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Overcoming misconceptions about hospice
Neurology, like any other field, has its share of tragic and incurable diseases. We do our best to shepherd patients and their families through a disorder by offering advice, symptomatic treatment, Family and Medical Leave Act signatures, and a shoulder.
But, inevitably, we come down to one of the most difficult discussions: the end game.
Hospice is never an easy subject to raise. I try to initiate the discussion in advance, so that the decisions and paperwork are in place.
One of the hardest parts is the misconception that hospice means you’re giving up: giving up on caring, giving up on hoping, giving up on treating. I work to try and overcome this.
Hospice may be a change in the treatment plan, but it’s still part of treatment. Finding a way to relieve suffering and provide comfortable surroundings in the final days, while often overlooked, is very important. Peace at a difficult time is sorely needed, more so than another round of tests or invasive procedures.
Yet, it’s not seen that way. Maybe this is cultural. Here, medicine is seen as a cutting-edge field, where there’s always something else that can be done: more scans, another hi-tech bioengineered drug, or some sort of amazing interventional procedure. Although we usually think of all the things we can do, it’s equally important to focus on what we should do. They aren’t always the same – a point that’s often lost.
Sometimes the best thing to do is … everything you can to just make someone comfortable. That’s not giving up. It’s recognizing when it becomes the right decision for the patient and not their family, friends, or anyone else. The patient is the one who really matters.
In an age when newer and flashier facilities and treatments are promoted, keeping the patient’s best interests in mind is critical. Sometimes we get blindsided by the amazing breakthroughs we didn’t have 20, 10, even 5 years ago. So we need to recognize when the best treatment is … to stop.
Quality of life extends all the way up to the moment of death. Part of our job is to keep the Grim Reaper away, but we inevitably lose. It is equally important, though, and sometimes forgotten, to keep the patient as comfortable as possible on the journey. And that isn’t giving up.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
Neurology, like any other field, has its share of tragic and incurable diseases. We do our best to shepherd patients and their families through a disorder by offering advice, symptomatic treatment, Family and Medical Leave Act signatures, and a shoulder.
But, inevitably, we come down to one of the most difficult discussions: the end game.
Hospice is never an easy subject to raise. I try to initiate the discussion in advance, so that the decisions and paperwork are in place.
One of the hardest parts is the misconception that hospice means you’re giving up: giving up on caring, giving up on hoping, giving up on treating. I work to try and overcome this.
Hospice may be a change in the treatment plan, but it’s still part of treatment. Finding a way to relieve suffering and provide comfortable surroundings in the final days, while often overlooked, is very important. Peace at a difficult time is sorely needed, more so than another round of tests or invasive procedures.
Yet, it’s not seen that way. Maybe this is cultural. Here, medicine is seen as a cutting-edge field, where there’s always something else that can be done: more scans, another hi-tech bioengineered drug, or some sort of amazing interventional procedure. Although we usually think of all the things we can do, it’s equally important to focus on what we should do. They aren’t always the same – a point that’s often lost.
Sometimes the best thing to do is … everything you can to just make someone comfortable. That’s not giving up. It’s recognizing when it becomes the right decision for the patient and not their family, friends, or anyone else. The patient is the one who really matters.
In an age when newer and flashier facilities and treatments are promoted, keeping the patient’s best interests in mind is critical. Sometimes we get blindsided by the amazing breakthroughs we didn’t have 20, 10, even 5 years ago. So we need to recognize when the best treatment is … to stop.
Quality of life extends all the way up to the moment of death. Part of our job is to keep the Grim Reaper away, but we inevitably lose. It is equally important, though, and sometimes forgotten, to keep the patient as comfortable as possible on the journey. And that isn’t giving up.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
Neurology, like any other field, has its share of tragic and incurable diseases. We do our best to shepherd patients and their families through a disorder by offering advice, symptomatic treatment, Family and Medical Leave Act signatures, and a shoulder.
But, inevitably, we come down to one of the most difficult discussions: the end game.
Hospice is never an easy subject to raise. I try to initiate the discussion in advance, so that the decisions and paperwork are in place.
One of the hardest parts is the misconception that hospice means you’re giving up: giving up on caring, giving up on hoping, giving up on treating. I work to try and overcome this.
Hospice may be a change in the treatment plan, but it’s still part of treatment. Finding a way to relieve suffering and provide comfortable surroundings in the final days, while often overlooked, is very important. Peace at a difficult time is sorely needed, more so than another round of tests or invasive procedures.
Yet, it’s not seen that way. Maybe this is cultural. Here, medicine is seen as a cutting-edge field, where there’s always something else that can be done: more scans, another hi-tech bioengineered drug, or some sort of amazing interventional procedure. Although we usually think of all the things we can do, it’s equally important to focus on what we should do. They aren’t always the same – a point that’s often lost.
Sometimes the best thing to do is … everything you can to just make someone comfortable. That’s not giving up. It’s recognizing when it becomes the right decision for the patient and not their family, friends, or anyone else. The patient is the one who really matters.
In an age when newer and flashier facilities and treatments are promoted, keeping the patient’s best interests in mind is critical. Sometimes we get blindsided by the amazing breakthroughs we didn’t have 20, 10, even 5 years ago. So we need to recognize when the best treatment is … to stop.
Quality of life extends all the way up to the moment of death. Part of our job is to keep the Grim Reaper away, but we inevitably lose. It is equally important, though, and sometimes forgotten, to keep the patient as comfortable as possible on the journey. And that isn’t giving up.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
Saying thank you to patients
I say “Thank you” a lot to patients. And I mean it.
I like being a doctor. It’s something I always wanted to do. For all the difficulties that go along with it, I still enjoy the actual job of caring for those who come to me. They’re the reason I’m here, and they keep my practice afloat and let me do what I want in life.
Like any other business, I have competitors. In my area, people have a choice of neurologists, and I appreciate that they picked me. So I always try to thank them when walking up to checkout.
A big part of what makes the job rewarding are those who feel the same way about me. It’s always nice when they thank me for helping, or trying to help, or just listening. I try to be a good doctor, so I’m glad to have someone recognize that. In this field, you can’t make everyone happy, but if I can have a solid majority who understand that I’m doing my best for them, I’ll take it.
I’m not fishing for compliments, or gifts, or a parade. Experience has taught me that patients who are overly flattering are most likely not to mean it. If someone calls me too many wonderful things, I immediately worry about their ulterior motives. Are they looking for narcotics? Disability? A legal action?
But a simple, sincere, “Thank you” from a patient can make it all worthwhile. Even on a bad day, it’s still a bright spot. It’s nice to know I’m making a difference. When I get a small note or appreciative Christmas card from a patient, I save it. They go in a drawer to be taken out and read after a particularly rough time, to remind myself that I must be doing something right.
Being appreciated reminds me why I’m here, and that this was the right choice for me. It lets me know that I’m doing what I set out to do many years ago: to help people.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
I say “Thank you” a lot to patients. And I mean it.
I like being a doctor. It’s something I always wanted to do. For all the difficulties that go along with it, I still enjoy the actual job of caring for those who come to me. They’re the reason I’m here, and they keep my practice afloat and let me do what I want in life.
Like any other business, I have competitors. In my area, people have a choice of neurologists, and I appreciate that they picked me. So I always try to thank them when walking up to checkout.
A big part of what makes the job rewarding are those who feel the same way about me. It’s always nice when they thank me for helping, or trying to help, or just listening. I try to be a good doctor, so I’m glad to have someone recognize that. In this field, you can’t make everyone happy, but if I can have a solid majority who understand that I’m doing my best for them, I’ll take it.
