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Note to self: Relax!
During my usual 2 weeks off over the holidays I did my usual stuff – taxes, read journals, do CME, review legal cases that have come in, hang out with my family, nap with my dogs.
Somewhere in that stretch of time off. I run out of things to do, and that’s when I have to confront an odd truth: I’ve forgotten how to relax.
In medical school and residency I certainly could enjoy the rare weekend time off. I’d watch sports, go running, do things with friends.
But now it’s a different world. My friends, while still people I enjoy, are on the other end of a computer, far away. My interest in sports and movies waned years ago, and I avoid televisions as part of my aversion to the news. Even the books I used to enjoy, such as the late Clive Cussler’s, don’t hold my attention anymore. If I’m going to read anything it’s going to be humor, because the medical field is serious enough as it is.
The bottom line is that it’s hard for me to relax and “do nothing” anymore. I don’t know if that’s just me, or if it’s part of the personality of being a doctor, or both.
If I’m not at my desk working, I feel like I’m not doing anything. Do other doctors feel that way?
Is this a bad thing?
It probably is, and I should look to the beginning of a new year to make some changes. Maybe I should go back to running (or, at this point in my life, walking) or finding some humor books I enjoy and reading them. The old standby of going on a vacation is kind of limited right now.
I’ve been an attending physician for 24 years now, which is still hard to believe. My retirement isn’t (hopefully) anytime soon, but is coming up faster than it seems. If I don’t relearn to relax by then, when will I?
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
During my usual 2 weeks off over the holidays I did my usual stuff – taxes, read journals, do CME, review legal cases that have come in, hang out with my family, nap with my dogs.
Somewhere in that stretch of time off. I run out of things to do, and that’s when I have to confront an odd truth: I’ve forgotten how to relax.
In medical school and residency I certainly could enjoy the rare weekend time off. I’d watch sports, go running, do things with friends.
But now it’s a different world. My friends, while still people I enjoy, are on the other end of a computer, far away. My interest in sports and movies waned years ago, and I avoid televisions as part of my aversion to the news. Even the books I used to enjoy, such as the late Clive Cussler’s, don’t hold my attention anymore. If I’m going to read anything it’s going to be humor, because the medical field is serious enough as it is.
The bottom line is that it’s hard for me to relax and “do nothing” anymore. I don’t know if that’s just me, or if it’s part of the personality of being a doctor, or both.
If I’m not at my desk working, I feel like I’m not doing anything. Do other doctors feel that way?
Is this a bad thing?
It probably is, and I should look to the beginning of a new year to make some changes. Maybe I should go back to running (or, at this point in my life, walking) or finding some humor books I enjoy and reading them. The old standby of going on a vacation is kind of limited right now.
I’ve been an attending physician for 24 years now, which is still hard to believe. My retirement isn’t (hopefully) anytime soon, but is coming up faster than it seems. If I don’t relearn to relax by then, when will I?
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
During my usual 2 weeks off over the holidays I did my usual stuff – taxes, read journals, do CME, review legal cases that have come in, hang out with my family, nap with my dogs.
Somewhere in that stretch of time off. I run out of things to do, and that’s when I have to confront an odd truth: I’ve forgotten how to relax.
In medical school and residency I certainly could enjoy the rare weekend time off. I’d watch sports, go running, do things with friends.
But now it’s a different world. My friends, while still people I enjoy, are on the other end of a computer, far away. My interest in sports and movies waned years ago, and I avoid televisions as part of my aversion to the news. Even the books I used to enjoy, such as the late Clive Cussler’s, don’t hold my attention anymore. If I’m going to read anything it’s going to be humor, because the medical field is serious enough as it is.
The bottom line is that it’s hard for me to relax and “do nothing” anymore. I don’t know if that’s just me, or if it’s part of the personality of being a doctor, or both.
If I’m not at my desk working, I feel like I’m not doing anything. Do other doctors feel that way?
Is this a bad thing?
It probably is, and I should look to the beginning of a new year to make some changes. Maybe I should go back to running (or, at this point in my life, walking) or finding some humor books I enjoy and reading them. The old standby of going on a vacation is kind of limited right now.
I’ve been an attending physician for 24 years now, which is still hard to believe. My retirement isn’t (hopefully) anytime soon, but is coming up faster than it seems. If I don’t relearn to relax by then, when will I?
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
Wisdom from an unexpected source
“I am capable and ready to begin.”
Sounds trite, doesn’t it? What slush pile did that come from?
Actually, it was the closing sentence of the 1988 “personal statement” I wrote for my medical school applications. (I applied to something like 25 schools, maybe more.) Come to think of it, I suspect my father came up with that line.
Have you read your personal statement since you became an attending? It’s like a letter from an alternate universe, where you weren’t a doctor, weren’t sure you’d ever be one, and were trying very hard to sound confident in the face of an uncertain future.
Mine began in a melodramatic way, emphasizing what I’d seen as an emergency department volunteer. When I wrote it I thought I’d be an ED doc, and never imagined that years later I’d be doing something entirely different – and loving it.
Having the opportunity to go back and talk to our younger selves is a common trope in movies, but in real life reading something like this is as close as it gets. But it’s still neat. It brings back not who you are, but who you were. Reminds you why you wanted to be a doctor, when you were younger, probably more naive, and felt medicine was a calling, not a job.
Do you still feel that way, after years of paperwork, insurance games, a mortgage, a family, defensive medicine, your own health changes, and all the other things life and the often-jaded medical field bring?
I hope the answer is still yes.
On my first day at Creighton Medical School, our dean – the late William L. Pancoe, PhD – gave us a “go get ‘em!” speech. His main theme was that we should “wear sneakers and hit the ground running” on day 1, because otherwise we’d never catch up. But he also told us to remember and hold on to the feeling we had when we got our first medical school acceptance letter. That feeling of relief, joy, the realization that we’d been given a chance to make our dream come true. He told us that feeling might be all that would get us through the long nights of studying, the occasional failures, the self-doubts, and all the other things in the 4 years to come.
Dean Pancoe, you were absolutely right. Today I’m older than you were when you gave us that speech. My only additions would be:
1. Don’t just hold onto that feeling for medical school, but for life.
2. Always keep one copy of your personal statement (even if in your picture you were wearing hideous 1980s-style glasses, like mine). Keep it in your work desk, not in the bottom of a filing cabinet or scrapbook. Read it at least once a year. It’ll take maybe 2 minutes. You have that much time to spare.
Because
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
“I am capable and ready to begin.”
