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Don’t be bullied by patients threatening bad reviews
“I’m giving you a bad review on Yelp over this.”
He said that, and I honestly didn’t care.
When he called for the appointment, he told my staff he was on a PPO plan that I’m contracted with. But when he came in 2 weeks later, he had a completely different card: an HMO that I’ve never been affiliated with.
I’m an adult neurologist, and don’t see anyone under 18. If you’re an adult, you need to start taking responsibility for your actions. One of them should be knowing what your medical insurance is. This is your job. Not ours. When you tell us what your insurance is, we take you at your word.
But I’m here to help people, and he said he really needed to see me. So I offered to see him at my cash discount rate.
He said no.
I then said I’d see him, and bill it to his insurance to see if they paid anything, and we could work out what he still might owe after that. I was genuinely trying to help him.
Not surprisingly, he again said no.
Then he made me this counteroffer: See me for free, and I won’t post a negative online review about you.
Predictably, he left. And wrote the review on a rate-a-doc site.
Does the bad review bother me? Not at all. The nature of medicine is such that you can’t please everyone. And those you do please likely won’t write a review.
I come here each day to do my best to help people. Threatening me to start a medical relationship will find you going nowhere.
And taking responsibility for your own actions, like I tell my kids, is a big part of being a grownup.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
“I’m giving you a bad review on Yelp over this.”
He said that, and I honestly didn’t care.
When he called for the appointment, he told my staff he was on a PPO plan that I’m contracted with. But when he came in 2 weeks later, he had a completely different card: an HMO that I’ve never been affiliated with.
I’m an adult neurologist, and don’t see anyone under 18. If you’re an adult, you need to start taking responsibility for your actions. One of them should be knowing what your medical insurance is. This is your job. Not ours. When you tell us what your insurance is, we take you at your word.
But I’m here to help people, and he said he really needed to see me. So I offered to see him at my cash discount rate.
He said no.
I then said I’d see him, and bill it to his insurance to see if they paid anything, and we could work out what he still might owe after that. I was genuinely trying to help him.
Not surprisingly, he again said no.
Then he made me this counteroffer: See me for free, and I won’t post a negative online review about you.
Predictably, he left. And wrote the review on a rate-a-doc site.
Does the bad review bother me? Not at all. The nature of medicine is such that you can’t please everyone. And those you do please likely won’t write a review.
I come here each day to do my best to help people. Threatening me to start a medical relationship will find you going nowhere.
And taking responsibility for your own actions, like I tell my kids, is a big part of being a grownup.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
“I’m giving you a bad review on Yelp over this.”
He said that, and I honestly didn’t care.
When he called for the appointment, he told my staff he was on a PPO plan that I’m contracted with. But when he came in 2 weeks later, he had a completely different card: an HMO that I’ve never been affiliated with.
I’m an adult neurologist, and don’t see anyone under 18. If you’re an adult, you need to start taking responsibility for your actions. One of them should be knowing what your medical insurance is. This is your job. Not ours. When you tell us what your insurance is, we take you at your word.
But I’m here to help people, and he said he really needed to see me. So I offered to see him at my cash discount rate.
He said no.
I then said I’d see him, and bill it to his insurance to see if they paid anything, and we could work out what he still might owe after that. I was genuinely trying to help him.
Not surprisingly, he again said no.
Then he made me this counteroffer: See me for free, and I won’t post a negative online review about you.
Predictably, he left. And wrote the review on a rate-a-doc site.
Does the bad review bother me? Not at all. The nature of medicine is such that you can’t please everyone. And those you do please likely won’t write a review.
I come here each day to do my best to help people. Threatening me to start a medical relationship will find you going nowhere.
And taking responsibility for your own actions, like I tell my kids, is a big part of being a grownup.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
How would you handle predictions of Alzheimer’s disease?
We love to try and predict the future. Some of it is scientific, like checking the weather forecast to see what we’re in for. (Here in Phoenix, it’s always hot, hotter, or melting.)
On the other hand, some of it is just for entertainment, like checking a horoscope or seeing what a fortune cookie says.
The breakthroughs in biomarkers for Alzheimer’s disease are accelerating. Although still experimental, we’re getting pretty close to predicting the disease many years before it develops. At the same time, we aren’t nearly as close to a treatment that will have a meaningful impact on the course of the disease.
In 1993, the genetic marker for Huntington’s disease was identified, quickly leading to a blood test with high accuracy to know if you were – or were not – going to develop the fatal disorder down the road.
Some wanted to know and used the information to decide if they wanted to have families. Others, understandably fearful, decided not to and let their lives play out as they will. Sadly, either way we have nothing close to a cure for the disease.
Now, we come to Alzheimer’s disease, many times more common than Huntington’s. Close to predicting its coming and not really close to a cure.
What would you do?
[polldaddy:9778279]
In “Back to the Future,” Doc Brown said “no man should know too much about their own destiny” (though later changed his mind). But, for Doc Brown, a bulletproof vest was all he needed. In Alzheimer’s disease, it’s not that simple.
I’m sure some would see it as a way to have their affairs in order long in advance, to spare themselves and their loved ones the frantic scramble that often comes after a diagnosis. Others would be afraid to know what the future holds, with every misplaced set of keys or iPhone becoming a reason to panic.
Obviously, if we had a true cure for the disorder, the decision would be easy. Then, it becomes a preventive measure in the same category as mammograms and colonoscopies. Early detection saves lives.
What would you do? And how will you guide the patients who ask your opinion?
For better or worse, these questions are coming. All of us need to think about how we’ll handle them.
Dr. Block has a solo neurology private practice in Scottsdale, Ariz.
We love to try and predict the future. Some of it is scientific, like checking the weather forecast to see what we’re in for. (Here in Phoenix, it’s always hot, hotter, or melting.)
