Hitting a Nerve

Recently, I celebrated Maui Independence Day. I do this every so often, and even change my office message to let patients know my office is closed in honor of said holiday.

Of course, the week afterward I usually get questions about it. As far as I know there is no such holiday. In the 1980s, for various bizarre reasons, my father was trying to think of a fictitious holiday that a Maui resort would celebrate, and came up with this one. Since then, it’s been a family joke – until about 10 years ago, when I officially adopted it into my practice.

Courtesy Wikimedia Commons/Julius Silver/Creative Commons License

Maui Independence Day is now the official holiday of my desert practice. It’s whenever I decide to close the practice on a nonholiday. Recently, for example, my secretary was on vacation and my assistant and I were swamped. Since we only had two patients on the schedule for Friday, I moved them to the next week and closed the office for a 3-day weekend.

Being solo gives me the freedom to do this on occasion. I have no partners to disagree with me. After years in practice, there are days when I’m willing to trade time for dollars and try to regain some sanity.

Maui Independence Day is never anything like "Ferris Bueller’s Day Off." I think the most exciting thing I ever did on it was take my kids to a water park. This past one I spent catching up on paperwork and dictations, trying to fix computer issues, and taking my family out to dinner. But it gives you a few extra hours to catch up on things that would otherwise be crammed into the limited time of a workday, helping you decompress.

Personally, I think everyone should celebrate Maui Independence Day here and there. It helps keep some sanity in an often insane job.

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

Recently, I celebrated Maui Independence Day. I do this every so often, and even change my office message to let patients know my office is closed in honor of said holiday.

Of course, the week afterward I usually get questions about it. As far as I know there is no such holiday. In the 1980s, for various bizarre reasons, my father was trying to think of a fictitious holiday that a Maui resort would celebrate, and came up with this one. Since then, it’s been a family joke – until about 10 years ago, when I officially adopted it into my practice.

Courtesy Wikimedia Commons/Julius Silver/Creative Commons License

Maui Independence Day is now the official holiday of my desert practice. It’s whenever I decide to close the practice on a nonholiday. Recently, for example, my secretary was on vacation and my assistant and I were swamped. Since we only had two patients on the schedule for Friday, I moved them to the next week and closed the office for a 3-day weekend.

Being solo gives me the freedom to do this on occasion. I have no partners to disagree with me. After years in practice, there are days when I’m willing to trade time for dollars and try to regain some sanity.

Maui Independence Day is never anything like "Ferris Bueller’s Day Off." I think the most exciting thing I ever did on it was take my kids to a water park. This past one I spent catching up on paperwork and dictations, trying to fix computer issues, and taking my family out to dinner. But it gives you a few extra hours to catch up on things that would otherwise be crammed into the limited time of a workday, helping you decompress.

Personally, I think everyone should celebrate Maui Independence Day here and there. It helps keep some sanity in an often insane job.

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

Recently, I celebrated Maui Independence Day. I do this every so often, and even change my office message to let patients know my office is closed in honor of said holiday.

Of course, the week afterward I usually get questions about it. As far as I know there is no such holiday. In the 1980s, for various bizarre reasons, my father was trying to think of a fictitious holiday that a Maui resort would celebrate, and came up with this one. Since then, it’s been a family joke – until about 10 years ago, when I officially adopted it into my practice.

Courtesy Wikimedia Commons/Julius Silver/Creative Commons License

Maui Independence Day is now the official holiday of my desert practice. It’s whenever I decide to close the practice on a nonholiday. Recently, for example, my secretary was on vacation and my assistant and I were swamped. Since we only had two patients on the schedule for Friday, I moved them to the next week and closed the office for a 3-day weekend.

Being solo gives me the freedom to do this on occasion. I have no partners to disagree with me. After years in practice, there are days when I’m willing to trade time for dollars and try to regain some sanity.

Maui Independence Day is never anything like "Ferris Bueller’s Day Off." I think the most exciting thing I ever did on it was take my kids to a water park. This past one I spent catching up on paperwork and dictations, trying to fix computer issues, and taking my family out to dinner. But it gives you a few extra hours to catch up on things that would otherwise be crammed into the limited time of a workday, helping you decompress.

Personally, I think everyone should celebrate Maui Independence Day here and there. It helps keep some sanity in an often insane job.

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

I don’t sell vitamins. You want a facial? Or eyelash extensions? Maybe a nice massage? Don’t come to my office.

My secretary is a scheduling wizard, but she’s not going to arrange your flight to Miami or dry-cleaning pick-up.

I don’t understand the number of doctors getting into these services, especially when they’re far outside their field of training. Selling vitamins? Okay, it’s innocuous, but I don’t think I could, with a straight face, convince a patient that the bottle I’m pushing for $40 is better than the one he could get at Costco for a lot cheaper.

Some may claim that this is the problem with American doctors. We don’t "think outside the box" or "embrace new business models." The people who say that are likely making far more money than I ever will.

But I trained to be a neurologist. I think I’m good at it, and I stick with what I know. You have a tremor? Epilepsy? Migraines? I will do my best to help you. This will not involve me trying to sell you a spa membership, bottle of energy tablets, hair extensions, or a "Platinum Package" of pretty much anything. I can only promise to care for you to the best of my ability.

I have nothing against making money. I’m trying to do that, too. But adding on seemingly harmless "services," at least to me, is only going to get in the way of the primary goal in a practice: providing good patient care.

Maybe I’m old fashioned, but I tend to believe doctors do best when they stick to what they know, not what will make the most money.

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

I don’t sell vitamins. You want a facial? Or eyelash extensions? Maybe a nice massage? Don’t come to my office.

My secretary is a scheduling wizard, but she’s not going to arrange your flight to Miami or dry-cleaning pick-up.

I don’t understand the number of doctors getting into these services, especially when they’re far outside their field of training. Selling vitamins? Okay, it’s innocuous, but I don’t think I could, with a straight face, convince a patient that the bottle I’m pushing for $40 is better than the one he could get at Costco for a lot cheaper.

