Allan M. Block, MD

I don’t have a patient portal. Probably never will.

This isn’t an attempt at “information blocking,” or intentional noncompliance, or a rebellious streak against the CURES act.

It’s practical: I can’t afford it.

I’m a small one-doc practice. My overhead is high, my profit margin is razor thin. In the sudden spike of COVID-19– and war-related inflation, my gas and office supply costs have gone up, but I’m in a field where I can’t raise my own prices to compensate. The restaurants and grocery stores near me can, but I can’t because of the way insurance works.

With that background, I don’t have the money to set up a patient portal for people to be able to get their notes, test results, anything.

This isn’t to say that I withhold things from patients. If they want a copy of my note, or their MRI report, or whatever, they’re welcome to it. I’m happy to fax it to them, or put it in the mail, or have them come by and pick it up.

I have no desire to keep information from patients. I actually try to stay on top of it, calling them with test results within 24 hours of receiving them and arranging follow-ups quickly when needed.

That’s one of the pluses of my dinky practice – I generally know my patients and can make decisions quickly on the next step once results come in. They don’t get tossed in a box to be reviewed in a few days. I take pride in staying on top of things – isn’t that how we all want to be treated when we’re on the other side of the desk?

Politicians like to say how much America depends on small businesses and how important we are to the economy. They love to do photo ops at a newly opened ice cream place or small barbecue joint. But if you’re a doctor in a small practice, you often get treated the same way the Mega-Med Group (“287 doctors! 19 specialties! 37 offices! No waiting!”) is treated. They can afford to have a digital portal, so why can’t you?

Just because I don’t have a patient portal, though, doesn’t mean I’m hiding things from patients.

Or not doing my best to care for them.

Like Avis, I may not be No. 1, but I sure try harder.

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

I don’t have a patient portal. Probably never will.

This isn’t an attempt at “information blocking,” or intentional noncompliance, or a rebellious streak against the CURES act.

It’s practical: I can’t afford it.

I’m a small one-doc practice. My overhead is high, my profit margin is razor thin. In the sudden spike of COVID-19– and war-related inflation, my gas and office supply costs have gone up, but I’m in a field where I can’t raise my own prices to compensate. The restaurants and grocery stores near me can, but I can’t because of the way insurance works.

With that background, I don’t have the money to set up a patient portal for people to be able to get their notes, test results, anything.

This isn’t to say that I withhold things from patients. If they want a copy of my note, or their MRI report, or whatever, they’re welcome to it. I’m happy to fax it to them, or put it in the mail, or have them come by and pick it up.

I have no desire to keep information from patients. I actually try to stay on top of it, calling them with test results within 24 hours of receiving them and arranging follow-ups quickly when needed.

That’s one of the pluses of my dinky practice – I generally know my patients and can make decisions quickly on the next step once results come in. They don’t get tossed in a box to be reviewed in a few days. I take pride in staying on top of things – isn’t that how we all want to be treated when we’re on the other side of the desk?

Politicians like to say how much America depends on small businesses and how important we are to the economy. They love to do photo ops at a newly opened ice cream place or small barbecue joint. But if you’re a doctor in a small practice, you often get treated the same way the Mega-Med Group (“287 doctors! 19 specialties! 37 offices! No waiting!”) is treated. They can afford to have a digital portal, so why can’t you?

Just because I don’t have a patient portal, though, doesn’t mean I’m hiding things from patients.

Or not doing my best to care for them.

Like Avis, I may not be No. 1, but I sure try harder.

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

I don’t have a patient portal. Probably never will.

This isn’t an attempt at “information blocking,” or intentional noncompliance, or a rebellious streak against the CURES act.

It’s practical: I can’t afford it.

I’m a small one-doc practice. My overhead is high, my profit margin is razor thin. In the sudden spike of COVID-19– and war-related inflation, my gas and office supply costs have gone up, but I’m in a field where I can’t raise my own prices to compensate. The restaurants and grocery stores near me can, but I can’t because of the way insurance works.

With that background, I don’t have the money to set up a patient portal for people to be able to get their notes, test results, anything.

This isn’t to say that I withhold things from patients. If they want a copy of my note, or their MRI report, or whatever, they’re welcome to it. I’m happy to fax it to them, or put it in the mail, or have them come by and pick it up.

I have no desire to keep information from patients. I actually try to stay on top of it, calling them with test results within 24 hours of receiving them and arranging follow-ups quickly when needed.

That’s one of the pluses of my dinky practice – I generally know my patients and can make decisions quickly on the next step once results come in. They don’t get tossed in a box to be reviewed in a few days. I take pride in staying on top of things – isn’t that how we all want to be treated when we’re on the other side of the desk?

Politicians like to say how much America depends on small businesses and how important we are to the economy. They love to do photo ops at a newly opened ice cream place or small barbecue joint. But if you’re a doctor in a small practice, you often get treated the same way the Mega-Med Group (“287 doctors! 19 specialties! 37 offices! No waiting!”) is treated. They can afford to have a digital portal, so why can’t you?

Just because I don’t have a patient portal, though, doesn’t mean I’m hiding things from patients.

Or not doing my best to care for them.

Like Avis, I may not be No. 1, but I sure try harder.

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

“It’s in the computer.”

How many times a week do you hear that?

The advent of the modern EMR has created a new belief in many patients: That all medical office computers are connected, and information from one can be obtained from any of them. So when I ask patients if they had labs, or an MRI, or what their medications are, that’s what I sometimes hear back.

“It’s in the computer.”

True, but not MY computer.

Then they get perplexed, and irritated. Didn’t someone at the other office, or their friends, or something they read online, tell them I’d have access to it? Isn’t all medical info in a giant online database, somewhere, and all doctors can get into it?

Admittedly, I’m probably in better shape than other solo-practice docs. I have access codes to two local radiology places, two large labs, and the largest health care system in my corner of Phoenix. So although I’m not technically a part of them, I can still pull records when I need them for patient care. But if the patient is in my office right then, it takes a minute. My office wifi isn’t the fastest, I have to enter passwords, then do two-factor authentication.

I understand – very much – the importance of the added layers of security, but it adds time to the visit.

Some people, with perhaps more faith in technology than is justified, still don’t understand this. Another doctor sent them to see me, so why don’t I have the results of previous tests and labs? If they tell us what tests they had, and where, and when they make the appointment I can often be prepared for them. But this isn’t consistent.

On the surface some sort of large-scale medical database for everyone sounds good. It would be nice to not have to scramble to get past test results when people come in, and would probably save a lot of money on duplicated labs. But there are legitimate concerns about security and privacy, too.

Not only that, but “it’s in the computer” is also only as good as the people working them. Recently I got a call from an office in a local health care system asking for my notes on a patient. I’d sent them, but they insisted they hadn’t received them. From my desk I logged into their system and found my notes, neatly scanned in and labeled with my name and specialty. When I picked up the phone and told the young lady where to look, she was nice enough to apologize.

I get that. I often overlook things under my own nose, too. But no amount of technology will fix that issue for me or anyone else.

Unfortunately, this misplaced faith in technology doesn’t seem to be going away. People will still keep believing that it works much better than it really does.

That’s human nature, too.

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

“It’s in the computer.”

How many times a week do you hear that?

The advent of the modern EMR has created a new belief in many patients: That all medical office computers are connected, and information from one can be obtained from any of them. So when I ask patients if they had labs, or an MRI, or what their medications are, that’s what I sometimes hear back.

“It’s in the computer.”

True, but not MY computer.

Then they get perplexed, and irritated. Didn’t someone at the other office, or their friends, or something they read online, tell them I’d have access to it? Isn’t all medical info in a giant online database, somewhere, and all doctors can get into it?

Admittedly, I’m probably in better shape than other solo-practice docs. I have access codes to two local radiology places, two large labs, and the largest health care system in my corner of Phoenix. So although I’m not technically a part of them, I can still pull records when I need them for patient care. But if the patient is in my office right then, it takes a minute. My office wifi isn’t the fastest, I have to enter passwords, then do two-factor authentication.