On the other hand, some of it is just for entertainment, like checking a horoscope or seeing what a fortune cookie says.
The breakthroughs in biomarkers for Alzheimer’s disease are accelerating. Although still experimental, we’re getting pretty close to predicting the disease many years before it develops. At the same time, we aren’t nearly as close to a treatment that will have a meaningful impact on the course of the disease.
In 1993, the genetic marker for Huntington’s disease was identified, quickly leading to a blood test with high accuracy to know if you were – or were not – going to develop the fatal disorder down the road.
Some wanted to know and used the information to decide if they wanted to have families. Others, understandably fearful, decided not to and let their lives play out as they will. Sadly, either way we have nothing close to a cure for the disease.
Now, we come to Alzheimer’s disease, many times more common than Huntington’s. Close to predicting its coming and not really close to a cure.
What would you do?
[polldaddy:9778279]
In “Back to the Future,” Doc Brown said “no man should know too much about their own destiny” (though later changed his mind). But, for Doc Brown, a bulletproof vest was all he needed. In Alzheimer’s disease, it’s not that simple.
I’m sure some would see it as a way to have their affairs in order long in advance, to spare themselves and their loved ones the frantic scramble that often comes after a diagnosis. Others would be afraid to know what the future holds, with every misplaced set of keys or iPhone becoming a reason to panic.
Obviously, if we had a true cure for the disorder, the decision would be easy. Then, it becomes a preventive measure in the same category as mammograms and colonoscopies. Early detection saves lives.
What would you do? And how will you guide the patients who ask your opinion?
For better or worse, these questions are coming. All of us need to think about how we’ll handle them.
Dr. Block has a solo neurology private practice in Scottsdale, Ariz.
We love to try and predict the future. Some of it is scientific, like checking the weather forecast to see what we’re in for. (Here in Phoenix, it’s always hot, hotter, or melting.)
On the other hand, some of it is just for entertainment, like checking a horoscope or seeing what a fortune cookie says.
The breakthroughs in biomarkers for Alzheimer’s disease are accelerating. Although still experimental, we’re getting pretty close to predicting the disease many years before it develops. At the same time, we aren’t nearly as close to a treatment that will have a meaningful impact on the course of the disease.
In 1993, the genetic marker for Huntington’s disease was identified, quickly leading to a blood test with high accuracy to know if you were – or were not – going to develop the fatal disorder down the road.
Some wanted to know and used the information to decide if they wanted to have families. Others, understandably fearful, decided not to and let their lives play out as they will. Sadly, either way we have nothing close to a cure for the disease.
Now, we come to Alzheimer’s disease, many times more common than Huntington’s. Close to predicting its coming and not really close to a cure.
What would you do?
[polldaddy:9778279]
In “Back to the Future,” Doc Brown said “no man should know too much about their own destiny” (though later changed his mind). But, for Doc Brown, a bulletproof vest was all he needed. In Alzheimer’s disease, it’s not that simple.
I’m sure some would see it as a way to have their affairs in order long in advance, to spare themselves and their loved ones the frantic scramble that often comes after a diagnosis. Others would be afraid to know what the future holds, with every misplaced set of keys or iPhone becoming a reason to panic.
Obviously, if we had a true cure for the disorder, the decision would be easy. Then, it becomes a preventive measure in the same category as mammograms and colonoscopies. Early detection saves lives.
What would you do? And how will you guide the patients who ask your opinion?
For better or worse, these questions are coming. All of us need to think about how we’ll handle them.
Dr. Block has a solo neurology private practice in Scottsdale, Ariz.
Risks of keeping controlled substances in office tilt away from benefits
I don’t stack narcotics in my office. Never have, never will.
Honestly, in this day and age, I don’t understand why anyone would.
I get the occasional patient with a bad migraine who wants to come in for “a shot.” Sorry, I don’t carry that. I suppose I could carry Ketorolac, but I try to run a simple, nonurgent practice. If you have an urgent situation, go to an emergency department or urgent care.
I couldn’t agree more. It’s better to avoid the problem altogether.
In 1998, on my very first day of work as an attending, the group I’d signed with put me in a satellite office normally used by their headache specialist. While familiarizing myself with what was where, I discovered a bottle of injectable meperidine. It wasn’t locked up, just sitting next to the zolmitriptan (Zomig) samples in an unsecured cabinet. I picked it up in shock to make sure I’d read the label correctly. I put it back down then (somewhat paranoid) picked it back up, wiped my fingerprints off, and put it down in the exact same spot it had been. Although it was obviously a serious infraction, I didn’t want to jeopardize my standing as a new hire. So, I just ignored it. But, I sure worried about what would happen if a DEA inspector showed up.
So, today, I just don’t deal with it. No controlled substances, less paperwork, fewer worries. Simplicity is bliss, and modern medicine has enough worries as it is.
This still gets me the occasional complaint of, “Well, my other neurologist did!” but, frankly, I don’t care. They can run their practice how they want, and I’ll run mine.
In a world of regulations, daily press stories on “pill mills” overusing narcotics, and my quarterly prescription tracking reports from the state board, I want to keep my involvement in them as minimal as possible. I may prescribe them, but I don’t want the potential nightmares of having them on site.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
I don’t stack narcotics in my office. Never have, never will.
Honestly, in this day and age, I don’t understand why anyone would.
I get the occasional patient with a bad migraine who wants to come in for “a shot.” Sorry, I don’t carry that. I suppose I could carry Ketorolac, but I try to run a simple, nonurgent practice. If you have an urgent situation, go to an emergency department or urgent care.
I couldn’t agree more. It’s better to avoid the problem altogether.