Some may claim that this is the problem with American doctors. We don’t "think outside the box" or "embrace new business models." The people who say that are likely making far more money than I ever will.

But I trained to be a neurologist. I think I’m good at it, and I stick with what I know. You have a tremor? Epilepsy? Migraines? I will do my best to help you. This will not involve me trying to sell you a spa membership, bottle of energy tablets, hair extensions, or a "Platinum Package" of pretty much anything. I can only promise to care for you to the best of my ability.

I have nothing against making money. I’m trying to do that, too. But adding on seemingly harmless "services," at least to me, is only going to get in the way of the primary goal in a practice: providing good patient care.

Maybe I’m old fashioned, but I tend to believe doctors do best when they stick to what they know, not what will make the most money.

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

I don’t sell vitamins. You want a facial? Or eyelash extensions? Maybe a nice massage? Don’t come to my office.

My secretary is a scheduling wizard, but she’s not going to arrange your flight to Miami or dry-cleaning pick-up.

I don’t understand the number of doctors getting into these services, especially when they’re far outside their field of training. Selling vitamins? Okay, it’s innocuous, but I don’t think I could, with a straight face, convince a patient that the bottle I’m pushing for $40 is better than the one he could get at Costco for a lot cheaper.

Some may claim that this is the problem with American doctors. We don’t "think outside the box" or "embrace new business models." The people who say that are likely making far more money than I ever will.

But I trained to be a neurologist. I think I’m good at it, and I stick with what I know. You have a tremor? Epilepsy? Migraines? I will do my best to help you. This will not involve me trying to sell you a spa membership, bottle of energy tablets, hair extensions, or a "Platinum Package" of pretty much anything. I can only promise to care for you to the best of my ability.

I have nothing against making money. I’m trying to do that, too. But adding on seemingly harmless "services," at least to me, is only going to get in the way of the primary goal in a practice: providing good patient care.

Maybe I’m old fashioned, but I tend to believe doctors do best when they stick to what they know, not what will make the most money.

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

An insurance company recently sent me a letter that said they’re going to start marking doctors in patient directories as to whether they’re cost efficient. This is done by "a methodology consistent with national standards ... based on a comparison of fee schedules, utilization patterns, and referral patterns."

I support the overall idea of cost efficiency, and try to follow it. I don’t order MRIs for everything, and typically start with conservative approaches before moving up. I prescribe generic medications when possible. I know patients want to save money, and I know that higher insurance costs affect all of our premiums.

But being cost efficient is certainly not the whole story in medicine. If I were to have a practice of primarily multiple sclerosis patients, I certainly wouldn’t be considered a cost-efficient doctor. Those patients will likely require far more costly drugs and frequent MRIs than someone with lumbar pain or migraines. Even if you’re an excellent doctor, you won’t get good marks for "cost efficiency."

The doctor who saves the most money isn’t necessarily the best doctor. Hell, I can do that. Don’t order expensive tests, diagnose based on clinical grounds, and treat with whatever is cheapest (amitriptyline, phenobarbital, aspirin). I’m sure I’d do fine for a while, until something serious is missed. That’s when the whole thing, medically, ethically, and legally, falls apart.

It’s not all about saving money. Dr. Linda Peeno, the whistleblower on the managed care industry, can tell you that. But rating doctors just on that measure can be misleading at best, and dangerous for all involved at worst.

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

An insurance company recently sent me a letter that said they’re going to start marking doctors in patient directories as to whether they’re cost efficient. This is done by "a methodology consistent with national standards ... based on a comparison of fee schedules, utilization patterns, and referral patterns."

I support the overall idea of cost efficiency, and try to follow it. I don’t order MRIs for everything, and typically start with conservative approaches before moving up. I prescribe generic medications when possible. I know patients want to save money, and I know that higher insurance costs affect all of our premiums.

But being cost efficient is certainly not the whole story in medicine. If I were to have a practice of primarily multiple sclerosis patients, I certainly wouldn’t be considered a cost-efficient doctor. Those patients will likely require far more costly drugs and frequent MRIs than someone with lumbar pain or migraines. Even if you’re an excellent doctor, you won’t get good marks for "cost efficiency."

The doctor who saves the most money isn’t necessarily the best doctor. Hell, I can do that. Don’t order expensive tests, diagnose based on clinical grounds, and treat with whatever is cheapest (amitriptyline, phenobarbital, aspirin). I’m sure I’d do fine for a while, until something serious is missed. That’s when the whole thing, medically, ethically, and legally, falls apart.

It’s not all about saving money. Dr. Linda Peeno, the whistleblower on the managed care industry, can tell you that. But rating doctors just on that measure can be misleading at best, and dangerous for all involved at worst.

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

An insurance company recently sent me a letter that said they’re going to start marking doctors in patient directories as to whether they’re cost efficient. This is done by "a methodology consistent with national standards ... based on a comparison of fee schedules, utilization patterns, and referral patterns."

I support the overall idea of cost efficiency, and try to follow it. I don’t order MRIs for everything, and typically start with conservative approaches before moving up. I prescribe generic medications when possible. I know patients want to save money, and I know that higher insurance costs affect all of our premiums.

But being cost efficient is certainly not the whole story in medicine. If I were to have a practice of primarily multiple sclerosis patients, I certainly wouldn’t be considered a cost-efficient doctor. Those patients will likely require far more costly drugs and frequent MRIs than someone with lumbar pain or migraines. Even if you’re an excellent doctor, you won’t get good marks for "cost efficiency."

The doctor who saves the most money isn’t necessarily the best doctor. Hell, I can do that. Don’t order expensive tests, diagnose based on clinical grounds, and treat with whatever is cheapest (amitriptyline, phenobarbital, aspirin). I’m sure I’d do fine for a while, until something serious is missed. That’s when the whole thing, medically, ethically, and legally, falls apart.

