User login
Everyone Needs a Maui Independence Day
Recently, I celebrated Maui Independence Day. I do this every so often, and even change my office message to let patients know my office is closed in honor of said holiday.
Of course, the week afterward I usually get questions about it. As far as I know there is no such holiday. In the 1980s, for various bizarre reasons, my father was trying to think of a fictitious holiday that a Maui resort would celebrate, and came up with this one. Since then, it’s been a family joke – until about 10 years ago, when I officially adopted it into my practice.
Maui Independence Day is now the official holiday of my desert practice. It’s whenever I decide to close the practice on a nonholiday. Recently, for example, my secretary was on vacation and my assistant and I were swamped. Since we only had two patients on the schedule for Friday, I moved them to the next week and closed the office for a 3-day weekend.
Being solo gives me the freedom to do this on occasion. I have no partners to disagree with me. After years in practice, there are days when I’m willing to trade time for dollars and try to regain some sanity.
Maui Independence Day is never anything like "Ferris Bueller’s Day Off." I think the most exciting thing I ever did on it was take my kids to a water park. This past one I spent catching up on paperwork and dictations, trying to fix computer issues, and taking my family out to dinner. But it gives you a few extra hours to catch up on things that would otherwise be crammed into the limited time of a workday, helping you decompress.
Personally, I think everyone should celebrate Maui Independence Day here and there. It helps keep some sanity in an often insane job.
Dr. Block has a solo neurology private practice in Scottsdale, Ariz. E-mail him at [email protected].
Recently, I celebrated Maui Independence Day. I do this every so often, and even change my office message to let patients know my office is closed in honor of said holiday.
Of course, the week afterward I usually get questions about it. As far as I know there is no such holiday. In the 1980s, for various bizarre reasons, my father was trying to think of a fictitious holiday that a Maui resort would celebrate, and came up with this one. Since then, it’s been a family joke – until about 10 years ago, when I officially adopted it into my practice.
Maui Independence Day is now the official holiday of my desert practice. It’s whenever I decide to close the practice on a nonholiday. Recently, for example, my secretary was on vacation and my assistant and I were swamped. Since we only had two patients on the schedule for Friday, I moved them to the next week and closed the office for a 3-day weekend.
Being solo gives me the freedom to do this on occasion. I have no partners to disagree with me. After years in practice, there are days when I’m willing to trade time for dollars and try to regain some sanity.
Maui Independence Day is never anything like "Ferris Bueller’s Day Off." I think the most exciting thing I ever did on it was take my kids to a water park. This past one I spent catching up on paperwork and dictations, trying to fix computer issues, and taking my family out to dinner. But it gives you a few extra hours to catch up on things that would otherwise be crammed into the limited time of a workday, helping you decompress.
Personally, I think everyone should celebrate Maui Independence Day here and there. It helps keep some sanity in an often insane job.
Dr. Block has a solo neurology private practice in Scottsdale, Ariz. E-mail him at [email protected].
Recently, I celebrated Maui Independence Day. I do this every so often, and even change my office message to let patients know my office is closed in honor of said holiday.
Of course, the week afterward I usually get questions about it. As far as I know there is no such holiday. In the 1980s, for various bizarre reasons, my father was trying to think of a fictitious holiday that a Maui resort would celebrate, and came up with this one. Since then, it’s been a family joke – until about 10 years ago, when I officially adopted it into my practice.
Maui Independence Day is now the official holiday of my desert practice. It’s whenever I decide to close the practice on a nonholiday. Recently, for example, my secretary was on vacation and my assistant and I were swamped. Since we only had two patients on the schedule for Friday, I moved them to the next week and closed the office for a 3-day weekend.
Being solo gives me the freedom to do this on occasion. I have no partners to disagree with me. After years in practice, there are days when I’m willing to trade time for dollars and try to regain some sanity.
Maui Independence Day is never anything like "Ferris Bueller’s Day Off." I think the most exciting thing I ever did on it was take my kids to a water park. This past one I spent catching up on paperwork and dictations, trying to fix computer issues, and taking my family out to dinner. But it gives you a few extra hours to catch up on things that would otherwise be crammed into the limited time of a workday, helping you decompress.
Personally, I think everyone should celebrate Maui Independence Day here and there. It helps keep some sanity in an often insane job.
Dr. Block has a solo neurology private practice in Scottsdale, Ariz. E-mail him at [email protected].
