Allan M. Block, MD

Recently Sermo had an interesting case report. A young woman, a few hours after undergoing cupping and acupuncture to her upper back, developed dyspnea and presented to the emergency department. There she was found to have a pneumothorax requiring chest tube placement.

I’m certainly not an expert on pneumothoraces, cupping, or acupuncture. Maybe the occurrence is coincidental, though it certainly is temporally concerning.

If I were to cause a pneumothorax doing an electromyography and nerve conduction velocity of the chest wall or upper back, I’m sure I’d have a lot to answer for. Beyond just arranging care for the patient and explaining things to her and her family members, I’d probably have to deal with a board investigation and/or malpractice claim.

Yet, in my experience, people who provide such services rarely face legal accountability, whereas their counterparts in allopathic medicine regularly do so. How many late-night TV attorney ads have you seen that say “have you been injured by an acupuncturist?”

Me, neither.

I’m not going to go into the questions of whether acupuncture, or even cupping, do anything at all. But this case also raises the point that people tend to think of “alternative” medical treatments as things that, while of unclear benefit, are generally harmless.

The fact is that there is no such thing as a risk-free medical procedure. There probably never will be. No matter how well trained and intentioned the person doing it is, there is always the chance of something going wrong. Human error, mechanical failure, bad luck. As they say, dung happens.

In medicine we think about the risk-benefit ratio and proceed accordingly. But the risk, no matter how low, is never zero. People need to understand this applies to pretty much everything health-related. Even over-the-counter supplements, no matter how great their claims may sound (also unproven) have their issues.

Caveat emptor.

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

Recently Sermo had an interesting case report. A young woman, a few hours after undergoing cupping and acupuncture to her upper back, developed dyspnea and presented to the emergency department. There she was found to have a pneumothorax requiring chest tube placement.

I’m certainly not an expert on pneumothoraces, cupping, or acupuncture. Maybe the occurrence is coincidental, though it certainly is temporally concerning.

If I were to cause a pneumothorax doing an electromyography and nerve conduction velocity of the chest wall or upper back, I’m sure I’d have a lot to answer for. Beyond just arranging care for the patient and explaining things to her and her family members, I’d probably have to deal with a board investigation and/or malpractice claim.

Yet, in my experience, people who provide such services rarely face legal accountability, whereas their counterparts in allopathic medicine regularly do so. How many late-night TV attorney ads have you seen that say “have you been injured by an acupuncturist?”

Me, neither.

I’m not going to go into the questions of whether acupuncture, or even cupping, do anything at all. But this case also raises the point that people tend to think of “alternative” medical treatments as things that, while of unclear benefit, are generally harmless.

The fact is that there is no such thing as a risk-free medical procedure. There probably never will be. No matter how well trained and intentioned the person doing it is, there is always the chance of something going wrong. Human error, mechanical failure, bad luck. As they say, dung happens.

In medicine we think about the risk-benefit ratio and proceed accordingly. But the risk, no matter how low, is never zero. People need to understand this applies to pretty much everything health-related. Even over-the-counter supplements, no matter how great their claims may sound (also unproven) have their issues.

Caveat emptor.

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

Recently Sermo had an interesting case report. A young woman, a few hours after undergoing cupping and acupuncture to her upper back, developed dyspnea and presented to the emergency department. There she was found to have a pneumothorax requiring chest tube placement.

I’m certainly not an expert on pneumothoraces, cupping, or acupuncture. Maybe the occurrence is coincidental, though it certainly is temporally concerning.

If I were to cause a pneumothorax doing an electromyography and nerve conduction velocity of the chest wall or upper back, I’m sure I’d have a lot to answer for. Beyond just arranging care for the patient and explaining things to her and her family members, I’d probably have to deal with a board investigation and/or malpractice claim.

Yet, in my experience, people who provide such services rarely face legal accountability, whereas their counterparts in allopathic medicine regularly do so. How many late-night TV attorney ads have you seen that say “have you been injured by an acupuncturist?”

Me, neither.

I’m not going to go into the questions of whether acupuncture, or even cupping, do anything at all. But this case also raises the point that people tend to think of “alternative” medical treatments as things that, while of unclear benefit, are generally harmless.

The fact is that there is no such thing as a risk-free medical procedure. There probably never will be. No matter how well trained and intentioned the person doing it is, there is always the chance of something going wrong. Human error, mechanical failure, bad luck. As they say, dung happens.

In medicine we think about the risk-benefit ratio and proceed accordingly. But the risk, no matter how low, is never zero. People need to understand this applies to pretty much everything health-related. Even over-the-counter supplements, no matter how great their claims may sound (also unproven) have their issues.

Caveat emptor.

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

News reports this week indicate that the U.S. Department of Justice is investigating Cassava Sciences over the investigational Alzheimer’s disease agent simufilam. An article in Science alleged that the company’s research included altered or duplicated brain images.

Cassava, not surprisingly, denies this. And I’m not going to take sides. Maybe they’ll be exonerated, maybe not.

But the bigger point here is the importance of checking such things. Alzheimer’s disease, beyond being a horrible neurological disease, is also big money. REALLY big money. If a company were to develop a truly effective treatment for it, they’d be poised to reap a worldwide financial windfall.

I’m not criticizing that, either. If such a drug were to be developed, with all of the time and money that goes into such things, they’d have earned every penny.

But the financial incentives certainly do increase the risk of less-than-ethical behavior. This isn’t just in Alzheimer’s disease, but across the board in medicine. The main plot line of the 1993 Harrison Ford flick “The Fugitive” was based on a drug company using falsified data, bribes, and other criminal activities (like murder) to bring a potentially dangerous (but high-profit) drug to market.

Less-than-ethical behavior is not new in research either. In 1926 Paul Kammerer’s attempt to prove Lamarckian evolution was shown to be a fraud. Cover-ups of potentially dangerous drugs have also occurred, or been alleged, and resulted in some being withdrawn from the market.

I’m not sure this is any worse than the multitude of over-the-counter products I see in the store saying they promote brain health, joint health, immune health, whatever ... then, in tiny letters, adding “these statements have not been authorized by the FDA. This drug is not intended to cure, prevent, or treat any disease.” This is no different than guys selling snake oil and other worthless elixirs out of a horse-drawn wagon. Why they aren’t regulated in the same way Pfizer or Lilly are is beyond me.

Even beyond the old method of making up figures, data can still be iffy. We use the phrase “numbers don’t lie” – and generally they don’t – but the ability to “spin” them to suit any narrative has become an art form. If you can’t change the data, make them fit into a better scenario. Somehow.

Which brings me back to why it’s critically important that such studies be open to review by people who don’t have a conflict of interest in the success or failure of the drugs. No matter how well-intentioned a company and its scientists may be, no person is entirely immune to the pressures involved to succeed. And there are many: from shareholders, from executives, even from the knowledge that a bad outcome may mean they’re out of a job.

Fraud is nothing new in medicine. I also don’t see it going away anytime in the future. It’s not the nature of medicine, but it is the nature of some people. And a few of them increase the need for legitimacy in everyone else.

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

News reports this week indicate that the U.S. Department of Justice is investigating Cassava Sciences over the investigational Alzheimer’s disease agent simufilam. An article in Science alleged that the company’s research included altered or duplicated brain images.

