Hitting a Nerve

During an elective in my fourth year of medical school, a neurology professor told me how the brain never really turns off reading. He explained this with the example of driving: Heading down a road, you pass signs constantly: traffic signs, billboards, names on buildings, etc. Anything that you look at you automatically read and register.

The only way to not do this is to not see it (I don’t recommend driving blindfolded). The ability to decode symbols into meaningful language becomes such an automatic part of our functioning that we end up screening for what is and isn’t immediately relevant to us (probably a speed limit sign, but not a "waiter wanted" sign [but who knows?]) without even thinking about it.

Likewise, neurologists develop what I call "neurovision." After years of training and clinical experience, it becomes second nature to screen people we pass in the store, restaurant, sidewalk – pretty much anywhere.

It’s impossible NOT to notice things: a slight pill-rolling tremor, an equine gait from a foot drop, a paretic arm from a stroke. Some days, it’s all I can do not to hand out business cards. Granted, this skill has little practical use outside the office (unless you like to approach strangers at restaurants and suggest a higher Sinemet dose), but it makes life more interesting in a weird neuro-nerd sort of way.

Even at family gatherings you notice things – and sometimes check further. An uncle has a slight tremor or hypomimia, and so you check his tone while shaking hands. A cousin seems more forgetful than you remembered, and so you ask seemingly innocuous questions to check cognition.

I’m sure every specialty has a similar skill. I suppose it keeps you on your toes as you go through the days, and I think it’s reassuring to remind yourself that you’re always alert for the things you’re supposed to be.

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

During an elective in my fourth year of medical school, a neurology professor told me how the brain never really turns off reading. He explained this with the example of driving: Heading down a road, you pass signs constantly: traffic signs, billboards, names on buildings, etc. Anything that you look at you automatically read and register.

The only way to not do this is to not see it (I don’t recommend driving blindfolded). The ability to decode symbols into meaningful language becomes such an automatic part of our functioning that we end up screening for what is and isn’t immediately relevant to us (probably a speed limit sign, but not a "waiter wanted" sign [but who knows?]) without even thinking about it.

Likewise, neurologists develop what I call "neurovision." After years of training and clinical experience, it becomes second nature to screen people we pass in the store, restaurant, sidewalk – pretty much anywhere.

It’s impossible NOT to notice things: a slight pill-rolling tremor, an equine gait from a foot drop, a paretic arm from a stroke. Some days, it’s all I can do not to hand out business cards. Granted, this skill has little practical use outside the office (unless you like to approach strangers at restaurants and suggest a higher Sinemet dose), but it makes life more interesting in a weird neuro-nerd sort of way.

Even at family gatherings you notice things – and sometimes check further. An uncle has a slight tremor or hypomimia, and so you check his tone while shaking hands. A cousin seems more forgetful than you remembered, and so you ask seemingly innocuous questions to check cognition.

I’m sure every specialty has a similar skill. I suppose it keeps you on your toes as you go through the days, and I think it’s reassuring to remind yourself that you’re always alert for the things you’re supposed to be.

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

During an elective in my fourth year of medical school, a neurology professor told me how the brain never really turns off reading. He explained this with the example of driving: Heading down a road, you pass signs constantly: traffic signs, billboards, names on buildings, etc. Anything that you look at you automatically read and register.

The only way to not do this is to not see it (I don’t recommend driving blindfolded). The ability to decode symbols into meaningful language becomes such an automatic part of our functioning that we end up screening for what is and isn’t immediately relevant to us (probably a speed limit sign, but not a "waiter wanted" sign [but who knows?]) without even thinking about it.

Likewise, neurologists develop what I call "neurovision." After years of training and clinical experience, it becomes second nature to screen people we pass in the store, restaurant, sidewalk – pretty much anywhere.

It’s impossible NOT to notice things: a slight pill-rolling tremor, an equine gait from a foot drop, a paretic arm from a stroke. Some days, it’s all I can do not to hand out business cards. Granted, this skill has little practical use outside the office (unless you like to approach strangers at restaurants and suggest a higher Sinemet dose), but it makes life more interesting in a weird neuro-nerd sort of way.

Even at family gatherings you notice things – and sometimes check further. An uncle has a slight tremor or hypomimia, and so you check his tone while shaking hands. A cousin seems more forgetful than you remembered, and so you ask seemingly innocuous questions to check cognition.

I’m sure every specialty has a similar skill. I suppose it keeps you on your toes as you go through the days, and I think it’s reassuring to remind yourself that you’re always alert for the things you’re supposed to be.