I understand – very much – the importance of the added layers of security, but it adds time to the visit.

Some people, with perhaps more faith in technology than is justified, still don’t understand this. Another doctor sent them to see me, so why don’t I have the results of previous tests and labs? If they tell us what tests they had, and where, and when they make the appointment I can often be prepared for them. But this isn’t consistent.

On the surface some sort of large-scale medical database for everyone sounds good. It would be nice to not have to scramble to get past test results when people come in, and would probably save a lot of money on duplicated labs. But there are legitimate concerns about security and privacy, too.

Not only that, but “it’s in the computer” is also only as good as the people working them. Recently I got a call from an office in a local health care system asking for my notes on a patient. I’d sent them, but they insisted they hadn’t received them. From my desk I logged into their system and found my notes, neatly scanned in and labeled with my name and specialty. When I picked up the phone and told the young lady where to look, she was nice enough to apologize.

I get that. I often overlook things under my own nose, too. But no amount of technology will fix that issue for me or anyone else.

Unfortunately, this misplaced faith in technology doesn’t seem to be going away. People will still keep believing that it works much better than it really does.

That’s human nature, too.

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

“It’s in the computer.”

How many times a week do you hear that?

The advent of the modern EMR has created a new belief in many patients: That all medical office computers are connected, and information from one can be obtained from any of them. So when I ask patients if they had labs, or an MRI, or what their medications are, that’s what I sometimes hear back.

“It’s in the computer.”

True, but not MY computer.

Then they get perplexed, and irritated. Didn’t someone at the other office, or their friends, or something they read online, tell them I’d have access to it? Isn’t all medical info in a giant online database, somewhere, and all doctors can get into it?

Admittedly, I’m probably in better shape than other solo-practice docs. I have access codes to two local radiology places, two large labs, and the largest health care system in my corner of Phoenix. So although I’m not technically a part of them, I can still pull records when I need them for patient care. But if the patient is in my office right then, it takes a minute. My office wifi isn’t the fastest, I have to enter passwords, then do two-factor authentication.

I understand – very much – the importance of the added layers of security, but it adds time to the visit.

Some people, with perhaps more faith in technology than is justified, still don’t understand this. Another doctor sent them to see me, so why don’t I have the results of previous tests and labs? If they tell us what tests they had, and where, and when they make the appointment I can often be prepared for them. But this isn’t consistent.

On the surface some sort of large-scale medical database for everyone sounds good. It would be nice to not have to scramble to get past test results when people come in, and would probably save a lot of money on duplicated labs. But there are legitimate concerns about security and privacy, too.

Not only that, but “it’s in the computer” is also only as good as the people working them. Recently I got a call from an office in a local health care system asking for my notes on a patient. I’d sent them, but they insisted they hadn’t received them. From my desk I logged into their system and found my notes, neatly scanned in and labeled with my name and specialty. When I picked up the phone and told the young lady where to look, she was nice enough to apologize.

I get that. I often overlook things under my own nose, too. But no amount of technology will fix that issue for me or anyone else.

Unfortunately, this misplaced faith in technology doesn’t seem to be going away. People will still keep believing that it works much better than it really does.

That’s human nature, too.

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

Mr. Jones has had multiple sclerosis (MS) since 2008. Initially it was pretty active, though I was able to bring it under control with drug A. He didn’t like the side effects, or the shots, but at that time options for MS treatment were kind of limited.

When the oral agents came out he switched to drug B. He still had some side effects on it, which he didn’t like, but his insurance didn’t cover the other oral agent that was available. So he soldiered on.

Then, in late 2019, he had an episode of optic neuritis, and a repeat MRI showed that in the last 2 years he’d had an uptick in demyelinating plaques. So, in early 2020, he switched to drug C.

Drug C has, to date, been pretty good. He’s had no side effects or relapses, and a recent brain MRI was stable.

Of course, drug C ain’t cheap. Its price isn’t even listed on ePocrates or GoodRx. So my staff and I have to do all kinds of paperwork and hoop-jumping to get it covered each year.

So in late 2021 we started the annual process, which doesn’t happen overnight. We finally received notice he’d been approved – until March 1, 2022. Only 3 months.

Given the alacrity with which these companies seem to work, we began the new authorization paperwork almost as soon as we got the last one in mid-January. This time we didn’t hear back, and every time we called they told us the application was “under review.” In the meantime, Mr. Jones’ supply of pills, which are pretty critical to his health and well-being, was gradually decreasing.

Recently, out of the blue, a 1-month supply of drug C showed up in his mailbox, along with a bill for $3,000. Mr. Jones is a career waiter at a local restaurant, and had no way to pay for this. So my staff went to work on the phones, and after a few hours got it in writing that it was being covered as a bridging supply under the manufacturer’s assistance program. Okay. That crises was averted. (I have no idea if the insurance really pays $3,000/month. Like buying a car, there can be a big difference between a drug’s asking price and what’s really paid for it).

The next morning, however, we got a note from his insurance company saying the medical reviewer had decided he didn’t need drug C, and wanted him to go back to drug B. After all, it was cheaper. I called the reviewer and argued with him. I told him he’d clinically worsened on drug B, not to mention the side effects. The reviewer said I should have mentioned that in my notes. I pointed out that it was in my notes, which had been sent along with the forms I’d filled out. He didn’t answer that, just said he’d have them fax me an appeal form.

The appeal form showed up about an hour later, so I took some time out of my weekend to fill it out. Then I faxed it back, along with (as they requested) chart notes and MRI reports dating back to 2008. Which was a lot.

So now we’ll see what happens.

Do other countries have this sort of thing? Or is this a product of the bizarre patchwork that makes up the American health care system? Different insurance companies, different subplans, and regional sub-subplans, and so on, each with a different set of rules, forms, and obstacle courses to navigate.

For all their glitzy TV commercials showing smiling, happy, multigenerational families, all looking to be in glowing health from the medical care they’re receiving, they seem to be pretty determined to keep Mr. Jones from receiving a drug that’s allowing him to continue working as a waiter 50-60 hours per week. Without it, he’d likely be unable to work and, at some point, would have to file for disability. Probably would eventually need increasingly high-cost items, going to a cane, then a walker, then a wheelchair, then a power wheelchair. ER visits, things that. In the long run, those would cost a helluva lot more than drug C.

Of course, that may be part of their game, too. Maybe they figure he’ll end up dropping off their insurance as he worsens, and then their shareholders don’t have to pay for his bad luck. I hope I’m wrong in thinking that, but such is the nature of business. And health insurance is a HUGE business.

So now I’ve faxed in the appeal forms, and can move on, for the time being, to the needs of other patients (not to mention spending time with my family). But Mr. Jones’ pill supply will run out on April 1, 2022, and I still have no idea what will happen then.

Neither does he. And for him, that’s pretty scary.

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

Mr. Jones has had multiple sclerosis (MS) since 2008. Initially it was pretty active, though I was able to bring it under control with drug A. He didn’t like the side effects, or the shots, but at that time options for MS treatment were kind of limited.

When the oral agents came out he switched to drug B. He still had some side effects on it, which he didn’t like, but his insurance didn’t cover the other oral agent that was available. So he soldiered on.

Then, in late 2019, he had an episode of optic neuritis, and a repeat MRI showed that in the last 2 years he’d had an uptick in demyelinating plaques. So, in early 2020, he switched to drug C.

Drug C has, to date, been pretty good. He’s had no side effects or relapses, and a recent brain MRI was stable.

Of course, drug C ain’t cheap. Its price isn’t even listed on ePocrates or GoodRx. So my staff and I have to do all kinds of paperwork and hoop-jumping to get it covered each year.

So in late 2021 we started the annual process, which doesn’t happen overnight. We finally received notice he’d been approved – until March 1, 2022. Only 3 months.

Given the alacrity with which these companies seem to work, we began the new authorization paperwork almost as soon as we got the last one in mid-January. This time we didn’t hear back, and every time we called they told us the application was “under review.” In the meantime, Mr. Jones’ supply of pills, which are pretty critical to his health and well-being, was gradually decreasing.