Cassava, not surprisingly, denies this. And I’m not going to take sides. Maybe they’ll be exonerated, maybe not.

But the bigger point here is the importance of checking such things. Alzheimer’s disease, beyond being a horrible neurological disease, is also big money. REALLY big money. If a company were to develop a truly effective treatment for it, they’d be poised to reap a worldwide financial windfall.

I’m not criticizing that, either. If such a drug were to be developed, with all of the time and money that goes into such things, they’d have earned every penny.

But the financial incentives certainly do increase the risk of less-than-ethical behavior. This isn’t just in Alzheimer’s disease, but across the board in medicine. The main plot line of the 1993 Harrison Ford flick “The Fugitive” was based on a drug company using falsified data, bribes, and other criminal activities (like murder) to bring a potentially dangerous (but high-profit) drug to market.

Less-than-ethical behavior is not new in research either. In 1926 Paul Kammerer’s attempt to prove Lamarckian evolution was shown to be a fraud. Cover-ups of potentially dangerous drugs have also occurred, or been alleged, and resulted in some being withdrawn from the market.

I’m not sure this is any worse than the multitude of over-the-counter products I see in the store saying they promote brain health, joint health, immune health, whatever ... then, in tiny letters, adding “these statements have not been authorized by the FDA. This drug is not intended to cure, prevent, or treat any disease.” This is no different than guys selling snake oil and other worthless elixirs out of a horse-drawn wagon. Why they aren’t regulated in the same way Pfizer or Lilly are is beyond me.

Even beyond the old method of making up figures, data can still be iffy. We use the phrase “numbers don’t lie” – and generally they don’t – but the ability to “spin” them to suit any narrative has become an art form. If you can’t change the data, make them fit into a better scenario. Somehow.

Which brings me back to why it’s critically important that such studies be open to review by people who don’t have a conflict of interest in the success or failure of the drugs. No matter how well-intentioned a company and its scientists may be, no person is entirely immune to the pressures involved to succeed. And there are many: from shareholders, from executives, even from the knowledge that a bad outcome may mean they’re out of a job.

Fraud is nothing new in medicine. I also don’t see it going away anytime in the future. It’s not the nature of medicine, but it is the nature of some people. And a few of them increase the need for legitimacy in everyone else.

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

News reports this week indicate that the U.S. Department of Justice is investigating Cassava Sciences over the investigational Alzheimer’s disease agent simufilam. An article in Science alleged that the company’s research included altered or duplicated brain images.

Cassava, not surprisingly, denies this. And I’m not going to take sides. Maybe they’ll be exonerated, maybe not.

But the bigger point here is the importance of checking such things. Alzheimer’s disease, beyond being a horrible neurological disease, is also big money. REALLY big money. If a company were to develop a truly effective treatment for it, they’d be poised to reap a worldwide financial windfall.

I’m not criticizing that, either. If such a drug were to be developed, with all of the time and money that goes into such things, they’d have earned every penny.

But the financial incentives certainly do increase the risk of less-than-ethical behavior. This isn’t just in Alzheimer’s disease, but across the board in medicine. The main plot line of the 1993 Harrison Ford flick “The Fugitive” was based on a drug company using falsified data, bribes, and other criminal activities (like murder) to bring a potentially dangerous (but high-profit) drug to market.

Less-than-ethical behavior is not new in research either. In 1926 Paul Kammerer’s attempt to prove Lamarckian evolution was shown to be a fraud. Cover-ups of potentially dangerous drugs have also occurred, or been alleged, and resulted in some being withdrawn from the market.

I’m not sure this is any worse than the multitude of over-the-counter products I see in the store saying they promote brain health, joint health, immune health, whatever ... then, in tiny letters, adding “these statements have not been authorized by the FDA. This drug is not intended to cure, prevent, or treat any disease.” This is no different than guys selling snake oil and other worthless elixirs out of a horse-drawn wagon. Why they aren’t regulated in the same way Pfizer or Lilly are is beyond me.

Even beyond the old method of making up figures, data can still be iffy. We use the phrase “numbers don’t lie” – and generally they don’t – but the ability to “spin” them to suit any narrative has become an art form. If you can’t change the data, make them fit into a better scenario. Somehow.

Which brings me back to why it’s critically important that such studies be open to review by people who don’t have a conflict of interest in the success or failure of the drugs. No matter how well-intentioned a company and its scientists may be, no person is entirely immune to the pressures involved to succeed. And there are many: from shareholders, from executives, even from the knowledge that a bad outcome may mean they’re out of a job.

Fraud is nothing new in medicine. I also don’t see it going away anytime in the future. It’s not the nature of medicine, but it is the nature of some people. And a few of them increase the need for legitimacy in everyone else.

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

There was a recent post on Sermo about medical office staff cross-training. It talked about the importance of the scheduler being able to cover for the medical assistant (to an extent), a billing person being able to room patients, and so on.

Here, in my little three-person office, the only thing my staff can’t do is see patients.

Actually, more than 2 years out since the pandemic changed everyone’s lives, we’ve settled into a very different cross-training routine. I’m the only one at my office. My medical assistant works from home, far north of me, and so does my scheduler, who is across town.

So, at the office, I handle it all. I check people in, copy insurance cards, collect copays, see patients, and make follow-ups.

At this time, I’ve not only gotten used to it, but really don’t mind it.

We don’t worry about freeway traffic. My staff starts at the exact time each day, and so I don’t worry about one of them being an hour late, trapped behind a rush-hour pile-up on the 101. Staying at home with a sick kid isn’t an issue either, anymore. If my secretary has to make her young daughter lunch, or run her over to a birthday party, I don’t even notice it. If there are any problems, she knows how to reach me. Same with my medical assistant.

Nobody worries about what to throw together for dinner if they get home late.

In an era where other businesses want to reverse the work-from-home trend, I don’t see an issue with its continuing for some jobs. It saves money on rent, and money and time on transportation.

Gas prices, at least for driving to and from work for them, don’t have to be factored into the wage equations. I’d guess it’s about 1,000 gallons of gas a year saved. On a national scale that’s nothing, but to my staff right now that’s $3,000-$4,000 more in their pockets at the end of the year. Not to mention it’s two more cars off the road.

Granted, this doesn’t change what I’m doing. Seeing patients in person is a key part of being a doctor. Some things can be handled equally well over the phone or Zoom, but many can’t. It’s what I signed up for, and I really don’t mind it. Seeing patients is still what I enjoy.

My staff is a lot happier with this arrangement, and I don’t mind it either. I always, by nature, kept a reasonably paced schedule. Trying to shoehorn patients in has never been my way, so I have time to run a credit card or scan insurance information.

When one of my staff goes out of town, the other covers her calls and relays messages to me. Yes, it’s extra work, but no more so than if they were here in person. Probably less.

I’m sure many physicians wouldn’t agree with my office model, but it suits me fine. Cross-training and all.

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

There was a recent post on Sermo about medical office staff cross-training. It talked about the importance of the scheduler being able to cover for the medical assistant (to an extent), a billing person being able to room patients, and so on.

Here, in my little three-person office, the only thing my staff can’t do is see patients.

Actually, more than 2 years out since the pandemic changed everyone’s lives, we’ve settled into a very different cross-training routine. I’m the only one at my office. My medical assistant works from home, far north of me, and so does my scheduler, who is across town.