It’s not all about saving money. Dr. Linda Peeno, the whistleblower on the managed care industry, can tell you that. But rating doctors just on that measure can be misleading at best, and dangerous for all involved at worst.

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

Patient theft isn’t technically theft. Or even a crime for that matter. It’s unethical, but it happens all the time.

Here’s an example: My patient lands in a hospital I don’t go to. Even though it’s clearly documented in the chart that they see me as an outpatient, I see notes from the neurologist there saying, "Follow-up with Dr. X in 6 weeks." It’s people like this who give all of us a bad name.

I’m not talking about situations where the other doctor doesn’t know that the patient sees me. In those cases, any of us, when follow-up is needed, would tell the patient to see us in the office. But to try to take a patient knowingly from another physician? That’s wrong.

I share call with three other neurologists, and we addressed this issue long ago. If another person’s patient is seen in the hospital, we make it clear that their regular doctor will resume care when they return, or they should follow up with them.

Sometimes I’ll hear, "But I like you better." In those cases, I tell them that they need to follow up with the established doctor to discuss it further. If they want to look me up and transfer care as an outpatient, I’m not going to stop them, but I’m not going to help them do it, either.

Equally irritating, and perhaps even more unethical, is patient redirection for tests. I see this more often than I care to admit. Two weeks ago, a pain specialist referred a patient to me for hand numbness. I scheduled her to come back for electromyogram/nerve conduction velocity testing, and I sent the specialist the usual letter.

What did he do? He had his staff cancel her EMG appointment with me, and then scheduled her to see one of his partners who did the test. I didn’t know about this until the EMG report showed up on my fax machine with a note saying that the patient would be returning to me to discuss the results.

Likewise, there is an internist in my area who, if I order an MRI on one of his patients, immediately cancels it and redirects the patient to a facility in which he’s a part-owner. I don’t like the place because they use a low-Tesla scanner and don’t have a neuroradiologist. (Disclaimer: I have no financial affiliations with the facility I normally use.)

The sad part of these games is that people are downgraded to pawns, used by physicians as an item of monetary value rather than someone who is seeking care. And that isn’t good for anyone, especially the patient.

Dr. Block has a solo neurology private practice in Scottsdale, Ariz. To respond to this post, e-mail him at [email protected].

Patient theft isn’t technically theft. Or even a crime for that matter. It’s unethical, but it happens all the time.

Here’s an example: My patient lands in a hospital I don’t go to. Even though it’s clearly documented in the chart that they see me as an outpatient, I see notes from the neurologist there saying, "Follow-up with Dr. X in 6 weeks." It’s people like this who give all of us a bad name.

I’m not talking about situations where the other doctor doesn’t know that the patient sees me. In those cases, any of us, when follow-up is needed, would tell the patient to see us in the office. But to try to take a patient knowingly from another physician? That’s wrong.

I share call with three other neurologists, and we addressed this issue long ago. If another person’s patient is seen in the hospital, we make it clear that their regular doctor will resume care when they return, or they should follow up with them.

Sometimes I’ll hear, "But I like you better." In those cases, I tell them that they need to follow up with the established doctor to discuss it further. If they want to look me up and transfer care as an outpatient, I’m not going to stop them, but I’m not going to help them do it, either.

Equally irritating, and perhaps even more unethical, is patient redirection for tests. I see this more often than I care to admit. Two weeks ago, a pain specialist referred a patient to me for hand numbness. I scheduled her to come back for electromyogram/nerve conduction velocity testing, and I sent the specialist the usual letter.

What did he do? He had his staff cancel her EMG appointment with me, and then scheduled her to see one of his partners who did the test. I didn’t know about this until the EMG report showed up on my fax machine with a note saying that the patient would be returning to me to discuss the results.

Likewise, there is an internist in my area who, if I order an MRI on one of his patients, immediately cancels it and redirects the patient to a facility in which he’s a part-owner. I don’t like the place because they use a low-Tesla scanner and don’t have a neuroradiologist. (Disclaimer: I have no financial affiliations with the facility I normally use.)

The sad part of these games is that people are downgraded to pawns, used by physicians as an item of monetary value rather than someone who is seeking care. And that isn’t good for anyone, especially the patient.

Dr. Block has a solo neurology private practice in Scottsdale, Ariz. To respond to this post, e-mail him at [email protected].

Patient theft isn’t technically theft. Or even a crime for that matter. It’s unethical, but it happens all the time.

Here’s an example: My patient lands in a hospital I don’t go to. Even though it’s clearly documented in the chart that they see me as an outpatient, I see notes from the neurologist there saying, "Follow-up with Dr. X in 6 weeks." It’s people like this who give all of us a bad name.

I’m not talking about situations where the other doctor doesn’t know that the patient sees me. In those cases, any of us, when follow-up is needed, would tell the patient to see us in the office. But to try to take a patient knowingly from another physician? That’s wrong.

I share call with three other neurologists, and we addressed this issue long ago. If another person’s patient is seen in the hospital, we make it clear that their regular doctor will resume care when they return, or they should follow up with them.

Sometimes I’ll hear, "But I like you better." In those cases, I tell them that they need to follow up with the established doctor to discuss it further. If they want to look me up and transfer care as an outpatient, I’m not going to stop them, but I’m not going to help them do it, either.

Equally irritating, and perhaps even more unethical, is patient redirection for tests. I see this more often than I care to admit. Two weeks ago, a pain specialist referred a patient to me for hand numbness. I scheduled her to come back for electromyogram/nerve conduction velocity testing, and I sent the specialist the usual letter.

What did he do? He had his staff cancel her EMG appointment with me, and then scheduled her to see one of his partners who did the test. I didn’t know about this until the EMG report showed up on my fax machine with a note saying that the patient would be returning to me to discuss the results.

Likewise, there is an internist in my area who, if I order an MRI on one of his patients, immediately cancels it and redirects the patient to a facility in which he’s a part-owner. I don’t like the place because they use a low-Tesla scanner and don’t have a neuroradiologist. (Disclaimer: I have no financial affiliations with the facility I normally use.)