Recently, out of the blue, a 1-month supply of drug C showed up in his mailbox, along with a bill for $3,000. Mr. Jones is a career waiter at a local restaurant, and had no way to pay for this. So my staff went to work on the phones, and after a few hours got it in writing that it was being covered as a bridging supply under the manufacturer’s assistance program. Okay. That crises was averted. (I have no idea if the insurance really pays $3,000/month. Like buying a car, there can be a big difference between a drug’s asking price and what’s really paid for it).

The next morning, however, we got a note from his insurance company saying the medical reviewer had decided he didn’t need drug C, and wanted him to go back to drug B. After all, it was cheaper. I called the reviewer and argued with him. I told him he’d clinically worsened on drug B, not to mention the side effects. The reviewer said I should have mentioned that in my notes. I pointed out that it was in my notes, which had been sent along with the forms I’d filled out. He didn’t answer that, just said he’d have them fax me an appeal form.

The appeal form showed up about an hour later, so I took some time out of my weekend to fill it out. Then I faxed it back, along with (as they requested) chart notes and MRI reports dating back to 2008. Which was a lot.

So now we’ll see what happens.

Do other countries have this sort of thing? Or is this a product of the bizarre patchwork that makes up the American health care system? Different insurance companies, different subplans, and regional sub-subplans, and so on, each with a different set of rules, forms, and obstacle courses to navigate.

For all their glitzy TV commercials showing smiling, happy, multigenerational families, all looking to be in glowing health from the medical care they’re receiving, they seem to be pretty determined to keep Mr. Jones from receiving a drug that’s allowing him to continue working as a waiter 50-60 hours per week. Without it, he’d likely be unable to work and, at some point, would have to file for disability. Probably would eventually need increasingly high-cost items, going to a cane, then a walker, then a wheelchair, then a power wheelchair. ER visits, things that. In the long run, those would cost a helluva lot more than drug C.

Of course, that may be part of their game, too. Maybe they figure he’ll end up dropping off their insurance as he worsens, and then their shareholders don’t have to pay for his bad luck. I hope I’m wrong in thinking that, but such is the nature of business. And health insurance is a HUGE business.

So now I’ve faxed in the appeal forms, and can move on, for the time being, to the needs of other patients (not to mention spending time with my family). But Mr. Jones’ pill supply will run out on April 1, 2022, and I still have no idea what will happen then.

Neither does he. And for him, that’s pretty scary.

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

Mr. Jones has had multiple sclerosis (MS) since 2008. Initially it was pretty active, though I was able to bring it under control with drug A. He didn’t like the side effects, or the shots, but at that time options for MS treatment were kind of limited.

When the oral agents came out he switched to drug B. He still had some side effects on it, which he didn’t like, but his insurance didn’t cover the other oral agent that was available. So he soldiered on.

Then, in late 2019, he had an episode of optic neuritis, and a repeat MRI showed that in the last 2 years he’d had an uptick in demyelinating plaques. So, in early 2020, he switched to drug C.

Drug C has, to date, been pretty good. He’s had no side effects or relapses, and a recent brain MRI was stable.

Of course, drug C ain’t cheap. Its price isn’t even listed on ePocrates or GoodRx. So my staff and I have to do all kinds of paperwork and hoop-jumping to get it covered each year.

So in late 2021 we started the annual process, which doesn’t happen overnight. We finally received notice he’d been approved – until March 1, 2022. Only 3 months.

Given the alacrity with which these companies seem to work, we began the new authorization paperwork almost as soon as we got the last one in mid-January. This time we didn’t hear back, and every time we called they told us the application was “under review.” In the meantime, Mr. Jones’ supply of pills, which are pretty critical to his health and well-being, was gradually decreasing.

Recently, out of the blue, a 1-month supply of drug C showed up in his mailbox, along with a bill for $3,000. Mr. Jones is a career waiter at a local restaurant, and had no way to pay for this. So my staff went to work on the phones, and after a few hours got it in writing that it was being covered as a bridging supply under the manufacturer’s assistance program. Okay. That crises was averted. (I have no idea if the insurance really pays $3,000/month. Like buying a car, there can be a big difference between a drug’s asking price and what’s really paid for it).

The next morning, however, we got a note from his insurance company saying the medical reviewer had decided he didn’t need drug C, and wanted him to go back to drug B. After all, it was cheaper. I called the reviewer and argued with him. I told him he’d clinically worsened on drug B, not to mention the side effects. The reviewer said I should have mentioned that in my notes. I pointed out that it was in my notes, which had been sent along with the forms I’d filled out. He didn’t answer that, just said he’d have them fax me an appeal form.

The appeal form showed up about an hour later, so I took some time out of my weekend to fill it out. Then I faxed it back, along with (as they requested) chart notes and MRI reports dating back to 2008. Which was a lot.

So now we’ll see what happens.

Do other countries have this sort of thing? Or is this a product of the bizarre patchwork that makes up the American health care system? Different insurance companies, different subplans, and regional sub-subplans, and so on, each with a different set of rules, forms, and obstacle courses to navigate.

For all their glitzy TV commercials showing smiling, happy, multigenerational families, all looking to be in glowing health from the medical care they’re receiving, they seem to be pretty determined to keep Mr. Jones from receiving a drug that’s allowing him to continue working as a waiter 50-60 hours per week. Without it, he’d likely be unable to work and, at some point, would have to file for disability. Probably would eventually need increasingly high-cost items, going to a cane, then a walker, then a wheelchair, then a power wheelchair. ER visits, things that. In the long run, those would cost a helluva lot more than drug C.

Of course, that may be part of their game, too. Maybe they figure he’ll end up dropping off their insurance as he worsens, and then their shareholders don’t have to pay for his bad luck. I hope I’m wrong in thinking that, but such is the nature of business. And health insurance is a HUGE business.

So now I’ve faxed in the appeal forms, and can move on, for the time being, to the needs of other patients (not to mention spending time with my family). But Mr. Jones’ pill supply will run out on April 1, 2022, and I still have no idea what will happen then.

Neither does he. And for him, that’s pretty scary.

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

My office was open on Presidents Day this year. Granted, I’ve never closed for it.

We’re also open on Veteran’s Day, Columbus Day, and Martin Luther King Jr. Day.

Occasionally (usually MLK or Veteran’s days) we get a call from someone unhappy we’re open that day. Banks, government offices, and schools are closed, and they feel that, by not following suit, I’m insulting the memory of veterans and those who fought for civil rights.

Nothing could be farther from the truth. In fact, I don’t know any doctors’ offices that AREN’T open on those days.

Part of this is patient centered. When people need to see a doctor, they don’t want to wait too long. The emergency room isn’t where the majority of things should be handled. Besides, they’re already swamped with nonemergent cases.

Most practices work 8-5 on weekdays, and are booked out. Every additional weekday you’re closed only adds to the wait. So I try to be there enough days to care for people, but not enough so that I lose my sanity or family.

In my area, a fair number of my patients are schoolteachers, who work the same hours I do. So many of them come in on those days, and appreciate that I’m open when they’re off.

Another part is practical. In a small practice, cash flow is critical, and there are just so many days in a given year you can be closed without hurting your financial picture. So most practices are closed for the Big 6 (Memorial Day, Independence Day, Labor Day, Thanksgiving, Christmas, and New Years). Usually this also includes Black Friday and Christmas Eve. So a total of 8 days per year (in addition to vacations).

Unlike other businesses (such as stores and restaurants) most medical offices aren’t open on weekends and nights, so our entire revenue stream is dependent on weekdays from 8 to 5. In this day and age, with most practices running on razor-thin margins, every day off adds to the red line. I can’t take care of anyone if I can’t pay my rent and staff.

I mean no disrespect to anyone. Like other doctors I work hard to provide quality care to all. But the nature of medicine is such that we give up our own time to help others. So I try to be there for them as much as I can, without going overboard and at the same time keeping my small practice afloat.

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

My office was open on Presidents Day this year. Granted, I’ve never closed for it.

