in my practice. Some doctors will say I’m missing an opportunity to educate them about important issues, such as the Patient Protection and Affordable Care Act, but I take the view that such isn’t my job.

I’m here to provide medical care and education about their condition. Discussions about politics, no matter how well intended, can often lead beyond polite disagreements to anger or resentment – elements that are never good things in the doctor-patient relationship.

When I was a younger doctor, once a week I’d work at a prisoner clinic. It was strictly forbidden to ask what the person was in for, on the same grounds: If it was, say, a child molester, would that alter the care you’d provide? Maybe, maybe not. We are all human, and it’s not easy to remain objective when dealing with someone who might disgust you.

Objectivity is a critical element in patient care. It’s the same reason we (generally) try not to treat family members or friends. Once you lose it, the relationship can’t be returned to its previous level. So it’s best not to start at all.

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

I don’t belong to any organizations. Not one. I’m not saying this to brag, nor do I claim to be a rebel. It’s just the way it is.

When I was in residency, and later fellowship, my department paid for my membership. So I was in the American Academy of Neurology and the American Epilepsy Society. I got some nice department-funded trips for meetings and a subscription to the thick green journal. I tried to keep up on the reading, but the pile eventually won and ended up in a recycling bin when I moved.

I’m not an academic and never will be. I have nothing against those who are, but it’s just not my thing. So joining various medical associations for contacts and publications doesn’t serve me in that regard. I don’t conduct research, either. And I do my own continuing medical education from various free sources.

I don’t have time to go to meetings anymore. Some will argue that they’re tax deductible, but I don’t care. If I’m going to spend money on a trip, I’d rather spend the whole time with my family and relax. In the "eat what you kill" world of solo practice, taking time off is a financial hit. So I try to limit it to important things, such as family.

Financial realities can also lead you away from organizations. Most annual memberships are several hundred dollars, which seems like a big chunk of change for a journal you don’t have time to read, annual meetings you don’t have time to go to (and which can cost a fortune when added up), and a membership card for your wallet. I’m sure others will argue that organizations serve purposes of CME and political representation, but at this point in my life I get all my own CME anyway, and I am skeptical about the latter.

So I save my time and money for things that are more important to me. Memberships in big organizations aren’t on the list.

Besides, as Groucho Marx once said, "I don’t care to belong to any club that will have me as a member."

I don’t belong to any organizations. Not one. I’m not saying this to brag, nor do I claim to be a rebel. It’s just the way it is.

When I was in residency, and later fellowship, my department paid for my membership. So I was in the American Academy of Neurology and the American Epilepsy Society. I got some nice department-funded trips for meetings and a subscription to the thick green journal. I tried to keep up on the reading, but the pile eventually won and ended up in a recycling bin when I moved.

I’m not an academic and never will be. I have nothing against those who are, but it’s just not my thing. So joining various medical associations for contacts and publications doesn’t serve me in that regard. I don’t conduct research, either. And I do my own continuing medical education from various free sources.

I don’t have time to go to meetings anymore. Some will argue that they’re tax deductible, but I don’t care. If I’m going to spend money on a trip, I’d rather spend the whole time with my family and relax. In the "eat what you kill" world of solo practice, taking time off is a financial hit. So I try to limit it to important things, such as family.

Financial realities can also lead you away from organizations. Most annual memberships are several hundred dollars, which seems like a big chunk of change for a journal you don’t have time to read, annual meetings you don’t have time to go to (and which can cost a fortune when added up), and a membership card for your wallet. I’m sure others will argue that organizations serve purposes of CME and political representation, but at this point in my life I get all my own CME anyway, and I am skeptical about the latter.

So I save my time and money for things that are more important to me. Memberships in big organizations aren’t on the list.

Besides, as Groucho Marx once said, "I don’t care to belong to any club that will have me as a member."

I don’t belong to any organizations. Not one. I’m not saying this to brag, nor do I claim to be a rebel. It’s just the way it is.