The sad part of these games is that people are downgraded to pawns, used by physicians as an item of monetary value rather than someone who is seeking care. And that isn’t good for anyone, especially the patient.

Dr. Block has a solo neurology private practice in Scottsdale, Ariz. To respond to this post, e-mail him at [email protected].

Of all the diseases I treat, epilepsy is probably the most poorly understood by the general public. I suppose this is a holdover from the days when it was believed to be demonic possession, or a sign of mental illness. Prince John, youngest child of King George V, was hidden from public view just 100 years ago because of the "shame" the disease might bring on the royal family.

We’ve made great strides in our understanding and treatment of epilepsy in the last 100 years, with the disease slowly changing from a social stigma to just another disorder, like hypertension or diabetes, that – when treated – allows for a normal, fulfilling life. I work hard to educate my patients and their families about the disorder, as the world and Internet are full of myths.

Courtesy Wikimedia Commons

Regardless of what you think about the Supreme Court’s recent decision on the Patient Protection and Affordable Care Act, as neurologists, I suspect many of us were horrified by conservative talk-show host Michael Savage’s comments. He said Chief Justice John Roberts’s vote was likely influenced by his epilepsy treatment causing "cognitive disassociation."

This disgusts me. Cognitive side effects, like side effects in general, occur in the minority of patients. While I don’t know who treats Justice Roberts, I have to assume that, like me, they’ve worked hard to find a treatment that works without affecting his thinking.

Comments like Mr. Savage’s are certainly his right to make. But they’re a slap in the face of every epilepsy patient out there who has to overcome bias to hold down a job, raise a family, drive a car, and do their best to have the same quality of life we all want.

And it appalls me that people still demonize epilepsy patients for their disease, rather than respecting what they are: Human beings who, like Mr. Savage, are entitled to their opinions.

Dr. Block has a solo neurology private practice in Scottsdale, Ariz. To respond to this post, e-mail him at [email protected].

Of all the diseases I treat, epilepsy is probably the most poorly understood by the general public. I suppose this is a holdover from the days when it was believed to be demonic possession, or a sign of mental illness. Prince John, youngest child of King George V, was hidden from public view just 100 years ago because of the "shame" the disease might bring on the royal family.

We’ve made great strides in our understanding and treatment of epilepsy in the last 100 years, with the disease slowly changing from a social stigma to just another disorder, like hypertension or diabetes, that – when treated – allows for a normal, fulfilling life. I work hard to educate my patients and their families about the disorder, as the world and Internet are full of myths.

Courtesy Wikimedia Commons

Regardless of what you think about the Supreme Court’s recent decision on the Patient Protection and Affordable Care Act, as neurologists, I suspect many of us were horrified by conservative talk-show host Michael Savage’s comments. He said Chief Justice John Roberts’s vote was likely influenced by his epilepsy treatment causing "cognitive disassociation."

This disgusts me. Cognitive side effects, like side effects in general, occur in the minority of patients. While I don’t know who treats Justice Roberts, I have to assume that, like me, they’ve worked hard to find a treatment that works without affecting his thinking.

Comments like Mr. Savage’s are certainly his right to make. But they’re a slap in the face of every epilepsy patient out there who has to overcome bias to hold down a job, raise a family, drive a car, and do their best to have the same quality of life we all want.

And it appalls me that people still demonize epilepsy patients for their disease, rather than respecting what they are: Human beings who, like Mr. Savage, are entitled to their opinions.

Dr. Block has a solo neurology private practice in Scottsdale, Ariz. To respond to this post, e-mail him at [email protected].

Of all the diseases I treat, epilepsy is probably the most poorly understood by the general public. I suppose this is a holdover from the days when it was believed to be demonic possession, or a sign of mental illness. Prince John, youngest child of King George V, was hidden from public view just 100 years ago because of the "shame" the disease might bring on the royal family.

We’ve made great strides in our understanding and treatment of epilepsy in the last 100 years, with the disease slowly changing from a social stigma to just another disorder, like hypertension or diabetes, that – when treated – allows for a normal, fulfilling life. I work hard to educate my patients and their families about the disorder, as the world and Internet are full of myths.

Courtesy Wikimedia Commons

Regardless of what you think about the Supreme Court’s recent decision on the Patient Protection and Affordable Care Act, as neurologists, I suspect many of us were horrified by conservative talk-show host Michael Savage’s comments. He said Chief Justice John Roberts’s vote was likely influenced by his epilepsy treatment causing "cognitive disassociation."

This disgusts me. Cognitive side effects, like side effects in general, occur in the minority of patients. While I don’t know who treats Justice Roberts, I have to assume that, like me, they’ve worked hard to find a treatment that works without affecting his thinking.

Comments like Mr. Savage’s are certainly his right to make. But they’re a slap in the face of every epilepsy patient out there who has to overcome bias to hold down a job, raise a family, drive a car, and do their best to have the same quality of life we all want.

And it appalls me that people still demonize epilepsy patients for their disease, rather than respecting what they are: Human beings who, like Mr. Savage, are entitled to their opinions.

Dr. Block has a solo neurology private practice in Scottsdale, Ariz. To respond to this post, e-mail him at [email protected].

I don’t do walk-ins for the most part. My hours are by appointment and, generally, patients who ask to be "squeezed in" can’t be.

I run a small, solo practice. My work hours are set in stone by having to pick up my kids after work, and I can only absorb a certain number of delays in a given day.

If I have the time and someone shows up, I’ll see them, but on a busy day, I usually can’t. In my experience, the person who walks in and says they’ll need "just a few seconds" will be 30 minutes minimum. So it’s best not to start.

I’ll catch flack for this, as I know some doctors will see any established patient who shows up saying they have an urgent issue. But let’s face it – most things patients consider urgent are not. Their reason for coming to my office might be a typical migraine they want treated (when they could have just called for a prescription refill), a drug side effect (which could be handled by phone), or because they woke up with a pulled muscle. None of these are medically urgent.