Sounds trite, doesn’t it? What slush pile did that come from?
Actually, it was the closing sentence of the 1988 “personal statement” I wrote for my medical school applications. (I applied to something like 25 schools, maybe more.) Come to think of it, I suspect my father came up with that line.
Have you read your personal statement since you became an attending? It’s like a letter from an alternate universe, where you weren’t a doctor, weren’t sure you’d ever be one, and were trying very hard to sound confident in the face of an uncertain future.
Mine began in a melodramatic way, emphasizing what I’d seen as an emergency department volunteer. When I wrote it I thought I’d be an ED doc, and never imagined that years later I’d be doing something entirely different – and loving it.
Having the opportunity to go back and talk to our younger selves is a common trope in movies, but in real life reading something like this is as close as it gets. But it’s still neat. It brings back not who you are, but who you were. Reminds you why you wanted to be a doctor, when you were younger, probably more naive, and felt medicine was a calling, not a job.
Do you still feel that way, after years of paperwork, insurance games, a mortgage, a family, defensive medicine, your own health changes, and all the other things life and the often-jaded medical field bring?
I hope the answer is still yes.
On my first day at Creighton Medical School, our dean – the late William L. Pancoe, PhD – gave us a “go get ‘em!” speech. His main theme was that we should “wear sneakers and hit the ground running” on day 1, because otherwise we’d never catch up. But he also told us to remember and hold on to the feeling we had when we got our first medical school acceptance letter. That feeling of relief, joy, the realization that we’d been given a chance to make our dream come true. He told us that feeling might be all that would get us through the long nights of studying, the occasional failures, the self-doubts, and all the other things in the 4 years to come.
Dean Pancoe, you were absolutely right. Today I’m older than you were when you gave us that speech. My only additions would be:
1. Don’t just hold onto that feeling for medical school, but for life.
2. Always keep one copy of your personal statement (even if in your picture you were wearing hideous 1980s-style glasses, like mine). Keep it in your work desk, not in the bottom of a filing cabinet or scrapbook. Read it at least once a year. It’ll take maybe 2 minutes. You have that much time to spare.
Because
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
“I am capable and ready to begin.”
Sounds trite, doesn’t it? What slush pile did that come from?
Actually, it was the closing sentence of the 1988 “personal statement” I wrote for my medical school applications. (I applied to something like 25 schools, maybe more.) Come to think of it, I suspect my father came up with that line.
Have you read your personal statement since you became an attending? It’s like a letter from an alternate universe, where you weren’t a doctor, weren’t sure you’d ever be one, and were trying very hard to sound confident in the face of an uncertain future.
Mine began in a melodramatic way, emphasizing what I’d seen as an emergency department volunteer. When I wrote it I thought I’d be an ED doc, and never imagined that years later I’d be doing something entirely different – and loving it.
Having the opportunity to go back and talk to our younger selves is a common trope in movies, but in real life reading something like this is as close as it gets. But it’s still neat. It brings back not who you are, but who you were. Reminds you why you wanted to be a doctor, when you were younger, probably more naive, and felt medicine was a calling, not a job.
Do you still feel that way, after years of paperwork, insurance games, a mortgage, a family, defensive medicine, your own health changes, and all the other things life and the often-jaded medical field bring?
I hope the answer is still yes.
On my first day at Creighton Medical School, our dean – the late William L. Pancoe, PhD – gave us a “go get ‘em!” speech. His main theme was that we should “wear sneakers and hit the ground running” on day 1, because otherwise we’d never catch up. But he also told us to remember and hold on to the feeling we had when we got our first medical school acceptance letter. That feeling of relief, joy, the realization that we’d been given a chance to make our dream come true. He told us that feeling might be all that would get us through the long nights of studying, the occasional failures, the self-doubts, and all the other things in the 4 years to come.
Dean Pancoe, you were absolutely right. Today I’m older than you were when you gave us that speech. My only additions would be:
1. Don’t just hold onto that feeling for medical school, but for life.
2. Always keep one copy of your personal statement (even if in your picture you were wearing hideous 1980s-style glasses, like mine). Keep it in your work desk, not in the bottom of a filing cabinet or scrapbook. Read it at least once a year. It’ll take maybe 2 minutes. You have that much time to spare.
Because
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
When the benchwarmer is a slugger
I still, on occasion, use Felbatol (felbamate).
Thirty years since its explosive entrance to the market, then even more explosive collapse, it remains, in my opinion, the most effective of the second generation of anti-seizure medications. Arguably, even more effective than any of the third generation, too.
That’s not to say I use a lot of it. I don’t. It’s like handling unstable dynamite. Tremendous power, but also an above-average degree of risk. Even after things hit the fan with it in the mid-90s, I remember one of my epilepsy clinic attendings telling me, “This is a home-run drug. In refractory patients you might see some benefit by adding another agent, but with this one, you could stop their seizures and hit it out of the park.”
Like most neurologists, I use other epilepsy options first and second line. But sometimes you get the patient who’s failed the usual ones. Then I start to think about Felbatol. I explain the situation to the patients and their families and let them make the final decision. I worry and watch labs very closely for a while. I probably have no more than three to five patients on it in the practice. But when it works, it’s amazing stuff.
Now, let’s jump ahead to 2021. The year of Aduhelm (and several similar agents racing up behind it).
None of these drugs are even close to hitting home runs. For that matter, I’m not convinced they’re even able to get a man on base. To stretch my baseball analogy a bit, imagine watching a game by looking only at the RBI and ERA stats changing. The numbers change slightly, but you have no evidence that either team is winning. Which is, after all, the whole point.
And, to some extent, that’s the basis of Aduhelm’s approval, and likely the same standards its competitors will be held to.
Although they treat different conditions, and are chemically unrelated, the similarities between Felbatol and the currently advancing bunch of monoclonal antibody (MAB) agents for Alzheimer’s disease make an interesting contrast.
Unlike Felbatol’s proven efficacy for epilepsy, the current MABs offer minimal statistically significant clinical benefit for Alzheimer’s disease. At the same time the risk of amyloid-related imaging abnormalities (ARIA) and its complications with them is significantly higher than that of either of Felbatol’s known, potentially lethal, idiosyncratic effects.
With those odds, In medicine, every day is an exercise in working through the risks and benefits of each patient’s individual situation.
As I’ve stated before, I’m not in the grandstand rooting for these Alzheimer’s drugs to fail. I’ve lost a few family members, and certainly my share of patients, to dementia. I’d be thrilled, and more than willing to prescribe it, if something truly effective came along for it.