I’m not fishing for compliments, or gifts, or a parade. Experience has taught me that patients who are overly flattering are most likely not to mean it. If someone calls me too many wonderful things, I immediately worry about their ulterior motives. Are they looking for narcotics? Disability? A legal action?
But a simple, sincere, “Thank you” from a patient can make it all worthwhile. Even on a bad day, it’s still a bright spot. It’s nice to know I’m making a difference. When I get a small note or appreciative Christmas card from a patient, I save it. They go in a drawer to be taken out and read after a particularly rough time, to remind myself that I must be doing something right.
Being appreciated reminds me why I’m here, and that this was the right choice for me. It lets me know that I’m doing what I set out to do many years ago: to help people.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
I say “Thank you” a lot to patients. And I mean it.
I like being a doctor. It’s something I always wanted to do. For all the difficulties that go along with it, I still enjoy the actual job of caring for those who come to me. They’re the reason I’m here, and they keep my practice afloat and let me do what I want in life.
Like any other business, I have competitors. In my area, people have a choice of neurologists, and I appreciate that they picked me. So I always try to thank them when walking up to checkout.
A big part of what makes the job rewarding are those who feel the same way about me. It’s always nice when they thank me for helping, or trying to help, or just listening. I try to be a good doctor, so I’m glad to have someone recognize that. In this field, you can’t make everyone happy, but if I can have a solid majority who understand that I’m doing my best for them, I’ll take it.
I’m not fishing for compliments, or gifts, or a parade. Experience has taught me that patients who are overly flattering are most likely not to mean it. If someone calls me too many wonderful things, I immediately worry about their ulterior motives. Are they looking for narcotics? Disability? A legal action?
But a simple, sincere, “Thank you” from a patient can make it all worthwhile. Even on a bad day, it’s still a bright spot. It’s nice to know I’m making a difference. When I get a small note or appreciative Christmas card from a patient, I save it. They go in a drawer to be taken out and read after a particularly rough time, to remind myself that I must be doing something right.
Being appreciated reminds me why I’m here, and that this was the right choice for me. It lets me know that I’m doing what I set out to do many years ago: to help people.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
Your practice moves but your address on the Internet doesn’t
I moved offices in April 2014, for the first time in my career. Overall, it went quite smoothly.
But one problem persists, thanks to the Internet age.
The majority of search engines and rate-a-doc sites haven’t updated my address. I’ve e-mailed them about it, but get either no response or (even better) a response saying “We’ve reviewed your note and found our information is correct.” Apparently, I don’t know my correct address, in spite of driving there every day.
But what’s even more frustrating is when my patients follow these instructions. My secretary is quite conscientious about giving patients, new and old, the correct location when they make the appointment. My practice website even has a map.
Despite this, we still have a roughly 20% rate of people going to my old office across the street, then calling to see where we went. Worse, this even happens with patients who were never even seen at that office, yet have been to my new one several times.
Then they come in and yell at my staff for giving them the wrong address. They claim my website has the wrong address. It doesn’t, but I can’t control other sites.
The problem is that most don’t trust other people as much as they trust their phones. Rather than writing down my address when talking to my secretary, it’s easier to just tell Siri, “find Dr. Allan Block’s office.” Siri checks the Internet, where the majority of incorrect listings drown out my dinky little practice site. So people follow the phone’s instructions without questioning them. Even those who’ve previously been to this office, or think, “that doesn’t sound right,” will often follow the directions without question. After all, the Internet knows best.
I’m not knocking the rise of the smartphone. They’re awesome. I rely on Siri myself a great deal. But the phone is only as good as the data supplied, and isn’t capable of questioning it. If most sites list an incorrect address, then who am I to argue? I’m just the guy who’s actually renting the place.
The problem is that information itself is often unhelpful and misleading, and the Internet isn’t always right.
When I dictate an EEG report, I often end it with “clinical correlation is advised.” We need to keep that in mind for everyday life, too.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
I moved offices in April 2014, for the first time in my career. Overall, it went quite smoothly.
But one problem persists, thanks to the Internet age.
The majority of search engines and rate-a-doc sites haven’t updated my address. I’ve e-mailed them about it, but get either no response or (even better) a response saying “We’ve reviewed your note and found our information is correct.” Apparently, I don’t know my correct address, in spite of driving there every day.
But what’s even more frustrating is when my patients follow these instructions. My secretary is quite conscientious about giving patients, new and old, the correct location when they make the appointment. My practice website even has a map.
Despite this, we still have a roughly 20% rate of people going to my old office across the street, then calling to see where we went. Worse, this even happens with patients who were never even seen at that office, yet have been to my new one several times.
Then they come in and yell at my staff for giving them the wrong address. They claim my website has the wrong address. It doesn’t, but I can’t control other sites.
The problem is that most don’t trust other people as much as they trust their phones. Rather than writing down my address when talking to my secretary, it’s easier to just tell Siri, “find Dr. Allan Block’s office.” Siri checks the Internet, where the majority of incorrect listings drown out my dinky little practice site. So people follow the phone’s instructions without questioning them. Even those who’ve previously been to this office, or think, “that doesn’t sound right,” will often follow the directions without question. After all, the Internet knows best.
I’m not knocking the rise of the smartphone. They’re awesome. I rely on Siri myself a great deal. But the phone is only as good as the data supplied, and isn’t capable of questioning it. If most sites list an incorrect address, then who am I to argue? I’m just the guy who’s actually renting the place.
The problem is that information itself is often unhelpful and misleading, and the Internet isn’t always right.
When I dictate an EEG report, I often end it with “clinical correlation is advised.” We need to keep that in mind for everyday life, too.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
I moved offices in April 2014, for the first time in my career. Overall, it went quite smoothly.
But one problem persists, thanks to the Internet age.
The majority of search engines and rate-a-doc sites haven’t updated my address. I’ve e-mailed them about it, but get either no response or (even better) a response saying “We’ve reviewed your note and found our information is correct.” Apparently, I don’t know my correct address, in spite of driving there every day.
But what’s even more frustrating is when my patients follow these instructions. My secretary is quite conscientious about giving patients, new and old, the correct location when they make the appointment. My practice website even has a map.
Despite this, we still have a roughly 20% rate of people going to my old office across the street, then calling to see where we went. Worse, this even happens with patients who were never even seen at that office, yet have been to my new one several times.
Then they come in and yell at my staff for giving them the wrong address. They claim my website has the wrong address. It doesn’t, but I can’t control other sites.
The problem is that most don’t trust other people as much as they trust their phones. Rather than writing down my address when talking to my secretary, it’s easier to just tell Siri, “find Dr. Allan Block’s office.” Siri checks the Internet, where the majority of incorrect listings drown out my dinky little practice site. So people follow the phone’s instructions without questioning them. Even those who’ve previously been to this office, or think, “that doesn’t sound right,” will often follow the directions without question. After all, the Internet knows best.
I’m not knocking the rise of the smartphone. They’re awesome. I rely on Siri myself a great deal. But the phone is only as good as the data supplied, and isn’t capable of questioning it. If most sites list an incorrect address, then who am I to argue? I’m just the guy who’s actually renting the place.
The problem is that information itself is often unhelpful and misleading, and the Internet isn’t always right.
When I dictate an EEG report, I often end it with “clinical correlation is advised.” We need to keep that in mind for everyday life, too.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
Doctors are easy targets for threats and attacks
Buried under news of the terrible Charlie Hebdo terrorism murders was another serious attack. A doctor was shot and killed by an angry patient at a Texas VA hospital, who then took his own life.
I’m not trying to belittle the tragedy in Paris, but instead point out that medicine can be more hazardous than many realize.