So, at the office, I handle it all. I check people in, copy insurance cards, collect copays, see patients, and make follow-ups.

At this time, I’ve not only gotten used to it, but really don’t mind it.

We don’t worry about freeway traffic. My staff starts at the exact time each day, and so I don’t worry about one of them being an hour late, trapped behind a rush-hour pile-up on the 101. Staying at home with a sick kid isn’t an issue either, anymore. If my secretary has to make her young daughter lunch, or run her over to a birthday party, I don’t even notice it. If there are any problems, she knows how to reach me. Same with my medical assistant.

Nobody worries about what to throw together for dinner if they get home late.

In an era where other businesses want to reverse the work-from-home trend, I don’t see an issue with its continuing for some jobs. It saves money on rent, and money and time on transportation.

Gas prices, at least for driving to and from work for them, don’t have to be factored into the wage equations. I’d guess it’s about 1,000 gallons of gas a year saved. On a national scale that’s nothing, but to my staff right now that’s $3,000-$4,000 more in their pockets at the end of the year. Not to mention it’s two more cars off the road.

Granted, this doesn’t change what I’m doing. Seeing patients in person is a key part of being a doctor. Some things can be handled equally well over the phone or Zoom, but many can’t. It’s what I signed up for, and I really don’t mind it. Seeing patients is still what I enjoy.

My staff is a lot happier with this arrangement, and I don’t mind it either. I always, by nature, kept a reasonably paced schedule. Trying to shoehorn patients in has never been my way, so I have time to run a credit card or scan insurance information.

When one of my staff goes out of town, the other covers her calls and relays messages to me. Yes, it’s extra work, but no more so than if they were here in person. Probably less.

I’m sure many physicians wouldn’t agree with my office model, but it suits me fine. Cross-training and all.

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

There was a recent post on Sermo about medical office staff cross-training. It talked about the importance of the scheduler being able to cover for the medical assistant (to an extent), a billing person being able to room patients, and so on.

Here, in my little three-person office, the only thing my staff can’t do is see patients.

Actually, more than 2 years out since the pandemic changed everyone’s lives, we’ve settled into a very different cross-training routine. I’m the only one at my office. My medical assistant works from home, far north of me, and so does my scheduler, who is across town.

So, at the office, I handle it all. I check people in, copy insurance cards, collect copays, see patients, and make follow-ups.

At this time, I’ve not only gotten used to it, but really don’t mind it.

We don’t worry about freeway traffic. My staff starts at the exact time each day, and so I don’t worry about one of them being an hour late, trapped behind a rush-hour pile-up on the 101. Staying at home with a sick kid isn’t an issue either, anymore. If my secretary has to make her young daughter lunch, or run her over to a birthday party, I don’t even notice it. If there are any problems, she knows how to reach me. Same with my medical assistant.

Nobody worries about what to throw together for dinner if they get home late.

In an era where other businesses want to reverse the work-from-home trend, I don’t see an issue with its continuing for some jobs. It saves money on rent, and money and time on transportation.

Gas prices, at least for driving to and from work for them, don’t have to be factored into the wage equations. I’d guess it’s about 1,000 gallons of gas a year saved. On a national scale that’s nothing, but to my staff right now that’s $3,000-$4,000 more in their pockets at the end of the year. Not to mention it’s two more cars off the road.

Granted, this doesn’t change what I’m doing. Seeing patients in person is a key part of being a doctor. Some things can be handled equally well over the phone or Zoom, but many can’t. It’s what I signed up for, and I really don’t mind it. Seeing patients is still what I enjoy.

My staff is a lot happier with this arrangement, and I don’t mind it either. I always, by nature, kept a reasonably paced schedule. Trying to shoehorn patients in has never been my way, so I have time to run a credit card or scan insurance information.

When one of my staff goes out of town, the other covers her calls and relays messages to me. Yes, it’s extra work, but no more so than if they were here in person. Probably less.

I’m sure many physicians wouldn’t agree with my office model, but it suits me fine. Cross-training and all.

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

The shell game is probably the world’s oldest confidence game, going back 2,000-3,000 years. You still see people getting lured into it in cities today.

It’s also played, albeit legally, in physician offices and pharmacies around the country.

The medical equivalent of the shell game involves one of those ubiquitous manufacturer copay coupons. You know, the ones piled up in your sample cabinet. Get a month free of Whateveritscalled to try and/or have your copay reduced to $0 or something reasonably low. All, of course, subject to terms and conditions in the small print and that of your insurance carrier. Your mileage may vary.

In my experience these things often don’t work as well as advertised. Sometimes it’s because the patient doesn’t understand how to use them, other times because their pharmacy doesn’t want to have anything to do with the cards, and still other times because their insurance has some exclusion against them.

But they do sometimes work ... until they don’t. Sometimes, out of the blue, they’ll stop. Maybe there was an insurance change, or the pharmacy policy changed, or the manufacturer’s program changed, or the offer expired. I usually don’t know and rarely find out.

So the shell game begins. The patients call multiple pharmacies, trying to find one that may be able to honor the coupons. Then they call my office and ask me to switch the script. So I do. They they go to the pharmacy. Sometimes they can get the script, sometimes not. If not, they move to another pharmacy and call my office to switch it again. Wash, rinse, repeat.

Other times it’s more complicated. They want a new card for each try, so they show up at my office asking for one (usually they can be downloaded online so some try that. Others do both). Like pebbles under a shell, the prescriptions and cards get switched from pharmacy to pharmacy.

This isn’t exclusive to manufacturers’ copay cards. I see the same phenomenon with GoodRx and similar cost-saving programs. People move scripts around to find the best deal. It may be helping them, but it certainly doesn’t help me and my staff as we try to keep up, or the badly overworked pharmacy staff.

I’ve even had some patients take the audacious step of asking me to write a script in the name of their spouses so they can double their supply. Obviously, such requests are refused. I’m not going to play that game.

I understand new drugs are costly, and often outside the reach of many patients today. I know the manufacturers are trying to get their products tried, or even make them more affordable for those who need it.

But, in many cases, this becomes (unintentionally or intentionally; I’m not sure) a shell game. Legal, perhaps, but still equally frustrating for all of us who are trying to keep up with it.

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

The shell game is probably the world’s oldest confidence game, going back 2,000-3,000 years. You still see people getting lured into it in cities today.

It’s also played, albeit legally, in physician offices and pharmacies around the country.

The medical equivalent of the shell game involves one of those ubiquitous manufacturer copay coupons. You know, the ones piled up in your sample cabinet. Get a month free of Whateveritscalled to try and/or have your copay reduced to $0 or something reasonably low. All, of course, subject to terms and conditions in the small print and that of your insurance carrier. Your mileage may vary.

In my experience these things often don’t work as well as advertised. Sometimes it’s because the patient doesn’t understand how to use them, other times because their pharmacy doesn’t want to have anything to do with the cards, and still other times because their insurance has some exclusion against them.

But they do sometimes work ... until they don’t. Sometimes, out of the blue, they’ll stop. Maybe there was an insurance change, or the pharmacy policy changed, or the manufacturer’s program changed, or the offer expired. I usually don’t know and rarely find out.

So the shell game begins. The patients call multiple pharmacies, trying to find one that may be able to honor the coupons. Then they call my office and ask me to switch the script. So I do. They they go to the pharmacy. Sometimes they can get the script, sometimes not. If not, they move to another pharmacy and call my office to switch it again. Wash, rinse, repeat.