Nor do I take any kind of pleasure in the recent news that, because of Aduhelm’s failings, around 1,000 Biogen employees will lose their jobs. I feel terrible for them, as most had nothing to do with the decision to forge ahead with the product. More may soon follow at other companies working with similar agents.
Here we are, though, going into 2022. I’m still, albeit rarely, writing for Felbatol 30 years after it came to market for one reason: It works. But it seems pretty unlikely that future neurologists in 2052 will say the same about the current crops of MABs for Alzheimer’s disease.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
I still, on occasion, use Felbatol (felbamate).
Thirty years since its explosive entrance to the market, then even more explosive collapse, it remains, in my opinion, the most effective of the second generation of anti-seizure medications. Arguably, even more effective than any of the third generation, too.
That’s not to say I use a lot of it. I don’t. It’s like handling unstable dynamite. Tremendous power, but also an above-average degree of risk. Even after things hit the fan with it in the mid-90s, I remember one of my epilepsy clinic attendings telling me, “This is a home-run drug. In refractory patients you might see some benefit by adding another agent, but with this one, you could stop their seizures and hit it out of the park.”
Like most neurologists, I use other epilepsy options first and second line. But sometimes you get the patient who’s failed the usual ones. Then I start to think about Felbatol. I explain the situation to the patients and their families and let them make the final decision. I worry and watch labs very closely for a while. I probably have no more than three to five patients on it in the practice. But when it works, it’s amazing stuff.
Now, let’s jump ahead to 2021. The year of Aduhelm (and several similar agents racing up behind it).
None of these drugs are even close to hitting home runs. For that matter, I’m not convinced they’re even able to get a man on base. To stretch my baseball analogy a bit, imagine watching a game by looking only at the RBI and ERA stats changing. The numbers change slightly, but you have no evidence that either team is winning. Which is, after all, the whole point.
And, to some extent, that’s the basis of Aduhelm’s approval, and likely the same standards its competitors will be held to.
Although they treat different conditions, and are chemically unrelated, the similarities between Felbatol and the currently advancing bunch of monoclonal antibody (MAB) agents for Alzheimer’s disease make an interesting contrast.
Unlike Felbatol’s proven efficacy for epilepsy, the current MABs offer minimal statistically significant clinical benefit for Alzheimer’s disease. At the same time the risk of amyloid-related imaging abnormalities (ARIA) and its complications with them is significantly higher than that of either of Felbatol’s known, potentially lethal, idiosyncratic effects.
With those odds, In medicine, every day is an exercise in working through the risks and benefits of each patient’s individual situation.
As I’ve stated before, I’m not in the grandstand rooting for these Alzheimer’s drugs to fail. I’ve lost a few family members, and certainly my share of patients, to dementia. I’d be thrilled, and more than willing to prescribe it, if something truly effective came along for it.
Nor do I take any kind of pleasure in the recent news that, because of Aduhelm’s failings, around 1,000 Biogen employees will lose their jobs. I feel terrible for them, as most had nothing to do with the decision to forge ahead with the product. More may soon follow at other companies working with similar agents.
Here we are, though, going into 2022. I’m still, albeit rarely, writing for Felbatol 30 years after it came to market for one reason: It works. But it seems pretty unlikely that future neurologists in 2052 will say the same about the current crops of MABs for Alzheimer’s disease.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
I still, on occasion, use Felbatol (felbamate).
Thirty years since its explosive entrance to the market, then even more explosive collapse, it remains, in my opinion, the most effective of the second generation of anti-seizure medications. Arguably, even more effective than any of the third generation, too.
That’s not to say I use a lot of it. I don’t. It’s like handling unstable dynamite. Tremendous power, but also an above-average degree of risk. Even after things hit the fan with it in the mid-90s, I remember one of my epilepsy clinic attendings telling me, “This is a home-run drug. In refractory patients you might see some benefit by adding another agent, but with this one, you could stop their seizures and hit it out of the park.”
Like most neurologists, I use other epilepsy options first and second line. But sometimes you get the patient who’s failed the usual ones. Then I start to think about Felbatol. I explain the situation to the patients and their families and let them make the final decision. I worry and watch labs very closely for a while. I probably have no more than three to five patients on it in the practice. But when it works, it’s amazing stuff.
Now, let’s jump ahead to 2021. The year of Aduhelm (and several similar agents racing up behind it).
None of these drugs are even close to hitting home runs. For that matter, I’m not convinced they’re even able to get a man on base. To stretch my baseball analogy a bit, imagine watching a game by looking only at the RBI and ERA stats changing. The numbers change slightly, but you have no evidence that either team is winning. Which is, after all, the whole point.
And, to some extent, that’s the basis of Aduhelm’s approval, and likely the same standards its competitors will be held to.
Although they treat different conditions, and are chemically unrelated, the similarities between Felbatol and the currently advancing bunch of monoclonal antibody (MAB) agents for Alzheimer’s disease make an interesting contrast.
Unlike Felbatol’s proven efficacy for epilepsy, the current MABs offer minimal statistically significant clinical benefit for Alzheimer’s disease. At the same time the risk of amyloid-related imaging abnormalities (ARIA) and its complications with them is significantly higher than that of either of Felbatol’s known, potentially lethal, idiosyncratic effects.
With those odds, In medicine, every day is an exercise in working through the risks and benefits of each patient’s individual situation.
As I’ve stated before, I’m not in the grandstand rooting for these Alzheimer’s drugs to fail. I’ve lost a few family members, and certainly my share of patients, to dementia. I’d be thrilled, and more than willing to prescribe it, if something truly effective came along for it.
Nor do I take any kind of pleasure in the recent news that, because of Aduhelm’s failings, around 1,000 Biogen employees will lose their jobs. I feel terrible for them, as most had nothing to do with the decision to forge ahead with the product. More may soon follow at other companies working with similar agents.
Here we are, though, going into 2022. I’m still, albeit rarely, writing for Felbatol 30 years after it came to market for one reason: It works. But it seems pretty unlikely that future neurologists in 2052 will say the same about the current crops of MABs for Alzheimer’s disease.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
An expensive lesson
In mid-July my son strained his neck working out at the gym.
It was an obvious generic muscle pull. I told him to take some ibuprofen and use a heating pad. My wife, a nurse, told him the same thing.