Doctor Cost-Efficiency Listings Are Misleading
An insurance company recently sent me a letter that said they’re going to start marking doctors in patient directories as to whether they’re cost efficient. This is done by "a methodology consistent with national standards ... based on a comparison of fee schedules, utilization patterns, and referral patterns."
I support the overall idea of cost efficiency, and try to follow it. I don’t order MRIs for everything, and typically start with conservative approaches before moving up. I prescribe generic medications when possible. I know patients want to save money, and I know that higher insurance costs affect all of our premiums.
But being cost efficient is certainly not the whole story in medicine. If I were to have a practice of primarily multiple sclerosis patients, I certainly wouldn’t be considered a cost-efficient doctor. Those patients will likely require far more costly drugs and frequent MRIs than someone with lumbar pain or migraines. Even if you’re an excellent doctor, you won’t get good marks for "cost efficiency."
The doctor who saves the most money isn’t necessarily the best doctor. Hell, I can do that. Don’t order expensive tests, diagnose based on clinical grounds, and treat with whatever is cheapest (amitriptyline, phenobarbital, aspirin). I’m sure I’d do fine for a while, until something serious is missed. That’s when the whole thing, medically, ethically, and legally, falls apart.
It’s not all about saving money. Dr. Linda Peeno, the whistleblower on the managed care industry, can tell you that. But rating doctors just on that measure can be misleading at best, and dangerous for all involved at worst.
Dr. Block has a solo neurology private practice in Scottsdale, Ariz. E-mail him at [email protected].
An insurance company recently sent me a letter that said they’re going to start marking doctors in patient directories as to whether they’re cost efficient. This is done by "a methodology consistent with national standards ... based on a comparison of fee schedules, utilization patterns, and referral patterns."
I support the overall idea of cost efficiency, and try to follow it. I don’t order MRIs for everything, and typically start with conservative approaches before moving up. I prescribe generic medications when possible. I know patients want to save money, and I know that higher insurance costs affect all of our premiums.
But being cost efficient is certainly not the whole story in medicine. If I were to have a practice of primarily multiple sclerosis patients, I certainly wouldn’t be considered a cost-efficient doctor. Those patients will likely require far more costly drugs and frequent MRIs than someone with lumbar pain or migraines. Even if you’re an excellent doctor, you won’t get good marks for "cost efficiency."
The doctor who saves the most money isn’t necessarily the best doctor. Hell, I can do that. Don’t order expensive tests, diagnose based on clinical grounds, and treat with whatever is cheapest (amitriptyline, phenobarbital, aspirin). I’m sure I’d do fine for a while, until something serious is missed. That’s when the whole thing, medically, ethically, and legally, falls apart.
It’s not all about saving money. Dr. Linda Peeno, the whistleblower on the managed care industry, can tell you that. But rating doctors just on that measure can be misleading at best, and dangerous for all involved at worst.
Dr. Block has a solo neurology private practice in Scottsdale, Ariz. E-mail him at [email protected].
An insurance company recently sent me a letter that said they’re going to start marking doctors in patient directories as to whether they’re cost efficient. This is done by "a methodology consistent with national standards ... based on a comparison of fee schedules, utilization patterns, and referral patterns."
I support the overall idea of cost efficiency, and try to follow it. I don’t order MRIs for everything, and typically start with conservative approaches before moving up. I prescribe generic medications when possible. I know patients want to save money, and I know that higher insurance costs affect all of our premiums.
But being cost efficient is certainly not the whole story in medicine. If I were to have a practice of primarily multiple sclerosis patients, I certainly wouldn’t be considered a cost-efficient doctor. Those patients will likely require far more costly drugs and frequent MRIs than someone with lumbar pain or migraines. Even if you’re an excellent doctor, you won’t get good marks for "cost efficiency."
The doctor who saves the most money isn’t necessarily the best doctor. Hell, I can do that. Don’t order expensive tests, diagnose based on clinical grounds, and treat with whatever is cheapest (amitriptyline, phenobarbital, aspirin). I’m sure I’d do fine for a while, until something serious is missed. That’s when the whole thing, medically, ethically, and legally, falls apart.
It’s not all about saving money. Dr. Linda Peeno, the whistleblower on the managed care industry, can tell you that. But rating doctors just on that measure can be misleading at best, and dangerous for all involved at worst.
Dr. Block has a solo neurology private practice in Scottsdale, Ariz. E-mail him at [email protected].
Doctoring by Phone
How often do you get requests to do telemedicine? I get a few per month, all offering money (usually $20-$30 per call) for me to manage patients by phone. I’m not talking about Viagra or Vicodin mills, but places that cater to patients who either can’t or won’t see a doctor.