Other times it’s more complicated. They want a new card for each try, so they show up at my office asking for one (usually they can be downloaded online so some try that. Others do both). Like pebbles under a shell, the prescriptions and cards get switched from pharmacy to pharmacy.

This isn’t exclusive to manufacturers’ copay cards. I see the same phenomenon with GoodRx and similar cost-saving programs. People move scripts around to find the best deal. It may be helping them, but it certainly doesn’t help me and my staff as we try to keep up, or the badly overworked pharmacy staff.

I’ve even had some patients take the audacious step of asking me to write a script in the name of their spouses so they can double their supply. Obviously, such requests are refused. I’m not going to play that game.

I understand new drugs are costly, and often outside the reach of many patients today. I know the manufacturers are trying to get their products tried, or even make them more affordable for those who need it.

But, in many cases, this becomes (unintentionally or intentionally; I’m not sure) a shell game. Legal, perhaps, but still equally frustrating for all of us who are trying to keep up with it.

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

The shell game is probably the world’s oldest confidence game, going back 2,000-3,000 years. You still see people getting lured into it in cities today.

It’s also played, albeit legally, in physician offices and pharmacies around the country.

The medical equivalent of the shell game involves one of those ubiquitous manufacturer copay coupons. You know, the ones piled up in your sample cabinet. Get a month free of Whateveritscalled to try and/or have your copay reduced to $0 or something reasonably low. All, of course, subject to terms and conditions in the small print and that of your insurance carrier. Your mileage may vary.

In my experience these things often don’t work as well as advertised. Sometimes it’s because the patient doesn’t understand how to use them, other times because their pharmacy doesn’t want to have anything to do with the cards, and still other times because their insurance has some exclusion against them.

But they do sometimes work ... until they don’t. Sometimes, out of the blue, they’ll stop. Maybe there was an insurance change, or the pharmacy policy changed, or the manufacturer’s program changed, or the offer expired. I usually don’t know and rarely find out.

So the shell game begins. The patients call multiple pharmacies, trying to find one that may be able to honor the coupons. Then they call my office and ask me to switch the script. So I do. They they go to the pharmacy. Sometimes they can get the script, sometimes not. If not, they move to another pharmacy and call my office to switch it again. Wash, rinse, repeat.

Other times it’s more complicated. They want a new card for each try, so they show up at my office asking for one (usually they can be downloaded online so some try that. Others do both). Like pebbles under a shell, the prescriptions and cards get switched from pharmacy to pharmacy.

This isn’t exclusive to manufacturers’ copay cards. I see the same phenomenon with GoodRx and similar cost-saving programs. People move scripts around to find the best deal. It may be helping them, but it certainly doesn’t help me and my staff as we try to keep up, or the badly overworked pharmacy staff.

I’ve even had some patients take the audacious step of asking me to write a script in the name of their spouses so they can double their supply. Obviously, such requests are refused. I’m not going to play that game.

I understand new drugs are costly, and often outside the reach of many patients today. I know the manufacturers are trying to get their products tried, or even make them more affordable for those who need it.

But, in many cases, this becomes (unintentionally or intentionally; I’m not sure) a shell game. Legal, perhaps, but still equally frustrating for all of us who are trying to keep up with it.

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

One to two times a week I go through my junk mail folder. Usually it’s a collection of, well, junk: ads for CME, office software, car warranties, gift cards, dating sites, eyeglass or razor sellers, etc.

But there are usually a few items I’m glad I found, ones that I’m not sure how they ended up there. Bank notifications, package-tracking updates, a few other things. By the same token, every day a few pieces of junk land in my inbox.

This is, however, what we do for a living in this job.

Some patients are straightforward. The story is clear, the plan obvious.

Some require a bit more thinking.

And some are all over the place. Histories that wander everywhere, a million symptoms and clues. Most are likely red herrings, but which ones isn’t immediately obvious. And it’s up to the doctor to work this out.

With my junk folder, though, it’s usually immediately obvious what the useless things are compared with those of value. In medicine it’s often not so simple. You have to be careful what you discard, and you always need to be ready to change your mind and backtrack.

Artificial intelligence gets better every year but still makes plenty of mistakes. In sorting email my computer has to work out the signal-to-noise ratio of incoming items and decide which ones mean something. If my junk folder is any indication, it still has a ways to go.

This isn’t to say I’m infallible. I’m not. Unlike the algorithms my email program uses, there are no definite rules in medical cases. Picking through the clues is something that comes with training, experience, and a bit of luck. When I realize I’m going in the wrong direction I have to step back and rethink it all.

A lot of chart systems try to incorporate algorithms into medical decision-making. Sometimes they’re helpful, such as pointing out a drug interaction I wasn’t aware of. At other times they’re not, telling me I shouldn’t be ordering a test because such-and-such criteria haven’t been met. The trouble is these algorithms are written to apply to all cases, even though every patient is different. Sometimes the best we can go on is what I call “spidey sense” – realizing that there’s more than meets the eye here. In 24 years it’s served me well, far better than any computer algorithm has.

People talk about a natural fear of being replaced by computers. I agree that there are some things they’re very good at, and they keep getting better. But medicine isn’t a one-size-fits-all field. And the consequences are a lot higher than those from my bank statement being overlooked for a few days.

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

One to two times a week I go through my junk mail folder. Usually it’s a collection of, well, junk: ads for CME, office software, car warranties, gift cards, dating sites, eyeglass or razor sellers, etc.

But there are usually a few items I’m glad I found, ones that I’m not sure how they ended up there. Bank notifications, package-tracking updates, a few other things. By the same token, every day a few pieces of junk land in my inbox.

This is, however, what we do for a living in this job.

Some patients are straightforward. The story is clear, the plan obvious.

Some require a bit more thinking.

And some are all over the place. Histories that wander everywhere, a million symptoms and clues. Most are likely red herrings, but which ones isn’t immediately obvious. And it’s up to the doctor to work this out.

With my junk folder, though, it’s usually immediately obvious what the useless things are compared with those of value. In medicine it’s often not so simple. You have to be careful what you discard, and you always need to be ready to change your mind and backtrack.

Artificial intelligence gets better every year but still makes plenty of mistakes. In sorting email my computer has to work out the signal-to-noise ratio of incoming items and decide which ones mean something. If my junk folder is any indication, it still has a ways to go.

This isn’t to say I’m infallible. I’m not. Unlike the algorithms my email program uses, there are no definite rules in medical cases. Picking through the clues is something that comes with training, experience, and a bit of luck. When I realize I’m going in the wrong direction I have to step back and rethink it all.

A lot of chart systems try to incorporate algorithms into medical decision-making. Sometimes they’re helpful, such as pointing out a drug interaction I wasn’t aware of. At other times they’re not, telling me I shouldn’t be ordering a test because such-and-such criteria haven’t been met. The trouble is these algorithms are written to apply to all cases, even though every patient is different. Sometimes the best we can go on is what I call “spidey sense” – realizing that there’s more than meets the eye here. In 24 years it’s served me well, far better than any computer algorithm has.

People talk about a natural fear of being replaced by computers. I agree that there are some things they’re very good at, and they keep getting better. But medicine isn’t a one-size-fits-all field. And the consequences are a lot higher than those from my bank statement being overlooked for a few days.