We don’t intentionally try to offend, but in a field like this, it’s impossible to please everyone. People get upset that I can’t cure them or find a cause for their (medically unexplainable) symptoms, or won’t give them as many narcotics as they want. The unhappy ones never come back, or post an angry review on Yelp, or send a nasty letter, or some combination of the above.
But, occasionally, we get threats. They’re rare in an office practice, though I suspect surprisingly common in emergency department work. Most are empty threats to sue, but occasionally my staff and I get threatened with physical harm. While most are simply words, there’s really no easy way of knowing who will or won’t actually snap and carry them out.
We live in a society where guns are common, easily obtained, and affordable. So anyone might have one. Unless your office has a metal detector or does pat downs, you’re at risk (at least hypothetically). Putting up a sign that says “no guns allowed” isn’t going to stop anyone. Neither do laws to protect health professionals. Those who have decided to harm others don’t worry about such things.
For that matter, I have several patients who usually have a gun on them. Sometimes concealed, sometimes obvious. Does it bother me? Not at all. They’re all polite and pleasant, and I understand their reason for keeping one on hand.
But doctors, unfortunately, are easy targets for the irrational and armed. The shooting in El Paso occurred in a government hospital with armed security, and that certainly didn’t make a difference. We generally keep predictable hours, park in the same spaces, and our offices aren’t locked up. We do a job where trust is assumed, because people are coming to us for help and we’re here for their benefit.
Is there an answer? I know doctors who keep a handgun under their coats, or in their desks. In a perfect world, they wouldn’t need it, but our world is far from it. Being a doctor, whether you’re on the front line in the emergency department or hidden in a nameless medical plaza, can still be a dangerous business.
Medicine is a surprising field to think of as a hazardous one, but these days, sadly, it is.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
Buried under news of the terrible Charlie Hebdo terrorism murders was another serious attack. A doctor was shot and killed by an angry patient at a Texas VA hospital, who then took his own life.
I’m not trying to belittle the tragedy in Paris, but instead point out that medicine can be more hazardous than many realize.
We don’t intentionally try to offend, but in a field like this, it’s impossible to please everyone. People get upset that I can’t cure them or find a cause for their (medically unexplainable) symptoms, or won’t give them as many narcotics as they want. The unhappy ones never come back, or post an angry review on Yelp, or send a nasty letter, or some combination of the above.
But, occasionally, we get threats. They’re rare in an office practice, though I suspect surprisingly common in emergency department work. Most are empty threats to sue, but occasionally my staff and I get threatened with physical harm. While most are simply words, there’s really no easy way of knowing who will or won’t actually snap and carry them out.
We live in a society where guns are common, easily obtained, and affordable. So anyone might have one. Unless your office has a metal detector or does pat downs, you’re at risk (at least hypothetically). Putting up a sign that says “no guns allowed” isn’t going to stop anyone. Neither do laws to protect health professionals. Those who have decided to harm others don’t worry about such things.
For that matter, I have several patients who usually have a gun on them. Sometimes concealed, sometimes obvious. Does it bother me? Not at all. They’re all polite and pleasant, and I understand their reason for keeping one on hand.
But doctors, unfortunately, are easy targets for the irrational and armed. The shooting in El Paso occurred in a government hospital with armed security, and that certainly didn’t make a difference. We generally keep predictable hours, park in the same spaces, and our offices aren’t locked up. We do a job where trust is assumed, because people are coming to us for help and we’re here for their benefit.
Is there an answer? I know doctors who keep a handgun under their coats, or in their desks. In a perfect world, they wouldn’t need it, but our world is far from it. Being a doctor, whether you’re on the front line in the emergency department or hidden in a nameless medical plaza, can still be a dangerous business.
Medicine is a surprising field to think of as a hazardous one, but these days, sadly, it is.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
Buried under news of the terrible Charlie Hebdo terrorism murders was another serious attack. A doctor was shot and killed by an angry patient at a Texas VA hospital, who then took his own life.
I’m not trying to belittle the tragedy in Paris, but instead point out that medicine can be more hazardous than many realize.
We don’t intentionally try to offend, but in a field like this, it’s impossible to please everyone. People get upset that I can’t cure them or find a cause for their (medically unexplainable) symptoms, or won’t give them as many narcotics as they want. The unhappy ones never come back, or post an angry review on Yelp, or send a nasty letter, or some combination of the above.
But, occasionally, we get threats. They’re rare in an office practice, though I suspect surprisingly common in emergency department work. Most are empty threats to sue, but occasionally my staff and I get threatened with physical harm. While most are simply words, there’s really no easy way of knowing who will or won’t actually snap and carry them out.
We live in a society where guns are common, easily obtained, and affordable. So anyone might have one. Unless your office has a metal detector or does pat downs, you’re at risk (at least hypothetically). Putting up a sign that says “no guns allowed” isn’t going to stop anyone. Neither do laws to protect health professionals. Those who have decided to harm others don’t worry about such things.
For that matter, I have several patients who usually have a gun on them. Sometimes concealed, sometimes obvious. Does it bother me? Not at all. They’re all polite and pleasant, and I understand their reason for keeping one on hand.
But doctors, unfortunately, are easy targets for the irrational and armed. The shooting in El Paso occurred in a government hospital with armed security, and that certainly didn’t make a difference. We generally keep predictable hours, park in the same spaces, and our offices aren’t locked up. We do a job where trust is assumed, because people are coming to us for help and we’re here for their benefit.
Is there an answer? I know doctors who keep a handgun under their coats, or in their desks. In a perfect world, they wouldn’t need it, but our world is far from it. Being a doctor, whether you’re on the front line in the emergency department or hidden in a nameless medical plaza, can still be a dangerous business.
Medicine is a surprising field to think of as a hazardous one, but these days, sadly, it is.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
Taking a look at neurologist burnout
There’s a lot in the news these days about doctor burnout. More specifically, neurologist burnout.
In a 2012 survey study, about 53% of neurologists reported burnout, which was third among all specialties surveyed, behind emergency medicine physicians and general internists. Neurologists also reported the fourth lowest job satisfaction with work-life balance, with about 41% satisfied that work leaves enough time for personal or family life. Neurology was the only one out of five specialties with the highest rates of burnout that was also among the five specialties with the lowest work-life balance.
Granted, the term “burnout” can mean a lot, but these days seems to refer to the fall of the American physician: Overworked, with rising costs, and falling reimbursements, sandwiched between patients who want to be cured immediately and those who want to sue us, and even on a good day facing a litany of terrible diseases.
Heck, I’d be burned out, too. Maybe I am.
Some say this is from the worries of solo practice, since we’re usually more pressed for time and money. I disagree, as I’ve seen it on both sides.
Recently, I saw my own internist. Six months ago she closed her own solo practice to join a large, hospital-owned group. She looked exhausted, worse than I’d ever seen her. She told me that she now gets a secure paycheck, but her stress level is worse. The hospital sets her schedule, tells her how much time she can spend with each patient, gives her quotas she has to meet, and has supplied an electronic health record (EHR) system that’s less than user friendly. (Personally, all of the ones I’ve tried are terrible.) When she goes home, she told me that now after dinner she still has to log on and do 2-3 more hours of charting just to catch up.
The grass is always greener. In her, I see a doctor who doesn’t have to watch each penny and worry about whether she’ll get a paycheck next week. In me, she looks at someone who’s free to pick their vacation days and isn’t chained to a quota system and a burdensome EHR.
Who’s right? I suppose it depends on what your life preferences are. Are we both burned out? We probably are, but in different ways.