Regrettably, while my medical training (hopefully) counts for something with my patients, it doesn’t mean much to my kids. The unqualified opinions of their friends and Google are far more worthwhile, convincing him he had any number of serious injuries.
As a result, while we were at work he went to the emergency department to get checked out. He was evaluated by one of my colleagues who did x-rays and a cervical spine CT. (I figure the last one was because my son kept reminding them I was a doctor). After all the results were in, the ED physician told him he had a muscle strain, and to take ibuprofen and use a heating pad.
Big surprise, huh? I’m sure he was shocked to find out that his old man knew what he was doing. Of course, I didn’t order any tests so the ED doc tops me for that in my son’s mind.
But kids not believing their parents is nothing new, and I can’t claim innocence either from what I remember of being a teenager.
Fast-forward to today. From what I can see, the total bills for his little adventure in modern medicine were around $4,000-$5,000. Granted, I’m well aware that what gets charged has no relationship to what’s actually going to be collected but I’m not going to write about modern medical charges or collections or even defensive medicine. I understand all those, and certainly don’t fault my ED colleague for how he handled it.
Reassurance isn’t cheap, though. When it’s all over, our out-of-pocket share will be roughly $1,000, which we certainly hadn’t planned for in the usually money-tight months of December and January.
That’s a lot of money for ibuprofen and a heating pad (we had both at home, and they’re around $20 total at Target, anyway).
There’s certainly no shortage of research on unnecessary ED visits for minor things, but to me this is a classic example of it. Beyond just the financial cost (which, admittedly, I’m pretty irritated with him about) he tied up a bed and ED staff that someone in more dire circumstances may have needed.
His injury could have been handled at an urgent care, or, even better, just by staying home, listening to us, and using ibuprofen and a heating pad.
, and clarify what constitutes an emergency in the first place. There’s no shortage of urgent cares and other walk-in clinics that are there specifically to handle such things during daylight hours, if they need to be seen at all.
Of course, I can’t change the results of Google searches, or the age-old teenage belief that parents are morons.
But he is going to learn about what constitutes an emergency, and what else that $1,000 could have been used for.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
In mid-July my son strained his neck working out at the gym.
It was an obvious generic muscle pull. I told him to take some ibuprofen and use a heating pad. My wife, a nurse, told him the same thing.
Regrettably, while my medical training (hopefully) counts for something with my patients, it doesn’t mean much to my kids. The unqualified opinions of their friends and Google are far more worthwhile, convincing him he had any number of serious injuries.
As a result, while we were at work he went to the emergency department to get checked out. He was evaluated by one of my colleagues who did x-rays and a cervical spine CT. (I figure the last one was because my son kept reminding them I was a doctor). After all the results were in, the ED physician told him he had a muscle strain, and to take ibuprofen and use a heating pad.
Big surprise, huh? I’m sure he was shocked to find out that his old man knew what he was doing. Of course, I didn’t order any tests so the ED doc tops me for that in my son’s mind.
But kids not believing their parents is nothing new, and I can’t claim innocence either from what I remember of being a teenager.
Fast-forward to today. From what I can see, the total bills for his little adventure in modern medicine were around $4,000-$5,000. Granted, I’m well aware that what gets charged has no relationship to what’s actually going to be collected but I’m not going to write about modern medical charges or collections or even defensive medicine. I understand all those, and certainly don’t fault my ED colleague for how he handled it.
Reassurance isn’t cheap, though. When it’s all over, our out-of-pocket share will be roughly $1,000, which we certainly hadn’t planned for in the usually money-tight months of December and January.
That’s a lot of money for ibuprofen and a heating pad (we had both at home, and they’re around $20 total at Target, anyway).
There’s certainly no shortage of research on unnecessary ED visits for minor things, but to me this is a classic example of it. Beyond just the financial cost (which, admittedly, I’m pretty irritated with him about) he tied up a bed and ED staff that someone in more dire circumstances may have needed.
His injury could have been handled at an urgent care, or, even better, just by staying home, listening to us, and using ibuprofen and a heating pad.
, and clarify what constitutes an emergency in the first place. There’s no shortage of urgent cares and other walk-in clinics that are there specifically to handle such things during daylight hours, if they need to be seen at all.
Of course, I can’t change the results of Google searches, or the age-old teenage belief that parents are morons.
But he is going to learn about what constitutes an emergency, and what else that $1,000 could have been used for.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
In mid-July my son strained his neck working out at the gym.
It was an obvious generic muscle pull. I told him to take some ibuprofen and use a heating pad. My wife, a nurse, told him the same thing.
Regrettably, while my medical training (hopefully) counts for something with my patients, it doesn’t mean much to my kids. The unqualified opinions of their friends and Google are far more worthwhile, convincing him he had any number of serious injuries.
As a result, while we were at work he went to the emergency department to get checked out. He was evaluated by one of my colleagues who did x-rays and a cervical spine CT. (I figure the last one was because my son kept reminding them I was a doctor). After all the results were in, the ED physician told him he had a muscle strain, and to take ibuprofen and use a heating pad.
Big surprise, huh? I’m sure he was shocked to find out that his old man knew what he was doing. Of course, I didn’t order any tests so the ED doc tops me for that in my son’s mind.
But kids not believing their parents is nothing new, and I can’t claim innocence either from what I remember of being a teenager.
Fast-forward to today. From what I can see, the total bills for his little adventure in modern medicine were around $4,000-$5,000. Granted, I’m well aware that what gets charged has no relationship to what’s actually going to be collected but I’m not going to write about modern medical charges or collections or even defensive medicine. I understand all those, and certainly don’t fault my ED colleague for how he handled it.
Reassurance isn’t cheap, though. When it’s all over, our out-of-pocket share will be roughly $1,000, which we certainly hadn’t planned for in the usually money-tight months of December and January.
That’s a lot of money for ibuprofen and a heating pad (we had both at home, and they’re around $20 total at Target, anyway).
There’s certainly no shortage of research on unnecessary ED visits for minor things, but to me this is a classic example of it. Beyond just the financial cost (which, admittedly, I’m pretty irritated with him about) he tied up a bed and ED staff that someone in more dire circumstances may have needed.
His injury could have been handled at an urgent care, or, even better, just by staying home, listening to us, and using ibuprofen and a heating pad.
, and clarify what constitutes an emergency in the first place. There’s no shortage of urgent cares and other walk-in clinics that are there specifically to handle such things during daylight hours, if they need to be seen at all.
Of course, I can’t change the results of Google searches, or the age-old teenage belief that parents are morons.