In 1998, on my very first day of work as an attending, the group I’d signed with put me in a satellite office normally used by their headache specialist. While familiarizing myself with what was where, I discovered a bottle of injectable meperidine. It wasn’t locked up, just sitting next to the zolmitriptan (Zomig) samples in an unsecured cabinet. I picked it up in shock to make sure I’d read the label correctly. I put it back down then (somewhat paranoid) picked it back up, wiped my fingerprints off, and put it down in the exact same spot it had been. Although it was obviously a serious infraction, I didn’t want to jeopardize my standing as a new hire. So, I just ignored it. But, I sure worried about what would happen if a DEA inspector showed up.
So, today, I just don’t deal with it. No controlled substances, less paperwork, fewer worries. Simplicity is bliss, and modern medicine has enough worries as it is.
This still gets me the occasional complaint of, “Well, my other neurologist did!” but, frankly, I don’t care. They can run their practice how they want, and I’ll run mine.
In a world of regulations, daily press stories on “pill mills” overusing narcotics, and my quarterly prescription tracking reports from the state board, I want to keep my involvement in them as minimal as possible. I may prescribe them, but I don’t want the potential nightmares of having them on site.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
I don’t stack narcotics in my office. Never have, never will.
Honestly, in this day and age, I don’t understand why anyone would.
I get the occasional patient with a bad migraine who wants to come in for “a shot.” Sorry, I don’t carry that. I suppose I could carry Ketorolac, but I try to run a simple, nonurgent practice. If you have an urgent situation, go to an emergency department or urgent care.
I couldn’t agree more. It’s better to avoid the problem altogether.
In 1998, on my very first day of work as an attending, the group I’d signed with put me in a satellite office normally used by their headache specialist. While familiarizing myself with what was where, I discovered a bottle of injectable meperidine. It wasn’t locked up, just sitting next to the zolmitriptan (Zomig) samples in an unsecured cabinet. I picked it up in shock to make sure I’d read the label correctly. I put it back down then (somewhat paranoid) picked it back up, wiped my fingerprints off, and put it down in the exact same spot it had been. Although it was obviously a serious infraction, I didn’t want to jeopardize my standing as a new hire. So, I just ignored it. But, I sure worried about what would happen if a DEA inspector showed up.
So, today, I just don’t deal with it. No controlled substances, less paperwork, fewer worries. Simplicity is bliss, and modern medicine has enough worries as it is.
This still gets me the occasional complaint of, “Well, my other neurologist did!” but, frankly, I don’t care. They can run their practice how they want, and I’ll run mine.
In a world of regulations, daily press stories on “pill mills” overusing narcotics, and my quarterly prescription tracking reports from the state board, I want to keep my involvement in them as minimal as possible. I may prescribe them, but I don’t want the potential nightmares of having them on site.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
Access to ‘the little blue book’ just got a lot more expensive
“The little blue book” has been an office standard as long as I’ve been in practice. Every practice has a dog-eared copy in a drawer somewhere that’s constantly being pulled out to look up hospitals, other doctors, and pharmacies.
As small as it is, it’s pretty useful in the daily flow of my office routine.
Until now.
Sadly, 2016 was apparently the year I ordered my last copies. The publisher’s marketing people inform me that the paper version has been discontinued, and I can now get the digital version for only ... $500 per year.
Thanks, but no thanks.
I have nothing against digital editions. In fact, if it was the same price as the paper one, I’d get it. If I were a big practice that needed, say, 50 copies for the staff, the $500 per practice fee is a deal, compared with the $998 I’d pay for 50 paper copies.
But for my dinky little two-person practice? The difference between $39.90 and $500 just isn’t worth all the advantages a digital version may offer. For that kind of money, I’ll use Google.
This is another part of a gradual, and disturbing, trend in medicine: ignoring small practices. Large corporate practices are worth a lot more in sales than little one-to-three doctor groups, so companies, such as “the little blue book,” have no incentive to tailor their products to us. We have become medical persona non grata.
I understand this is a business decision. It’s not specifically directed at me.
Yet ...
I’ve been in practice for almost 20 years now, and buying two copies of the LBB is something I’ve done annually, in good and bad economic years. I’ve supported the publisher because it was a good product at a fair price. Sadly, they no longer find my little practice to be worth the effort or profit margin.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
“The little blue book” has been an office standard as long as I’ve been in practice. Every practice has a dog-eared copy in a drawer somewhere that’s constantly being pulled out to look up hospitals, other doctors, and pharmacies.
As small as it is, it’s pretty useful in the daily flow of my office routine.
Until now.
Sadly, 2016 was apparently the year I ordered my last copies. The publisher’s marketing people inform me that the paper version has been discontinued, and I can now get the digital version for only ... $500 per year.
Thanks, but no thanks.
I have nothing against digital editions. In fact, if it was the same price as the paper one, I’d get it. If I were a big practice that needed, say, 50 copies for the staff, the $500 per practice fee is a deal, compared with the $998 I’d pay for 50 paper copies.
But for my dinky little two-person practice? The difference between $39.90 and $500 just isn’t worth all the advantages a digital version may offer. For that kind of money, I’ll use Google.
This is another part of a gradual, and disturbing, trend in medicine: ignoring small practices. Large corporate practices are worth a lot more in sales than little one-to-three doctor groups, so companies, such as “the little blue book,” have no incentive to tailor their products to us. We have become medical persona non grata.
I understand this is a business decision. It’s not specifically directed at me.
Yet ...
I’ve been in practice for almost 20 years now, and buying two copies of the LBB is something I’ve done annually, in good and bad economic years. I’ve supported the publisher because it was a good product at a fair price. Sadly, they no longer find my little practice to be worth the effort or profit margin.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
“The little blue book” has been an office standard as long as I’ve been in practice. Every practice has a dog-eared copy in a drawer somewhere that’s constantly being pulled out to look up hospitals, other doctors, and pharmacies.