But why the high rate of burnout for neurologists? Likely because of the issues I mentioned above. For myself, I’ve seen my salary drop 50% since its highest point in 2005. We’re faced with rising costs (like many other businesses). Unlike other professions, however, we don’t have much control over our reimbursement. Peculiar to medicine is the simple fact that what we charge has no bearing on what we get paid. Those rates are set by factors over which we have no control. Worse, they’re often set by politicians and insurance executives, who see us as the enemy.
There’s also the way reimbursements are set-up: they still favor docs who do a lot of procedures. While neurologists have a few, most of our job is thinking. And that’s not compensated nearly as well as jabbing needles and scalpels in people.
Then you get beyond financial issues. Many of us go through the day feeling like we have a target on our backs, in fear of patients becoming plaintiffs. What else? The nature of our field is such that we deal with diseases that are often challenging to diagnose and sometimes difficult, if not impossible, to treat. Yet, we still have to put on our best show and attitude for those afflicted. Part of why they come to us is to have questions answered and be given any glimmer of hope we can find.
In spite of this, the majority of us go on. Even burned out, we came here to help others. It’s part of what makes us tick and drives us to look in the mirror and head to the office. I wouldn’t trade what I do for anything. But I wish I could do it in a less adversarial world where I’m forced to choose between freedom and a (even temporary) sense of security.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
There’s a lot in the news these days about doctor burnout. More specifically, neurologist burnout.
In a 2012 survey study, about 53% of neurologists reported burnout, which was third among all specialties surveyed, behind emergency medicine physicians and general internists. Neurologists also reported the fourth lowest job satisfaction with work-life balance, with about 41% satisfied that work leaves enough time for personal or family life. Neurology was the only one out of five specialties with the highest rates of burnout that was also among the five specialties with the lowest work-life balance.
Granted, the term “burnout” can mean a lot, but these days seems to refer to the fall of the American physician: Overworked, with rising costs, and falling reimbursements, sandwiched between patients who want to be cured immediately and those who want to sue us, and even on a good day facing a litany of terrible diseases.
Heck, I’d be burned out, too. Maybe I am.
Some say this is from the worries of solo practice, since we’re usually more pressed for time and money. I disagree, as I’ve seen it on both sides.
Recently, I saw my own internist. Six months ago she closed her own solo practice to join a large, hospital-owned group. She looked exhausted, worse than I’d ever seen her. She told me that she now gets a secure paycheck, but her stress level is worse. The hospital sets her schedule, tells her how much time she can spend with each patient, gives her quotas she has to meet, and has supplied an electronic health record (EHR) system that’s less than user friendly. (Personally, all of the ones I’ve tried are terrible.) When she goes home, she told me that now after dinner she still has to log on and do 2-3 more hours of charting just to catch up.
The grass is always greener. In her, I see a doctor who doesn’t have to watch each penny and worry about whether she’ll get a paycheck next week. In me, she looks at someone who’s free to pick their vacation days and isn’t chained to a quota system and a burdensome EHR.
Who’s right? I suppose it depends on what your life preferences are. Are we both burned out? We probably are, but in different ways.
But why the high rate of burnout for neurologists? Likely because of the issues I mentioned above. For myself, I’ve seen my salary drop 50% since its highest point in 2005. We’re faced with rising costs (like many other businesses). Unlike other professions, however, we don’t have much control over our reimbursement. Peculiar to medicine is the simple fact that what we charge has no bearing on what we get paid. Those rates are set by factors over which we have no control. Worse, they’re often set by politicians and insurance executives, who see us as the enemy.
There’s also the way reimbursements are set-up: they still favor docs who do a lot of procedures. While neurologists have a few, most of our job is thinking. And that’s not compensated nearly as well as jabbing needles and scalpels in people.
Then you get beyond financial issues. Many of us go through the day feeling like we have a target on our backs, in fear of patients becoming plaintiffs. What else? The nature of our field is such that we deal with diseases that are often challenging to diagnose and sometimes difficult, if not impossible, to treat. Yet, we still have to put on our best show and attitude for those afflicted. Part of why they come to us is to have questions answered and be given any glimmer of hope we can find.
In spite of this, the majority of us go on. Even burned out, we came here to help others. It’s part of what makes us tick and drives us to look in the mirror and head to the office. I wouldn’t trade what I do for anything. But I wish I could do it in a less adversarial world where I’m forced to choose between freedom and a (even temporary) sense of security.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
There’s a lot in the news these days about doctor burnout. More specifically, neurologist burnout.
In a 2012 survey study, about 53% of neurologists reported burnout, which was third among all specialties surveyed, behind emergency medicine physicians and general internists. Neurologists also reported the fourth lowest job satisfaction with work-life balance, with about 41% satisfied that work leaves enough time for personal or family life. Neurology was the only one out of five specialties with the highest rates of burnout that was also among the five specialties with the lowest work-life balance.
Granted, the term “burnout” can mean a lot, but these days seems to refer to the fall of the American physician: Overworked, with rising costs, and falling reimbursements, sandwiched between patients who want to be cured immediately and those who want to sue us, and even on a good day facing a litany of terrible diseases.
Heck, I’d be burned out, too. Maybe I am.
Some say this is from the worries of solo practice, since we’re usually more pressed for time and money. I disagree, as I’ve seen it on both sides.
Recently, I saw my own internist. Six months ago she closed her own solo practice to join a large, hospital-owned group. She looked exhausted, worse than I’d ever seen her. She told me that she now gets a secure paycheck, but her stress level is worse. The hospital sets her schedule, tells her how much time she can spend with each patient, gives her quotas she has to meet, and has supplied an electronic health record (EHR) system that’s less than user friendly. (Personally, all of the ones I’ve tried are terrible.) When she goes home, she told me that now after dinner she still has to log on and do 2-3 more hours of charting just to catch up.
The grass is always greener. In her, I see a doctor who doesn’t have to watch each penny and worry about whether she’ll get a paycheck next week. In me, she looks at someone who’s free to pick their vacation days and isn’t chained to a quota system and a burdensome EHR.
Who’s right? I suppose it depends on what your life preferences are. Are we both burned out? We probably are, but in different ways.
But why the high rate of burnout for neurologists? Likely because of the issues I mentioned above. For myself, I’ve seen my salary drop 50% since its highest point in 2005. We’re faced with rising costs (like many other businesses). Unlike other professions, however, we don’t have much control over our reimbursement. Peculiar to medicine is the simple fact that what we charge has no bearing on what we get paid. Those rates are set by factors over which we have no control. Worse, they’re often set by politicians and insurance executives, who see us as the enemy.
There’s also the way reimbursements are set-up: they still favor docs who do a lot of procedures. While neurologists have a few, most of our job is thinking. And that’s not compensated nearly as well as jabbing needles and scalpels in people.
Then you get beyond financial issues. Many of us go through the day feeling like we have a target on our backs, in fear of patients becoming plaintiffs. What else? The nature of our field is such that we deal with diseases that are often challenging to diagnose and sometimes difficult, if not impossible, to treat. Yet, we still have to put on our best show and attitude for those afflicted. Part of why they come to us is to have questions answered and be given any glimmer of hope we can find.
In spite of this, the majority of us go on. Even burned out, we came here to help others. It’s part of what makes us tick and drives us to look in the mirror and head to the office. I wouldn’t trade what I do for anything. But I wish I could do it in a less adversarial world where I’m forced to choose between freedom and a (even temporary) sense of security.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
Doctors and patients are ping-pong balls to those in power
It’s 2015. Where am I? I have no idea anymore. The state of American medicine is less predictable and arguably more adversarial than ever before.