We’re also open on Veteran’s Day, Columbus Day, and Martin Luther King Jr. Day.

Occasionally (usually MLK or Veteran’s days) we get a call from someone unhappy we’re open that day. Banks, government offices, and schools are closed, and they feel that, by not following suit, I’m insulting the memory of veterans and those who fought for civil rights.

Nothing could be farther from the truth. In fact, I don’t know any doctors’ offices that AREN’T open on those days.

Part of this is patient centered. When people need to see a doctor, they don’t want to wait too long. The emergency room isn’t where the majority of things should be handled. Besides, they’re already swamped with nonemergent cases.

Most practices work 8-5 on weekdays, and are booked out. Every additional weekday you’re closed only adds to the wait. So I try to be there enough days to care for people, but not enough so that I lose my sanity or family.

In my area, a fair number of my patients are schoolteachers, who work the same hours I do. So many of them come in on those days, and appreciate that I’m open when they’re off.

Another part is practical. In a small practice, cash flow is critical, and there are just so many days in a given year you can be closed without hurting your financial picture. So most practices are closed for the Big 6 (Memorial Day, Independence Day, Labor Day, Thanksgiving, Christmas, and New Years). Usually this also includes Black Friday and Christmas Eve. So a total of 8 days per year (in addition to vacations).

Unlike other businesses (such as stores and restaurants) most medical offices aren’t open on weekends and nights, so our entire revenue stream is dependent on weekdays from 8 to 5. In this day and age, with most practices running on razor-thin margins, every day off adds to the red line. I can’t take care of anyone if I can’t pay my rent and staff.

I mean no disrespect to anyone. Like other doctors I work hard to provide quality care to all. But the nature of medicine is such that we give up our own time to help others. So I try to be there for them as much as I can, without going overboard and at the same time keeping my small practice afloat.

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

My office was open on Presidents Day this year. Granted, I’ve never closed for it.

We’re also open on Veteran’s Day, Columbus Day, and Martin Luther King Jr. Day.

Occasionally (usually MLK or Veteran’s days) we get a call from someone unhappy we’re open that day. Banks, government offices, and schools are closed, and they feel that, by not following suit, I’m insulting the memory of veterans and those who fought for civil rights.

Nothing could be farther from the truth. In fact, I don’t know any doctors’ offices that AREN’T open on those days.

Part of this is patient centered. When people need to see a doctor, they don’t want to wait too long. The emergency room isn’t where the majority of things should be handled. Besides, they’re already swamped with nonemergent cases.

Most practices work 8-5 on weekdays, and are booked out. Every additional weekday you’re closed only adds to the wait. So I try to be there enough days to care for people, but not enough so that I lose my sanity or family.

In my area, a fair number of my patients are schoolteachers, who work the same hours I do. So many of them come in on those days, and appreciate that I’m open when they’re off.

Another part is practical. In a small practice, cash flow is critical, and there are just so many days in a given year you can be closed without hurting your financial picture. So most practices are closed for the Big 6 (Memorial Day, Independence Day, Labor Day, Thanksgiving, Christmas, and New Years). Usually this also includes Black Friday and Christmas Eve. So a total of 8 days per year (in addition to vacations).

Unlike other businesses (such as stores and restaurants) most medical offices aren’t open on weekends and nights, so our entire revenue stream is dependent on weekdays from 8 to 5. In this day and age, with most practices running on razor-thin margins, every day off adds to the red line. I can’t take care of anyone if I can’t pay my rent and staff.

I mean no disrespect to anyone. Like other doctors I work hard to provide quality care to all. But the nature of medicine is such that we give up our own time to help others. So I try to be there for them as much as I can, without going overboard and at the same time keeping my small practice afloat.

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

Any other docs out there have patients on what I call the migraine-go-round?

I first discovered this ride when I started in practice, though back then it was with triptans. You know the game, you’d start someone on one drug because you had samples, or a coupon, or both. A few months later the coupon had run out, and their insurance wouldn’t cover it, so you’d move them to another drug. Maxalt to Imitrex to Zomig to Relpax to Axert to Maxalt.

The ride continued until the majority had gone generic, and I’d almost forgotten about it. You can’t do it with seizure patients or Parkinson’s disease.

But with the advent of the CGRP era, it seems to have started again. Coverage coupons have a limited number of refills, or the deal changes, or a pharmacy stops taking them, or an insurance company changes their mind, or whatever. So we go from Aimovig to Emgality to Qulipta to Ajovy to Nurtec to Aimovig (not necessarily in that order).

It’s annoying (not just for the patients, but for me and my staff as we try to keep up with it), and obviously it doesn’t work for everyone because each patient responds differently. But, if it works, it at least gets some degree of coverage until an insurance company finally approves a given drug for that person. And even then a patient’s own financial circumstances or changing job situation can keep things spinning.

When you finally step off the ride you have to pore back through the chart to figure out which, if any, worked best, or had side effects, or whatever.

A good part of modern medicine is adapting to these sorts of things. Patient care isn’t always as simple as “take this and call me in the morning.” Sometimes we have to play the game to get things done.

The trick is learning the rules on the fly – for all involved.

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

Any other docs out there have patients on what I call the migraine-go-round?

I first discovered this ride when I started in practice, though back then it was with triptans. You know the game, you’d start someone on one drug because you had samples, or a coupon, or both. A few months later the coupon had run out, and their insurance wouldn’t cover it, so you’d move them to another drug. Maxalt to Imitrex to Zomig to Relpax to Axert to Maxalt.

The ride continued until the majority had gone generic, and I’d almost forgotten about it. You can’t do it with seizure patients or Parkinson’s disease.

But with the advent of the CGRP era, it seems to have started again. Coverage coupons have a limited number of refills, or the deal changes, or a pharmacy stops taking them, or an insurance company changes their mind, or whatever. So we go from Aimovig to Emgality to Qulipta to Ajovy to Nurtec to Aimovig (not necessarily in that order).

It’s annoying (not just for the patients, but for me and my staff as we try to keep up with it), and obviously it doesn’t work for everyone because each patient responds differently. But, if it works, it at least gets some degree of coverage until an insurance company finally approves a given drug for that person. And even then a patient’s own financial circumstances or changing job situation can keep things spinning.

When you finally step off the ride you have to pore back through the chart to figure out which, if any, worked best, or had side effects, or whatever.

A good part of modern medicine is adapting to these sorts of things. Patient care isn’t always as simple as “take this and call me in the morning.” Sometimes we have to play the game to get things done.

The trick is learning the rules on the fly – for all involved.

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

Any other docs out there have patients on what I call the migraine-go-round?

I first discovered this ride when I started in practice, though back then it was with triptans. You know the game, you’d start someone on one drug because you had samples, or a coupon, or both. A few months later the coupon had run out, and their insurance wouldn’t cover it, so you’d move them to another drug. Maxalt to Imitrex to Zomig to Relpax to Axert to Maxalt.

The ride continued until the majority had gone generic, and I’d almost forgotten about it. You can’t do it with seizure patients or Parkinson’s disease.

But with the advent of the CGRP era, it seems to have started again. Coverage coupons have a limited number of refills, or the deal changes, or a pharmacy stops taking them, or an insurance company changes their mind, or whatever. So we go from Aimovig to Emgality to Qulipta to Ajovy to Nurtec to Aimovig (not necessarily in that order).

It’s annoying (not just for the patients, but for me and my staff as we try to keep up with it), and obviously it doesn’t work for everyone because each patient responds differently. But, if it works, it at least gets some degree of coverage until an insurance company finally approves a given drug for that person. And even then a patient’s own financial circumstances or changing job situation can keep things spinning.

When you finally step off the ride you have to pore back through the chart to figure out which, if any, worked best, or had side effects, or whatever.

A good part of modern medicine is adapting to these sorts of things. Patient care isn’t always as simple as “take this and call me in the morning.” Sometimes we have to play the game to get things done.

The trick is learning the rules on the fly – for all involved.

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

I’m not fanatical about dragging stable patients in. If someone is doing fine, having them come in once a year is all I ask. They have better things to do, and I have patients who need my attention more.