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

I turn patients away. I don’t do it all the time, but once a week or so. Calling with an unusually complex case? Not me. Been through multiple other neurologists without luck? Nope. Have a rare disease that I’ve never seen? I’m not your man. Sorry.

My secretary knows my preferences very well and often checks with me before scheduling someone. If there are still questions she’ll have them send records for me to review.

I’m never looking to turn away business or people who need help, but I also know my limitations. If I can’t help someone, or if they have a rare and/or complicated disorder that’s out of my league, why waste their time and mine? I’m at least lucky enough to practice in a city that has two major neurology tertiary care centers, and my staff gives out their phone numbers when needed.

I hear other doctors try to justify these things, often on financial grounds: "I’ll get an EEG/EMG/whatever" out of it. In almost all of these cases, the patient has already had the tests from previous physicians (sometimes multiple times), and to me, repeating them is often an exercise in futility.

My office website says that I’m a general neurologist who’s a "jack-of-all-trades, and master of none." I try to live by that ideal. If I can’t help a patient, I think it’s more important that they be directed to someone who can than waste their time with me.

I still try to consider patient care above other factors. If seeing me is just going to delay someone from getting the care they need, why bother?

Dr. Block has a solo neurology practice in Scottsdale, Ariz. E-mail him at [email protected].

I turn patients away. I don’t do it all the time, but once a week or so. Calling with an unusually complex case? Not me. Been through multiple other neurologists without luck? Nope. Have a rare disease that I’ve never seen? I’m not your man. Sorry.

My secretary knows my preferences very well and often checks with me before scheduling someone. If there are still questions she’ll have them send records for me to review.

I’m never looking to turn away business or people who need help, but I also know my limitations. If I can’t help someone, or if they have a rare and/or complicated disorder that’s out of my league, why waste their time and mine? I’m at least lucky enough to practice in a city that has two major neurology tertiary care centers, and my staff gives out their phone numbers when needed.

I hear other doctors try to justify these things, often on financial grounds: "I’ll get an EEG/EMG/whatever" out of it. In almost all of these cases, the patient has already had the tests from previous physicians (sometimes multiple times), and to me, repeating them is often an exercise in futility.

My office website says that I’m a general neurologist who’s a "jack-of-all-trades, and master of none." I try to live by that ideal. If I can’t help a patient, I think it’s more important that they be directed to someone who can than waste their time with me.

I still try to consider patient care above other factors. If seeing me is just going to delay someone from getting the care they need, why bother?

Dr. Block has a solo neurology practice in Scottsdale, Ariz. E-mail him at [email protected].

I turn patients away. I don’t do it all the time, but once a week or so. Calling with an unusually complex case? Not me. Been through multiple other neurologists without luck? Nope. Have a rare disease that I’ve never seen? I’m not your man. Sorry.

My secretary knows my preferences very well and often checks with me before scheduling someone. If there are still questions she’ll have them send records for me to review.

I’m never looking to turn away business or people who need help, but I also know my limitations. If I can’t help someone, or if they have a rare and/or complicated disorder that’s out of my league, why waste their time and mine? I’m at least lucky enough to practice in a city that has two major neurology tertiary care centers, and my staff gives out their phone numbers when needed.

I hear other doctors try to justify these things, often on financial grounds: "I’ll get an EEG/EMG/whatever" out of it. In almost all of these cases, the patient has already had the tests from previous physicians (sometimes multiple times), and to me, repeating them is often an exercise in futility.

My office website says that I’m a general neurologist who’s a "jack-of-all-trades, and master of none." I try to live by that ideal. If I can’t help a patient, I think it’s more important that they be directed to someone who can than waste their time with me.

I still try to consider patient care above other factors. If seeing me is just going to delay someone from getting the care they need, why bother?

Dr. Block has a solo neurology practice in Scottsdale, Ariz. E-mail him at [email protected].

In his State of the Union address, President Obama obliquely referred to the Brain Activity Map project, which is now confirmed to be in its planning stages. It is an ambitious initiative, lasting (at least) 10 years, to map the structure and functions of the human brain in great detail.

I hope the project goes through as planned. Although the brain is arguably the most critical part of what makes us human, it’s often a forgotten stepchild in public forums. Medical dramas often dominate the TV schedule, but the only one to center around the brain ("3 lbs" on CBS) lasted for only three episodes over a 2-week period in 2006.

We tend to focus more on disease terms – Alzheimer’s or Parkinson’s – than the organ involved itself. But in order to find more effective treatments, we need to understand what’s underlying them. Without knowing how it works, we can’t fix it.

Certainly, knowledge about the brain is at its most advanced point ever, but a central effort certainly would help further it. Like space exploration, some things are simply too big for the private sector to handle alone.