Quality of care and (when possible) good outcomes aren’t the benchmarks they used to be. In the modern era of pay for performance, we’re graded on things such as reducing stroke risk, blood sugar control, whether we use a meaningless computer system instead of one that works, and how many patients we can cram into a fixed time frame. Things that we can’t control, such as patients continuing to smoke or flat-out refusing to take their medications, are often considered to be our fault, even though we’ve clearly emphasized the importance of our advice.
Rate-a-doc” sites continue to proliferate. Any of us can be given a terrible review by a patient who is upset that we didn’t give them enough Percocet, didn’t like our office building, or never even met us and is upset that our kid made honor band and theirs didn’t. And we’re powerless to respond with the truth. Yet, a frightening number of people trying to choose a physician will base their decisions on such sites.
Most of us are going to get penalized by our government (you know, the one we support with our taxes) because we can’t afford to upgrade to an electronic health record program that does nothing to improve quality of care. Based on my experience with them, I’d have to say they make things worse. Instead of telling what’s going on with the patient and showing the physician’s reasoning in the case, they give you a list of check boxes for negatives and positives, and an unhelpful string of ICD codes. In my opinion, it simply continues the degradation of a patient from a person to a number.
My salary has gone down every year since 2007. My staff hasn’t had a raise in that time, either, and I’m grateful they’re still with me. All my other expenses have gone up. Besides the above-mentioned penalty, the year starts (as all do) with threatened large-scale cuts in Medicare (and, by extension, all insurance payments). Hopefully, they’ll get canceled quickly as they are every year, but you never know. It’s been easier for the last 15 years or so for the government to simply slap on an expensive bandage than to actually fix the problem, and so the overall cost of a real repair keeps going up. The shift in Congress this year likely won’t change anything as our patients, careers, and livelihoods are simply ping-pong balls to those in power, bounced back and forth to score political points against each other.
A year ago, I didn’t know I’d still be here when 2014 ended, but, battered, I am. Like other doctors, I’m trying to see more patients and find other ways of supporting my practice and family, but no one is increasing reimbursements to keep up with inflation or adding more hours to the day. I can’t predict how 2015 will play out any more than you can. But I hope it will be better. My wonderful staff deserves a raise, and my family needs me more than my office does.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
It’s 2015. Where am I? I have no idea anymore. The state of American medicine is less predictable and arguably more adversarial than ever before.
Quality of care and (when possible) good outcomes aren’t the benchmarks they used to be. In the modern era of pay for performance, we’re graded on things such as reducing stroke risk, blood sugar control, whether we use a meaningless computer system instead of one that works, and how many patients we can cram into a fixed time frame. Things that we can’t control, such as patients continuing to smoke or flat-out refusing to take their medications, are often considered to be our fault, even though we’ve clearly emphasized the importance of our advice.
Rate-a-doc” sites continue to proliferate. Any of us can be given a terrible review by a patient who is upset that we didn’t give them enough Percocet, didn’t like our office building, or never even met us and is upset that our kid made honor band and theirs didn’t. And we’re powerless to respond with the truth. Yet, a frightening number of people trying to choose a physician will base their decisions on such sites.
Most of us are going to get penalized by our government (you know, the one we support with our taxes) because we can’t afford to upgrade to an electronic health record program that does nothing to improve quality of care. Based on my experience with them, I’d have to say they make things worse. Instead of telling what’s going on with the patient and showing the physician’s reasoning in the case, they give you a list of check boxes for negatives and positives, and an unhelpful string of ICD codes. In my opinion, it simply continues the degradation of a patient from a person to a number.
My salary has gone down every year since 2007. My staff hasn’t had a raise in that time, either, and I’m grateful they’re still with me. All my other expenses have gone up. Besides the above-mentioned penalty, the year starts (as all do) with threatened large-scale cuts in Medicare (and, by extension, all insurance payments). Hopefully, they’ll get canceled quickly as they are every year, but you never know. It’s been easier for the last 15 years or so for the government to simply slap on an expensive bandage than to actually fix the problem, and so the overall cost of a real repair keeps going up. The shift in Congress this year likely won’t change anything as our patients, careers, and livelihoods are simply ping-pong balls to those in power, bounced back and forth to score political points against each other.
A year ago, I didn’t know I’d still be here when 2014 ended, but, battered, I am. Like other doctors, I’m trying to see more patients and find other ways of supporting my practice and family, but no one is increasing reimbursements to keep up with inflation or adding more hours to the day. I can’t predict how 2015 will play out any more than you can. But I hope it will be better. My wonderful staff deserves a raise, and my family needs me more than my office does.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
It’s 2015. Where am I? I have no idea anymore. The state of American medicine is less predictable and arguably more adversarial than ever before.
Quality of care and (when possible) good outcomes aren’t the benchmarks they used to be. In the modern era of pay for performance, we’re graded on things such as reducing stroke risk, blood sugar control, whether we use a meaningless computer system instead of one that works, and how many patients we can cram into a fixed time frame. Things that we can’t control, such as patients continuing to smoke or flat-out refusing to take their medications, are often considered to be our fault, even though we’ve clearly emphasized the importance of our advice.
Rate-a-doc” sites continue to proliferate. Any of us can be given a terrible review by a patient who is upset that we didn’t give them enough Percocet, didn’t like our office building, or never even met us and is upset that our kid made honor band and theirs didn’t. And we’re powerless to respond with the truth. Yet, a frightening number of people trying to choose a physician will base their decisions on such sites.
Most of us are going to get penalized by our government (you know, the one we support with our taxes) because we can’t afford to upgrade to an electronic health record program that does nothing to improve quality of care. Based on my experience with them, I’d have to say they make things worse. Instead of telling what’s going on with the patient and showing the physician’s reasoning in the case, they give you a list of check boxes for negatives and positives, and an unhelpful string of ICD codes. In my opinion, it simply continues the degradation of a patient from a person to a number.
My salary has gone down every year since 2007. My staff hasn’t had a raise in that time, either, and I’m grateful they’re still with me. All my other expenses have gone up. Besides the above-mentioned penalty, the year starts (as all do) with threatened large-scale cuts in Medicare (and, by extension, all insurance payments). Hopefully, they’ll get canceled quickly as they are every year, but you never know. It’s been easier for the last 15 years or so for the government to simply slap on an expensive bandage than to actually fix the problem, and so the overall cost of a real repair keeps going up. The shift in Congress this year likely won’t change anything as our patients, careers, and livelihoods are simply ping-pong balls to those in power, bounced back and forth to score political points against each other.
A year ago, I didn’t know I’d still be here when 2014 ended, but, battered, I am. Like other doctors, I’m trying to see more patients and find other ways of supporting my practice and family, but no one is increasing reimbursements to keep up with inflation or adding more hours to the day. I can’t predict how 2015 will play out any more than you can. But I hope it will be better. My wonderful staff deserves a raise, and my family needs me more than my office does.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
Where’s the line on refusing to treat smokers?
We all dismiss patients who are noncompliant with treatment. The threshold varies between us, but all of us have fired (for example) an epilepsy patient who won’t take the meds and is in and out of the emergency department.
What about smokers? Do they count?
A recent article in Anesthesiology News (2014 September) featured a surgical group that won’t do elective hernia repairs on patients who don’t quit smoking. I can see their point. Smoking increases the risk of complications, which hurt the patient. So, having a good patient outcome depends on their condition, too. And, honestly, I don’t blame the surgeons for refusing to do nonurgent cases under these circumstances.
What about neurologists, though?
Smoking is a big one. The literature has no shortage of data on it worsening migraines and multiple sclerosis, increasing the risk of stroke and peripheral vascular disease, contributing to vascular dementia ... and many other things.