As small as it is, it’s pretty useful in the daily flow of my office routine.
Until now.
Sadly, 2016 was apparently the year I ordered my last copies. The publisher’s marketing people inform me that the paper version has been discontinued, and I can now get the digital version for only ... $500 per year.
Thanks, but no thanks.
I have nothing against digital editions. In fact, if it was the same price as the paper one, I’d get it. If I were a big practice that needed, say, 50 copies for the staff, the $500 per practice fee is a deal, compared with the $998 I’d pay for 50 paper copies.
But for my dinky little two-person practice? The difference between $39.90 and $500 just isn’t worth all the advantages a digital version may offer. For that kind of money, I’ll use Google.
This is another part of a gradual, and disturbing, trend in medicine: ignoring small practices. Large corporate practices are worth a lot more in sales than little one-to-three doctor groups, so companies, such as “the little blue book,” have no incentive to tailor their products to us. We have become medical persona non grata.
I understand this is a business decision. It’s not specifically directed at me.
Yet ...
I’ve been in practice for almost 20 years now, and buying two copies of the LBB is something I’ve done annually, in good and bad economic years. I’ve supported the publisher because it was a good product at a fair price. Sadly, they no longer find my little practice to be worth the effort or profit margin.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
The ‘monster note’ in EHR systems rarely helps
Recently, the hospital I take call at switched to Epic as its electronic health record system.
Overall, I don’t have too many complaints about it. It does some things better and some things worse than other systems I’ve used. That’s to be expected.
But with Epic has come an alarming new trend: the monster note.
Rarely does it ever give you a hint into the thought process or what’s going on that (at least to me) is so critical to medicine.
In a recent example of the insanity, one of my office patients was in the hospital overnight for a transient ischemic attack. When I went to get the discharge summary, it was 97 pages long! (Really, it was.) All of it was auto-filled in with test results, vital signs, MRI screening forms, medication administration records, and nurse, therapy, and respiratory notes. Most of it was far from the stuff that discharge summaries are supposed to contain. What part of “summary” are people not understanding anymore?
Of course, this isn’t Epic’s fault. It’s just a tool. It’s how humans use it that becomes the problem. This misuse of the system has made routine notes, as Shakespeare’s Macbeth said, “a tale told by an idiot, full of sound and fury, signifying nothing.”
For better or worse, I deliberately don’t do this. I let Epic put in the patient’s name, birthday, and most recent vital signs ... and nothing else. I’ll fill in the test results when needed, in a concise form that I can grasp. (It’s my note, after all.) To me, writing (or typing) the note is part of the thought process. As I enter results, I turn over what they mean, in a way that just seeing five paragraphs auto-pasted in doesn’t do. It also allows me to boil them down to one or two sentences.
After all, brevity is the soul of wit. And while I’m not trying to be witty in my notes, I am trying solve the problem in front of me. Taking the time write it out in my own words is essential to my thought process and letting others understand how I came to my plan. And, as a result, it is what’s best for the patient.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
Recently, the hospital I take call at switched to Epic as its electronic health record system.
Overall, I don’t have too many complaints about it. It does some things better and some things worse than other systems I’ve used. That’s to be expected.
But with Epic has come an alarming new trend: the monster note.
Rarely does it ever give you a hint into the thought process or what’s going on that (at least to me) is so critical to medicine.
In a recent example of the insanity, one of my office patients was in the hospital overnight for a transient ischemic attack. When I went to get the discharge summary, it was 97 pages long! (Really, it was.) All of it was auto-filled in with test results, vital signs, MRI screening forms, medication administration records, and nurse, therapy, and respiratory notes. Most of it was far from the stuff that discharge summaries are supposed to contain. What part of “summary” are people not understanding anymore?
Of course, this isn’t Epic’s fault. It’s just a tool. It’s how humans use it that becomes the problem. This misuse of the system has made routine notes, as Shakespeare’s Macbeth said, “a tale told by an idiot, full of sound and fury, signifying nothing.”
For better or worse, I deliberately don’t do this. I let Epic put in the patient’s name, birthday, and most recent vital signs ... and nothing else. I’ll fill in the test results when needed, in a concise form that I can grasp. (It’s my note, after all.) To me, writing (or typing) the note is part of the thought process. As I enter results, I turn over what they mean, in a way that just seeing five paragraphs auto-pasted in doesn’t do. It also allows me to boil them down to one or two sentences.
After all, brevity is the soul of wit. And while I’m not trying to be witty in my notes, I am trying solve the problem in front of me. Taking the time write it out in my own words is essential to my thought process and letting others understand how I came to my plan. And, as a result, it is what’s best for the patient.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
Recently, the hospital I take call at switched to Epic as its electronic health record system.
Overall, I don’t have too many complaints about it. It does some things better and some things worse than other systems I’ve used. That’s to be expected.
But with Epic has come an alarming new trend: the monster note.
Rarely does it ever give you a hint into the thought process or what’s going on that (at least to me) is so critical to medicine.
In a recent example of the insanity, one of my office patients was in the hospital overnight for a transient ischemic attack. When I went to get the discharge summary, it was 97 pages long! (Really, it was.) All of it was auto-filled in with test results, vital signs, MRI screening forms, medication administration records, and nurse, therapy, and respiratory notes. Most of it was far from the stuff that discharge summaries are supposed to contain. What part of “summary” are people not understanding anymore?
Of course, this isn’t Epic’s fault. It’s just a tool. It’s how humans use it that becomes the problem. This misuse of the system has made routine notes, as Shakespeare’s Macbeth said, “a tale told by an idiot, full of sound and fury, signifying nothing.”