It’s been over 20 years since President George H.W. Bush proclaimed the 1990s as the "Decade of the Brain." A tremendous amount of knowledge has since been gained, but the workings of the cerebrum still remain largely mysterious.

The Human Genome Project, as often noted, turned into both an economic and medical boon. It returned a significant net on its financial investment and led to new disease treatments that weren’t imagined 20-30 years ago. We can only hope the brain project will do the same. And, perhaps, bring more awareness to the tissues that led us out of the cave.

Dr. Block has a solo neurology practice in Scottsdale, Ariz. E-mail him at [email protected].

In his State of the Union address, President Obama obliquely referred to the Brain Activity Map project, which is now confirmed to be in its planning stages. It is an ambitious initiative, lasting (at least) 10 years, to map the structure and functions of the human brain in great detail.

I hope the project goes through as planned. Although the brain is arguably the most critical part of what makes us human, it’s often a forgotten stepchild in public forums. Medical dramas often dominate the TV schedule, but the only one to center around the brain ("3 lbs" on CBS) lasted for only three episodes over a 2-week period in 2006.

We tend to focus more on disease terms – Alzheimer’s or Parkinson’s – than the organ involved itself. But in order to find more effective treatments, we need to understand what’s underlying them. Without knowing how it works, we can’t fix it.

Certainly, knowledge about the brain is at its most advanced point ever, but a central effort certainly would help further it. Like space exploration, some things are simply too big for the private sector to handle alone.

It’s been over 20 years since President George H.W. Bush proclaimed the 1990s as the "Decade of the Brain." A tremendous amount of knowledge has since been gained, but the workings of the cerebrum still remain largely mysterious.

The Human Genome Project, as often noted, turned into both an economic and medical boon. It returned a significant net on its financial investment and led to new disease treatments that weren’t imagined 20-30 years ago. We can only hope the brain project will do the same. And, perhaps, bring more awareness to the tissues that led us out of the cave.

Dr. Block has a solo neurology practice in Scottsdale, Ariz. E-mail him at [email protected].

In his State of the Union address, President Obama obliquely referred to the Brain Activity Map project, which is now confirmed to be in its planning stages. It is an ambitious initiative, lasting (at least) 10 years, to map the structure and functions of the human brain in great detail.

I hope the project goes through as planned. Although the brain is arguably the most critical part of what makes us human, it’s often a forgotten stepchild in public forums. Medical dramas often dominate the TV schedule, but the only one to center around the brain ("3 lbs" on CBS) lasted for only three episodes over a 2-week period in 2006.

We tend to focus more on disease terms – Alzheimer’s or Parkinson’s – than the organ involved itself. But in order to find more effective treatments, we need to understand what’s underlying them. Without knowing how it works, we can’t fix it.

Certainly, knowledge about the brain is at its most advanced point ever, but a central effort certainly would help further it. Like space exploration, some things are simply too big for the private sector to handle alone.

It’s been over 20 years since President George H.W. Bush proclaimed the 1990s as the "Decade of the Brain." A tremendous amount of knowledge has since been gained, but the workings of the cerebrum still remain largely mysterious.

The Human Genome Project, as often noted, turned into both an economic and medical boon. It returned a significant net on its financial investment and led to new disease treatments that weren’t imagined 20-30 years ago. We can only hope the brain project will do the same. And, perhaps, bring more awareness to the tissues that led us out of the cave.

Dr. Block has a solo neurology practice in Scottsdale, Ariz. E-mail him at [email protected].

I’m an on-time nut. I’ve never understood doctors who routinely run way behind schedule. At my first job there were one to two guys who were notorious for waits in the 2- to 3-hour range.

I’m a fanatic. My schedule is structured to allow a decent amount of time for patients, and I work on other things (drug refills, nurses’ questions, test results) in the extra minutes where they happen. Granted, there are still rare emergencies (having to run to the hospital, or an unexpected patient issue) that are beyond my control, but most days I’m able to keep things running on time (give or take 5 minutes). If patients show up early, and I have time to see them, I see them. The extra time will always be needed later for something else.

From watching other doctors during training and at my first job, I came away feeling that the majority of running behind was preventable, and was primarily caused by a handful of factors:

• Time spent chatting with staff/colleagues about nonmedical issues (weekend camping, politics, last night’s baseball game).

• Cramming in far more patients in the schedule than can realistically be seen.

• Endlessly adding on anyone who calls in demanding to be seen that day.

• Other personal junk: phone calls, surfing the Internet, etc.