When I was in residency, and later fellowship, my department paid for my membership. So I was in the American Academy of Neurology and the American Epilepsy Society. I got some nice department-funded trips for meetings and a subscription to the thick green journal. I tried to keep up on the reading, but the pile eventually won and ended up in a recycling bin when I moved.

I’m not an academic and never will be. I have nothing against those who are, but it’s just not my thing. So joining various medical associations for contacts and publications doesn’t serve me in that regard. I don’t conduct research, either. And I do my own continuing medical education from various free sources.

I don’t have time to go to meetings anymore. Some will argue that they’re tax deductible, but I don’t care. If I’m going to spend money on a trip, I’d rather spend the whole time with my family and relax. In the "eat what you kill" world of solo practice, taking time off is a financial hit. So I try to limit it to important things, such as family.

Financial realities can also lead you away from organizations. Most annual memberships are several hundred dollars, which seems like a big chunk of change for a journal you don’t have time to read, annual meetings you don’t have time to go to (and which can cost a fortune when added up), and a membership card for your wallet. I’m sure others will argue that organizations serve purposes of CME and political representation, but at this point in my life I get all my own CME anyway, and I am skeptical about the latter.

So I save my time and money for things that are more important to me. Memberships in big organizations aren’t on the list.

Besides, as Groucho Marx once said, "I don’t care to belong to any club that will have me as a member."

I have a lot of stuff up on my office walls: pictures my kids drew, favorite quotes, a few cartoons, two M.C. Escher prints, a Lego Batman figure ... and absolutely no diplomas.

I have no idea when the tradition of doctors hanging up diplomas started. I assume it was quite a while ago.

Courtesy Dr. Allan M. Block

Some doctors just put up a medical school diploma, but most also have them from college, residency, and fellowship. I’ve even known a few who hung up high school and grade school diplomas, with as many continuing medical education certificates as they could find. Not me.

Maybe it’s just a complete lack of ego for this sort of thing on my part. I know I went through all the training, and I don’t need to remind myself.

I also don’t see the point of hanging them up for patients. At this point in history, most of them have seen my picture online, skimmed my website, and probably read my online reviews (in spite of which, they’re coming to me). So if they still question my qualifications, I don’t think having (or not having) a diploma up is going to convince them.

My office partner has his diplomas up in the main hallway. He’s 25 years older than I am, yet that doesn’t stop my patients from looking them over, not paying attention to the name on them, and commenting about how good I look for my age. (Okay, I suppose there’s a reason they’re seeing a neurologist.) It does, however, make me wonder how much attention anyone really pays to these things.

I’m guessing a lot of doctors display their diplomas for pride. You paid a fortune and invested several years in that piece of paper, and you want the world to see it. But at this point in my life and career, the pictures my kids drew for me have a lot more meaning. And because I spend most of my waking workdays in that room, I’d rather be looking at them.

For the record, my diplomas (all unframed) are neatly stacked on a dusty bookshelf in my home office. They lie under a shelf of paperbacks, my daughter’s money jar, an old piggy bank, and a picture of my late grandparents. They are above a shelf covered with foam-rubber brains I used to collect from drug companies and next to a plastic trophy of a ship I won in a trivia contest.

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

I have a lot of stuff up on my office walls: pictures my kids drew, favorite quotes, a few cartoons, two M.C. Escher prints, a Lego Batman figure ... and absolutely no diplomas.

I have no idea when the tradition of doctors hanging up diplomas started. I assume it was quite a while ago.

Courtesy Dr. Allan M. Block

Some doctors just put up a medical school diploma, but most also have them from college, residency, and fellowship. I’ve even known a few who hung up high school and grade school diplomas, with as many continuing medical education certificates as they could find. Not me.

Maybe it’s just a complete lack of ego for this sort of thing on my part. I know I went through all the training, and I don’t need to remind myself.

I also don’t see the point of hanging them up for patients. At this point in history, most of them have seen my picture online, skimmed my website, and probably read my online reviews (in spite of which, they’re coming to me). So if they still question my qualifications, I don’t think having (or not having) a diploma up is going to convince them.