This isn’t to say that real emergencies don’t come in. But, for those cases, I can’t do very much. Stroke? How many of you have a CT scanner or TPA in your office? Status epilepticus? I don’t carry controlled drugs here and never will. The only thing I can do is send these people to the emergency department immediately.

Even then, I’ve had a frightening number of my patients show up here with acute issues that are entirely non-neurologic. This has included crushing chest pain, unilateral leg edema, acute dyspnea on exertion, and (once) an obviously broken arm. So I send them to the ED, too.

I’m sure some people will say I’m uncaring, but that’s not true. Most days usually have 30-60 minutes of space where I can see someone in a pinch (noon, usually). So I can do the occasional legitimate work-in, and I do. Some patients try to take advantage of this more than once and quickly learn not to.

The problem is that if you accommodate everyone who wants to be worked in, your practice becomes a free-for-all. People cry "Wolf!" A line has to be drawn somewhere.

Dr. Block has a solo neurology private practice in Scottsdale, Ariz. To respond to this post, e-mail him at [email protected].

I don’t do walk-ins for the most part. My hours are by appointment and, generally, patients who ask to be "squeezed in" can’t be.

I run a small, solo practice. My work hours are set in stone by having to pick up my kids after work, and I can only absorb a certain number of delays in a given day.

If I have the time and someone shows up, I’ll see them, but on a busy day, I usually can’t. In my experience, the person who walks in and says they’ll need "just a few seconds" will be 30 minutes minimum. So it’s best not to start.

I’ll catch flack for this, as I know some doctors will see any established patient who shows up saying they have an urgent issue. But let’s face it – most things patients consider urgent are not. Their reason for coming to my office might be a typical migraine they want treated (when they could have just called for a prescription refill), a drug side effect (which could be handled by phone), or because they woke up with a pulled muscle. None of these are medically urgent.

This isn’t to say that real emergencies don’t come in. But, for those cases, I can’t do very much. Stroke? How many of you have a CT scanner or TPA in your office? Status epilepticus? I don’t carry controlled drugs here and never will. The only thing I can do is send these people to the emergency department immediately.

Even then, I’ve had a frightening number of my patients show up here with acute issues that are entirely non-neurologic. This has included crushing chest pain, unilateral leg edema, acute dyspnea on exertion, and (once) an obviously broken arm. So I send them to the ED, too.

I’m sure some people will say I’m uncaring, but that’s not true. Most days usually have 30-60 minutes of space where I can see someone in a pinch (noon, usually). So I can do the occasional legitimate work-in, and I do. Some patients try to take advantage of this more than once and quickly learn not to.

The problem is that if you accommodate everyone who wants to be worked in, your practice becomes a free-for-all. People cry "Wolf!" A line has to be drawn somewhere.

Dr. Block has a solo neurology private practice in Scottsdale, Ariz. To respond to this post, e-mail him at [email protected].

I don’t do walk-ins for the most part. My hours are by appointment and, generally, patients who ask to be "squeezed in" can’t be.

I run a small, solo practice. My work hours are set in stone by having to pick up my kids after work, and I can only absorb a certain number of delays in a given day.

If I have the time and someone shows up, I’ll see them, but on a busy day, I usually can’t. In my experience, the person who walks in and says they’ll need "just a few seconds" will be 30 minutes minimum. So it’s best not to start.

I’ll catch flack for this, as I know some doctors will see any established patient who shows up saying they have an urgent issue. But let’s face it – most things patients consider urgent are not. Their reason for coming to my office might be a typical migraine they want treated (when they could have just called for a prescription refill), a drug side effect (which could be handled by phone), or because they woke up with a pulled muscle. None of these are medically urgent.

This isn’t to say that real emergencies don’t come in. But, for those cases, I can’t do very much. Stroke? How many of you have a CT scanner or TPA in your office? Status epilepticus? I don’t carry controlled drugs here and never will. The only thing I can do is send these people to the emergency department immediately.

Even then, I’ve had a frightening number of my patients show up here with acute issues that are entirely non-neurologic. This has included crushing chest pain, unilateral leg edema, acute dyspnea on exertion, and (once) an obviously broken arm. So I send them to the ED, too.

I’m sure some people will say I’m uncaring, but that’s not true. Most days usually have 30-60 minutes of space where I can see someone in a pinch (noon, usually). So I can do the occasional legitimate work-in, and I do. Some patients try to take advantage of this more than once and quickly learn not to.

The problem is that if you accommodate everyone who wants to be worked in, your practice becomes a free-for-all. People cry "Wolf!" A line has to be drawn somewhere.

Dr. Block has a solo neurology private practice in Scottsdale, Ariz. To respond to this post, e-mail him at [email protected].

One of the nice things about solo office practice is occasionally being able to have one of my (or my staff members’) kids at the office. This isn’t, by any means, something I do often. But my wife’s job won’t allow her to have kids there, so when they’re too sick to go to school it comes down to one of us either staying home or me taking them to my office.

It actually works out pretty well. There’s an unused back office where they can set up shop, and the modern world is full of portable electronic gadgets to keep them busy. I can’t hear them from my office, and they can’t hear what’s said in my office.

What surprises me are the patients who find this upsetting. My kids know not to come out of there if I have a patient, and the only time a patient even knows a child is there is if they wander down the hall to use the bathroom or get something out of the refrigerator. And in my practice, I rarely see immune-suppressed patients.

In spite of this, I’ve had 5-10 patients in the last 10 years complain about it, always on the grounds that it "isn’t professional." Three patients have left the practice because of it. Not surprisingly, none of them had kids of their own.

I still don’t understand this. I have to see doctors myself, and the rare time I notice a child in the office I think nothing of it.