There will always be emergencies and circumstances we can’t control that interfere with our schedules. But after 14 years of running pretty close to on time, I’m glad that I keep my day controlled. I like it, the patients like it, and having predictable hours is nice. I like knowing what time I can leave each day, and then doing it.

Dr. Block has a solo neurology practice in Scottsdale, Ariz. E-mail him at [email protected].

I’m an on-time nut. I’ve never understood doctors who routinely run way behind schedule. At my first job there were one to two guys who were notorious for waits in the 2- to 3-hour range.

I’m a fanatic. My schedule is structured to allow a decent amount of time for patients, and I work on other things (drug refills, nurses’ questions, test results) in the extra minutes where they happen. Granted, there are still rare emergencies (having to run to the hospital, or an unexpected patient issue) that are beyond my control, but most days I’m able to keep things running on time (give or take 5 minutes). If patients show up early, and I have time to see them, I see them. The extra time will always be needed later for something else.

From watching other doctors during training and at my first job, I came away feeling that the majority of running behind was preventable, and was primarily caused by a handful of factors:

• Time spent chatting with staff/colleagues about nonmedical issues (weekend camping, politics, last night’s baseball game).

• Cramming in far more patients in the schedule than can realistically be seen.

• Endlessly adding on anyone who calls in demanding to be seen that day.

• Other personal junk: phone calls, surfing the Internet, etc.

There will always be emergencies and circumstances we can’t control that interfere with our schedules. But after 14 years of running pretty close to on time, I’m glad that I keep my day controlled. I like it, the patients like it, and having predictable hours is nice. I like knowing what time I can leave each day, and then doing it.

Dr. Block has a solo neurology practice in Scottsdale, Ariz. E-mail him at [email protected].

I’m an on-time nut. I’ve never understood doctors who routinely run way behind schedule. At my first job there were one to two guys who were notorious for waits in the 2- to 3-hour range.

I’m a fanatic. My schedule is structured to allow a decent amount of time for patients, and I work on other things (drug refills, nurses’ questions, test results) in the extra minutes where they happen. Granted, there are still rare emergencies (having to run to the hospital, or an unexpected patient issue) that are beyond my control, but most days I’m able to keep things running on time (give or take 5 minutes). If patients show up early, and I have time to see them, I see them. The extra time will always be needed later for something else.

From watching other doctors during training and at my first job, I came away feeling that the majority of running behind was preventable, and was primarily caused by a handful of factors:

• Time spent chatting with staff/colleagues about nonmedical issues (weekend camping, politics, last night’s baseball game).

• Cramming in far more patients in the schedule than can realistically be seen.

• Endlessly adding on anyone who calls in demanding to be seen that day.

• Other personal junk: phone calls, surfing the Internet, etc.

There will always be emergencies and circumstances we can’t control that interfere with our schedules. But after 14 years of running pretty close to on time, I’m glad that I keep my day controlled. I like it, the patients like it, and having predictable hours is nice. I like knowing what time I can leave each day, and then doing it.

Dr. Block has a solo neurology practice in Scottsdale, Ariz. E-mail him at [email protected].

In the old days, doctors (allegedly) never charged each other. This was labeled "professional courtesy." It’s a nice idea, but really only works when everyone is in a small practice and paying cash.

Today, everyone has insurance, with copays and deductibles. With that comes contracts specifically stating how much money we’re required to collect at the time of service. If one were to bypass them by writing "no copay" on a bill, an insurance company likely would either bill the patient for the uncollected amount or send the doctor a letter saying he or she is in violation of a contract.

I don’t ask for the courtesy myself. My kids have run up a small fortune over time in emergency department bills, radiology charges, and visits to their pediatrician. I fully expect to pay them all, and I do.

On paper, professional courtesy sounds good. But you can also argue it discriminates against nondoctors. Besides, even if you did it, how far should it extend? Immediate family members only? Cousins? Uncles? Aunts? Realistically, a pretty good chunk of the population is distantly related to a doctor. The money adds up over time. To continue being a doctor, I also have to stay in business. And the same goes for the ones my family sees.

Older physicians may be horrified at this approach, but I don’t have an issue with it. I see it as the fairest option: I pay for my family and expect others to do the same. In a perfect world, perhaps medical care would be free for all. But ours is far from it.

Dr. Block has a solo neurology practice in Scottsdale, Ariz. E-mail him at [email protected].

In the old days, doctors (allegedly) never charged each other. This was labeled "professional courtesy." It’s a nice idea, but really only works when everyone is in a small practice and paying cash.

Today, everyone has insurance, with copays and deductibles. With that comes contracts specifically stating how much money we’re required to collect at the time of service. If one were to bypass them by writing "no copay" on a bill, an insurance company likely would either bill the patient for the uncollected amount or send the doctor a letter saying he or she is in violation of a contract.