But he is going to learn about what constitutes an emergency, and what else that $1,000 could have been used for.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
Spin doctors
The 1992 presidential election fell during my last year of medical school. I remember watching the three-way debates over at a friend’s apartment.
After each one they’d cut to representatives of each candidate, and for the first time I heard the phrase “spin” or “spin doctors” referring to those who put a very selective angle on their candidates performance, no matter how bad it may have been, to make it sound like something amazingly awesome. This trend, driven now by the Internet and the 24/7 news cycle, has only accelerated over time.
Recently, I’ve been reading slides, press releases, and preliminary reports for the many agents that are seeking to cure Alzheimer’s disease. A desperately needed effort if ever there was one.
Yet, I get the same feeling I did in 1992. It seems like a lot of the statements are more selective than real: a carefully worded attempt to emphasize the good points and minimize the bad. Granted that’s the nature of many things, but here, in a world of a few percentage points, it seems more conspicuous than usual.
After all, even a non–statistically significant improvement of 1%-2% can look really good if you use the right graph style or comparison scale.
When I read such articles now, I find myself wondering if the drug really works or if the spin doctors have gotten so good at making even the most minuscule numbers look impressive that I can’t tell the difference. In theory many of these drugs should work, but, in Alzheimer’s disease “should” and “does” haven’t matched up particularly well to date.
To be clear, I’m not cheering for these drugs to fail. On the contrary, if one showed overwhelming evidence of benefit (as opposed to having to be spun to look good), I’d be thrilled. Along with the patients and their support circles, it’s their doctors who watch the sad downhill slide of dementia, with the patients dying long before their bodies do. I would be thrilled to be able to offer them something that had clearly meaningful benefit with a decent safety profile.
But, barring more solid data,
I hope I’m wrong.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
The 1992 presidential election fell during my last year of medical school. I remember watching the three-way debates over at a friend’s apartment.
After each one they’d cut to representatives of each candidate, and for the first time I heard the phrase “spin” or “spin doctors” referring to those who put a very selective angle on their candidates performance, no matter how bad it may have been, to make it sound like something amazingly awesome. This trend, driven now by the Internet and the 24/7 news cycle, has only accelerated over time.
Recently, I’ve been reading slides, press releases, and preliminary reports for the many agents that are seeking to cure Alzheimer’s disease. A desperately needed effort if ever there was one.
Yet, I get the same feeling I did in 1992. It seems like a lot of the statements are more selective than real: a carefully worded attempt to emphasize the good points and minimize the bad. Granted that’s the nature of many things, but here, in a world of a few percentage points, it seems more conspicuous than usual.
After all, even a non–statistically significant improvement of 1%-2% can look really good if you use the right graph style or comparison scale.
When I read such articles now, I find myself wondering if the drug really works or if the spin doctors have gotten so good at making even the most minuscule numbers look impressive that I can’t tell the difference. In theory many of these drugs should work, but, in Alzheimer’s disease “should” and “does” haven’t matched up particularly well to date.
To be clear, I’m not cheering for these drugs to fail. On the contrary, if one showed overwhelming evidence of benefit (as opposed to having to be spun to look good), I’d be thrilled. Along with the patients and their support circles, it’s their doctors who watch the sad downhill slide of dementia, with the patients dying long before their bodies do. I would be thrilled to be able to offer them something that had clearly meaningful benefit with a decent safety profile.
But, barring more solid data,
I hope I’m wrong.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
The 1992 presidential election fell during my last year of medical school. I remember watching the three-way debates over at a friend’s apartment.
After each one they’d cut to representatives of each candidate, and for the first time I heard the phrase “spin” or “spin doctors” referring to those who put a very selective angle on their candidates performance, no matter how bad it may have been, to make it sound like something amazingly awesome. This trend, driven now by the Internet and the 24/7 news cycle, has only accelerated over time.
Recently, I’ve been reading slides, press releases, and preliminary reports for the many agents that are seeking to cure Alzheimer’s disease. A desperately needed effort if ever there was one.
Yet, I get the same feeling I did in 1992. It seems like a lot of the statements are more selective than real: a carefully worded attempt to emphasize the good points and minimize the bad. Granted that’s the nature of many things, but here, in a world of a few percentage points, it seems more conspicuous than usual.
After all, even a non–statistically significant improvement of 1%-2% can look really good if you use the right graph style or comparison scale.
When I read such articles now, I find myself wondering if the drug really works or if the spin doctors have gotten so good at making even the most minuscule numbers look impressive that I can’t tell the difference. In theory many of these drugs should work, but, in Alzheimer’s disease “should” and “does” haven’t matched up particularly well to date.
To be clear, I’m not cheering for these drugs to fail. On the contrary, if one showed overwhelming evidence of benefit (as opposed to having to be spun to look good), I’d be thrilled. Along with the patients and their support circles, it’s their doctors who watch the sad downhill slide of dementia, with the patients dying long before their bodies do. I would be thrilled to be able to offer them something that had clearly meaningful benefit with a decent safety profile.
But, barring more solid data,
I hope I’m wrong.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
Gratitude, reflection, and catnaps with the dog
Now we’re in the final sprint.
Thanksgiving week is the first pause. I’m lucky. I have more things to be grateful for than I can count. I try to keep that in mind and instill it in my kids.
The second pause comes in December. I always close my office for the last 2 weeks of the year, since most patients are too busy during that time to see me. That means, in a little less than a month from now, my 2021 will be (from a practice point of view) pretty much over.
Of course, it’s really not. Just because the office is closed doesn’t mean there isn’t stuff to do. Patients will call in with pressing issues; refills have to be sent; test results come in and need to be handled correctly.
And that’s just the clinical part. The business part is there, too. It’s time to start wrapping up the corporate year, doing quarterly 941 forms, and preparing stuff for my accountant to file my taxes in the new year. Sifting through receipts, bills, and Quickbooks to get things ready.
But it’s still a relaxing time. My kids will all be home. We’ll have family dinners again for a few weeks. My hot tub will (hopefully) be up and running. I’ll have more time for walks, or talks, or naps (the last one usually with a dog sprawled out on the bed). For 2 weeks I can sleep in.
It also brings reflection. The same applies to personal thoughts: What can I do in the coming year to be a better person and a better doctor?
Two weeks off never seems like long enough, but it’s a good time to pause and think about my little world, and what I can change to make it better for all involved.
That kind of perspective should always be kept in mind, but in the day-to-day hectic world, often it isn’t. It’s important to put it back in place when I can.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
Now we’re in the final sprint.