Of course, there will always be those who abuse this. They try to drag it out to 18 months, sometimes 2 years. I don’t think having patients drop in for 10-15 minutes once a year to make sure they’re still alive is unreasonable, but maybe that’s just me. Admittedly, during the last 2 years I’ve kind of let it slide a bit, but I think everyone has.

Last week a lady I see for an annual check-in called to make an appointment. She’d been dodging my secretary’s reminders for a few months, so I cut her migraine refill from a 90-day supply to 30 days to encourage her. She called, made an appointment for the following morning, and asked that I send in a refill for 90 days because otherwise her insurance won’t cover it. So, trying to be nice, I did, figuring she was on the schedule now.

Of course, she didn’t show up the next morning. She didn’t cancel, or call in with “I’m sick” or “sorry, I spaced on it” or some other issue. She just no-showed. One of the many banes of outpatient medicine.

Normally I avoid looking at my patients’ online presence, but I got curious. This lady has often suggested I check out her social media account for financial and real estate tips. I never had, until that morning.

Her Twitter account for the last several days was full of reminders to her followers for an in-person seminar on real estate flipping that she was hosting, which, surprisingly, started at the exact time as her appointment with me was supposed to.

I’m pretty sure she ain’t that stupid. She knew exactly what she was doing, and never planned on keeping the appointment. Now she had a 90-day supply of meds and no incentive to follow up with me before then.

Certainly, it’s not the worst thing. The drug involved isn’t controlled, and in 24 years I’ve had patients do far worse.

But it still changes the trust factor in the medical relationship. She isn’t getting another 90-day refill without coming in, and if she has to pay cash for 30 days that’s her problem, not mine. She can avoid that by calling in to schedule before then. Though I doubt she will.

I try to work with my patients. I really do. Her behavior is rude and inconsiderate, but (at least to me) doesn’t cross the line to firing her from the practice.

But it does make it trickier to be her doctor, since I now know that she isn’t always truthful with me and my staff.

And that sort of thing is important in this field.

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

I’m not fanatical about dragging stable patients in. If someone is doing fine, having them come in once a year is all I ask. They have better things to do, and I have patients who need my attention more.

Of course, there will always be those who abuse this. They try to drag it out to 18 months, sometimes 2 years. I don’t think having patients drop in for 10-15 minutes once a year to make sure they’re still alive is unreasonable, but maybe that’s just me. Admittedly, during the last 2 years I’ve kind of let it slide a bit, but I think everyone has.

Last week a lady I see for an annual check-in called to make an appointment. She’d been dodging my secretary’s reminders for a few months, so I cut her migraine refill from a 90-day supply to 30 days to encourage her. She called, made an appointment for the following morning, and asked that I send in a refill for 90 days because otherwise her insurance won’t cover it. So, trying to be nice, I did, figuring she was on the schedule now.

Of course, she didn’t show up the next morning. She didn’t cancel, or call in with “I’m sick” or “sorry, I spaced on it” or some other issue. She just no-showed. One of the many banes of outpatient medicine.

Normally I avoid looking at my patients’ online presence, but I got curious. This lady has often suggested I check out her social media account for financial and real estate tips. I never had, until that morning.

Her Twitter account for the last several days was full of reminders to her followers for an in-person seminar on real estate flipping that she was hosting, which, surprisingly, started at the exact time as her appointment with me was supposed to.

I’m pretty sure she ain’t that stupid. She knew exactly what she was doing, and never planned on keeping the appointment. Now she had a 90-day supply of meds and no incentive to follow up with me before then.

Certainly, it’s not the worst thing. The drug involved isn’t controlled, and in 24 years I’ve had patients do far worse.

But it still changes the trust factor in the medical relationship. She isn’t getting another 90-day refill without coming in, and if she has to pay cash for 30 days that’s her problem, not mine. She can avoid that by calling in to schedule before then. Though I doubt she will.

I try to work with my patients. I really do. Her behavior is rude and inconsiderate, but (at least to me) doesn’t cross the line to firing her from the practice.

But it does make it trickier to be her doctor, since I now know that she isn’t always truthful with me and my staff.

And that sort of thing is important in this field.

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

I’m not fanatical about dragging stable patients in. If someone is doing fine, having them come in once a year is all I ask. They have better things to do, and I have patients who need my attention more.

Of course, there will always be those who abuse this. They try to drag it out to 18 months, sometimes 2 years. I don’t think having patients drop in for 10-15 minutes once a year to make sure they’re still alive is unreasonable, but maybe that’s just me. Admittedly, during the last 2 years I’ve kind of let it slide a bit, but I think everyone has.

Last week a lady I see for an annual check-in called to make an appointment. She’d been dodging my secretary’s reminders for a few months, so I cut her migraine refill from a 90-day supply to 30 days to encourage her. She called, made an appointment for the following morning, and asked that I send in a refill for 90 days because otherwise her insurance won’t cover it. So, trying to be nice, I did, figuring she was on the schedule now.

Of course, she didn’t show up the next morning. She didn’t cancel, or call in with “I’m sick” or “sorry, I spaced on it” or some other issue. She just no-showed. One of the many banes of outpatient medicine.

Normally I avoid looking at my patients’ online presence, but I got curious. This lady has often suggested I check out her social media account for financial and real estate tips. I never had, until that morning.

Her Twitter account for the last several days was full of reminders to her followers for an in-person seminar on real estate flipping that she was hosting, which, surprisingly, started at the exact time as her appointment with me was supposed to.

I’m pretty sure she ain’t that stupid. She knew exactly what she was doing, and never planned on keeping the appointment. Now she had a 90-day supply of meds and no incentive to follow up with me before then.

Certainly, it’s not the worst thing. The drug involved isn’t controlled, and in 24 years I’ve had patients do far worse.

But it still changes the trust factor in the medical relationship. She isn’t getting another 90-day refill without coming in, and if she has to pay cash for 30 days that’s her problem, not mine. She can avoid that by calling in to schedule before then. Though I doubt she will.

I try to work with my patients. I really do. Her behavior is rude and inconsiderate, but (at least to me) doesn’t cross the line to firing her from the practice.

But it does make it trickier to be her doctor, since I now know that she isn’t always truthful with me and my staff.

And that sort of thing is important in this field.

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

She was a 20-year-old barista when we first met, working her way through college.

I was a newly minted attending physician. I’d stopped at the place she worked for coffee on the way to my office. When I got up to the front she was wearing sunglasses and apologized for them. She said she was having bad headaches, and couldn’t get into a doctor she’d been referred to. Feeling bad for her, and needing patients, I handed her my card.

She showed up a few days later, a little nervous as she’d never met a “regular” outside the coffee place before, and had brought her sister along for support.

She was back last week. Now she’s head of human resources for the same chain of local coffee shops. She’s married, with kids, a mortgage, and a minivan.

We were talking about our chance meeting and reminiscing. Her migraines had taken a few medication trials to control, but after a year or 2 we’d found the right one for her and she’s been on it since.

Like many of my longtime patients, she moved past calling me “doctor” long ago. Our one to two visits a year are now more social than medical, chatting about our kids, dogs, and lives.

The same passage of time that brings us from grade school, to medical school, to medical practice takes others along with it. We may not see the changes of days, but when they drop by only once a year it’s obvious. Just like the way we don’t see daily changes in family and friends, but when we look at old pictures we’re shocked by how different they (not to mention ourselves) look.

We all follow the same course around the sun, usually facing the same milestones and similar memories on the trip. Our long-term patients, like distant relatives, may only come by infrequently, so the changes are greater. I’m sure they say the same things about me. “I saw Dr. Block today; boy, he’s really gone gray.”

I don’t mind that (too much) anymore. My thinning, graying, hair (I hope) makes me look a little more distinguished, although my complete lack of fashion sense more than goes the other way.

The river only goes in one direction, carrying us, our patients, and our families, all along with it. We often lose track of time’s effects on us until we see the changes it has brought to another.

It’s always a good reminder to pause and remember to enjoy the ride.