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

One to two times a week I go through my junk mail folder. Usually it’s a collection of, well, junk: ads for CME, office software, car warranties, gift cards, dating sites, eyeglass or razor sellers, etc.

But there are usually a few items I’m glad I found, ones that I’m not sure how they ended up there. Bank notifications, package-tracking updates, a few other things. By the same token, every day a few pieces of junk land in my inbox.

This is, however, what we do for a living in this job.

Some patients are straightforward. The story is clear, the plan obvious.

Some require a bit more thinking.

And some are all over the place. Histories that wander everywhere, a million symptoms and clues. Most are likely red herrings, but which ones isn’t immediately obvious. And it’s up to the doctor to work this out.

With my junk folder, though, it’s usually immediately obvious what the useless things are compared with those of value. In medicine it’s often not so simple. You have to be careful what you discard, and you always need to be ready to change your mind and backtrack.

Artificial intelligence gets better every year but still makes plenty of mistakes. In sorting email my computer has to work out the signal-to-noise ratio of incoming items and decide which ones mean something. If my junk folder is any indication, it still has a ways to go.

This isn’t to say I’m infallible. I’m not. Unlike the algorithms my email program uses, there are no definite rules in medical cases. Picking through the clues is something that comes with training, experience, and a bit of luck. When I realize I’m going in the wrong direction I have to step back and rethink it all.

A lot of chart systems try to incorporate algorithms into medical decision-making. Sometimes they’re helpful, such as pointing out a drug interaction I wasn’t aware of. At other times they’re not, telling me I shouldn’t be ordering a test because such-and-such criteria haven’t been met. The trouble is these algorithms are written to apply to all cases, even though every patient is different. Sometimes the best we can go on is what I call “spidey sense” – realizing that there’s more than meets the eye here. In 24 years it’s served me well, far better than any computer algorithm has.

People talk about a natural fear of being replaced by computers. I agree that there are some things they’re very good at, and they keep getting better. But medicine isn’t a one-size-fits-all field. And the consequences are a lot higher than those from my bank statement being overlooked for a few days.

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

“I love practicing medicine.”

The speaker was one of my patients. A distinguished, friendly, gentleman in his mid-to-late 70s, here to see me for a minor problem. He still practices medicine part time.

Since his neurologic issue was simple, we spent a fair amount of the time chatting. We’d both seen changes in medicine over time, he more than I, obviously.

Some good, some bad. Fancier toys, better drugs, more paperwork (even if it’s not all on paper anymore).

But we both still like what we do, and have no plans to give it up anytime soon.

Some doctors end up hating their jobs and leave the field. I understand that, and I don’t blame them. It’s not an easy one.

But I still enjoy the job. I look forward to seeing patients each day, turning over their cases, trying to figure them out, and doing what I can to help people.

After almost 30 years as a doctor the job becomes a part of your personality, one that’s as important as many other aspects of what makes us who we are.

I see that it is similar with attorneys. Maybe it’s part of the time and commitment you put into getting to a job that makes it hard to walk away as you get older. Or maybe (probably more likely) it’s some intrinsic part of the personality that drove you to get there.

I’m roughly two-thirds of the way through my career, but still don’t have any plans to close down. Granted, that’s practical – I have kids in college, a mortgage, and office overhead. My colleague across the desk can stop practicing whenever he wants, but gets satisfaction, validation, and enjoyment from doing the same job. At this point in his life that’s more important than the money.

I hope to someday feel that same way. I don’t want to always work the 80-90 hours a week I do now, but I can’t imagine not doing this, either.

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

“I love practicing medicine.”

The speaker was one of my patients. A distinguished, friendly, gentleman in his mid-to-late 70s, here to see me for a minor problem. He still practices medicine part time.

Since his neurologic issue was simple, we spent a fair amount of the time chatting. We’d both seen changes in medicine over time, he more than I, obviously.

Some good, some bad. Fancier toys, better drugs, more paperwork (even if it’s not all on paper anymore).

But we both still like what we do, and have no plans to give it up anytime soon.

Some doctors end up hating their jobs and leave the field. I understand that, and I don’t blame them. It’s not an easy one.

But I still enjoy the job. I look forward to seeing patients each day, turning over their cases, trying to figure them out, and doing what I can to help people.

After almost 30 years as a doctor the job becomes a part of your personality, one that’s as important as many other aspects of what makes us who we are.

I see that it is similar with attorneys. Maybe it’s part of the time and commitment you put into getting to a job that makes it hard to walk away as you get older. Or maybe (probably more likely) it’s some intrinsic part of the personality that drove you to get there.

I’m roughly two-thirds of the way through my career, but still don’t have any plans to close down. Granted, that’s practical – I have kids in college, a mortgage, and office overhead. My colleague across the desk can stop practicing whenever he wants, but gets satisfaction, validation, and enjoyment from doing the same job. At this point in his life that’s more important than the money.

I hope to someday feel that same way. I don’t want to always work the 80-90 hours a week I do now, but I can’t imagine not doing this, either.

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

“I love practicing medicine.”

The speaker was one of my patients. A distinguished, friendly, gentleman in his mid-to-late 70s, here to see me for a minor problem. He still practices medicine part time.

Since his neurologic issue was simple, we spent a fair amount of the time chatting. We’d both seen changes in medicine over time, he more than I, obviously.

Some good, some bad. Fancier toys, better drugs, more paperwork (even if it’s not all on paper anymore).

But we both still like what we do, and have no plans to give it up anytime soon.

Some doctors end up hating their jobs and leave the field. I understand that, and I don’t blame them. It’s not an easy one.

But I still enjoy the job. I look forward to seeing patients each day, turning over their cases, trying to figure them out, and doing what I can to help people.

After almost 30 years as a doctor the job becomes a part of your personality, one that’s as important as many other aspects of what makes us who we are.

I see that it is similar with attorneys. Maybe it’s part of the time and commitment you put into getting to a job that makes it hard to walk away as you get older. Or maybe (probably more likely) it’s some intrinsic part of the personality that drove you to get there.

I’m roughly two-thirds of the way through my career, but still don’t have any plans to close down. Granted, that’s practical – I have kids in college, a mortgage, and office overhead. My colleague across the desk can stop practicing whenever he wants, but gets satisfaction, validation, and enjoyment from doing the same job. At this point in his life that’s more important than the money.

I hope to someday feel that same way. I don’t want to always work the 80-90 hours a week I do now, but I can’t imagine not doing this, either.

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

A weekend, for most of us in solo practice, doesn’t really signify time off from work. It just means we’re not seeing patients at the office.

There’s always business stuff to do (like payroll and paying bills), legal cases to review, the never-ending forms for a million things, and all the other stuff there never seems to be enough time to do on weekdays.

So this weekend I started attacking the pile after dinner on Friday and found myself done by Saturday afternoon. Which is rare, usually I spend the better part of a weekend at my desk.

And then, unexpectedly faced with an empty desk, I found myself wondering what to do.

Boredom is one of the odder human conditions. Certainly, there are more ways to waste time now than there ever have been. TV, Netflix, phone games, TikTok, books, just to name a few.

But do we always have to be entertained? Many great scientists have said that world-changing ideas have come to them when they weren’t working, such as while showering or riding to work. Leo Szilard was crossing a London street in 1933 when he suddenly saw how a nuclear chain reaction would be self-sustaining once initiated. (Fortunately, he wasn’t hit by a car in the process.)