My office partner has his diplomas up in the main hallway. He’s 25 years older than I am, yet that doesn’t stop my patients from looking them over, not paying attention to the name on them, and commenting about how good I look for my age. (Okay, I suppose there’s a reason they’re seeing a neurologist.) It does, however, make me wonder how much attention anyone really pays to these things.

I’m guessing a lot of doctors display their diplomas for pride. You paid a fortune and invested several years in that piece of paper, and you want the world to see it. But at this point in my life and career, the pictures my kids drew for me have a lot more meaning. And because I spend most of my waking workdays in that room, I’d rather be looking at them.

For the record, my diplomas (all unframed) are neatly stacked on a dusty bookshelf in my home office. They lie under a shelf of paperbacks, my daughter’s money jar, an old piggy bank, and a picture of my late grandparents. They are above a shelf covered with foam-rubber brains I used to collect from drug companies and next to a plastic trophy of a ship I won in a trivia contest.

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

I have a lot of stuff up on my office walls: pictures my kids drew, favorite quotes, a few cartoons, two M.C. Escher prints, a Lego Batman figure ... and absolutely no diplomas.

I have no idea when the tradition of doctors hanging up diplomas started. I assume it was quite a while ago.

Courtesy Dr. Allan M. Block

Some doctors just put up a medical school diploma, but most also have them from college, residency, and fellowship. I’ve even known a few who hung up high school and grade school diplomas, with as many continuing medical education certificates as they could find. Not me.

Maybe it’s just a complete lack of ego for this sort of thing on my part. I know I went through all the training, and I don’t need to remind myself.

I also don’t see the point of hanging them up for patients. At this point in history, most of them have seen my picture online, skimmed my website, and probably read my online reviews (in spite of which, they’re coming to me). So if they still question my qualifications, I don’t think having (or not having) a diploma up is going to convince them.

My office partner has his diplomas up in the main hallway. He’s 25 years older than I am, yet that doesn’t stop my patients from looking them over, not paying attention to the name on them, and commenting about how good I look for my age. (Okay, I suppose there’s a reason they’re seeing a neurologist.) It does, however, make me wonder how much attention anyone really pays to these things.

I’m guessing a lot of doctors display their diplomas for pride. You paid a fortune and invested several years in that piece of paper, and you want the world to see it. But at this point in my life and career, the pictures my kids drew for me have a lot more meaning. And because I spend most of my waking workdays in that room, I’d rather be looking at them.

For the record, my diplomas (all unframed) are neatly stacked on a dusty bookshelf in my home office. They lie under a shelf of paperbacks, my daughter’s money jar, an old piggy bank, and a picture of my late grandparents. They are above a shelf covered with foam-rubber brains I used to collect from drug companies and next to a plastic trophy of a ship I won in a trivia contest.

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

I sometimes swear while talking to patients. It’s not the sole part of the conversation, and I certainly never swear at them. But I do swear on occasion.

When I was a kid, my dad told me swearing was for grown-ups, when talking about grown-up things. Well, I’m a grown-up now, and if "grown-up things" don’t include serious health problems, I don’t know what does.

A lot of people may see this as unprofessional, rude, or insensitive. I disagree. There are times when strong language is the only way of getting a point across. I generally have a good gauge of patient personality, and I am careful with what I say in front of certain people.

Language is one of our most useful tools as a species. I submit that swearing, like many other things, is part of the art of medicine. Knowing how to use it properly (and how not to) is a critical skill. Using it properly can be a central part of communicating properly with certain patients. Using it too much, or inappropriately, is obviously detrimental and unprofessional.

It may take a four-letter word to make yourself clear, or to help others understand what you’re trying to say. Some people don’t pay attention until certain words make them.

This is not something anyone will ever teach you in residency, and it would likely get you in trouble at most academic centers, but in the trenches of private practice neurology, sometimes the best way to talk to patients is to be an ordinary person, not a doctor.