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

She was a 20-year-old barista when we first met, working her way through college.

I was a newly minted attending physician. I’d stopped at the place she worked for coffee on the way to my office. When I got up to the front she was wearing sunglasses and apologized for them. She said she was having bad headaches, and couldn’t get into a doctor she’d been referred to. Feeling bad for her, and needing patients, I handed her my card.

She showed up a few days later, a little nervous as she’d never met a “regular” outside the coffee place before, and had brought her sister along for support.

She was back last week. Now she’s head of human resources for the same chain of local coffee shops. She’s married, with kids, a mortgage, and a minivan.

We were talking about our chance meeting and reminiscing. Her migraines had taken a few medication trials to control, but after a year or 2 we’d found the right one for her and she’s been on it since.

Like many of my longtime patients, she moved past calling me “doctor” long ago. Our one to two visits a year are now more social than medical, chatting about our kids, dogs, and lives.

The same passage of time that brings us from grade school, to medical school, to medical practice takes others along with it. We may not see the changes of days, but when they drop by only once a year it’s obvious. Just like the way we don’t see daily changes in family and friends, but when we look at old pictures we’re shocked by how different they (not to mention ourselves) look.

We all follow the same course around the sun, usually facing the same milestones and similar memories on the trip. Our long-term patients, like distant relatives, may only come by infrequently, so the changes are greater. I’m sure they say the same things about me. “I saw Dr. Block today; boy, he’s really gone gray.”

I don’t mind that (too much) anymore. My thinning, graying, hair (I hope) makes me look a little more distinguished, although my complete lack of fashion sense more than goes the other way.

The river only goes in one direction, carrying us, our patients, and our families, all along with it. We often lose track of time’s effects on us until we see the changes it has brought to another.

It’s always a good reminder to pause and remember to enjoy the ride.

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

She was a 20-year-old barista when we first met, working her way through college.

I was a newly minted attending physician. I’d stopped at the place she worked for coffee on the way to my office. When I got up to the front she was wearing sunglasses and apologized for them. She said she was having bad headaches, and couldn’t get into a doctor she’d been referred to. Feeling bad for her, and needing patients, I handed her my card.

She showed up a few days later, a little nervous as she’d never met a “regular” outside the coffee place before, and had brought her sister along for support.

She was back last week. Now she’s head of human resources for the same chain of local coffee shops. She’s married, with kids, a mortgage, and a minivan.

We were talking about our chance meeting and reminiscing. Her migraines had taken a few medication trials to control, but after a year or 2 we’d found the right one for her and she’s been on it since.

Like many of my longtime patients, she moved past calling me “doctor” long ago. Our one to two visits a year are now more social than medical, chatting about our kids, dogs, and lives.

The same passage of time that brings us from grade school, to medical school, to medical practice takes others along with it. We may not see the changes of days, but when they drop by only once a year it’s obvious. Just like the way we don’t see daily changes in family and friends, but when we look at old pictures we’re shocked by how different they (not to mention ourselves) look.

We all follow the same course around the sun, usually facing the same milestones and similar memories on the trip. Our long-term patients, like distant relatives, may only come by infrequently, so the changes are greater. I’m sure they say the same things about me. “I saw Dr. Block today; boy, he’s really gone gray.”

I don’t mind that (too much) anymore. My thinning, graying, hair (I hope) makes me look a little more distinguished, although my complete lack of fashion sense more than goes the other way.

The river only goes in one direction, carrying us, our patients, and our families, all along with it. We often lose track of time’s effects on us until we see the changes it has brought to another.

It’s always a good reminder to pause and remember to enjoy the ride.

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

Fifteen years ago, Mrs. Smith was hospitalized for a dural sinus thrombosis.

This is a scary enough diagnosis as it is, but with the miracle of modern medicine she did great. She still checks in with me every year or so, but hasn’t had any recurrence.

Three years ago she tripped over her dog (amazing how often that seems to happen) and broke her arm. She landed in the hospital and needed orthopedic surgery, so they consulted me about the safety of getting her off the antiplatelet agent she was taking since stopping Coumadin.

When I arrived someone had already written an admitting note, which included a past history of “subdural hematoma, maintained on daily aspirin.”

Where this error came from, I don’t know. When I asked Mrs. Smith, she was quite clear on her correct diagnosis, and said she’d given it to the person who admitted her. So I dictated a consult, and typed it into my progress note each day. My notes made it clear that she’d had a dural sinus thrombosis and not a subdural hematoma.

This isn’t just nitpicking, obviously. They’re entirely different disorders. While the point may not be critical to her needing wrist surgery, these are medical records, and medical records need to be as accurate as possible for this, and future hospital stays and for physicians to be aware of.

I signed off after a few days and didn’t think much of it until I was faxed a copy of her discharge summary. Which listed “subdural hematoma, maintained on daily aspirin.”

Apparently no one read my notes. Not that I’m really surprised.

We’re now 3 years later. As do many patients of her age, Mrs. Smith has landed in the hospital a few times since then. COVID, syncope, another fall. In each one of them the “subdural hematoma, maintained on daily aspirin” shows up.

At the most recent incident, the hospital’s neurologist called and asked me why I was treating a subdural hematoma with aspirin, then said Mrs. Smith had told him it was a dural sinus thrombosis. I said she was right, and he said “that makes more sense” and that he’d put it in his note.

He did, but it didn’t change anything. The discharge summary still listed “subdural hematoma, maintained on daily aspirin.”

At some point resistance is futile.

The stupidity of the whole thing is frustrating, as is knowing that it’s not just Mrs. Smith. The same scenario of incorrect history and medications is propagated from visit to visit. Taking a history is too time consuming for some. It’s easier to just read off, or cut and paste, a previous note. In cases where the patient can’t give a history I understand this. But when they can it’s just being too rushed – or lazy – to care.

It’s easy to blame EMRs as the culprits. Bashing them is fashionable. But in this case I can’t. They make it easier, but it’s nothing new. I remember a night almost 30 years ago when I was doing an admission at the Phoenix VA. When I picked up the most recent volume of the patient’s old chart to look at labs, the previous H&P said “see old chart.”

The problem is human nature. Not the computer.

But in this field the fallout can be serious – the wrong precautions taken, or medication given, based on a nonexistent contraindication. In medicine the stakes are high. Our decisions are only as good as the information we base them on, and if that information is wrong ...

Shortcuts have consequences.

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

Fifteen years ago, Mrs. Smith was hospitalized for a dural sinus thrombosis.

This is a scary enough diagnosis as it is, but with the miracle of modern medicine she did great. She still checks in with me every year or so, but hasn’t had any recurrence.

Three years ago she tripped over her dog (amazing how often that seems to happen) and broke her arm. She landed in the hospital and needed orthopedic surgery, so they consulted me about the safety of getting her off the antiplatelet agent she was taking since stopping Coumadin.

When I arrived someone had already written an admitting note, which included a past history of “subdural hematoma, maintained on daily aspirin.”

Where this error came from, I don’t know. When I asked Mrs. Smith, she was quite clear on her correct diagnosis, and said she’d given it to the person who admitted her. So I dictated a consult, and typed it into my progress note each day. My notes made it clear that she’d had a dural sinus thrombosis and not a subdural hematoma.

This isn’t just nitpicking, obviously. They’re entirely different disorders. While the point may not be critical to her needing wrist surgery, these are medical records, and medical records need to be as accurate as possible for this, and future hospital stays and for physicians to be aware of.

I signed off after a few days and didn’t think much of it until I was faxed a copy of her discharge summary. Which listed “subdural hematoma, maintained on daily aspirin.”

Apparently no one read my notes. Not that I’m really surprised.

We’re now 3 years later. As do many patients of her age, Mrs. Smith has landed in the hospital a few times since then. COVID, syncope, another fall. In each one of them the “subdural hematoma, maintained on daily aspirin” shows up.

At the most recent incident, the hospital’s neurologist called and asked me why I was treating a subdural hematoma with aspirin, then said Mrs. Smith had told him it was a dural sinus thrombosis. I said she was right, and he said “that makes more sense” and that he’d put it in his note.