But I’m not Szilard. So I rationalized a reason not to exercise and sat on the couch with a book.

The remarkable human brain doesn’t shut down easily. With nothing else to do, most other mammals tend to doze off. But not us. It’s always on, trying to think of the next goal, the next move, the next whatever.

Having nothing to do sounds like a great idea, until you have nothing to do. It may be fine for a few days, but after a while you realize there’s only so long you can stare at the waves or mountains before your mind turns back to “what’s next.” Many patients tell me how retirement sounded good until they got there, then found themselves volunteering or taking new jobs just to keep busy.

This isn’t a bad thing. Being bored is probably constructive. Without realizing it we use it to form new ideas and start new plans.

Maybe this is why we’re here. The mind that keeps working is a powerful tool, driving us forward in all walks of life. Perhaps it’s this feature that pushed the development of intelligence further and led us to form civilizations.

Perhaps it’s the real reason we keep moving forward.

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

A weekend, for most of us in solo practice, doesn’t really signify time off from work. It just means we’re not seeing patients at the office.

There’s always business stuff to do (like payroll and paying bills), legal cases to review, the never-ending forms for a million things, and all the other stuff there never seems to be enough time to do on weekdays.

So this weekend I started attacking the pile after dinner on Friday and found myself done by Saturday afternoon. Which is rare, usually I spend the better part of a weekend at my desk.

And then, unexpectedly faced with an empty desk, I found myself wondering what to do.

Boredom is one of the odder human conditions. Certainly, there are more ways to waste time now than there ever have been. TV, Netflix, phone games, TikTok, books, just to name a few.

But do we always have to be entertained? Many great scientists have said that world-changing ideas have come to them when they weren’t working, such as while showering or riding to work. Leo Szilard was crossing a London street in 1933 when he suddenly saw how a nuclear chain reaction would be self-sustaining once initiated. (Fortunately, he wasn’t hit by a car in the process.)

But I’m not Szilard. So I rationalized a reason not to exercise and sat on the couch with a book.

The remarkable human brain doesn’t shut down easily. With nothing else to do, most other mammals tend to doze off. But not us. It’s always on, trying to think of the next goal, the next move, the next whatever.

Having nothing to do sounds like a great idea, until you have nothing to do. It may be fine for a few days, but after a while you realize there’s only so long you can stare at the waves or mountains before your mind turns back to “what’s next.” Many patients tell me how retirement sounded good until they got there, then found themselves volunteering or taking new jobs just to keep busy.

This isn’t a bad thing. Being bored is probably constructive. Without realizing it we use it to form new ideas and start new plans.

Maybe this is why we’re here. The mind that keeps working is a powerful tool, driving us forward in all walks of life. Perhaps it’s this feature that pushed the development of intelligence further and led us to form civilizations.

Perhaps it’s the real reason we keep moving forward.

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

A weekend, for most of us in solo practice, doesn’t really signify time off from work. It just means we’re not seeing patients at the office.

There’s always business stuff to do (like payroll and paying bills), legal cases to review, the never-ending forms for a million things, and all the other stuff there never seems to be enough time to do on weekdays.

So this weekend I started attacking the pile after dinner on Friday and found myself done by Saturday afternoon. Which is rare, usually I spend the better part of a weekend at my desk.

And then, unexpectedly faced with an empty desk, I found myself wondering what to do.

Boredom is one of the odder human conditions. Certainly, there are more ways to waste time now than there ever have been. TV, Netflix, phone games, TikTok, books, just to name a few.

But do we always have to be entertained? Many great scientists have said that world-changing ideas have come to them when they weren’t working, such as while showering or riding to work. Leo Szilard was crossing a London street in 1933 when he suddenly saw how a nuclear chain reaction would be self-sustaining once initiated. (Fortunately, he wasn’t hit by a car in the process.)

But I’m not Szilard. So I rationalized a reason not to exercise and sat on the couch with a book.

The remarkable human brain doesn’t shut down easily. With nothing else to do, most other mammals tend to doze off. But not us. It’s always on, trying to think of the next goal, the next move, the next whatever.

Having nothing to do sounds like a great idea, until you have nothing to do. It may be fine for a few days, but after a while you realize there’s only so long you can stare at the waves or mountains before your mind turns back to “what’s next.” Many patients tell me how retirement sounded good until they got there, then found themselves volunteering or taking new jobs just to keep busy.

This isn’t a bad thing. Being bored is probably constructive. Without realizing it we use it to form new ideas and start new plans.

Maybe this is why we’re here. The mind that keeps working is a powerful tool, driving us forward in all walks of life. Perhaps it’s this feature that pushed the development of intelligence further and led us to form civilizations.

Perhaps it’s the real reason we keep moving forward.

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

I’m not hiding anything.

Occasionally I deal with patients and families who seem to think I have some miracle cure for a condition that I’m not telling them about.

I promise, I don’t work that way. Besides the obvious ethical issues, why would I? What could I possibly gain from doing that?

The trouble is that people are blanketed by news headlines, some reputable and some not, about a research study suggesting a new direction in treatment, or that a new drug in development has promise. Often these stories are forwarded to them by well-meaning relatives and friends, or just show up in their social media feed.

While some of these findings may actually lead somewhere, the vast majority don’t. In my career I’ve seen statins touted as potential treatments for MS and Alzheimer’s disease, and vilified as causes of dementia and peripheral neuropathy, all disproved or (to date) still up in the air.

But nonmedical people don’t understand that. It made the news, so it must mean something. I have no problem trying to explain this to them, but it’s never easy.

It’s even harder to explain to the ones who’ve already purchased a costly over-the-counter placebo for such a condition that they wasted their money.

We live in a world of amazing technological achievements, but that doesn’t mean all diseases have been cured and problems fixed. Far from it.

New discoveries are made, but a lot of times it’s a very slow journey to find the solution. One discovery may not lead to THE answer, but hopefully will get you closer to it.

That generally doesn’t happen overnight. The mathematical problem of Goldbach’s Conjecture has been around since 1742 and still hasn’t been definitively answered.

Medicine isn’t math, either. The people and families dealing with these conditions want answers. I don’t blame them. So do I. Believe me, there would be nothing that would bring me more joy as a doctor than to be able to give someone with a serious diagnosis the comfort that comes with saying it’s also curable.

I never have, and never would, withhold such a thing from a patient. Ever. I just wish some of them would believe me when I say that.

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

I’m not hiding anything.

Occasionally I deal with patients and families who seem to think I have some miracle cure for a condition that I’m not telling them about.

I promise, I don’t work that way. Besides the obvious ethical issues, why would I? What could I possibly gain from doing that?

The trouble is that people are blanketed by news headlines, some reputable and some not, about a research study suggesting a new direction in treatment, or that a new drug in development has promise. Often these stories are forwarded to them by well-meaning relatives and friends, or just show up in their social media feed.

While some of these findings may actually lead somewhere, the vast majority don’t. In my career I’ve seen statins touted as potential treatments for MS and Alzheimer’s disease, and vilified as causes of dementia and peripheral neuropathy, all disproved or (to date) still up in the air.

But nonmedical people don’t understand that. It made the news, so it must mean something. I have no problem trying to explain this to them, but it’s never easy.