For better or worse, I deliberately don’t do this. I let Epic put in the patient’s name, birthday, and most recent vital signs ... and nothing else. I’ll fill in the test results when needed, in a concise form that I can grasp. (It’s my note, after all.) To me, writing (or typing) the note is part of the thought process. As I enter results, I turn over what they mean, in a way that just seeing five paragraphs auto-pasted in doesn’t do. It also allows me to boil them down to one or two sentences.
After all, brevity is the soul of wit. And while I’m not trying to be witty in my notes, I am trying solve the problem in front of me. Taking the time write it out in my own words is essential to my thought process and letting others understand how I came to my plan. And, as a result, it is what’s best for the patient.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
My mundane genetic testing results
I’ve never been particularly curious about my genetic background. We have a pretty clear family history that I’m of central European and Russian descent, with my ancestors coming over in groups between 1900 and 1938.
Recently, my mother decided she wanted more genetic information on us, so she paid $99 for us to send saliva samples to a company that advertises such services.
A few weeks went by. You read about people who find out they have a genetic background that’s quite surprising. I began to wonder: Would there be some giant family history shocker when the results came in?
I’ve since spoken to others who had paid for this service and found most had the same experience. The test confirmed what was already well known, except for one friend whose results suggested a trace of Polynesian blood somewhere in his background. He believes this was likely artefactual, though he enjoys the idea that somewhere in history a Tongan warrior was blown off course at sea and somehow ended up in Odessa, Ukraine.
Of course, as I’ve now learned, that’s only the start of things. These days, I get emails advertising a more detailed panel (for an additional fee), looking for genetic markers for disease and more obscure traits. I also receive the occasional one from someone who, through the company’s anonymous servers, thinks they may be related to me.
I don’t answer either of those. I have no desire to expand my family circle beyond what it already is.
As for the disease testing? Not interested. Yes, some genetic tests may be helpful in making better choices, but the majority, at least to me, are still a work in progress. We deal with both false negatives and false positives in medicine. I routinely discourage my patients from spending money on unproven testing and treatments and have no desire to do the same myself. Maybe someday it will be worth the additional dollars, but I’m not convinced it’s there.
Money is, for better or worse, the driving force for all technologies, medical and otherwise. Maybe my $99 investment will help pay dividends down the road for someone, but today it only resulted in a shoulder shrug and chuckle at what I already knew.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
I’ve never been particularly curious about my genetic background. We have a pretty clear family history that I’m of central European and Russian descent, with my ancestors coming over in groups between 1900 and 1938.
Recently, my mother decided she wanted more genetic information on us, so she paid $99 for us to send saliva samples to a company that advertises such services.
A few weeks went by. You read about people who find out they have a genetic background that’s quite surprising. I began to wonder: Would there be some giant family history shocker when the results came in?
I’ve since spoken to others who had paid for this service and found most had the same experience. The test confirmed what was already well known, except for one friend whose results suggested a trace of Polynesian blood somewhere in his background. He believes this was likely artefactual, though he enjoys the idea that somewhere in history a Tongan warrior was blown off course at sea and somehow ended up in Odessa, Ukraine.
Of course, as I’ve now learned, that’s only the start of things. These days, I get emails advertising a more detailed panel (for an additional fee), looking for genetic markers for disease and more obscure traits. I also receive the occasional one from someone who, through the company’s anonymous servers, thinks they may be related to me.
I don’t answer either of those. I have no desire to expand my family circle beyond what it already is.
As for the disease testing? Not interested. Yes, some genetic tests may be helpful in making better choices, but the majority, at least to me, are still a work in progress. We deal with both false negatives and false positives in medicine. I routinely discourage my patients from spending money on unproven testing and treatments and have no desire to do the same myself. Maybe someday it will be worth the additional dollars, but I’m not convinced it’s there.
Money is, for better or worse, the driving force for all technologies, medical and otherwise. Maybe my $99 investment will help pay dividends down the road for someone, but today it only resulted in a shoulder shrug and chuckle at what I already knew.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
I’ve never been particularly curious about my genetic background. We have a pretty clear family history that I’m of central European and Russian descent, with my ancestors coming over in groups between 1900 and 1938.
Recently, my mother decided she wanted more genetic information on us, so she paid $99 for us to send saliva samples to a company that advertises such services.
A few weeks went by. You read about people who find out they have a genetic background that’s quite surprising. I began to wonder: Would there be some giant family history shocker when the results came in?
I’ve since spoken to others who had paid for this service and found most had the same experience. The test confirmed what was already well known, except for one friend whose results suggested a trace of Polynesian blood somewhere in his background. He believes this was likely artefactual, though he enjoys the idea that somewhere in history a Tongan warrior was blown off course at sea and somehow ended up in Odessa, Ukraine.
Of course, as I’ve now learned, that’s only the start of things. These days, I get emails advertising a more detailed panel (for an additional fee), looking for genetic markers for disease and more obscure traits. I also receive the occasional one from someone who, through the company’s anonymous servers, thinks they may be related to me.
I don’t answer either of those. I have no desire to expand my family circle beyond what it already is.
As for the disease testing? Not interested. Yes, some genetic tests may be helpful in making better choices, but the majority, at least to me, are still a work in progress. We deal with both false negatives and false positives in medicine. I routinely discourage my patients from spending money on unproven testing and treatments and have no desire to do the same myself. Maybe someday it will be worth the additional dollars, but I’m not convinced it’s there.
Money is, for better or worse, the driving force for all technologies, medical and otherwise. Maybe my $99 investment will help pay dividends down the road for someone, but today it only resulted in a shoulder shrug and chuckle at what I already knew.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
Getting paid when patients aren’t in the room
We get paid to see patients. So what happens when patients aren’t in the room?
This is a big, and growing, issue in medicine.
I do hospital call on weekends, and occasionally, I have a long meeting with families. In some cases, this involves a large group in a conference room. These meetings can take quite a bit of time, but since, technically, the patient isn’t present, it requires different charges than if he or she were, even if the whole meeting is about him or her.