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

I sometimes swear while talking to patients. It’s not the sole part of the conversation, and I certainly never swear at them. But I do swear on occasion.

When I was a kid, my dad told me swearing was for grown-ups, when talking about grown-up things. Well, I’m a grown-up now, and if "grown-up things" don’t include serious health problems, I don’t know what does.

A lot of people may see this as unprofessional, rude, or insensitive. I disagree. There are times when strong language is the only way of getting a point across. I generally have a good gauge of patient personality, and I am careful with what I say in front of certain people.

Language is one of our most useful tools as a species. I submit that swearing, like many other things, is part of the art of medicine. Knowing how to use it properly (and how not to) is a critical skill. Using it properly can be a central part of communicating properly with certain patients. Using it too much, or inappropriately, is obviously detrimental and unprofessional.

It may take a four-letter word to make yourself clear, or to help others understand what you’re trying to say. Some people don’t pay attention until certain words make them.

This is not something anyone will ever teach you in residency, and it would likely get you in trouble at most academic centers, but in the trenches of private practice neurology, sometimes the best way to talk to patients is to be an ordinary person, not a doctor.

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

I sometimes swear while talking to patients. It’s not the sole part of the conversation, and I certainly never swear at them. But I do swear on occasion.

When I was a kid, my dad told me swearing was for grown-ups, when talking about grown-up things. Well, I’m a grown-up now, and if "grown-up things" don’t include serious health problems, I don’t know what does.

A lot of people may see this as unprofessional, rude, or insensitive. I disagree. There are times when strong language is the only way of getting a point across. I generally have a good gauge of patient personality, and I am careful with what I say in front of certain people.

Language is one of our most useful tools as a species. I submit that swearing, like many other things, is part of the art of medicine. Knowing how to use it properly (and how not to) is a critical skill. Using it properly can be a central part of communicating properly with certain patients. Using it too much, or inappropriately, is obviously detrimental and unprofessional.

It may take a four-letter word to make yourself clear, or to help others understand what you’re trying to say. Some people don’t pay attention until certain words make them.

This is not something anyone will ever teach you in residency, and it would likely get you in trouble at most academic centers, but in the trenches of private practice neurology, sometimes the best way to talk to patients is to be an ordinary person, not a doctor.

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

How many of you out there prescribe your own medications? Nobody wants to admit it? Okay, I’ll raise my hand. I’m not talking controlled drugs here, only simvastatin.

Once upon a time, I did see an internist. Initially, I was on atorvastatin (Lipitor), but when Zocor became generic, I switched to it. I’m a busy doctor, and it was easier to just take it over myself than ask him about it or have blood drawn regularly.

I must admit, I’d probably fire my own patients for similar behavior, but suspect this sort of thing is quite normal for doctors. After all, we have too much going on with juggling patients and family and meetings and such to have time for this.

I’m not defending this. Any of us know that we shouldn’t be our own patients. But my conversations with other doctors indicate that I’m far from the only one.

I suppose if it were something more complex than dyslipidemia I’d see someone for it. At least, I hope I would. At heart, I’m a coward and thoroughly lacking confidence in anything outside neurology.

It’s an odd paradox of medicine that so many of us, while preaching to our patients, often ignore our own advice. Or don’t follow it as we should.

A little knowledge is a dangerous thing. Sometimes, a lot is even worse. Even knowing this, I still won’t stop writing my own simvastatin prescription. Like other doctors, I just don’t have time to do it otherwise.

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

How many of you out there prescribe your own medications? Nobody wants to admit it? Okay, I’ll raise my hand. I’m not talking controlled drugs here, only simvastatin.

Once upon a time, I did see an internist. Initially, I was on atorvastatin (Lipitor), but when Zocor became generic, I switched to it. I’m a busy doctor, and it was easier to just take it over myself than ask him about it or have blood drawn regularly.