It’s even harder to explain to the ones who’ve already purchased a costly over-the-counter placebo for such a condition that they wasted their money.

We live in a world of amazing technological achievements, but that doesn’t mean all diseases have been cured and problems fixed. Far from it.

New discoveries are made, but a lot of times it’s a very slow journey to find the solution. One discovery may not lead to THE answer, but hopefully will get you closer to it.

That generally doesn’t happen overnight. The mathematical problem of Goldbach’s Conjecture has been around since 1742 and still hasn’t been definitively answered.

Medicine isn’t math, either. The people and families dealing with these conditions want answers. I don’t blame them. So do I. Believe me, there would be nothing that would bring me more joy as a doctor than to be able to give someone with a serious diagnosis the comfort that comes with saying it’s also curable.

I never have, and never would, withhold such a thing from a patient. Ever. I just wish some of them would believe me when I say that.

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

I’m not hiding anything.

Occasionally I deal with patients and families who seem to think I have some miracle cure for a condition that I’m not telling them about.

I promise, I don’t work that way. Besides the obvious ethical issues, why would I? What could I possibly gain from doing that?

The trouble is that people are blanketed by news headlines, some reputable and some not, about a research study suggesting a new direction in treatment, or that a new drug in development has promise. Often these stories are forwarded to them by well-meaning relatives and friends, or just show up in their social media feed.

While some of these findings may actually lead somewhere, the vast majority don’t. In my career I’ve seen statins touted as potential treatments for MS and Alzheimer’s disease, and vilified as causes of dementia and peripheral neuropathy, all disproved or (to date) still up in the air.

But nonmedical people don’t understand that. It made the news, so it must mean something. I have no problem trying to explain this to them, but it’s never easy.

It’s even harder to explain to the ones who’ve already purchased a costly over-the-counter placebo for such a condition that they wasted their money.

We live in a world of amazing technological achievements, but that doesn’t mean all diseases have been cured and problems fixed. Far from it.

New discoveries are made, but a lot of times it’s a very slow journey to find the solution. One discovery may not lead to THE answer, but hopefully will get you closer to it.

That generally doesn’t happen overnight. The mathematical problem of Goldbach’s Conjecture has been around since 1742 and still hasn’t been definitively answered.

Medicine isn’t math, either. The people and families dealing with these conditions want answers. I don’t blame them. So do I. Believe me, there would be nothing that would bring me more joy as a doctor than to be able to give someone with a serious diagnosis the comfort that comes with saying it’s also curable.

I never have, and never would, withhold such a thing from a patient. Ever. I just wish some of them would believe me when I say that.

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

Growing up, my dad would often go to his law office on weekends to get work done.

As a kid I didn’t really understand this. Dad had an office at home, and could close the door if he needed to. Usually he did this, but sometimes he left to go to his REAL office.

And now ... I sometimes do the same thing.

I don’t see patients on Fridays these days. In the postpandemic world my schedule still hasn’t returned to normal (maybe it never will and this is the new normal), and with research and case reviews and other stuff it seemed logical to just work from home and do them that day. My staff works from home, so if I’m not seeing patients, why can’t I?

After a few Fridays of this, I began going to my empty office, too, and understood where my dad was coming from.

My little solo office, as non-fancy as it is (the carpeting and interior are all from 1993), is quiet. From my back office I can’t hear the corridor hustle and bustle of people going to their appointments or arguing on a cell phone. Just the hum of the air conditioner and the occasional few seconds of a car alarm outside. If I put on iTunes no one complains about my musical tastes.

There isn’t much to do there BUT work, which is the idea. The building’s wifi is too slow to stream or watch Youtube. I’m not tempted to work on a puzzle with my daughter, take a book off a shelf, play with my dogs, or go down the hall for a nap. All the little things we do to procrastinate aren’t there, like convincing myself that I need to clean the pool or balance the checkbook ASAP.

I don’t have the distractions of my dogs barking at passing cars, or kids going up and down the hall, or the phone ringing with people asking who I’m voting for.

My little office is a private oasis, of sorts. Quiet and undisturbed.

Not quite Superman’s Fortress of Solitude, but close enough for me.

And, with all due respect to the Man of Steel, the Fortress of Solitude doesn’t have a Keurig.

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

Growing up, my dad would often go to his law office on weekends to get work done.

As a kid I didn’t really understand this. Dad had an office at home, and could close the door if he needed to. Usually he did this, but sometimes he left to go to his REAL office.

And now ... I sometimes do the same thing.

I don’t see patients on Fridays these days. In the postpandemic world my schedule still hasn’t returned to normal (maybe it never will and this is the new normal), and with research and case reviews and other stuff it seemed logical to just work from home and do them that day. My staff works from home, so if I’m not seeing patients, why can’t I?

After a few Fridays of this, I began going to my empty office, too, and understood where my dad was coming from.

My little solo office, as non-fancy as it is (the carpeting and interior are all from 1993), is quiet. From my back office I can’t hear the corridor hustle and bustle of people going to their appointments or arguing on a cell phone. Just the hum of the air conditioner and the occasional few seconds of a car alarm outside. If I put on iTunes no one complains about my musical tastes.

There isn’t much to do there BUT work, which is the idea. The building’s wifi is too slow to stream or watch Youtube. I’m not tempted to work on a puzzle with my daughter, take a book off a shelf, play with my dogs, or go down the hall for a nap. All the little things we do to procrastinate aren’t there, like convincing myself that I need to clean the pool or balance the checkbook ASAP.

I don’t have the distractions of my dogs barking at passing cars, or kids going up and down the hall, or the phone ringing with people asking who I’m voting for.

My little office is a private oasis, of sorts. Quiet and undisturbed.

Not quite Superman’s Fortress of Solitude, but close enough for me.

And, with all due respect to the Man of Steel, the Fortress of Solitude doesn’t have a Keurig.

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

Growing up, my dad would often go to his law office on weekends to get work done.

As a kid I didn’t really understand this. Dad had an office at home, and could close the door if he needed to. Usually he did this, but sometimes he left to go to his REAL office.

And now ... I sometimes do the same thing.

I don’t see patients on Fridays these days. In the postpandemic world my schedule still hasn’t returned to normal (maybe it never will and this is the new normal), and with research and case reviews and other stuff it seemed logical to just work from home and do them that day. My staff works from home, so if I’m not seeing patients, why can’t I?

After a few Fridays of this, I began going to my empty office, too, and understood where my dad was coming from.

My little solo office, as non-fancy as it is (the carpeting and interior are all from 1993), is quiet. From my back office I can’t hear the corridor hustle and bustle of people going to their appointments or arguing on a cell phone. Just the hum of the air conditioner and the occasional few seconds of a car alarm outside. If I put on iTunes no one complains about my musical tastes.

There isn’t much to do there BUT work, which is the idea. The building’s wifi is too slow to stream or watch Youtube. I’m not tempted to work on a puzzle with my daughter, take a book off a shelf, play with my dogs, or go down the hall for a nap. All the little things we do to procrastinate aren’t there, like convincing myself that I need to clean the pool or balance the checkbook ASAP.

I don’t have the distractions of my dogs barking at passing cars, or kids going up and down the hall, or the phone ringing with people asking who I’m voting for.

My little office is a private oasis, of sorts. Quiet and undisturbed.