He did, but it didn’t change anything. The discharge summary still listed “subdural hematoma, maintained on daily aspirin.”

At some point resistance is futile.

The stupidity of the whole thing is frustrating, as is knowing that it’s not just Mrs. Smith. The same scenario of incorrect history and medications is propagated from visit to visit. Taking a history is too time consuming for some. It’s easier to just read off, or cut and paste, a previous note. In cases where the patient can’t give a history I understand this. But when they can it’s just being too rushed – or lazy – to care.

It’s easy to blame EMRs as the culprits. Bashing them is fashionable. But in this case I can’t. They make it easier, but it’s nothing new. I remember a night almost 30 years ago when I was doing an admission at the Phoenix VA. When I picked up the most recent volume of the patient’s old chart to look at labs, the previous H&P said “see old chart.”

The problem is human nature. Not the computer.

But in this field the fallout can be serious – the wrong precautions taken, or medication given, based on a nonexistent contraindication. In medicine the stakes are high. Our decisions are only as good as the information we base them on, and if that information is wrong ...

Shortcuts have consequences.

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

Fifteen years ago, Mrs. Smith was hospitalized for a dural sinus thrombosis.

This is a scary enough diagnosis as it is, but with the miracle of modern medicine she did great. She still checks in with me every year or so, but hasn’t had any recurrence.

Three years ago she tripped over her dog (amazing how often that seems to happen) and broke her arm. She landed in the hospital and needed orthopedic surgery, so they consulted me about the safety of getting her off the antiplatelet agent she was taking since stopping Coumadin.

When I arrived someone had already written an admitting note, which included a past history of “subdural hematoma, maintained on daily aspirin.”

Where this error came from, I don’t know. When I asked Mrs. Smith, she was quite clear on her correct diagnosis, and said she’d given it to the person who admitted her. So I dictated a consult, and typed it into my progress note each day. My notes made it clear that she’d had a dural sinus thrombosis and not a subdural hematoma.

This isn’t just nitpicking, obviously. They’re entirely different disorders. While the point may not be critical to her needing wrist surgery, these are medical records, and medical records need to be as accurate as possible for this, and future hospital stays and for physicians to be aware of.

I signed off after a few days and didn’t think much of it until I was faxed a copy of her discharge summary. Which listed “subdural hematoma, maintained on daily aspirin.”

Apparently no one read my notes. Not that I’m really surprised.

We’re now 3 years later. As do many patients of her age, Mrs. Smith has landed in the hospital a few times since then. COVID, syncope, another fall. In each one of them the “subdural hematoma, maintained on daily aspirin” shows up.

At the most recent incident, the hospital’s neurologist called and asked me why I was treating a subdural hematoma with aspirin, then said Mrs. Smith had told him it was a dural sinus thrombosis. I said she was right, and he said “that makes more sense” and that he’d put it in his note.

He did, but it didn’t change anything. The discharge summary still listed “subdural hematoma, maintained on daily aspirin.”

At some point resistance is futile.

The stupidity of the whole thing is frustrating, as is knowing that it’s not just Mrs. Smith. The same scenario of incorrect history and medications is propagated from visit to visit. Taking a history is too time consuming for some. It’s easier to just read off, or cut and paste, a previous note. In cases where the patient can’t give a history I understand this. But when they can it’s just being too rushed – or lazy – to care.

It’s easy to blame EMRs as the culprits. Bashing them is fashionable. But in this case I can’t. They make it easier, but it’s nothing new. I remember a night almost 30 years ago when I was doing an admission at the Phoenix VA. When I picked up the most recent volume of the patient’s old chart to look at labs, the previous H&P said “see old chart.”

The problem is human nature. Not the computer.

But in this field the fallout can be serious – the wrong precautions taken, or medication given, based on a nonexistent contraindication. In medicine the stakes are high. Our decisions are only as good as the information we base them on, and if that information is wrong ...

Shortcuts have consequences.

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

“Why did the other doctor say that?”

I get that question here and there, and it’s always irritating. How should I know?

Generally it’s referring to something they say their family doctor told them: A scan that showed normal pressure hydrocephalus or multiple sclerosis, but when I actually get the neuroradiologist’s report it was normal. Sometimes it’s an alleged side effect from a drug for which I can find nothing in the literature or something that requires urgent surgery in spite of all objective evidence to the contrary.

These appointments are always frustrating. The patient is upset that what they’ve been told (or at least think they’ve been told) is incorrect. They’ve spent a few weeks doing medical research on Google for a condition they don’t have. They’re angry at me for shooting them down. They’re angry at the person who referred them for not being right. They’re angry that they wasted their time coming to me.

And then they ask me why the other doctor said that. I wasn’t there. I don’t know. Medicine is a less-than-perfect science. Maybe they were looking at the wrong report. Maybe they’d gotten an incorrect “wet read” by phone. (How many doctors today even know where the term came from?) Maybe they were having a bad day, were overwhelmed, and misread something.

There’s also the possibility that the other doctor didn’t say it at all. Many people will only hear what they want to hear. Or they’ve already decided what they have and are claiming “the other doctor” told them just to give credence to it, even if it’s not true.

Such visits often end on an ugly note. The patient doesn’t want to be billed because I didn’t say what they wanted me to say. Or pay a copay. Or just get up and leave.

I try, very hard, to be polite when this happens. I don’t know what really went on at the other office – if what’s claimed even happened at all. Even if the patient is telling the truth, all doctors, like all people, make mistakes. It’s not like they were trying to be wrong or deceptive. I don’t fault my colleagues if they make an error, and hope they feel the same way about me.

But it’s still frustrating when it occurs. In many cases I’m left dictating a polite note back to the referring physician, explaining what happened. I chalk it up to a communication error, or experience, or even just a difficult patient. I never really know for sure.

I don’t think any of us are here to willfully deceive patients. We want to do our best for them. It’s frustrating when something happens to lead them to believe otherwise.

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

“Why did the other doctor say that?”

I get that question here and there, and it’s always irritating. How should I know?

Generally it’s referring to something they say their family doctor told them: A scan that showed normal pressure hydrocephalus or multiple sclerosis, but when I actually get the neuroradiologist’s report it was normal. Sometimes it’s an alleged side effect from a drug for which I can find nothing in the literature or something that requires urgent surgery in spite of all objective evidence to the contrary.

These appointments are always frustrating. The patient is upset that what they’ve been told (or at least think they’ve been told) is incorrect. They’ve spent a few weeks doing medical research on Google for a condition they don’t have. They’re angry at me for shooting them down. They’re angry at the person who referred them for not being right. They’re angry that they wasted their time coming to me.

And then they ask me why the other doctor said that. I wasn’t there. I don’t know. Medicine is a less-than-perfect science. Maybe they were looking at the wrong report. Maybe they’d gotten an incorrect “wet read” by phone. (How many doctors today even know where the term came from?) Maybe they were having a bad day, were overwhelmed, and misread something.

There’s also the possibility that the other doctor didn’t say it at all. Many people will only hear what they want to hear. Or they’ve already decided what they have and are claiming “the other doctor” told them just to give credence to it, even if it’s not true.

Such visits often end on an ugly note. The patient doesn’t want to be billed because I didn’t say what they wanted me to say. Or pay a copay. Or just get up and leave.

I try, very hard, to be polite when this happens. I don’t know what really went on at the other office – if what’s claimed even happened at all. Even if the patient is telling the truth, all doctors, like all people, make mistakes. It’s not like they were trying to be wrong or deceptive. I don’t fault my colleagues if they make an error, and hope they feel the same way about me.

But it’s still frustrating when it occurs. In many cases I’m left dictating a polite note back to the referring physician, explaining what happened. I chalk it up to a communication error, or experience, or even just a difficult patient. I never really know for sure.

I don’t think any of us are here to willfully deceive patients. We want to do our best for them. It’s frustrating when something happens to lead them to believe otherwise.

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

“Why did the other doctor say that?”

I get that question here and there, and it’s always irritating. How should I know?