Unfortunately, these visits usually aren’t covered by insurance (although this is slowly changing), so families have to pay cash for them, even if they have a direct impact on patient care and take a lot of time.
Telemedicine is the same way. Although it’s getting easier to get visits paid, it’s still not consistent. After all, the patient isn’t physically in the room with you, either. This one, though, at least is starting to take off. But it still has a long way to go.
To date, I haven’t done telemedicine. In a small practice, I can’t afford to lose money on visits, so I don’t plan on starting these until the reimbursement is higher and more consistent. I have to keep the lights on for the patients who depend on me. There are liability issues with it as well since I am unable to examine the patient more than just by sight.
I’m surprised that it’s taking so long for these visits to catch on. If I see someone in my office, I may get paid $80, but if I do it remotely, even for the same amount of time, I get $0. In an era in which people are pushing “patient-centric” care, you’d think telemedicine would be about as patient-centric as you can get. But, apparently, that’s not the case, given the reluctance of many insurers to cover it. And if it’s not being adequately covered, many of us can’t afford to do it.
There needs to be a better realization among payers that patient care doesn’t always involve the patient being physically present, even though we’re still trying to help them.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
We get paid to see patients. So what happens when patients aren’t in the room?
This is a big, and growing, issue in medicine.
I do hospital call on weekends, and occasionally, I have a long meeting with families. In some cases, this involves a large group in a conference room. These meetings can take quite a bit of time, but since, technically, the patient isn’t present, it requires different charges than if he or she were, even if the whole meeting is about him or her.
Unfortunately, these visits usually aren’t covered by insurance (although this is slowly changing), so families have to pay cash for them, even if they have a direct impact on patient care and take a lot of time.
Telemedicine is the same way. Although it’s getting easier to get visits paid, it’s still not consistent. After all, the patient isn’t physically in the room with you, either. This one, though, at least is starting to take off. But it still has a long way to go.
To date, I haven’t done telemedicine. In a small practice, I can’t afford to lose money on visits, so I don’t plan on starting these until the reimbursement is higher and more consistent. I have to keep the lights on for the patients who depend on me. There are liability issues with it as well since I am unable to examine the patient more than just by sight.
I’m surprised that it’s taking so long for these visits to catch on. If I see someone in my office, I may get paid $80, but if I do it remotely, even for the same amount of time, I get $0. In an era in which people are pushing “patient-centric” care, you’d think telemedicine would be about as patient-centric as you can get. But, apparently, that’s not the case, given the reluctance of many insurers to cover it. And if it’s not being adequately covered, many of us can’t afford to do it.
There needs to be a better realization among payers that patient care doesn’t always involve the patient being physically present, even though we’re still trying to help them.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
We get paid to see patients. So what happens when patients aren’t in the room?
This is a big, and growing, issue in medicine.
I do hospital call on weekends, and occasionally, I have a long meeting with families. In some cases, this involves a large group in a conference room. These meetings can take quite a bit of time, but since, technically, the patient isn’t present, it requires different charges than if he or she were, even if the whole meeting is about him or her.
Unfortunately, these visits usually aren’t covered by insurance (although this is slowly changing), so families have to pay cash for them, even if they have a direct impact on patient care and take a lot of time.
Telemedicine is the same way. Although it’s getting easier to get visits paid, it’s still not consistent. After all, the patient isn’t physically in the room with you, either. This one, though, at least is starting to take off. But it still has a long way to go.
To date, I haven’t done telemedicine. In a small practice, I can’t afford to lose money on visits, so I don’t plan on starting these until the reimbursement is higher and more consistent. I have to keep the lights on for the patients who depend on me. There are liability issues with it as well since I am unable to examine the patient more than just by sight.
I’m surprised that it’s taking so long for these visits to catch on. If I see someone in my office, I may get paid $80, but if I do it remotely, even for the same amount of time, I get $0. In an era in which people are pushing “patient-centric” care, you’d think telemedicine would be about as patient-centric as you can get. But, apparently, that’s not the case, given the reluctance of many insurers to cover it. And if it’s not being adequately covered, many of us can’t afford to do it.
There needs to be a better realization among payers that patient care doesn’t always involve the patient being physically present, even though we’re still trying to help them.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
Rumors about the death of tPA are exaggerated
Where do we go from here?
More than 20 years after IV tissue plasminogen activator was officially approved for use in acute ischemic stroke, now data suggest mechanical thrombectomy is superior, regardless of whether tPA is given.
Granted, these are preliminary trials, and a lot more research needs to be done: randomized studies, determinations of which patients are the best candidates, which devices are most useful, etc.
Of course, it’s not that simple. The data thus far suggest thrombectomy is best when used in anterior circulation strokes, with a National Institutes of Health Stroke Scale score of greater than 6, so obviously we shouldn’t be calling them in on every case.
You have to balance that against legal issues. It certainly isn’t too far-fetched to imagine being sued because you didn’t call an interventionalist, or another neurologist testifying that you fell below the standard of care by not doing so. The right person will say that about anything, regardless of clinical data.
This is still up in the air right now, as I doubt the interventionalists want to take acute ischemic stroke off our hands, nor do we want to give it up, either. It’s a disorder of the brain, and that is what we deal with, isn’t it?
The bottom line is that rumors about the death of tPA in acute ischemic stroke are greatly exaggerated. Only time will tell.
Medicine, for better or worse, is an inexact science. No one can predict outcomes, adverse reactions, or complications with 100% certainty. Which treatment will work best for which patient is never known. That’s why we need controlled trials to know which odds are best overall, and take it from there. Preliminary trials can be very helpful at pointing us in the right directions, but are for from definitive. As with so many other things, your mileage may vary.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
Where do we go from here?