I always tell smokers that they should quit, but should I be going beyond that? Refuse to treat migraines until someone quits smoking? The other conditions I mentioned have enough serious health risks that I don’t think it’s ethical to withhold care over smoking.
At my first job, I had a partner who took this approach. She routinely told migraineurs who smoked that they couldn’t return to her until they’d quit. Her view was that then she could treat them to her best ability without tobacco as a confounding factor, or they’d simply not come back.
I can understand this approach, and, in a perfect world, would do it myself. I certainly don’t support tobacco use and wish I had a magic bullet to help them quit. But I don’t. I can preach it, explain why they should quit, review the risks, send them to their internist for cessation ... but I’m still not sure I’d flat out turn them away.
I’m trying to help them. Refusing to provide care, even in the name of quitting smoking, is only going to alienate them. They may get turned off to seeing doctors altogether and consequently develop other issues. I don’t want them to smoke, but none of us is without our vices, either.
I’m also not them, and don’t know what’s going on in their lives. Maybe they are taking care of a parent with a terminal condition, going through a divorce, have a terrible job, or a million other stressors and just don’t have the will right now to quit tobacco.
Migraines, in the grand scheme of medicine, are certainly a lower-risk issue than surgical complications. So, while I disapprove of tobacco and encourage smokers to stop, my door remains open to them. Part of caring for my patients is accepting them as they are and trying to work with them inside that framework.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
We all dismiss patients who are noncompliant with treatment. The threshold varies between us, but all of us have fired (for example) an epilepsy patient who won’t take the meds and is in and out of the emergency department.
What about smokers? Do they count?
A recent article in Anesthesiology News (2014 September) featured a surgical group that won’t do elective hernia repairs on patients who don’t quit smoking. I can see their point. Smoking increases the risk of complications, which hurt the patient. So, having a good patient outcome depends on their condition, too. And, honestly, I don’t blame the surgeons for refusing to do nonurgent cases under these circumstances.
What about neurologists, though?
Smoking is a big one. The literature has no shortage of data on it worsening migraines and multiple sclerosis, increasing the risk of stroke and peripheral vascular disease, contributing to vascular dementia ... and many other things.
I always tell smokers that they should quit, but should I be going beyond that? Refuse to treat migraines until someone quits smoking? The other conditions I mentioned have enough serious health risks that I don’t think it’s ethical to withhold care over smoking.
At my first job, I had a partner who took this approach. She routinely told migraineurs who smoked that they couldn’t return to her until they’d quit. Her view was that then she could treat them to her best ability without tobacco as a confounding factor, or they’d simply not come back.
I can understand this approach, and, in a perfect world, would do it myself. I certainly don’t support tobacco use and wish I had a magic bullet to help them quit. But I don’t. I can preach it, explain why they should quit, review the risks, send them to their internist for cessation ... but I’m still not sure I’d flat out turn them away.
I’m trying to help them. Refusing to provide care, even in the name of quitting smoking, is only going to alienate them. They may get turned off to seeing doctors altogether and consequently develop other issues. I don’t want them to smoke, but none of us is without our vices, either.
I’m also not them, and don’t know what’s going on in their lives. Maybe they are taking care of a parent with a terminal condition, going through a divorce, have a terrible job, or a million other stressors and just don’t have the will right now to quit tobacco.
Migraines, in the grand scheme of medicine, are certainly a lower-risk issue than surgical complications. So, while I disapprove of tobacco and encourage smokers to stop, my door remains open to them. Part of caring for my patients is accepting them as they are and trying to work with them inside that framework.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
We all dismiss patients who are noncompliant with treatment. The threshold varies between us, but all of us have fired (for example) an epilepsy patient who won’t take the meds and is in and out of the emergency department.
What about smokers? Do they count?
A recent article in Anesthesiology News (2014 September) featured a surgical group that won’t do elective hernia repairs on patients who don’t quit smoking. I can see their point. Smoking increases the risk of complications, which hurt the patient. So, having a good patient outcome depends on their condition, too. And, honestly, I don’t blame the surgeons for refusing to do nonurgent cases under these circumstances.
What about neurologists, though?
Smoking is a big one. The literature has no shortage of data on it worsening migraines and multiple sclerosis, increasing the risk of stroke and peripheral vascular disease, contributing to vascular dementia ... and many other things.
I always tell smokers that they should quit, but should I be going beyond that? Refuse to treat migraines until someone quits smoking? The other conditions I mentioned have enough serious health risks that I don’t think it’s ethical to withhold care over smoking.
At my first job, I had a partner who took this approach. She routinely told migraineurs who smoked that they couldn’t return to her until they’d quit. Her view was that then she could treat them to her best ability without tobacco as a confounding factor, or they’d simply not come back.
I can understand this approach, and, in a perfect world, would do it myself. I certainly don’t support tobacco use and wish I had a magic bullet to help them quit. But I don’t. I can preach it, explain why they should quit, review the risks, send them to their internist for cessation ... but I’m still not sure I’d flat out turn them away.
I’m trying to help them. Refusing to provide care, even in the name of quitting smoking, is only going to alienate them. They may get turned off to seeing doctors altogether and consequently develop other issues. I don’t want them to smoke, but none of us is without our vices, either.
I’m also not them, and don’t know what’s going on in their lives. Maybe they are taking care of a parent with a terminal condition, going through a divorce, have a terrible job, or a million other stressors and just don’t have the will right now to quit tobacco.
Migraines, in the grand scheme of medicine, are certainly a lower-risk issue than surgical complications. So, while I disapprove of tobacco and encourage smokers to stop, my door remains open to them. Part of caring for my patients is accepting them as they are and trying to work with them inside that framework.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
Why you’ll find no TV in my waiting room
I don’t want a TV in my waiting room. Absolutely, positively, not.
I get plenty of letters, calls, and faxes offering me a “free” one. Recently, it’s even expanded to include tablets connected to the programming, so patients can continue watching the same stuff after being taken back.
Still, I’m not interested.
Why? Maybe other doctors would jump at the opportunity, but not me. Visits to the doctor can be very stressful for some people, and I try to keep things as tranquil as possible. Silence, the sound of my secretary on the phone muted by the glass window, the quiet hum of the air conditioner ... I think that’s enough.
I see migraine patients, and the last thing they want during a headache is extraneous noise. Likewise, I see a lot of the older crowd with hearing problems. Trying to keep sound down, so they can understand my secretary, helps a lot.
I try hard to run on time, so the wait usually isn’t more than a few minutes. It’s easy to fill that with one of the literary offerings I keep around, and many people bring their own books and iPads anyway these days. I don’t see a need to provide video entertainment.
The choice of programming also concerns me. While they tell me it’s customizable, that still doesn’t mean I’ll agree with everything they show. And since I’m not about to watch it all myself to check, I don’t even want to start.
I worry about the “free” part. It isn’t free. Nothing is. The TV, and tablets, and their programming, are all paid for by advertising. This is primarily from drug companies. While many of them have useful products, those decisions are between me and my patients, not them and a commercial that ends with “ask your doctor.” They’re here for my advice, not to be told what brand-name medications they should be on (which often aren’t covered by their insurance) when a generic I might suggest is better. Advertising often portrays products in an unrealistic light, with the TV leaving me the dirty job of putting a damper on expectations.
And the last thing I want is them seeing a charlatan selling snake oil, using their MD title to give it legitimacy (but I’m not going to name names).
The world is full of medical information sources, and my patients can find them easily without me forcing one upon them. My lobby may be their only quiet moment in a tumultuous day, and I’ll try to preserve that. It’s the least I can do.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
I don’t want a TV in my waiting room. Absolutely, positively, not.