Not quite Superman’s Fortress of Solitude, but close enough for me.

And, with all due respect to the Man of Steel, the Fortress of Solitude doesn’t have a Keurig.

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

This past weekend, because of a series of unfortunate events, I had to move a lot of furniture. This included the bookshelves in my home office. I began by taking books off the shelves to make the bookcase easier to move.

After blowing away a few pounds of dust, I found myself staring at tomes that were once the center of my life: Robbin’s “Pathological Basis of Disease,” Cecil’s “Essentials of Medicine,” Stryer’s “Biochemistry, Grant’s Method of Anatomy,” Stedman’s “Medical Dictionary,” and a few others. All of them more than 30 years old.

I piled the books up on a table as I moved the bookcase, thinking about them. I hadn’t opened any of them in at least 20 years, probably more.

When it was time to put them back, I stared at the pile. They’re big and heavy, qualities that we assume are good things in textbooks. Especially in medical school.

Books have heft. Their knowledge and supposed wisdom are measured by weight and size as you slowly turn the pages under a desk lamp. Not like today, where all the libraries of the world are accessible from a single lightweight iPad.

I remember carrying those books around, stuffed in a backpack draped over my left shoulder. In retrospect it’s amazing I didn’t develop a long thoracic nerve palsy during those years.

They were expensive. I mean, in 1989 dollars, they were all between $50 and $100. I long ago shredded my credit card statements from that era, but my spending for books was pretty high. Fortunately my dad stood behind me for a big chunk of this, and told me to get whatever I needed. Believe me, I know how lucky I am.

I looked at the books. We’d been through a lot together. Long nights at my apartment across the street from Creighton, reading and rereading them. The pages still marked with the yellow highlighter pen that never left my side back then. A younger version of myself traced these pages, committing things to memory that I now have no recollection of. (If you can still draw the Krebs cycle from memory you’re way ahead of me.)

Realistically, though, there was no reason to hold onto them anymore. I’m about two-thirds of the way through my career. If I haven’t opened my old medical textbooks in 20-25 years, the odds are that I’m not going to now.

Plus, they’re out of date. Basic anatomy knowledge hasn’t changed much, but most everything else has. I started med school in 1989, and if I’d been looking things up in 1959 textbooks then, I probably wouldn’t have gotten very far. When I need to look things up these days I go to UpToDate, or Epocrates, or other online sources or apps.

I carried the majority of the books out to the recycling can. (It took a few trips.)

Facing some now-empty space on my bookshelf, I put my next challenge there: A pile of 33-RPM records that I still can’t bring myself to get rid of.

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

This past weekend, because of a series of unfortunate events, I had to move a lot of furniture. This included the bookshelves in my home office. I began by taking books off the shelves to make the bookcase easier to move.

After blowing away a few pounds of dust, I found myself staring at tomes that were once the center of my life: Robbin’s “Pathological Basis of Disease,” Cecil’s “Essentials of Medicine,” Stryer’s “Biochemistry, Grant’s Method of Anatomy,” Stedman’s “Medical Dictionary,” and a few others. All of them more than 30 years old.

I piled the books up on a table as I moved the bookcase, thinking about them. I hadn’t opened any of them in at least 20 years, probably more.

When it was time to put them back, I stared at the pile. They’re big and heavy, qualities that we assume are good things in textbooks. Especially in medical school.

Books have heft. Their knowledge and supposed wisdom are measured by weight and size as you slowly turn the pages under a desk lamp. Not like today, where all the libraries of the world are accessible from a single lightweight iPad.

I remember carrying those books around, stuffed in a backpack draped over my left shoulder. In retrospect it’s amazing I didn’t develop a long thoracic nerve palsy during those years.

They were expensive. I mean, in 1989 dollars, they were all between $50 and $100. I long ago shredded my credit card statements from that era, but my spending for books was pretty high. Fortunately my dad stood behind me for a big chunk of this, and told me to get whatever I needed. Believe me, I know how lucky I am.

I looked at the books. We’d been through a lot together. Long nights at my apartment across the street from Creighton, reading and rereading them. The pages still marked with the yellow highlighter pen that never left my side back then. A younger version of myself traced these pages, committing things to memory that I now have no recollection of. (If you can still draw the Krebs cycle from memory you’re way ahead of me.)

Realistically, though, there was no reason to hold onto them anymore. I’m about two-thirds of the way through my career. If I haven’t opened my old medical textbooks in 20-25 years, the odds are that I’m not going to now.

Plus, they’re out of date. Basic anatomy knowledge hasn’t changed much, but most everything else has. I started med school in 1989, and if I’d been looking things up in 1959 textbooks then, I probably wouldn’t have gotten very far. When I need to look things up these days I go to UpToDate, or Epocrates, or other online sources or apps.

I carried the majority of the books out to the recycling can. (It took a few trips.)

Facing some now-empty space on my bookshelf, I put my next challenge there: A pile of 33-RPM records that I still can’t bring myself to get rid of.

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

This past weekend, because of a series of unfortunate events, I had to move a lot of furniture. This included the bookshelves in my home office. I began by taking books off the shelves to make the bookcase easier to move.

After blowing away a few pounds of dust, I found myself staring at tomes that were once the center of my life: Robbin’s “Pathological Basis of Disease,” Cecil’s “Essentials of Medicine,” Stryer’s “Biochemistry, Grant’s Method of Anatomy,” Stedman’s “Medical Dictionary,” and a few others. All of them more than 30 years old.

I piled the books up on a table as I moved the bookcase, thinking about them. I hadn’t opened any of them in at least 20 years, probably more.

When it was time to put them back, I stared at the pile. They’re big and heavy, qualities that we assume are good things in textbooks. Especially in medical school.

Books have heft. Their knowledge and supposed wisdom are measured by weight and size as you slowly turn the pages under a desk lamp. Not like today, where all the libraries of the world are accessible from a single lightweight iPad.

I remember carrying those books around, stuffed in a backpack draped over my left shoulder. In retrospect it’s amazing I didn’t develop a long thoracic nerve palsy during those years.

They were expensive. I mean, in 1989 dollars, they were all between $50 and $100. I long ago shredded my credit card statements from that era, but my spending for books was pretty high. Fortunately my dad stood behind me for a big chunk of this, and told me to get whatever I needed. Believe me, I know how lucky I am.

I looked at the books. We’d been through a lot together. Long nights at my apartment across the street from Creighton, reading and rereading them. The pages still marked with the yellow highlighter pen that never left my side back then. A younger version of myself traced these pages, committing things to memory that I now have no recollection of. (If you can still draw the Krebs cycle from memory you’re way ahead of me.)

Realistically, though, there was no reason to hold onto them anymore. I’m about two-thirds of the way through my career. If I haven’t opened my old medical textbooks in 20-25 years, the odds are that I’m not going to now.

Plus, they’re out of date. Basic anatomy knowledge hasn’t changed much, but most everything else has. I started med school in 1989, and if I’d been looking things up in 1959 textbooks then, I probably wouldn’t have gotten very far. When I need to look things up these days I go to UpToDate, or Epocrates, or other online sources or apps.

I carried the majority of the books out to the recycling can. (It took a few trips.)

Facing some now-empty space on my bookshelf, I put my next challenge there: A pile of 33-RPM records that I still can’t bring myself to get rid of.

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