More than 20 years after IV tissue plasminogen activator was officially approved for use in acute ischemic stroke, now data suggest mechanical thrombectomy is superior, regardless of whether tPA is given.
Granted, these are preliminary trials, and a lot more research needs to be done: randomized studies, determinations of which patients are the best candidates, which devices are most useful, etc.
Of course, it’s not that simple. The data thus far suggest thrombectomy is best when used in anterior circulation strokes, with a National Institutes of Health Stroke Scale score of greater than 6, so obviously we shouldn’t be calling them in on every case.
You have to balance that against legal issues. It certainly isn’t too far-fetched to imagine being sued because you didn’t call an interventionalist, or another neurologist testifying that you fell below the standard of care by not doing so. The right person will say that about anything, regardless of clinical data.
This is still up in the air right now, as I doubt the interventionalists want to take acute ischemic stroke off our hands, nor do we want to give it up, either. It’s a disorder of the brain, and that is what we deal with, isn’t it?
The bottom line is that rumors about the death of tPA in acute ischemic stroke are greatly exaggerated. Only time will tell.
Medicine, for better or worse, is an inexact science. No one can predict outcomes, adverse reactions, or complications with 100% certainty. Which treatment will work best for which patient is never known. That’s why we need controlled trials to know which odds are best overall, and take it from there. Preliminary trials can be very helpful at pointing us in the right directions, but are for from definitive. As with so many other things, your mileage may vary.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
Where do we go from here?
More than 20 years after IV tissue plasminogen activator was officially approved for use in acute ischemic stroke, now data suggest mechanical thrombectomy is superior, regardless of whether tPA is given.
Granted, these are preliminary trials, and a lot more research needs to be done: randomized studies, determinations of which patients are the best candidates, which devices are most useful, etc.
Of course, it’s not that simple. The data thus far suggest thrombectomy is best when used in anterior circulation strokes, with a National Institutes of Health Stroke Scale score of greater than 6, so obviously we shouldn’t be calling them in on every case.
You have to balance that against legal issues. It certainly isn’t too far-fetched to imagine being sued because you didn’t call an interventionalist, or another neurologist testifying that you fell below the standard of care by not doing so. The right person will say that about anything, regardless of clinical data.
This is still up in the air right now, as I doubt the interventionalists want to take acute ischemic stroke off our hands, nor do we want to give it up, either. It’s a disorder of the brain, and that is what we deal with, isn’t it?
The bottom line is that rumors about the death of tPA in acute ischemic stroke are greatly exaggerated. Only time will tell.
Medicine, for better or worse, is an inexact science. No one can predict outcomes, adverse reactions, or complications with 100% certainty. Which treatment will work best for which patient is never known. That’s why we need controlled trials to know which odds are best overall, and take it from there. Preliminary trials can be very helpful at pointing us in the right directions, but are for from definitive. As with so many other things, your mileage may vary.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
Do you attend a patient’s funeral?
I’ve never been to a patient’s funeral, though I know plenty of other doctors who have.
I suppose this is a highly personal decision. Some feel they should go out of respect to the patient, or if they had a particularly strong or longstanding relationship with them.
Part of it is feeling like an outsider. To me, funerals are a chance for loved ones and close friends to say their goodbyes. I generally try to keep a professional distance. It makes the job easier.
Another is simply a reluctance to take time off from the office. Even though someone I cared for is gone, that person is not the only one that I see. I have to continue caring for the patients who still need me.
There’s also an aspect of fear. Family members who don’t know you well may see your presence as a sign of guilt that you did something wrong. Or, in the irrational nature of grief and anger, become belligerent, accusing you of incompetence. These sorts of confrontations can never end well for either side.
All of us are facing death sooner or later. As physicians, our job is to prolong and improve quality of life as best we can, knowing that inevitably we’ll lose. When that happens, the most we can ever ask is that we did our best. And that we continue to care for those who still depend on us.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
[polldaddy:9711658]
I’ve never been to a patient’s funeral, though I know plenty of other doctors who have.
I suppose this is a highly personal decision. Some feel they should go out of respect to the patient, or if they had a particularly strong or longstanding relationship with them.
Part of it is feeling like an outsider. To me, funerals are a chance for loved ones and close friends to say their goodbyes. I generally try to keep a professional distance. It makes the job easier.
Another is simply a reluctance to take time off from the office. Even though someone I cared for is gone, that person is not the only one that I see. I have to continue caring for the patients who still need me.
There’s also an aspect of fear. Family members who don’t know you well may see your presence as a sign of guilt that you did something wrong. Or, in the irrational nature of grief and anger, become belligerent, accusing you of incompetence. These sorts of confrontations can never end well for either side.
All of us are facing death sooner or later. As physicians, our job is to prolong and improve quality of life as best we can, knowing that inevitably we’ll lose. When that happens, the most we can ever ask is that we did our best. And that we continue to care for those who still depend on us.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
[polldaddy:9711658]
I’ve never been to a patient’s funeral, though I know plenty of other doctors who have.
I suppose this is a highly personal decision. Some feel they should go out of respect to the patient, or if they had a particularly strong or longstanding relationship with them.
Part of it is feeling like an outsider. To me, funerals are a chance for loved ones and close friends to say their goodbyes. I generally try to keep a professional distance. It makes the job easier.
Another is simply a reluctance to take time off from the office. Even though someone I cared for is gone, that person is not the only one that I see. I have to continue caring for the patients who still need me.
There’s also an aspect of fear. Family members who don’t know you well may see your presence as a sign of guilt that you did something wrong. Or, in the irrational nature of grief and anger, become belligerent, accusing you of incompetence. These sorts of confrontations can never end well for either side.