I don’t ask for the courtesy myself. My kids have run up a small fortune over time in emergency department bills, radiology charges, and visits to their pediatrician. I fully expect to pay them all, and I do.

On paper, professional courtesy sounds good. But you can also argue it discriminates against nondoctors. Besides, even if you did it, how far should it extend? Immediate family members only? Cousins? Uncles? Aunts? Realistically, a pretty good chunk of the population is distantly related to a doctor. The money adds up over time. To continue being a doctor, I also have to stay in business. And the same goes for the ones my family sees.

Older physicians may be horrified at this approach, but I don’t have an issue with it. I see it as the fairest option: I pay for my family and expect others to do the same. In a perfect world, perhaps medical care would be free for all. But ours is far from it.

Dr. Block has a solo neurology practice in Scottsdale, Ariz. E-mail him at [email protected].

In the old days, doctors (allegedly) never charged each other. This was labeled "professional courtesy." It’s a nice idea, but really only works when everyone is in a small practice and paying cash.

Today, everyone has insurance, with copays and deductibles. With that comes contracts specifically stating how much money we’re required to collect at the time of service. If one were to bypass them by writing "no copay" on a bill, an insurance company likely would either bill the patient for the uncollected amount or send the doctor a letter saying he or she is in violation of a contract.

I don’t ask for the courtesy myself. My kids have run up a small fortune over time in emergency department bills, radiology charges, and visits to their pediatrician. I fully expect to pay them all, and I do.

On paper, professional courtesy sounds good. But you can also argue it discriminates against nondoctors. Besides, even if you did it, how far should it extend? Immediate family members only? Cousins? Uncles? Aunts? Realistically, a pretty good chunk of the population is distantly related to a doctor. The money adds up over time. To continue being a doctor, I also have to stay in business. And the same goes for the ones my family sees.

Older physicians may be horrified at this approach, but I don’t have an issue with it. I see it as the fairest option: I pay for my family and expect others to do the same. In a perfect world, perhaps medical care would be free for all. But ours is far from it.

Dr. Block has a solo neurology practice in Scottsdale, Ariz. E-mail him at [email protected].

A few times a week a fax comes to my office, usually from a doctor who doesn’t commonly refer to me. It will include insurance information and a phone number, with a note saying, "Please call patient for an appointment."

We don’t call. My secretary puts the notes in a file for people who haven’t been seen yet, and we move on.

Why don’t we call? We used to. I’m certainly not in the habit of turning away business. What stopped us is that it became a far bigger nightmare than we expected. When my staff called to set up appointments, we found the vast majority of people hadn’t even been told they should see a neurologist. This resulted in my secretary having to deal with panicked individuals demanding to know why they needed to see a neurologist, what their tests showed, and what does a neurologist do, anyway?

In all cases except for the last one, she wasn’t able to answer their questions, which only infuriated them. When we told them to call their internist, it only made things worse.

Some even accused us of lying about getting a fax, and claimed we were just calling people randomly to drum up business. Believe me, we haven’t sunk that low.

So we don’t call anymore. We figure that if patients can answer the phone to make an appointment, they can also dial our number. Other offices may find this to be unfriendly, but we learned our lesson the hard way. At least when people call us themselves, they usually know why they’re being sent.

Communication is perhaps the most critical step in all levels of medicine. It’s best to start off on the right foot with a patient who already has some idea of what to expect.

Dr. Block has a solo neurology practice in Scottsdale, Ariz. E-mail him at [email protected].

A few times a week a fax comes to my office, usually from a doctor who doesn’t commonly refer to me. It will include insurance information and a phone number, with a note saying, "Please call patient for an appointment."

We don’t call. My secretary puts the notes in a file for people who haven’t been seen yet, and we move on.

Why don’t we call? We used to. I’m certainly not in the habit of turning away business. What stopped us is that it became a far bigger nightmare than we expected. When my staff called to set up appointments, we found the vast majority of people hadn’t even been told they should see a neurologist. This resulted in my secretary having to deal with panicked individuals demanding to know why they needed to see a neurologist, what their tests showed, and what does a neurologist do, anyway?

In all cases except for the last one, she wasn’t able to answer their questions, which only infuriated them. When we told them to call their internist, it only made things worse.

Some even accused us of lying about getting a fax, and claimed we were just calling people randomly to drum up business. Believe me, we haven’t sunk that low.

So we don’t call anymore. We figure that if patients can answer the phone to make an appointment, they can also dial our number. Other offices may find this to be unfriendly, but we learned our lesson the hard way. At least when people call us themselves, they usually know why they’re being sent.