I always say no. In my mind, this is just another way to cheapen our profession, but I also have serious concerns about it.
There’s a lot to worry about when trying to treat patients without seeing them. Most migraines are migraines, but what if you can’t examine the patient? You might miss papilledema, or a reflex asymmetry, or other signs that something is amiss. The same could be said for routine lumbar pain or carpal tunnel syndrome.
I don’t mind handling the occasional phone call for an office patient I’m familiar with. And, of course, we all have to deal with cross-cover calls on nonpatients. But to try and do a full history and physical by phone? That doesn’t work for me.
I’m not deluding myself into believing that my refusal to participate will keep these things from happening. Hungry physicians willing to take the legal risks will be hired, and may end up costing me a few patients who would have otherwise come to my office. I’ve been told that I should participate in this sort of thing so at least I can shape the way it develops.
But my belief in my field makes me reluctant to compromise. I also have a family to provide for, and medicine is a risky enough undertaking as it is without adding more potential liability. And I just don’t believe you can provide a decent level of care solely by phone.
Knowingly doing an incomplete job is never a good idea, especially in medicine. And the people who use such services, as in everything else, get what they pay for.
Dr. Block has a solo neurology private practice in Scottsdale, Ariz. He has been a practicing neurologist since 1998 and in private practice since 2000.
How often do you get requests to do telemedicine? I get a few per month, all offering money (usually $20-$30 per call) for me to manage patients by phone. I’m not talking about Viagra or Vicodin mills, but places that cater to patients who either can’t or won’t see a doctor.
I always say no. In my mind, this is just another way to cheapen our profession, but I also have serious concerns about it.
There’s a lot to worry about when trying to treat patients without seeing them. Most migraines are migraines, but what if you can’t examine the patient? You might miss papilledema, or a reflex asymmetry, or other signs that something is amiss. The same could be said for routine lumbar pain or carpal tunnel syndrome.
I don’t mind handling the occasional phone call for an office patient I’m familiar with. And, of course, we all have to deal with cross-cover calls on nonpatients. But to try and do a full history and physical by phone? That doesn’t work for me.
I’m not deluding myself into believing that my refusal to participate will keep these things from happening. Hungry physicians willing to take the legal risks will be hired, and may end up costing me a few patients who would have otherwise come to my office. I’ve been told that I should participate in this sort of thing so at least I can shape the way it develops.
But my belief in my field makes me reluctant to compromise. I also have a family to provide for, and medicine is a risky enough undertaking as it is without adding more potential liability. And I just don’t believe you can provide a decent level of care solely by phone.
Knowingly doing an incomplete job is never a good idea, especially in medicine. And the people who use such services, as in everything else, get what they pay for.
Dr. Block has a solo neurology private practice in Scottsdale, Ariz. He has been a practicing neurologist since 1998 and in private practice since 2000.
How often do you get requests to do telemedicine? I get a few per month, all offering money (usually $20-$30 per call) for me to manage patients by phone. I’m not talking about Viagra or Vicodin mills, but places that cater to patients who either can’t or won’t see a doctor.
I always say no. In my mind, this is just another way to cheapen our profession, but I also have serious concerns about it.
There’s a lot to worry about when trying to treat patients without seeing them. Most migraines are migraines, but what if you can’t examine the patient? You might miss papilledema, or a reflex asymmetry, or other signs that something is amiss. The same could be said for routine lumbar pain or carpal tunnel syndrome.
I don’t mind handling the occasional phone call for an office patient I’m familiar with. And, of course, we all have to deal with cross-cover calls on nonpatients. But to try and do a full history and physical by phone? That doesn’t work for me.
I’m not deluding myself into believing that my refusal to participate will keep these things from happening. Hungry physicians willing to take the legal risks will be hired, and may end up costing me a few patients who would have otherwise come to my office. I’ve been told that I should participate in this sort of thing so at least I can shape the way it develops.
But my belief in my field makes me reluctant to compromise. I also have a family to provide for, and medicine is a risky enough undertaking as it is without adding more potential liability. And I just don’t believe you can provide a decent level of care solely by phone.
Knowingly doing an incomplete job is never a good idea, especially in medicine. And the people who use such services, as in everything else, get what they pay for.
Dr. Block has a solo neurology private practice in Scottsdale, Ariz. He has been a practicing neurologist since 1998 and in private practice since 2000.