Granted, many of us don’t have the luxury of doing this. But when it’s possible, I have no issues with it at all. I’d rather have a doctor who is concerned enough to bring his kids to work rather than leave them at home alone.

One of the nice things about solo office practice is occasionally being able to have one of my (or my staff members’) kids at the office. This isn’t, by any means, something I do often. But my wife’s job won’t allow her to have kids there, so when they’re too sick to go to school it comes down to one of us either staying home or me taking them to my office.

It actually works out pretty well. There’s an unused back office where they can set up shop, and the modern world is full of portable electronic gadgets to keep them busy. I can’t hear them from my office, and they can’t hear what’s said in my office.

What surprises me are the patients who find this upsetting. My kids know not to come out of there if I have a patient, and the only time a patient even knows a child is there is if they wander down the hall to use the bathroom or get something out of the refrigerator. And in my practice, I rarely see immune-suppressed patients.

In spite of this, I’ve had 5-10 patients in the last 10 years complain about it, always on the grounds that it "isn’t professional." Three patients have left the practice because of it. Not surprisingly, none of them had kids of their own.

I still don’t understand this. I have to see doctors myself, and the rare time I notice a child in the office I think nothing of it.

Granted, many of us don’t have the luxury of doing this. But when it’s possible, I have no issues with it at all. I’d rather have a doctor who is concerned enough to bring his kids to work rather than leave them at home alone.

One of the nice things about solo office practice is occasionally being able to have one of my (or my staff members’) kids at the office. This isn’t, by any means, something I do often. But my wife’s job won’t allow her to have kids there, so when they’re too sick to go to school it comes down to one of us either staying home or me taking them to my office.

It actually works out pretty well. There’s an unused back office where they can set up shop, and the modern world is full of portable electronic gadgets to keep them busy. I can’t hear them from my office, and they can’t hear what’s said in my office.

What surprises me are the patients who find this upsetting. My kids know not to come out of there if I have a patient, and the only time a patient even knows a child is there is if they wander down the hall to use the bathroom or get something out of the refrigerator. And in my practice, I rarely see immune-suppressed patients.

In spite of this, I’ve had 5-10 patients in the last 10 years complain about it, always on the grounds that it "isn’t professional." Three patients have left the practice because of it. Not surprisingly, none of them had kids of their own.

I still don’t understand this. I have to see doctors myself, and the rare time I notice a child in the office I think nothing of it.

Granted, many of us don’t have the luxury of doing this. But when it’s possible, I have no issues with it at all. I’d rather have a doctor who is concerned enough to bring his kids to work rather than leave them at home alone.

How often do you take a sick day? For me, maybe 1-2 times a year.

I hate doing it because it’s a nightmare for my staff (to do the frantic rescheduling) and the patients. I have to work overtime down the road to get the rescheduled people seen in a timely fashion. Not only that, but from a solo practice financial point of view, if I’m not there, the revenue stream is shut off. So I’ll pretty much go to work unless I’m incapacitated.

Most patients are understanding when this happens, but a vocal minority become quite upset. They somehow expect us to be unaffected by the health concerns of nondoctors.

The nature of our work as healers doesn’t make us superhuman. We can have the same illnesses and injuries as our patients. Our kids bring home the same germs. We have to negotiate the same traffic hazards.

By the same token, it’s amazing how often I hear other doctors saying of their illness, "How could this happen to me? I’m a doctor!" There seems to be an unspoken belief that by caring for others we should be magically protected from those same diseases.

In spite of our knowledge, we’re still human. Most of us will take the cheeseburger over the tofu patty any day. And, as I noted in a previous column, the stress and hours of this job likely put us at higher risk of vascular disease than our own patients.

For better or worse, none of us are superhuman. And never will be.

Dr. Block has a solo neurology private practice in Scottsdale, Ariz. To respond to this column, e-mail him at [email protected].

How often do you take a sick day? For me, maybe 1-2 times a year.

I hate doing it because it’s a nightmare for my staff (to do the frantic rescheduling) and the patients. I have to work overtime down the road to get the rescheduled people seen in a timely fashion. Not only that, but from a solo practice financial point of view, if I’m not there, the revenue stream is shut off. So I’ll pretty much go to work unless I’m incapacitated.

Most patients are understanding when this happens, but a vocal minority become quite upset. They somehow expect us to be unaffected by the health concerns of nondoctors.

The nature of our work as healers doesn’t make us superhuman. We can have the same illnesses and injuries as our patients. Our kids bring home the same germs. We have to negotiate the same traffic hazards.

By the same token, it’s amazing how often I hear other doctors saying of their illness, "How could this happen to me? I’m a doctor!" There seems to be an unspoken belief that by caring for others we should be magically protected from those same diseases.

In spite of our knowledge, we’re still human. Most of us will take the cheeseburger over the tofu patty any day. And, as I noted in a previous column, the stress and hours of this job likely put us at higher risk of vascular disease than our own patients.

For better or worse, none of us are superhuman. And never will be.

Dr. Block has a solo neurology private practice in Scottsdale, Ariz. To respond to this column, e-mail him at [email protected].

How often do you take a sick day? For me, maybe 1-2 times a year.

I hate doing it because it’s a nightmare for my staff (to do the frantic rescheduling) and the patients. I have to work overtime down the road to get the rescheduled people seen in a timely fashion. Not only that, but from a solo practice financial point of view, if I’m not there, the revenue stream is shut off. So I’ll pretty much go to work unless I’m incapacitated.

Most patients are understanding when this happens, but a vocal minority become quite upset. They somehow expect us to be unaffected by the health concerns of nondoctors.

The nature of our work as healers doesn’t make us superhuman. We can have the same illnesses and injuries as our patients. Our kids bring home the same germs. We have to negotiate the same traffic hazards.

By the same token, it’s amazing how often I hear other doctors saying of their illness, "How could this happen to me? I’m a doctor!" There seems to be an unspoken belief that by caring for others we should be magically protected from those same diseases.