I must admit, I’d probably fire my own patients for similar behavior, but suspect this sort of thing is quite normal for doctors. After all, we have too much going on with juggling patients and family and meetings and such to have time for this.

I’m not defending this. Any of us know that we shouldn’t be our own patients. But my conversations with other doctors indicate that I’m far from the only one.

I suppose if it were something more complex than dyslipidemia I’d see someone for it. At least, I hope I would. At heart, I’m a coward and thoroughly lacking confidence in anything outside neurology.

It’s an odd paradox of medicine that so many of us, while preaching to our patients, often ignore our own advice. Or don’t follow it as we should.

A little knowledge is a dangerous thing. Sometimes, a lot is even worse. Even knowing this, I still won’t stop writing my own simvastatin prescription. Like other doctors, I just don’t have time to do it otherwise.

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

How many of you out there prescribe your own medications? Nobody wants to admit it? Okay, I’ll raise my hand. I’m not talking controlled drugs here, only simvastatin.

Once upon a time, I did see an internist. Initially, I was on atorvastatin (Lipitor), but when Zocor became generic, I switched to it. I’m a busy doctor, and it was easier to just take it over myself than ask him about it or have blood drawn regularly.

I must admit, I’d probably fire my own patients for similar behavior, but suspect this sort of thing is quite normal for doctors. After all, we have too much going on with juggling patients and family and meetings and such to have time for this.

I’m not defending this. Any of us know that we shouldn’t be our own patients. But my conversations with other doctors indicate that I’m far from the only one.

I suppose if it were something more complex than dyslipidemia I’d see someone for it. At least, I hope I would. At heart, I’m a coward and thoroughly lacking confidence in anything outside neurology.

It’s an odd paradox of medicine that so many of us, while preaching to our patients, often ignore our own advice. Or don’t follow it as we should.

A little knowledge is a dangerous thing. Sometimes, a lot is even worse. Even knowing this, I still won’t stop writing my own simvastatin prescription. Like other doctors, I just don’t have time to do it otherwise.

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

I love the troll tracker. In case you’re unfamiliar with the term (or your state doesn’t have one), this is the online Prescription Monitoring Program database to see who is (or isn’t) getting controlled drugs from too many prescribers. It’s an excellent way to track the doctor-shoppers, emergency department-habituators, and other known problem patients.

I generally assume someone is innocent until proven guilty. And, in all fairness, I must admit the PMP has exonerated more patients than it’s caught (at least in my practice). Many of the people I’ve nailed with it were ones I had absolutely no suspicion of, while a lot of patients I was sure I was going to catch turned out to be innocent.

©PhotoDisk

I’d love to see a program like this on a national scale. For my practice, it wouldn’t really matter (I’m several hours from the nearest state line), but for cities that straddle state borders (such as Kansas City) it would be very helpful. If a state program only tracks pharmacies within a state, it’s easy for patients to easily cross back and forth in some areas.

What surprises me is that so many states (and politicians) are opposed to these programs. They claim it’s a violation of privacy! Well, in my view, if you’re committing a crime (like abusing controlled drugs and lying to doctors to get them) that should trump your personal privacy.

The database tracks only controlled drugs. If you’re on HIV treatment, or Zocor, or lithium, I’m not able to see that. And I’m not snooping on my neighbors for the hell of it, either. The database is audited and, at any time, the state could call me to question my searches. I have to be able to show I have a good cause for looking up a person, otherwise I’ll find myself in deep doo-doo.

We doctors are in a difficult bind. There are laws and ethics that require us to alleviate pain and suffering. Balanced against those are the laws, watchdogs, and boards that can nail us for overprescribing controlled drugs.

So any tool that can help us stay on the right side of this issue is a good one. It can help confirm the guilty, and clear the innocent. This allows those who truly need pain relief to continue getting it and, if relieving suffering isn’t a central tenet of medicine, I don’t know what is.

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

I love the troll tracker. In case you’re unfamiliar with the term (or your state doesn’t have one), this is the online Prescription Monitoring Program database to see who is (or isn’t) getting controlled drugs from too many prescribers. It’s an excellent way to track the doctor-shoppers, emergency department-habituators, and other known problem patients.