Thanksgiving week is the first pause. I’m lucky. I have more things to be grateful for than I can count. I try to keep that in mind and instill it in my kids.
The second pause comes in December. I always close my office for the last 2 weeks of the year, since most patients are too busy during that time to see me. That means, in a little less than a month from now, my 2021 will be (from a practice point of view) pretty much over.
Of course, it’s really not. Just because the office is closed doesn’t mean there isn’t stuff to do. Patients will call in with pressing issues; refills have to be sent; test results come in and need to be handled correctly.
And that’s just the clinical part. The business part is there, too. It’s time to start wrapping up the corporate year, doing quarterly 941 forms, and preparing stuff for my accountant to file my taxes in the new year. Sifting through receipts, bills, and Quickbooks to get things ready.
But it’s still a relaxing time. My kids will all be home. We’ll have family dinners again for a few weeks. My hot tub will (hopefully) be up and running. I’ll have more time for walks, or talks, or naps (the last one usually with a dog sprawled out on the bed). For 2 weeks I can sleep in.
It also brings reflection. The same applies to personal thoughts: What can I do in the coming year to be a better person and a better doctor?
Two weeks off never seems like long enough, but it’s a good time to pause and think about my little world, and what I can change to make it better for all involved.
That kind of perspective should always be kept in mind, but in the day-to-day hectic world, often it isn’t. It’s important to put it back in place when I can.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
Now we’re in the final sprint.
Thanksgiving week is the first pause. I’m lucky. I have more things to be grateful for than I can count. I try to keep that in mind and instill it in my kids.
The second pause comes in December. I always close my office for the last 2 weeks of the year, since most patients are too busy during that time to see me. That means, in a little less than a month from now, my 2021 will be (from a practice point of view) pretty much over.
Of course, it’s really not. Just because the office is closed doesn’t mean there isn’t stuff to do. Patients will call in with pressing issues; refills have to be sent; test results come in and need to be handled correctly.
And that’s just the clinical part. The business part is there, too. It’s time to start wrapping up the corporate year, doing quarterly 941 forms, and preparing stuff for my accountant to file my taxes in the new year. Sifting through receipts, bills, and Quickbooks to get things ready.
But it’s still a relaxing time. My kids will all be home. We’ll have family dinners again for a few weeks. My hot tub will (hopefully) be up and running. I’ll have more time for walks, or talks, or naps (the last one usually with a dog sprawled out on the bed). For 2 weeks I can sleep in.
It also brings reflection. The same applies to personal thoughts: What can I do in the coming year to be a better person and a better doctor?
Two weeks off never seems like long enough, but it’s a good time to pause and think about my little world, and what I can change to make it better for all involved.
That kind of perspective should always be kept in mind, but in the day-to-day hectic world, often it isn’t. It’s important to put it back in place when I can.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
A fair trade-off
In the mid-90s, as a resident, I gave tissue plasminogen activator (tPA) one night to the first patient my institution registered in the study that got it approved by the Food and Drug Administration. Our director of stroke gave me a bottle of champagne the next day to thank me. That was where my career in acute inpatient neurology began.
Like many docs of my age, my hospital work has been dwindling with time, and was down to just 1-2 weekends a month in a small three-doc rotation. Not much, but it still made for some busy weekends.
The first wave of mass quarantining happened to fall just as our quarterly schedule was ending. In fact, I’d been working on writing it up for the next quarter when things began.
But then, in the course of a few days, one of us decided to retire early, and the other doc and I couldn’t agree on how to handle the rotation with only two people (somewhat naively, I told him the whole COVID thing would be over in 2-3 months; obviously I was WAY wrong).
So I finished up my last scheduled hospital call, figuring I’d be back in a few months.
So far that hasn’t happened. I’m now 17 months out since the last time I rounded on hospital patients.
And I don’t miss it at all.
This surprises me. I mean, we all start out, in medical school and residency, immersed in the hospital. It’s where the action is. Rounding, checking tests results, talking to patients, families, and nurses is ingrained into us. When I started in 1998 I hustled between four hospitals and enjoyed it (the work, not the driving).
Now I realize that my inpatient days are probably behind me, and I’m not bothered by it. That’s not to say I may not go back. Circumstances change, so, as before, I try to keep up on both inpatient and outpatient neurologic care and developments.
But for now, I’m happier without it. My weekends are my own. I don’t dread the Friday afternoon switchover where new consults suddenly start showing up on my cell phone. I don’t have to worry about running in at 2:00 a.m. to decide tPA or not tPA. My wife and I don’t have to take separate cars to go out to dinner, just in case I have to leave.
I’m sure I’ve lost some revenue because of it, but in the overall downturn of the pandemic it’s hard to know how much.
But I do know that I’ve gained time at home. With my wife, my kids, my dogs, and even just myself. My start and stop times on weekdays, and now plans for weekends, are now more predictable.
At some point those things are worth the money lost, and I’m happy to take them.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
In the mid-90s, as a resident, I gave tissue plasminogen activator (tPA) one night to the first patient my institution registered in the study that got it approved by the Food and Drug Administration. Our director of stroke gave me a bottle of champagne the next day to thank me. That was where my career in acute inpatient neurology began.
Like many docs of my age, my hospital work has been dwindling with time, and was down to just 1-2 weekends a month in a small three-doc rotation. Not much, but it still made for some busy weekends.
The first wave of mass quarantining happened to fall just as our quarterly schedule was ending. In fact, I’d been working on writing it up for the next quarter when things began.
But then, in the course of a few days, one of us decided to retire early, and the other doc and I couldn’t agree on how to handle the rotation with only two people (somewhat naively, I told him the whole COVID thing would be over in 2-3 months; obviously I was WAY wrong).
So I finished up my last scheduled hospital call, figuring I’d be back in a few months.
So far that hasn’t happened. I’m now 17 months out since the last time I rounded on hospital patients.
And I don’t miss it at all.
This surprises me. I mean, we all start out, in medical school and residency, immersed in the hospital. It’s where the action is. Rounding, checking tests results, talking to patients, families, and nurses is ingrained into us. When I started in 1998 I hustled between four hospitals and enjoyed it (the work, not the driving).
Now I realize that my inpatient days are probably behind me, and I’m not bothered by it. That’s not to say I may not go back. Circumstances change, so, as before, I try to keep up on both inpatient and outpatient neurologic care and developments.