Communication is perhaps the most critical step in all levels of medicine. It’s best to start off on the right foot with a patient who already has some idea of what to expect.

Dr. Block has a solo neurology practice in Scottsdale, Ariz. E-mail him at [email protected].

A few times a week a fax comes to my office, usually from a doctor who doesn’t commonly refer to me. It will include insurance information and a phone number, with a note saying, "Please call patient for an appointment."

We don’t call. My secretary puts the notes in a file for people who haven’t been seen yet, and we move on.

Why don’t we call? We used to. I’m certainly not in the habit of turning away business. What stopped us is that it became a far bigger nightmare than we expected. When my staff called to set up appointments, we found the vast majority of people hadn’t even been told they should see a neurologist. This resulted in my secretary having to deal with panicked individuals demanding to know why they needed to see a neurologist, what their tests showed, and what does a neurologist do, anyway?

In all cases except for the last one, she wasn’t able to answer their questions, which only infuriated them. When we told them to call their internist, it only made things worse.

Some even accused us of lying about getting a fax, and claimed we were just calling people randomly to drum up business. Believe me, we haven’t sunk that low.

So we don’t call anymore. We figure that if patients can answer the phone to make an appointment, they can also dial our number. Other offices may find this to be unfriendly, but we learned our lesson the hard way. At least when people call us themselves, they usually know why they’re being sent.

Communication is perhaps the most critical step in all levels of medicine. It’s best to start off on the right foot with a patient who already has some idea of what to expect.

Dr. Block has a solo neurology practice in Scottsdale, Ariz. E-mail him at [email protected].

Last November, several news outlets carried a story about Dr. Russell Dohner of Rushville, Ill.

Dr. Dohner takes no insurances, works 7 days a week, and charges $5 per visit. I respect that. I really do. I wish I could give care to all in need.

The article brought out a lot of comments wondering why all doctors can’t be like him because obviously he cares about patients. Unfortunately, most of the stories about him don’t mention his financial backing until the bottom third of the story – long after most people have stopped reading and moved on to other things. It says he’s primarily supported by a farm that his family owns, allowing him to practice at $5 a person.

If I had enough money to support my family and practice independently, I might do it, too. I like this job. I always have, and hopefully always will.

But the financial reality is that I have kids (Dr. Dohner has none) and a wife (ditto). My two staff members also have families to support, and they can’t work for free, either. So I have to charge people their copays, and bill insurance companies for the balance, and hope I can collect enough to keep my door open. This isn’t just medicine: It’s any business model. No matter how much you love what you do, it’s the rare (and lucky) person who can continue doing it for practically nothing.

Charging for your services isn’t a sign of not caring. It’s a sign of having the same responsibilities that your patients do. In a perfect world, perhaps medical care would be free (or even unnecessary). But our world will never be perfect. And I’ll always have an overhead (both business and personal) to meet. So, to keep caring for patients the best I can, I’ll have to keep charging them.

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

Last November, several news outlets carried a story about Dr. Russell Dohner of Rushville, Ill.

Dr. Dohner takes no insurances, works 7 days a week, and charges $5 per visit. I respect that. I really do. I wish I could give care to all in need.

The article brought out a lot of comments wondering why all doctors can’t be like him because obviously he cares about patients. Unfortunately, most of the stories about him don’t mention his financial backing until the bottom third of the story – long after most people have stopped reading and moved on to other things. It says he’s primarily supported by a farm that his family owns, allowing him to practice at $5 a person.

If I had enough money to support my family and practice independently, I might do it, too. I like this job. I always have, and hopefully always will.

But the financial reality is that I have kids (Dr. Dohner has none) and a wife (ditto). My two staff members also have families to support, and they can’t work for free, either. So I have to charge people their copays, and bill insurance companies for the balance, and hope I can collect enough to keep my door open. This isn’t just medicine: It’s any business model. No matter how much you love what you do, it’s the rare (and lucky) person who can continue doing it for practically nothing.

Charging for your services isn’t a sign of not caring. It’s a sign of having the same responsibilities that your patients do. In a perfect world, perhaps medical care would be free (or even unnecessary). But our world will never be perfect. And I’ll always have an overhead (both business and personal) to meet. So, to keep caring for patients the best I can, I’ll have to keep charging them.

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

Last November, several news outlets carried a story about Dr. Russell Dohner of Rushville, Ill.

Dr. Dohner takes no insurances, works 7 days a week, and charges $5 per visit. I respect that. I really do. I wish I could give care to all in need.