Generally it’s referring to something they say their family doctor told them: A scan that showed normal pressure hydrocephalus or multiple sclerosis, but when I actually get the neuroradiologist’s report it was normal. Sometimes it’s an alleged side effect from a drug for which I can find nothing in the literature or something that requires urgent surgery in spite of all objective evidence to the contrary.

These appointments are always frustrating. The patient is upset that what they’ve been told (or at least think they’ve been told) is incorrect. They’ve spent a few weeks doing medical research on Google for a condition they don’t have. They’re angry at me for shooting them down. They’re angry at the person who referred them for not being right. They’re angry that they wasted their time coming to me.

And then they ask me why the other doctor said that. I wasn’t there. I don’t know. Medicine is a less-than-perfect science. Maybe they were looking at the wrong report. Maybe they’d gotten an incorrect “wet read” by phone. (How many doctors today even know where the term came from?) Maybe they were having a bad day, were overwhelmed, and misread something.

There’s also the possibility that the other doctor didn’t say it at all. Many people will only hear what they want to hear. Or they’ve already decided what they have and are claiming “the other doctor” told them just to give credence to it, even if it’s not true.

Such visits often end on an ugly note. The patient doesn’t want to be billed because I didn’t say what they wanted me to say. Or pay a copay. Or just get up and leave.

I try, very hard, to be polite when this happens. I don’t know what really went on at the other office – if what’s claimed even happened at all. Even if the patient is telling the truth, all doctors, like all people, make mistakes. It’s not like they were trying to be wrong or deceptive. I don’t fault my colleagues if they make an error, and hope they feel the same way about me.

But it’s still frustrating when it occurs. In many cases I’m left dictating a polite note back to the referring physician, explaining what happened. I chalk it up to a communication error, or experience, or even just a difficult patient. I never really know for sure.

I don’t think any of us are here to willfully deceive patients. We want to do our best for them. It’s frustrating when something happens to lead them to believe otherwise.

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

There’s another doctor with whom I’ve referred patients, back and forth, for the last 20 years. I think he’s good at his job and assume he feels the same way about me. We aren’t social friends, but chat briefly when we run into each other at the hospital, or store, or local restaurants.

Last week I was at the hospital to read EEGs, and happened to see him in the doctor’s parking lot. We wished each other a happy new year, talked briefly about a few mutual patients, and then went our separate ways.

As he pulled out, I noticed his car had a bumper sticker for a cause I strongly disagree with. I mean, 180 degrees opposed.

Suddenly, I didn’t want to ever refer to him again. Why should I support him? He’s the enemy.

Why should I help him out by referring patients?

But then I had to stop. Isn’t this 2022? Aren’t we supposed to be in a civilized world? This isn’t my tribe versus your tribe, my cave versus your cave. The closest we’re supposed to come to direct conflict with others is the “us versus them” world of professional and college sports.

I hope.

Aren’t I supposed to be better than this? Isn’t learning to coexist the whole point of the playground as a kid (besides burning off energy and giving the teacher a break)? Isn’t the idea behind civilization to get along with each other, accept our differences as “agreeing to disagree,” and work together? Like Hamilton and Jefferson, or Ronald Reagan and Tip O’Neill?

Refusing to work with another competent physician because I disagree with their personal, religious, or political beliefs is just plain stupid.

Politicians and pundits try to convince us that people who disagree with us are the enemy, but that’s horse hockey. The truth is that the majority of people out there, regardless of personal beliefs, are decent, hardworking, and just trying to support their families like I am mine.

Later that week I had a patient who clearly needed the other doctor’s expertise, and I gave her his name and phone number. She asked if I’d send my own family to him, and I said, unequivocally, “yes” (actually I have).

Because, at the end of the day, we’re all people, along on the same ride. To not send a patient to him wouldn’t be in their best interest, which is what I’m supposed to be watching out for.

Not only that, but if I don’t refer just because I disagree with him as a person, then I’ve become the problem and not the solution.

Because I, and everyone else, have to try to be better than that.

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

There’s another doctor with whom I’ve referred patients, back and forth, for the last 20 years. I think he’s good at his job and assume he feels the same way about me. We aren’t social friends, but chat briefly when we run into each other at the hospital, or store, or local restaurants.

Last week I was at the hospital to read EEGs, and happened to see him in the doctor’s parking lot. We wished each other a happy new year, talked briefly about a few mutual patients, and then went our separate ways.

As he pulled out, I noticed his car had a bumper sticker for a cause I strongly disagree with. I mean, 180 degrees opposed.

Suddenly, I didn’t want to ever refer to him again. Why should I support him? He’s the enemy.

Why should I help him out by referring patients?

But then I had to stop. Isn’t this 2022? Aren’t we supposed to be in a civilized world? This isn’t my tribe versus your tribe, my cave versus your cave. The closest we’re supposed to come to direct conflict with others is the “us versus them” world of professional and college sports.

I hope.

Aren’t I supposed to be better than this? Isn’t learning to coexist the whole point of the playground as a kid (besides burning off energy and giving the teacher a break)? Isn’t the idea behind civilization to get along with each other, accept our differences as “agreeing to disagree,” and work together? Like Hamilton and Jefferson, or Ronald Reagan and Tip O’Neill?

Refusing to work with another competent physician because I disagree with their personal, religious, or political beliefs is just plain stupid.

Politicians and pundits try to convince us that people who disagree with us are the enemy, but that’s horse hockey. The truth is that the majority of people out there, regardless of personal beliefs, are decent, hardworking, and just trying to support their families like I am mine.

Later that week I had a patient who clearly needed the other doctor’s expertise, and I gave her his name and phone number. She asked if I’d send my own family to him, and I said, unequivocally, “yes” (actually I have).

Because, at the end of the day, we’re all people, along on the same ride. To not send a patient to him wouldn’t be in their best interest, which is what I’m supposed to be watching out for.

Not only that, but if I don’t refer just because I disagree with him as a person, then I’ve become the problem and not the solution.

Because I, and everyone else, have to try to be better than that.

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

There’s another doctor with whom I’ve referred patients, back and forth, for the last 20 years. I think he’s good at his job and assume he feels the same way about me. We aren’t social friends, but chat briefly when we run into each other at the hospital, or store, or local restaurants.

Last week I was at the hospital to read EEGs, and happened to see him in the doctor’s parking lot. We wished each other a happy new year, talked briefly about a few mutual patients, and then went our separate ways.

As he pulled out, I noticed his car had a bumper sticker for a cause I strongly disagree with. I mean, 180 degrees opposed.

Suddenly, I didn’t want to ever refer to him again. Why should I support him? He’s the enemy.

Why should I help him out by referring patients?

But then I had to stop. Isn’t this 2022? Aren’t we supposed to be in a civilized world? This isn’t my tribe versus your tribe, my cave versus your cave. The closest we’re supposed to come to direct conflict with others is the “us versus them” world of professional and college sports.

I hope.

Aren’t I supposed to be better than this? Isn’t learning to coexist the whole point of the playground as a kid (besides burning off energy and giving the teacher a break)? Isn’t the idea behind civilization to get along with each other, accept our differences as “agreeing to disagree,” and work together? Like Hamilton and Jefferson, or Ronald Reagan and Tip O’Neill?

Refusing to work with another competent physician because I disagree with their personal, religious, or political beliefs is just plain stupid.

Politicians and pundits try to convince us that people who disagree with us are the enemy, but that’s horse hockey. The truth is that the majority of people out there, regardless of personal beliefs, are decent, hardworking, and just trying to support their families like I am mine.

Later that week I had a patient who clearly needed the other doctor’s expertise, and I gave her his name and phone number. She asked if I’d send my own family to him, and I said, unequivocally, “yes” (actually I have).

Because, at the end of the day, we’re all people, along on the same ride. To not send a patient to him wouldn’t be in their best interest, which is what I’m supposed to be watching out for.

Not only that, but if I don’t refer just because I disagree with him as a person, then I’ve become the problem and not the solution.

Because I, and everyone else, have to try to be better than that.

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