But for now, I’m happier without it. My weekends are my own. I don’t dread the Friday afternoon switchover where new consults suddenly start showing up on my cell phone. I don’t have to worry about running in at 2:00 a.m. to decide tPA or not tPA. My wife and I don’t have to take separate cars to go out to dinner, just in case I have to leave.
I’m sure I’ve lost some revenue because of it, but in the overall downturn of the pandemic it’s hard to know how much.
But I do know that I’ve gained time at home. With my wife, my kids, my dogs, and even just myself. My start and stop times on weekdays, and now plans for weekends, are now more predictable.
At some point those things are worth the money lost, and I’m happy to take them.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
In the mid-90s, as a resident, I gave tissue plasminogen activator (tPA) one night to the first patient my institution registered in the study that got it approved by the Food and Drug Administration. Our director of stroke gave me a bottle of champagne the next day to thank me. That was where my career in acute inpatient neurology began.
Like many docs of my age, my hospital work has been dwindling with time, and was down to just 1-2 weekends a month in a small three-doc rotation. Not much, but it still made for some busy weekends.
The first wave of mass quarantining happened to fall just as our quarterly schedule was ending. In fact, I’d been working on writing it up for the next quarter when things began.
But then, in the course of a few days, one of us decided to retire early, and the other doc and I couldn’t agree on how to handle the rotation with only two people (somewhat naively, I told him the whole COVID thing would be over in 2-3 months; obviously I was WAY wrong).
So I finished up my last scheduled hospital call, figuring I’d be back in a few months.
So far that hasn’t happened. I’m now 17 months out since the last time I rounded on hospital patients.
And I don’t miss it at all.
This surprises me. I mean, we all start out, in medical school and residency, immersed in the hospital. It’s where the action is. Rounding, checking tests results, talking to patients, families, and nurses is ingrained into us. When I started in 1998 I hustled between four hospitals and enjoyed it (the work, not the driving).
Now I realize that my inpatient days are probably behind me, and I’m not bothered by it. That’s not to say I may not go back. Circumstances change, so, as before, I try to keep up on both inpatient and outpatient neurologic care and developments.
But for now, I’m happier without it. My weekends are my own. I don’t dread the Friday afternoon switchover where new consults suddenly start showing up on my cell phone. I don’t have to worry about running in at 2:00 a.m. to decide tPA or not tPA. My wife and I don’t have to take separate cars to go out to dinner, just in case I have to leave.
I’m sure I’ve lost some revenue because of it, but in the overall downturn of the pandemic it’s hard to know how much.
But I do know that I’ve gained time at home. With my wife, my kids, my dogs, and even just myself. My start and stop times on weekdays, and now plans for weekends, are now more predictable.
At some point those things are worth the money lost, and I’m happy to take them.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
From bored to springboard
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, records 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.
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 next.
Boredom is one of the odder human conditions. I have no idea if any other animal experiences it. Certainly, at least for us, there are more ways to entertain ourselves 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 mammals tend do doze off. But not us. Our brains are 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 and 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 are where we are. Perhaps it’s this feature that pushed the development of intelligence further and led us to form civilizations.
It’s how 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, records 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.
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 next.
Boredom is one of the odder human conditions. I have no idea if any other animal experiences it. Certainly, at least for us, there are more ways to entertain ourselves 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 mammals tend do doze off. But not us. Our brains are 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 and 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 are where we are. Perhaps it’s this feature that pushed the development of intelligence further and led us to form civilizations.
It’s how 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, records 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.
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 next.
Boredom is one of the odder human conditions. I have no idea if any other animal experiences it. Certainly, at least for us, there are more ways to entertain ourselves 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 mammals tend do doze off. But not us. Our brains are 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 and 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 are where we are. Perhaps it’s this feature that pushed the development of intelligence further and led us to form civilizations.
It’s how we keep moving forward.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
A box of memories
My office’s storage room has an old bankers box, which has been there since I moved 8 years ago. Before that it was at my other office, behind an old desk. I had no idea what was in it, I always assumed office supplies, surplus drug company pens and sticky notes, who-knows-whats.
Last week I had one of those days where everyone cancels, so I decided to investigate the box.
It was packed with 10 years worth (2000-2010) of my secretary’s MRI scheduling sheets that had somehow escaped occasional shredding purges. So I sat down next to the office shredder to get rid of them.
As I fed the sheets in, the names jumped out at me. Some I have absolutely no recollection of. Others I still see today.
There were names of the long-deceased, bringing them back to me for the first time in years. There were others that I have no idea what happened to – they must have just stopped seeing me at some point, though for the life of me I can’t remember when, or why. Yet, in my mind, there they were, as if I’d just seen them yesterday. A few times I got curious enough to turn back to my computer and look up their charts, trying to remember their stories.
Then there were those I still remember clearly, every single detail of, in spite of the elapsed time. Something about their case or personality had indelibly etched them in my memory. A valuable lesson learned from them that had something or nothing to do with medicine that’s still with me.
Looking back, I’d guess I’ve seen roughly 15,000-20,000 patients over my career. Not nearly as many as my colleagues in general practice, but still quite a few. A decent sized basketball arena full.
The majority don’t stick with you. That’s the way it is in life.
The ones we didn’t know long – but who are still clearly remembered – are also valuable. In their own way, perhaps unknowingly, they made an impact that hopefully makes us better.
For that I’ll always be grateful to them.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
My office’s storage room has an old bankers box, which has been there since I moved 8 years ago. Before that it was at my other office, behind an old desk. I had no idea what was in it, I always assumed office supplies, surplus drug company pens and sticky notes, who-knows-whats.
Last week I had one of those days where everyone cancels, so I decided to investigate the box.
It was packed with 10 years worth (2000-2010) of my secretary’s MRI scheduling sheets that had somehow escaped occasional shredding purges. So I sat down next to the office shredder to get rid of them.
As I fed the sheets in, the names jumped out at me. Some I have absolutely no recollection of. Others I still see today.
There were names of the long-deceased, bringing them back to me for the first time in years. There were others that I have no idea what happened to – they must have just stopped seeing me at some point, though for the life of me I can’t remember when, or why. Yet, in my mind, there they were, as if I’d just seen them yesterday. A few times I got curious enough to turn back to my computer and look up their charts, trying to remember their stories.
Then there were those I still remember clearly, every single detail of, in spite of the elapsed time. Something about their case or personality had indelibly etched them in my memory. A valuable lesson learned from them that had something or nothing to do with medicine that’s still with me.