I get plenty of letters, calls, and faxes offering me a “free” one. Recently, it’s even expanded to include tablets connected to the programming, so patients can continue watching the same stuff after being taken back.
Still, I’m not interested.
Why? Maybe other doctors would jump at the opportunity, but not me. Visits to the doctor can be very stressful for some people, and I try to keep things as tranquil as possible. Silence, the sound of my secretary on the phone muted by the glass window, the quiet hum of the air conditioner ... I think that’s enough.
I see migraine patients, and the last thing they want during a headache is extraneous noise. Likewise, I see a lot of the older crowd with hearing problems. Trying to keep sound down, so they can understand my secretary, helps a lot.
I try hard to run on time, so the wait usually isn’t more than a few minutes. It’s easy to fill that with one of the literary offerings I keep around, and many people bring their own books and iPads anyway these days. I don’t see a need to provide video entertainment.
The choice of programming also concerns me. While they tell me it’s customizable, that still doesn’t mean I’ll agree with everything they show. And since I’m not about to watch it all myself to check, I don’t even want to start.
I worry about the “free” part. It isn’t free. Nothing is. The TV, and tablets, and their programming, are all paid for by advertising. This is primarily from drug companies. While many of them have useful products, those decisions are between me and my patients, not them and a commercial that ends with “ask your doctor.” They’re here for my advice, not to be told what brand-name medications they should be on (which often aren’t covered by their insurance) when a generic I might suggest is better. Advertising often portrays products in an unrealistic light, with the TV leaving me the dirty job of putting a damper on expectations.
And the last thing I want is them seeing a charlatan selling snake oil, using their MD title to give it legitimacy (but I’m not going to name names).
The world is full of medical information sources, and my patients can find them easily without me forcing one upon them. My lobby may be their only quiet moment in a tumultuous day, and I’ll try to preserve that. It’s the least I can do.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
I don’t want a TV in my waiting room. Absolutely, positively, not.
I get plenty of letters, calls, and faxes offering me a “free” one. Recently, it’s even expanded to include tablets connected to the programming, so patients can continue watching the same stuff after being taken back.
Still, I’m not interested.
Why? Maybe other doctors would jump at the opportunity, but not me. Visits to the doctor can be very stressful for some people, and I try to keep things as tranquil as possible. Silence, the sound of my secretary on the phone muted by the glass window, the quiet hum of the air conditioner ... I think that’s enough.
I see migraine patients, and the last thing they want during a headache is extraneous noise. Likewise, I see a lot of the older crowd with hearing problems. Trying to keep sound down, so they can understand my secretary, helps a lot.
I try hard to run on time, so the wait usually isn’t more than a few minutes. It’s easy to fill that with one of the literary offerings I keep around, and many people bring their own books and iPads anyway these days. I don’t see a need to provide video entertainment.
The choice of programming also concerns me. While they tell me it’s customizable, that still doesn’t mean I’ll agree with everything they show. And since I’m not about to watch it all myself to check, I don’t even want to start.
I worry about the “free” part. It isn’t free. Nothing is. The TV, and tablets, and their programming, are all paid for by advertising. This is primarily from drug companies. While many of them have useful products, those decisions are between me and my patients, not them and a commercial that ends with “ask your doctor.” They’re here for my advice, not to be told what brand-name medications they should be on (which often aren’t covered by their insurance) when a generic I might suggest is better. Advertising often portrays products in an unrealistic light, with the TV leaving me the dirty job of putting a damper on expectations.
And the last thing I want is them seeing a charlatan selling snake oil, using their MD title to give it legitimacy (but I’m not going to name names).
The world is full of medical information sources, and my patients can find them easily without me forcing one upon them. My lobby may be their only quiet moment in a tumultuous day, and I’ll try to preserve that. It’s the least I can do.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
Incidentalomas: You can hate them but can’t ignore them
We order a lot of MRIs. Patients, in general, want a lot of MRIs (as long as insurance covers them). We have all this cool technology, so why not use it?
For the most part we’re doing them to rule-out bad things such as gliomas and ginormous aneurysms so we can say: “It looks fine, so I think you’re just having headaches/migraines/anxiety attacks, whatever.”
Unfortunately, as technology improves, we end up with a whole new issue that previous generations of neurologists didn’t have to deal with: the hated incidentaloma. And, often, this can be insanely frustrating. Just because an abnormality isn’t related to the symptoms doesn’t mean you can forget about it, either.
It’s amazing how many scans come back with small meningiomas, aneurysms, microadenomas, etc. Once you find them, you (and the patient) are stuck with it.
I usually try to downplay these findings, as they’re typically irrelevant. But, even then, you’re now obligated to repeat the scans every 1-5 years (depending on what you found) to make sure the thingamajig is stable. Which only drives up costs for the patient and their insurance.
Then there’s the aspect of how the patient sees this. Most are perfectly fine when you explain it to them, but you get some who are panicked (“OMG! I have a brain tumor!”) and require quite a bit of time to calm down.
There are others who latch onto it, and insist, against all rational evidence, that it’s the sole cause of their symptoms. They will often call at 2:00 a.m. for the slightest change in their symptoms or just go straight to an emergency department “because I have an aneurysm.” Trying to get them to accept that the finding is incidental is often a challenge, with them often seeking multiple other opinions.
In the best case, though, the finding is a nuisance to all involved. I have to enter that patient in my scheduled reminders to order a follow-up study. If they don’t respond to a phone call, or regular letter, I have to send them a certified letter. From their view they have to work another MRI into what’s probably a busy schedule. Depending on their deductible, they may have to pay a decent amount of money for it. And then it may add paperwork next time they apply for life insurance.
What’s to be done for it? Nothing that I can think of. If we don’t pursue the testing, we become legally liable if the lesion grows. The patient could decline it, but most don’t. And, as scans improve, the number of incidentalomas will increase.
The revolution that MRI has brought to neurology can’t be understated. But, at the same time, it has its drawbacks. For both patients and neurologists, dealing with the incidentals and their consequences is one of them.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
We order a lot of MRIs. Patients, in general, want a lot of MRIs (as long as insurance covers them). We have all this cool technology, so why not use it?
For the most part we’re doing them to rule-out bad things such as gliomas and ginormous aneurysms so we can say: “It looks fine, so I think you’re just having headaches/migraines/anxiety attacks, whatever.”
Unfortunately, as technology improves, we end up with a whole new issue that previous generations of neurologists didn’t have to deal with: the hated incidentaloma. And, often, this can be insanely frustrating. Just because an abnormality isn’t related to the symptoms doesn’t mean you can forget about it, either.
It’s amazing how many scans come back with small meningiomas, aneurysms, microadenomas, etc. Once you find them, you (and the patient) are stuck with it.
I usually try to downplay these findings, as they’re typically irrelevant. But, even then, you’re now obligated to repeat the scans every 1-5 years (depending on what you found) to make sure the thingamajig is stable. Which only drives up costs for the patient and their insurance.
Then there’s the aspect of how the patient sees this. Most are perfectly fine when you explain it to them, but you get some who are panicked (“OMG! I have a brain tumor!”) and require quite a bit of time to calm down.
There are others who latch onto it, and insist, against all rational evidence, that it’s the sole cause of their symptoms. They will often call at 2:00 a.m. for the slightest change in their symptoms or just go straight to an emergency department “because I have an aneurysm.” Trying to get them to accept that the finding is incidental is often a challenge, with them often seeking multiple other opinions.
In the best case, though, the finding is a nuisance to all involved. I have to enter that patient in my scheduled reminders to order a follow-up study. If they don’t respond to a phone call, or regular letter, I have to send them a certified letter. From their view they have to work another MRI into what’s probably a busy schedule. Depending on their deductible, they may have to pay a decent amount of money for it. And then it may add paperwork next time they apply for life insurance.