In spite of our knowledge, we’re still human. Most of us will take the cheeseburger over the tofu patty any day. And, as I noted in a previous column, the stress and hours of this job likely put us at higher risk of vascular disease than our own patients.

For better or worse, none of us are superhuman. And never will be.

Dr. Block has a solo neurology private practice in Scottsdale, Ariz. To respond to this column, e-mail him at [email protected].

A recent issue of Practical Neurology had a brief article titled, "CT Scans for Dizziness May Not be Cost Effective" (January/February 2012, p. 6). The article described a study that found that less than 1% of CT scans of 1,681 emergency department patients presenting with "dizziness" showed a serious cause, leaving the scan’s cost effectiveness questionable.

(Although "dizziness" might not be very specific to you, it’s what the article said, and what patients say, and what gets listed on the admitting sheet.)

How many times have we seen studies like this? There are a lot of them. And how many times do they really change physician behavior? Any hands? Nope.

The issue here is not that doing a head CT in these cases is pointless. I think most neurologists and ED docs would agree the scan is pretty low yield in generic dizziness (assuming no other significant symptoms or exam findings).

The real issue here is the practice of defensive medicine in America. Just because the CT scan probably won’t show anything significant doesn’t change the fact that it could. It’s like a serious surgical complication: There may be only a 1% chance of something going wrong, but if it happens to you the incidence just went up to 100% for your case, and you may be in some deep trouble.

We all live in fear of being sued, and a routine CT scan is a simple, reasonably safe, and quick study. Unless there’s a legislative sea change that protects doctors who don’t order one (and we all know that isn’t going to happen), I don’t see their use for routine dizziness decreasing anytime soon.

Yes, this is the sort of behavior that drives costs up. It’s defensive medicine. And I don’t know any doctors who don’t do it. In the current climate, protecting ourselves always trumps saving money for an insurance company, because it won’t be the one on the hook if a disaster is missed.

Dr. Block has a solo neurology private practice in Scottsdale, Ariz. He has been a practicing neurologist since 1998 and in private practice since 2000.

A recent issue of Practical Neurology had a brief article titled, "CT Scans for Dizziness May Not be Cost Effective" (January/February 2012, p. 6). The article described a study that found that less than 1% of CT scans of 1,681 emergency department patients presenting with "dizziness" showed a serious cause, leaving the scan’s cost effectiveness questionable.

(Although "dizziness" might not be very specific to you, it’s what the article said, and what patients say, and what gets listed on the admitting sheet.)

How many times have we seen studies like this? There are a lot of them. And how many times do they really change physician behavior? Any hands? Nope.

The issue here is not that doing a head CT in these cases is pointless. I think most neurologists and ED docs would agree the scan is pretty low yield in generic dizziness (assuming no other significant symptoms or exam findings).

The real issue here is the practice of defensive medicine in America. Just because the CT scan probably won’t show anything significant doesn’t change the fact that it could. It’s like a serious surgical complication: There may be only a 1% chance of something going wrong, but if it happens to you the incidence just went up to 100% for your case, and you may be in some deep trouble.

We all live in fear of being sued, and a routine CT scan is a simple, reasonably safe, and quick study. Unless there’s a legislative sea change that protects doctors who don’t order one (and we all know that isn’t going to happen), I don’t see their use for routine dizziness decreasing anytime soon.

Yes, this is the sort of behavior that drives costs up. It’s defensive medicine. And I don’t know any doctors who don’t do it. In the current climate, protecting ourselves always trumps saving money for an insurance company, because it won’t be the one on the hook if a disaster is missed.

Dr. Block has a solo neurology private practice in Scottsdale, Ariz. He has been a practicing neurologist since 1998 and in private practice since 2000.

A recent issue of Practical Neurology had a brief article titled, "CT Scans for Dizziness May Not be Cost Effective" (January/February 2012, p. 6). The article described a study that found that less than 1% of CT scans of 1,681 emergency department patients presenting with "dizziness" showed a serious cause, leaving the scan’s cost effectiveness questionable.

(Although "dizziness" might not be very specific to you, it’s what the article said, and what patients say, and what gets listed on the admitting sheet.)

How many times have we seen studies like this? There are a lot of them. And how many times do they really change physician behavior? Any hands? Nope.

The issue here is not that doing a head CT in these cases is pointless. I think most neurologists and ED docs would agree the scan is pretty low yield in generic dizziness (assuming no other significant symptoms or exam findings).

The real issue here is the practice of defensive medicine in America. Just because the CT scan probably won’t show anything significant doesn’t change the fact that it could. It’s like a serious surgical complication: There may be only a 1% chance of something going wrong, but if it happens to you the incidence just went up to 100% for your case, and you may be in some deep trouble.

We all live in fear of being sued, and a routine CT scan is a simple, reasonably safe, and quick study. Unless there’s a legislative sea change that protects doctors who don’t order one (and we all know that isn’t going to happen), I don’t see their use for routine dizziness decreasing anytime soon.

Yes, this is the sort of behavior that drives costs up. It’s defensive medicine. And I don’t know any doctors who don’t do it. In the current climate, protecting ourselves always trumps saving money for an insurance company, because it won’t be the one on the hook if a disaster is missed.

Dr. Block has a solo neurology private practice in Scottsdale, Ariz. He has been a practicing neurologist since 1998 and in private practice since 2000.

In my last post, I wrote about trying to practice medicine solely by telephone. This week I’m going to the opposite extreme.

In a recent Sermo.com post, a doctor commented about how he NEVER deals with patients by phone under any circumstances. He uses his answering service as a go-between, with two options:

• Call back tomorrow.

• If this is an emergency, I will meet you right now at my office (if I can find a chaperone) or at the emergency department (if I can’t).

He was critical of doctors who do anything by phone, mainly on the grounds of potential legal liability and lack of reimbursement for such. On paper, this is a great, if not commendable, view. In reality, it won’t work for the vast majority of us.