Looking back, I’d guess I’ve seen roughly 15,000-20,000 patients over my career. Not nearly as many as my colleagues in general practice, but still quite a few. A decent sized basketball arena full.
The majority don’t stick with you. That’s the way it is in life.
The ones we didn’t know long – but who are still clearly remembered – are also valuable. In their own way, perhaps unknowingly, they made an impact that hopefully makes us better.
For that I’ll always be grateful to them.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
My office’s storage room has an old bankers box, which has been there since I moved 8 years ago. Before that it was at my other office, behind an old desk. I had no idea what was in it, I always assumed office supplies, surplus drug company pens and sticky notes, who-knows-whats.
Last week I had one of those days where everyone cancels, so I decided to investigate the box.
It was packed with 10 years worth (2000-2010) of my secretary’s MRI scheduling sheets that had somehow escaped occasional shredding purges. So I sat down next to the office shredder to get rid of them.
As I fed the sheets in, the names jumped out at me. Some I have absolutely no recollection of. Others I still see today.
There were names of the long-deceased, bringing them back to me for the first time in years. There were others that I have no idea what happened to – they must have just stopped seeing me at some point, though for the life of me I can’t remember when, or why. Yet, in my mind, there they were, as if I’d just seen them yesterday. A few times I got curious enough to turn back to my computer and look up their charts, trying to remember their stories.
Then there were those I still remember clearly, every single detail of, in spite of the elapsed time. Something about their case or personality had indelibly etched them in my memory. A valuable lesson learned from them that had something or nothing to do with medicine that’s still with me.
Looking back, I’d guess I’ve seen roughly 15,000-20,000 patients over my career. Not nearly as many as my colleagues in general practice, but still quite a few. A decent sized basketball arena full.
The majority don’t stick with you. That’s the way it is in life.
The ones we didn’t know long – but who are still clearly remembered – are also valuable. In their own way, perhaps unknowingly, they made an impact that hopefully makes us better.
For that I’ll always be grateful to them.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
The missing puzzle piece
Mrs. Stevens died last week. She was 87.
That’s nothing new. The nature of medicine is such that you’ll see patients pass on.
But Mrs. Stevens bothers me, because even to the end I’m not sure I ever had an answer.
Her case began with somewhat nebulous, but clearly neurological, symptoms. An initial workup was normal, as was the secondary one.
The third stage of increasingly esoteric tests turned up some clues as to what was going wrong, even as she continued to dwindle. I could at least start working on a differential, even if none of it was good.
I met with her and her husband, and they wanted an answer, good or bad.
I pulled some strings at a local tertiary subspecialty center and got her in. They agreed with my suspicions, though also couldn’t find something definitive. They even repeated the tests, and came to the same conclusions – narrowed down to a few things, but no smoking gun.
Throughout all of this Mrs. Stevens kept spiraling down. After a few hospital admissions and even a biopsy of an abdominal mass we thought would give us the answer, we still didn’t solve the puzzle.
At some point she and her husband grew tired of looking and accepted that it wouldn’t change anything. Her internist called hospice in. They kept her comfortable for her last few weeks.
They didn’t want an autopsy, so the secret stayed with her.
Looking back, I agree with their decision to stop the workup. When looking further won’t change anything, why bother?
But, as a doctor, it’s frustrating. There’s a degree of intellectual curiosity that drives us. We want answers. We want to solve puzzles.
And sometimes we never get that final piece. Even if it’s the right decision for the patient, at the end of the day it’s still an unsolved crime to us. A reminder that,
We probably never will.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
Mrs. Stevens died last week. She was 87.
That’s nothing new. The nature of medicine is such that you’ll see patients pass on.
But Mrs. Stevens bothers me, because even to the end I’m not sure I ever had an answer.
Her case began with somewhat nebulous, but clearly neurological, symptoms. An initial workup was normal, as was the secondary one.
The third stage of increasingly esoteric tests turned up some clues as to what was going wrong, even as she continued to dwindle. I could at least start working on a differential, even if none of it was good.
I met with her and her husband, and they wanted an answer, good or bad.
I pulled some strings at a local tertiary subspecialty center and got her in. They agreed with my suspicions, though also couldn’t find something definitive. They even repeated the tests, and came to the same conclusions – narrowed down to a few things, but no smoking gun.
Throughout all of this Mrs. Stevens kept spiraling down. After a few hospital admissions and even a biopsy of an abdominal mass we thought would give us the answer, we still didn’t solve the puzzle.
At some point she and her husband grew tired of looking and accepted that it wouldn’t change anything. Her internist called hospice in. They kept her comfortable for her last few weeks.
They didn’t want an autopsy, so the secret stayed with her.
Looking back, I agree with their decision to stop the workup. When looking further won’t change anything, why bother?
But, as a doctor, it’s frustrating. There’s a degree of intellectual curiosity that drives us. We want answers. We want to solve puzzles.
And sometimes we never get that final piece. Even if it’s the right decision for the patient, at the end of the day it’s still an unsolved crime to us. A reminder that,
We probably never will.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
Mrs. Stevens died last week. She was 87.
That’s nothing new. The nature of medicine is such that you’ll see patients pass on.
But Mrs. Stevens bothers me, because even to the end I’m not sure I ever had an answer.
Her case began with somewhat nebulous, but clearly neurological, symptoms. An initial workup was normal, as was the secondary one.
The third stage of increasingly esoteric tests turned up some clues as to what was going wrong, even as she continued to dwindle. I could at least start working on a differential, even if none of it was good.
I met with her and her husband, and they wanted an answer, good or bad.
I pulled some strings at a local tertiary subspecialty center and got her in. They agreed with my suspicions, though also couldn’t find something definitive. They even repeated the tests, and came to the same conclusions – narrowed down to a few things, but no smoking gun.
Throughout all of this Mrs. Stevens kept spiraling down. After a few hospital admissions and even a biopsy of an abdominal mass we thought would give us the answer, we still didn’t solve the puzzle.
At some point she and her husband grew tired of looking and accepted that it wouldn’t change anything. Her internist called hospice in. They kept her comfortable for her last few weeks.
They didn’t want an autopsy, so the secret stayed with her.
Looking back, I agree with their decision to stop the workup. When looking further won’t change anything, why bother?
But, as a doctor, it’s frustrating. There’s a degree of intellectual curiosity that drives us. We want answers. We want to solve puzzles.
And sometimes we never get that final piece. Even if it’s the right decision for the patient, at the end of the day it’s still an unsolved crime to us. A reminder that,
We probably never will.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.