I generally assume someone is innocent until proven guilty. And, in all fairness, I must admit the PMP has exonerated more patients than it’s caught (at least in my practice). Many of the people I’ve nailed with it were ones I had absolutely no suspicion of, while a lot of patients I was sure I was going to catch turned out to be innocent.

©PhotoDisk

I’d love to see a program like this on a national scale. For my practice, it wouldn’t really matter (I’m several hours from the nearest state line), but for cities that straddle state borders (such as Kansas City) it would be very helpful. If a state program only tracks pharmacies within a state, it’s easy for patients to easily cross back and forth in some areas.

What surprises me is that so many states (and politicians) are opposed to these programs. They claim it’s a violation of privacy! Well, in my view, if you’re committing a crime (like abusing controlled drugs and lying to doctors to get them) that should trump your personal privacy.

The database tracks only controlled drugs. If you’re on HIV treatment, or Zocor, or lithium, I’m not able to see that. And I’m not snooping on my neighbors for the hell of it, either. The database is audited and, at any time, the state could call me to question my searches. I have to be able to show I have a good cause for looking up a person, otherwise I’ll find myself in deep doo-doo.

We doctors are in a difficult bind. There are laws and ethics that require us to alleviate pain and suffering. Balanced against those are the laws, watchdogs, and boards that can nail us for overprescribing controlled drugs.

So any tool that can help us stay on the right side of this issue is a good one. It can help confirm the guilty, and clear the innocent. This allows those who truly need pain relief to continue getting it and, if relieving suffering isn’t a central tenet of medicine, I don’t know what is.

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

I love the troll tracker. In case you’re unfamiliar with the term (or your state doesn’t have one), this is the online Prescription Monitoring Program database to see who is (or isn’t) getting controlled drugs from too many prescribers. It’s an excellent way to track the doctor-shoppers, emergency department-habituators, and other known problem patients.

I generally assume someone is innocent until proven guilty. And, in all fairness, I must admit the PMP has exonerated more patients than it’s caught (at least in my practice). Many of the people I’ve nailed with it were ones I had absolutely no suspicion of, while a lot of patients I was sure I was going to catch turned out to be innocent.

©PhotoDisk

I’d love to see a program like this on a national scale. For my practice, it wouldn’t really matter (I’m several hours from the nearest state line), but for cities that straddle state borders (such as Kansas City) it would be very helpful. If a state program only tracks pharmacies within a state, it’s easy for patients to easily cross back and forth in some areas.

What surprises me is that so many states (and politicians) are opposed to these programs. They claim it’s a violation of privacy! Well, in my view, if you’re committing a crime (like abusing controlled drugs and lying to doctors to get them) that should trump your personal privacy.

The database tracks only controlled drugs. If you’re on HIV treatment, or Zocor, or lithium, I’m not able to see that. And I’m not snooping on my neighbors for the hell of it, either. The database is audited and, at any time, the state could call me to question my searches. I have to be able to show I have a good cause for looking up a person, otherwise I’ll find myself in deep doo-doo.

We doctors are in a difficult bind. There are laws and ethics that require us to alleviate pain and suffering. Balanced against those are the laws, watchdogs, and boards that can nail us for overprescribing controlled drugs.

So any tool that can help us stay on the right side of this issue is a good one. It can help confirm the guilty, and clear the innocent. This allows those who truly need pain relief to continue getting it and, if relieving suffering isn’t a central tenet of medicine, I don’t know what is.

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

My billing company needs my approval to send a patient to collections, so once a month I get a list of people who owe me money. I hate this.

I didn’t become a doctor to get rich (actually, being a doctor is probably why I’m not rich). I did it to help people. The list is one of those reality doses I have to swallow.

I generally send them all to collections and try not to think about it too much. I don’t like it, but I have to focus on the basic facts: My practice supports three families (mine and two staffers), and I need to pay the bills.