I don’t like getting calls after hours, but they’re a fact of life in this business. Being in solo practice, I have the advantage of knowing my patients. My charts are only as far away as my MacBook (a relatively modern benefit).

Obviously, I’m not going to try to manage acute or serious things by phone, and have sent my share of patients to the ED. But I’d rather be called for a refill on an empty bottle of antiseizure medication by a patient than by an emergency physician seeing him for a missed-medication car wreck.

If one of my patients has a seizure (or other acute neurologic change) I’d rather know about it sooner than later. It’s easy to come to a decision and type up a quick note to document it. I’m not saying you should manage everything by phone, but refusing to manage anything by phone, especially in a patient who is well known to you, is just silly.

Yes, phone calls have legal liability, but so does everything else we do. Just like an office visit, you document it carefully. Even refusing to take phone calls and sending everyone to the ED has some degree of liability. It’s also going to cost you in the long run, from patients sick of being routed there for every call. They’ll leave your practice, and likely complain to your referring sources about you.

"We don't get paid to answer after-hours phone calls." So what? We also don’t get paid to write scripts for 90-day mail-in supplies, renew physical therapy, or order a follow-up MRI for a meningioma. Time is money, and dealing with phone calls can help. A simple question that could have been answered by phone will likely take up the same amount of schedule time as a more complex case that not only pays at a higher level, but needs to see you more.

Most doctors (I hope) have their own physicians. Have you ever called yours with a question after hours? If so, how would you have felt if they said "just go to the ED"?

No one likes getting calls after hours. But being able to tell what can (and can’t) be handled by phone is part of what we do. And part of providing good patient care.

In my last post, I wrote about trying to practice medicine solely by telephone. This week I’m going to the opposite extreme.

In a recent Sermo.com post, a doctor commented about how he NEVER deals with patients by phone under any circumstances. He uses his answering service as a go-between, with two options:

• Call back tomorrow.

• If this is an emergency, I will meet you right now at my office (if I can find a chaperone) or at the emergency department (if I can’t).

He was critical of doctors who do anything by phone, mainly on the grounds of potential legal liability and lack of reimbursement for such. On paper, this is a great, if not commendable, view. In reality, it won’t work for the vast majority of us.

I don’t like getting calls after hours, but they’re a fact of life in this business. Being in solo practice, I have the advantage of knowing my patients. My charts are only as far away as my MacBook (a relatively modern benefit).

Obviously, I’m not going to try to manage acute or serious things by phone, and have sent my share of patients to the ED. But I’d rather be called for a refill on an empty bottle of antiseizure medication by a patient than by an emergency physician seeing him for a missed-medication car wreck.

If one of my patients has a seizure (or other acute neurologic change) I’d rather know about it sooner than later. It’s easy to come to a decision and type up a quick note to document it. I’m not saying you should manage everything by phone, but refusing to manage anything by phone, especially in a patient who is well known to you, is just silly.

Yes, phone calls have legal liability, but so does everything else we do. Just like an office visit, you document it carefully. Even refusing to take phone calls and sending everyone to the ED has some degree of liability. It’s also going to cost you in the long run, from patients sick of being routed there for every call. They’ll leave your practice, and likely complain to your referring sources about you.

"We don't get paid to answer after-hours phone calls." So what? We also don’t get paid to write scripts for 90-day mail-in supplies, renew physical therapy, or order a follow-up MRI for a meningioma. Time is money, and dealing with phone calls can help. A simple question that could have been answered by phone will likely take up the same amount of schedule time as a more complex case that not only pays at a higher level, but needs to see you more.

Most doctors (I hope) have their own physicians. Have you ever called yours with a question after hours? If so, how would you have felt if they said "just go to the ED"?

No one likes getting calls after hours. But being able to tell what can (and can’t) be handled by phone is part of what we do. And part of providing good patient care.

In my last post, I wrote about trying to practice medicine solely by telephone. This week I’m going to the opposite extreme.

In a recent Sermo.com post, a doctor commented about how he NEVER deals with patients by phone under any circumstances. He uses his answering service as a go-between, with two options:

• Call back tomorrow.

• If this is an emergency, I will meet you right now at my office (if I can find a chaperone) or at the emergency department (if I can’t).

He was critical of doctors who do anything by phone, mainly on the grounds of potential legal liability and lack of reimbursement for such. On paper, this is a great, if not commendable, view. In reality, it won’t work for the vast majority of us.

I don’t like getting calls after hours, but they’re a fact of life in this business. Being in solo practice, I have the advantage of knowing my patients. My charts are only as far away as my MacBook (a relatively modern benefit).

Obviously, I’m not going to try to manage acute or serious things by phone, and have sent my share of patients to the ED. But I’d rather be called for a refill on an empty bottle of antiseizure medication by a patient than by an emergency physician seeing him for a missed-medication car wreck.

If one of my patients has a seizure (or other acute neurologic change) I’d rather know about it sooner than later. It’s easy to come to a decision and type up a quick note to document it. I’m not saying you should manage everything by phone, but refusing to manage anything by phone, especially in a patient who is well known to you, is just silly.

Yes, phone calls have legal liability, but so does everything else we do. Just like an office visit, you document it carefully. Even refusing to take phone calls and sending everyone to the ED has some degree of liability. It’s also going to cost you in the long run, from patients sick of being routed there for every call. They’ll leave your practice, and likely complain to your referring sources about you.

"We don't get paid to answer after-hours phone calls." So what? We also don’t get paid to write scripts for 90-day mail-in supplies, renew physical therapy, or order a follow-up MRI for a meningioma. Time is money, and dealing with phone calls can help. A simple question that could have been answered by phone will likely take up the same amount of schedule time as a more complex case that not only pays at a higher level, but needs to see you more.

Most doctors (I hope) have their own physicians. Have you ever called yours with a question after hours? If so, how would you have felt if they said "just go to the ED"?

No one likes getting calls after hours. But being able to tell what can (and can’t) be handled by phone is part of what we do. And part of providing good patient care.