The article brought out a lot of comments wondering why all doctors can’t be like him because obviously he cares about patients. Unfortunately, most of the stories about him don’t mention his financial backing until the bottom third of the story – long after most people have stopped reading and moved on to other things. It says he’s primarily supported by a farm that his family owns, allowing him to practice at $5 a person.

If I had enough money to support my family and practice independently, I might do it, too. I like this job. I always have, and hopefully always will.

But the financial reality is that I have kids (Dr. Dohner has none) and a wife (ditto). My two staff members also have families to support, and they can’t work for free, either. So I have to charge people their copays, and bill insurance companies for the balance, and hope I can collect enough to keep my door open. This isn’t just medicine: It’s any business model. No matter how much you love what you do, it’s the rare (and lucky) person who can continue doing it for practically nothing.

Charging for your services isn’t a sign of not caring. It’s a sign of having the same responsibilities that your patients do. In a perfect world, perhaps medical care would be free (or even unnecessary). But our world will never be perfect. And I’ll always have an overhead (both business and personal) to meet. So, to keep caring for patients the best I can, I’ll have to keep charging them.

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

The electromyography/nerve conduction velocity cuts for 2013 are a serious financial hit for most neurologists. Although the Sustainable Growth Rate formula cuts were halted for another year, their specter still looms for 2014. In addition, the automatic 2% cut to Medicare fees that was averted by the "fiscal cliff" deal will only last through February.

These cutbacks hurt all of us, but seem particularly onerous for doctors like myself who are in small or even solo practices.

The unpleasant fact that most neurologists (and doctors in general) have to face is this: With the current cuts, it’s impossible to stay in practice by doing what we’re trained to do – see and care for patients. This is similar to restaurants being told that they can only sell food and beverages at below cost. They couldn’t stay open, either.

There are no easy answers. Threatening to drop Medicare is a common sentiment, but realistically it’s not financially possible for most of us. Primary care practices can sometimes get away with it, but in frontline neurology it’s just not possible. The only neurologist I know who tried it closed his doors within a year.

Sadly, it actually pays better to do legal work, such as independent medical exams, than it does to take care of patients. I’ve generally tried to focus on being a doctor, but with these changes I find myself having to take a larger share of legal cases, too.

I try quite hard to be punctual. Double-booking slots certainly would increase revenue, but at what cost? Running behind and inconveniencing patients? Their time is as important as mine. I can’t bring myself to do that.

What about drug company work? I’ve always welcomed the occasional speaking or research job, but these seem to become fewer and farther between as time goes by.

There are always other ways to earn money, but I’m not ready to start doing dermal fillers, running a "MediSpa," or selling overpriced vitamin pills.

And so, like many other small-practice neurologists, I enter 2013 unsure if my business will survive the year. I’m curious to know what other practices are doing.

Dr. Block has a solo neurology practice in Scottsdale, Ariz. E-mail him at [email protected].

The electromyography/nerve conduction velocity cuts for 2013 are a serious financial hit for most neurologists. Although the Sustainable Growth Rate formula cuts were halted for another year, their specter still looms for 2014. In addition, the automatic 2% cut to Medicare fees that was averted by the "fiscal cliff" deal will only last through February.

These cutbacks hurt all of us, but seem particularly onerous for doctors like myself who are in small or even solo practices.

The unpleasant fact that most neurologists (and doctors in general) have to face is this: With the current cuts, it’s impossible to stay in practice by doing what we’re trained to do – see and care for patients. This is similar to restaurants being told that they can only sell food and beverages at below cost. They couldn’t stay open, either.

There are no easy answers. Threatening to drop Medicare is a common sentiment, but realistically it’s not financially possible for most of us. Primary care practices can sometimes get away with it, but in frontline neurology it’s just not possible. The only neurologist I know who tried it closed his doors within a year.

Sadly, it actually pays better to do legal work, such as independent medical exams, than it does to take care of patients. I’ve generally tried to focus on being a doctor, but with these changes I find myself having to take a larger share of legal cases, too.

I try quite hard to be punctual. Double-booking slots certainly would increase revenue, but at what cost? Running behind and inconveniencing patients? Their time is as important as mine. I can’t bring myself to do that.

What about drug company work? I’ve always welcomed the occasional speaking or research job, but these seem to become fewer and farther between as time goes by.

There are always other ways to earn money, but I’m not ready to start doing dermal fillers, running a "MediSpa," or selling overpriced vitamin pills.

And so, like many other small-practice neurologists, I enter 2013 unsure if my business will survive the year. I’m curious to know what other practices are doing.

Dr. Block has a solo neurology practice in Scottsdale, Ariz. E-mail him at [email protected].