All of us are facing death sooner or later. As physicians, our job is to prolong and improve quality of life as best we can, knowing that inevitably we’ll lose. When that happens, the most we can ever ask is that we did our best. And that we continue to care for those who still depend on us.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
[polldaddy:9711658]
On vacation, my patients go with me
I’m in the process of planning our family vacations for the summer. I do something different from most when on the road: I take my patients with me.
Well, obviously not physically, but I do cover everything, no matter where I am.
Yes, it takes time. In a ritual my family is used to, two to three times a day I’ll call my staff and go over a list of calls that came in, refills needed, and test results. We go back and forth for a bit. For more complicated questions, I may have to wait until I have my laptop, with the charts on it. If there’s an emergency they’ll call me, and if I can’t be reached, they’ll dial up my call partners.
• I know my patients. I think we all feel that way. I’m more comfortable, and I hope they are too, with the doc who knows them making the decisions.
• My call partners don’t know them. We’re all in solo practice. They don’t have access to my charts any more than I do to theirs. That’s an okay arrangement for a weekend call, but not 2 weeks.
• No surprises. I know that I’m not going to be coming home to a pile of MRI and lab reports that I need to review and act on. If my patient was in the ER or admitted, I spoke to the physician handling it.
A long time ago, when I first started out, I asked another neurologist in my building to cover for me when I was leaving town. I didn’t know him very well, but I was still learning the ropes. He said fine.
When I came home, I found he’d actually “poached” several who’d called, having them come in and convincing them to switch doctors. He’d also changed medications on well-controlled epilepsy and migraine patients who’d needed refills, leaving me to deal with the complications of it when I returned.
Granted, I’ve since learned that he was unusual in that degree, but it really rattled me. I decided I’d rather handle things on my own from then on.
This isn’t an easy decision, but I’m glad I do it. I come home to an office with no surprises, no test results piled up to review, no medication changes that I look at and wonder about.
Does it ruin my vacation? Not at all. Yes, it’s 30-60 minutes out of each day that I have to spend with my office, but I think it’s worth it. It’s peace of mind for me, my staff, and my patients, at least as much as you can ever have in this field.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
[polldaddy:9696724]
I’m in the process of planning our family vacations for the summer. I do something different from most when on the road: I take my patients with me.
Well, obviously not physically, but I do cover everything, no matter where I am.
Yes, it takes time. In a ritual my family is used to, two to three times a day I’ll call my staff and go over a list of calls that came in, refills needed, and test results. We go back and forth for a bit. For more complicated questions, I may have to wait until I have my laptop, with the charts on it. If there’s an emergency they’ll call me, and if I can’t be reached, they’ll dial up my call partners.
• I know my patients. I think we all feel that way. I’m more comfortable, and I hope they are too, with the doc who knows them making the decisions.
• My call partners don’t know them. We’re all in solo practice. They don’t have access to my charts any more than I do to theirs. That’s an okay arrangement for a weekend call, but not 2 weeks.
• No surprises. I know that I’m not going to be coming home to a pile of MRI and lab reports that I need to review and act on. If my patient was in the ER or admitted, I spoke to the physician handling it.
A long time ago, when I first started out, I asked another neurologist in my building to cover for me when I was leaving town. I didn’t know him very well, but I was still learning the ropes. He said fine.
When I came home, I found he’d actually “poached” several who’d called, having them come in and convincing them to switch doctors. He’d also changed medications on well-controlled epilepsy and migraine patients who’d needed refills, leaving me to deal with the complications of it when I returned.
Granted, I’ve since learned that he was unusual in that degree, but it really rattled me. I decided I’d rather handle things on my own from then on.
This isn’t an easy decision, but I’m glad I do it. I come home to an office with no surprises, no test results piled up to review, no medication changes that I look at and wonder about.
Does it ruin my vacation? Not at all. Yes, it’s 30-60 minutes out of each day that I have to spend with my office, but I think it’s worth it. It’s peace of mind for me, my staff, and my patients, at least as much as you can ever have in this field.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
[polldaddy:9696724]
I’m in the process of planning our family vacations for the summer. I do something different from most when on the road: I take my patients with me.
Well, obviously not physically, but I do cover everything, no matter where I am.
Yes, it takes time. In a ritual my family is used to, two to three times a day I’ll call my staff and go over a list of calls that came in, refills needed, and test results. We go back and forth for a bit. For more complicated questions, I may have to wait until I have my laptop, with the charts on it. If there’s an emergency they’ll call me, and if I can’t be reached, they’ll dial up my call partners.
• I know my patients. I think we all feel that way. I’m more comfortable, and I hope they are too, with the doc who knows them making the decisions.
• My call partners don’t know them. We’re all in solo practice. They don’t have access to my charts any more than I do to theirs. That’s an okay arrangement for a weekend call, but not 2 weeks.
• No surprises. I know that I’m not going to be coming home to a pile of MRI and lab reports that I need to review and act on. If my patient was in the ER or admitted, I spoke to the physician handling it.
A long time ago, when I first started out, I asked another neurologist in my building to cover for me when I was leaving town. I didn’t know him very well, but I was still learning the ropes. He said fine.
When I came home, I found he’d actually “poached” several who’d called, having them come in and convincing them to switch doctors. He’d also changed medications on well-controlled epilepsy and migraine patients who’d needed refills, leaving me to deal with the complications of it when I returned.
Granted, I’ve since learned that he was unusual in that degree, but it really rattled me. I decided I’d rather handle things on my own from then on.
This isn’t an easy decision, but I’m glad I do it. I come home to an office with no surprises, no test results piled up to review, no medication changes that I look at and wonder about.
Does it ruin my vacation? Not at all. Yes, it’s 30-60 minutes out of each day that I have to spend with my office, but I think it’s worth it. It’s peace of mind for me, my staff, and my patients, at least as much as you can ever have in this field.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
[polldaddy:9696724]