I scan the list. Sometimes I recognize the names, often I don’t. Many are people I only saw briefly in the hospital. If I know someone legitimately has serious problems and can’t pay it, I’ll often write the account off, but, in general, I send most of the list to collections. Sometimes it’s hard to draw a line.

I often wonder about those I recognize as being people who are employed, nice, financially stable, and (seemingly) honest. I know they can afford it, so why don’t they pay? Believe me, I don’t enjoy approving this. I wonder if they think I won’t do it, or they just don’t understand their insurance, or just believe they shouldn’t have to. I remind myself that shoplifting is still stealing, no matter what the circumstances are, and sign off on them, too.

The amounts vary, from small ($7.43) to large ($485.92 this month). I think about writing off the small ones, but where do you draw the line? If $7 is too small, then why not $10? If $15 is too small, why not $20? So I remind myself that it all adds up over time, think of my kids needing new school clothes, and sign off.

I do this job to help people, but if I can’t keep my practice open I can’t help anybody. And that’s a necessary evil of modern medicine.

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

My billing company needs my approval to send a patient to collections, so once a month I get a list of people who owe me money. I hate this.

I didn’t become a doctor to get rich (actually, being a doctor is probably why I’m not rich). I did it to help people. The list is one of those reality doses I have to swallow.

I generally send them all to collections and try not to think about it too much. I don’t like it, but I have to focus on the basic facts: My practice supports three families (mine and two staffers), and I need to pay the bills.

I scan the list. Sometimes I recognize the names, often I don’t. Many are people I only saw briefly in the hospital. If I know someone legitimately has serious problems and can’t pay it, I’ll often write the account off, but, in general, I send most of the list to collections. Sometimes it’s hard to draw a line.

I often wonder about those I recognize as being people who are employed, nice, financially stable, and (seemingly) honest. I know they can afford it, so why don’t they pay? Believe me, I don’t enjoy approving this. I wonder if they think I won’t do it, or they just don’t understand their insurance, or just believe they shouldn’t have to. I remind myself that shoplifting is still stealing, no matter what the circumstances are, and sign off on them, too.

The amounts vary, from small ($7.43) to large ($485.92 this month). I think about writing off the small ones, but where do you draw the line? If $7 is too small, then why not $10? If $15 is too small, why not $20? So I remind myself that it all adds up over time, think of my kids needing new school clothes, and sign off.

I do this job to help people, but if I can’t keep my practice open I can’t help anybody. And that’s a necessary evil of modern medicine.

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

My billing company needs my approval to send a patient to collections, so once a month I get a list of people who owe me money. I hate this.

I didn’t become a doctor to get rich (actually, being a doctor is probably why I’m not rich). I did it to help people. The list is one of those reality doses I have to swallow.

I generally send them all to collections and try not to think about it too much. I don’t like it, but I have to focus on the basic facts: My practice supports three families (mine and two staffers), and I need to pay the bills.

I scan the list. Sometimes I recognize the names, often I don’t. Many are people I only saw briefly in the hospital. If I know someone legitimately has serious problems and can’t pay it, I’ll often write the account off, but, in general, I send most of the list to collections. Sometimes it’s hard to draw a line.

I often wonder about those I recognize as being people who are employed, nice, financially stable, and (seemingly) honest. I know they can afford it, so why don’t they pay? Believe me, I don’t enjoy approving this. I wonder if they think I won’t do it, or they just don’t understand their insurance, or just believe they shouldn’t have to. I remind myself that shoplifting is still stealing, no matter what the circumstances are, and sign off on them, too.

The amounts vary, from small ($7.43) to large ($485.92 this month). I think about writing off the small ones, but where do you draw the line? If $7 is too small, then why not $10? If $15 is too small, why not $20? So I remind myself that it all adds up over time, think of my kids needing new school clothes, and sign off.

I do this job to help people, but if I can’t keep my practice open I can’t help anybody. And that’s a necessary evil of modern medicine.

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