What’s to be done for it? Nothing that I can think of. If we don’t pursue the testing, we become legally liable if the lesion grows. The patient could decline it, but most don’t. And, as scans improve, the number of incidentalomas will increase.
The revolution that MRI has brought to neurology can’t be understated. But, at the same time, it has its drawbacks. For both patients and neurologists, dealing with the incidentals and their consequences is one of them.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
We order a lot of MRIs. Patients, in general, want a lot of MRIs (as long as insurance covers them). We have all this cool technology, so why not use it?
For the most part we’re doing them to rule-out bad things such as gliomas and ginormous aneurysms so we can say: “It looks fine, so I think you’re just having headaches/migraines/anxiety attacks, whatever.”
Unfortunately, as technology improves, we end up with a whole new issue that previous generations of neurologists didn’t have to deal with: the hated incidentaloma. And, often, this can be insanely frustrating. Just because an abnormality isn’t related to the symptoms doesn’t mean you can forget about it, either.
It’s amazing how many scans come back with small meningiomas, aneurysms, microadenomas, etc. Once you find them, you (and the patient) are stuck with it.
I usually try to downplay these findings, as they’re typically irrelevant. But, even then, you’re now obligated to repeat the scans every 1-5 years (depending on what you found) to make sure the thingamajig is stable. Which only drives up costs for the patient and their insurance.
Then there’s the aspect of how the patient sees this. Most are perfectly fine when you explain it to them, but you get some who are panicked (“OMG! I have a brain tumor!”) and require quite a bit of time to calm down.
There are others who latch onto it, and insist, against all rational evidence, that it’s the sole cause of their symptoms. They will often call at 2:00 a.m. for the slightest change in their symptoms or just go straight to an emergency department “because I have an aneurysm.” Trying to get them to accept that the finding is incidental is often a challenge, with them often seeking multiple other opinions.
In the best case, though, the finding is a nuisance to all involved. I have to enter that patient in my scheduled reminders to order a follow-up study. If they don’t respond to a phone call, or regular letter, I have to send them a certified letter. From their view they have to work another MRI into what’s probably a busy schedule. Depending on their deductible, they may have to pay a decent amount of money for it. And then it may add paperwork next time they apply for life insurance.
What’s to be done for it? Nothing that I can think of. If we don’t pursue the testing, we become legally liable if the lesion grows. The patient could decline it, but most don’t. And, as scans improve, the number of incidentalomas will increase.
The revolution that MRI has brought to neurology can’t be understated. But, at the same time, it has its drawbacks. For both patients and neurologists, dealing with the incidentals and their consequences is one of them.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
'Tis the season for busy practices
The season’s upon us …
The holidays always seem to be a battle of extremes in my practice. A time of year when people are supposed to relax instead becomes a time of insane stressors for many. And those of us in the medical profession get stuck picking up the pieces.
People either want to put things off until the new year or need them addressed urgently. Migraine phone calls go up. Seizure medications are forgotten. Tempers flare (try getting a parking space at Costco if you don’t believe me).
College students come home and want to be worked in during their break. Patients with physical limitations who are traveling need notes written to assist them. People with migraines want them controlled so they don’t ruin their holidays. Those with Parkinson’s disease (and other movement disorders) often want to get “tuned-up” for family gatherings. People visiting relatives leave their medications behind and request replacements called to pharmacies far, far away (often at 2:00 a.m.).
It’s a season for injuries. Back pain from lifting and carrying trees, boxes, and decorations. Concussions from standing up in a low attic. Carpal tunnel syndrome from writing and mailing lots of cards.
The end of the year also brings deductibles into play. People suddenly find they’ve met theirs and call in wanting MRI scans done and medications refilled before the ball drops, usually giving my staff little time to negotiate through the authorization process.
Although everyone else wants time off for the holidays, many are angry when we do, too. The Friday after Thanksgiving traditionally gets a few angry messages from people unhappy that we’re closed.
Of course, human illness never takes time off, so those of us who cover hospitals still see our share of strokes, encephalopathies, and other acute neurologic disorders. Helping others, regardless of when they need us, is part of what we signed up for.
Somewhere in the controlled insanity of a medical practice, it’s often easy to lose sight of our own families and priorities. So try to focus on yours. It’s good to remember who you’re really working for.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
The season’s upon us …
The holidays always seem to be a battle of extremes in my practice. A time of year when people are supposed to relax instead becomes a time of insane stressors for many. And those of us in the medical profession get stuck picking up the pieces.
People either want to put things off until the new year or need them addressed urgently. Migraine phone calls go up. Seizure medications are forgotten. Tempers flare (try getting a parking space at Costco if you don’t believe me).
College students come home and want to be worked in during their break. Patients with physical limitations who are traveling need notes written to assist them. People with migraines want them controlled so they don’t ruin their holidays. Those with Parkinson’s disease (and other movement disorders) often want to get “tuned-up” for family gatherings. People visiting relatives leave their medications behind and request replacements called to pharmacies far, far away (often at 2:00 a.m.).
It’s a season for injuries. Back pain from lifting and carrying trees, boxes, and decorations. Concussions from standing up in a low attic. Carpal tunnel syndrome from writing and mailing lots of cards.
The end of the year also brings deductibles into play. People suddenly find they’ve met theirs and call in wanting MRI scans done and medications refilled before the ball drops, usually giving my staff little time to negotiate through the authorization process.
Although everyone else wants time off for the holidays, many are angry when we do, too. The Friday after Thanksgiving traditionally gets a few angry messages from people unhappy that we’re closed.
Of course, human illness never takes time off, so those of us who cover hospitals still see our share of strokes, encephalopathies, and other acute neurologic disorders. Helping others, regardless of when they need us, is part of what we signed up for.
Somewhere in the controlled insanity of a medical practice, it’s often easy to lose sight of our own families and priorities. So try to focus on yours. It’s good to remember who you’re really working for.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
The season’s upon us …
The holidays always seem to be a battle of extremes in my practice. A time of year when people are supposed to relax instead becomes a time of insane stressors for many. And those of us in the medical profession get stuck picking up the pieces.
People either want to put things off until the new year or need them addressed urgently. Migraine phone calls go up. Seizure medications are forgotten. Tempers flare (try getting a parking space at Costco if you don’t believe me).
College students come home and want to be worked in during their break. Patients with physical limitations who are traveling need notes written to assist them. People with migraines want them controlled so they don’t ruin their holidays. Those with Parkinson’s disease (and other movement disorders) often want to get “tuned-up” for family gatherings. People visiting relatives leave their medications behind and request replacements called to pharmacies far, far away (often at 2:00 a.m.).
It’s a season for injuries. Back pain from lifting and carrying trees, boxes, and decorations. Concussions from standing up in a low attic. Carpal tunnel syndrome from writing and mailing lots of cards.
The end of the year also brings deductibles into play. People suddenly find they’ve met theirs and call in wanting MRI scans done and medications refilled before the ball drops, usually giving my staff little time to negotiate through the authorization process.
Although everyone else wants time off for the holidays, many are angry when we do, too. The Friday after Thanksgiving traditionally gets a few angry messages from people unhappy that we’re closed.
Of course, human illness never takes time off, so those of us who cover hospitals still see our share of strokes, encephalopathies, and other acute neurologic disorders. Helping others, regardless of when they need us, is part of what we signed up for.
Somewhere in the controlled insanity of a medical practice, it’s often easy to lose sight of our own families and priorities. So try to focus on yours. It’s good to remember who you’re really working for.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