The electromyography/nerve conduction velocity cuts for 2013 are a serious financial hit for most neurologists. Although the Sustainable Growth Rate formula cuts were halted for another year, their specter still looms for 2014. In addition, the automatic 2% cut to Medicare fees that was averted by the "fiscal cliff" deal will only last through February.

These cutbacks hurt all of us, but seem particularly onerous for doctors like myself who are in small or even solo practices.

The unpleasant fact that most neurologists (and doctors in general) have to face is this: With the current cuts, it’s impossible to stay in practice by doing what we’re trained to do – see and care for patients. This is similar to restaurants being told that they can only sell food and beverages at below cost. They couldn’t stay open, either.

There are no easy answers. Threatening to drop Medicare is a common sentiment, but realistically it’s not financially possible for most of us. Primary care practices can sometimes get away with it, but in frontline neurology it’s just not possible. The only neurologist I know who tried it closed his doors within a year.

Sadly, it actually pays better to do legal work, such as independent medical exams, than it does to take care of patients. I’ve generally tried to focus on being a doctor, but with these changes I find myself having to take a larger share of legal cases, too.

I try quite hard to be punctual. Double-booking slots certainly would increase revenue, but at what cost? Running behind and inconveniencing patients? Their time is as important as mine. I can’t bring myself to do that.

What about drug company work? I’ve always welcomed the occasional speaking or research job, but these seem to become fewer and farther between as time goes by.

There are always other ways to earn money, but I’m not ready to start doing dermal fillers, running a "MediSpa," or selling overpriced vitamin pills.

And so, like many other small-practice neurologists, I enter 2013 unsure if my business will survive the year. I’m curious to know what other practices are doing.

Dr. Block has a solo neurology practice in Scottsdale, Ariz. E-mail him at [email protected].

Paperwork is never welcome, but it’s a part of this job. There are always forms – MRI approvals, patient disability, drug preauthorizations – a never-ending stream of paper in our allegedly paperless society. I can live with this.

What drives me nuts is unnecessary paperwork, often created for me by a well-meaning patient. My most hated are the multipage Food and Drug Administration forms that show up from time to time.

Let’s take Mrs. Smith, who has multiple sclerosis (MS). She’s on an injectable interferon. After 2 years, she has her first MS relapse since starting it. This is to be expected. Anyone who does this for a living knows that the medications only reduce, but don’t stop, relapses.

Besides calling me, she (for reasons I never understand) decides to notify the manufacturer. Now, Pharma Inc. is stuck with this knowledge and treats it as an adverse drug reaction. I don’t know why, but it does. So now it’s required by the FDA to send me a long form to report the problem. I fill it out and send it in and then get a second one back to clarify an answer from the first form. And so on.

Ignoring the forms won’t get you anywhere. They keep mailing them and calling until you return them. For MS drugs, this has happened twice to me in the last few months, with similar stories.

A patient gets a common (and well-documented) side effect, like chest pain after taking a triptan, and decides to report it to the manufacturer, which treats it like something previously unknown and sends me the dreaded paperwork looking for more information. Dispatching the paperwork quickly by writing, "It’s a triptan. This is what they do!" is not an acceptable answer. Trust me, I tried it.

Years ago, I saw a patient who took an overdose of a drug that is well known to cause seizures. Of course, he had a seizure. A friend of mine worked for the drug’s manufacturer at the time (although in another division), and I mentioned the story to him in a passing conversation about my weekend on call.

This was a big mistake, as he was then obliged to report it to his company, which of course sent me a 14-page form looking for more details than I had any idea of. So, with my lesson learned, now I don’t mention any of his current company’s products to him. It’s safer that way.

I have nothing against gathering new drug data or the paperwork that is involved. But to gather information that’s already well established? That’s a waste of everyone’s time.

Paperwork is never welcome, but it’s a part of this job. There are always forms – MRI approvals, patient disability, drug preauthorizations – a never-ending stream of paper in our allegedly paperless society. I can live with this.

What drives me nuts is unnecessary paperwork, often created for me by a well-meaning patient. My most hated are the multipage Food and Drug Administration forms that show up from time to time.

Let’s take Mrs. Smith, who has multiple sclerosis (MS). She’s on an injectable interferon. After 2 years, she has her first MS relapse since starting it. This is to be expected. Anyone who does this for a living knows that the medications only reduce, but don’t stop, relapses.

Besides calling me, she (for reasons I never understand) decides to notify the manufacturer. Now, Pharma Inc. is stuck with this knowledge and treats it as an adverse drug reaction. I don’t know why, but it does. So now it’s required by the FDA to send me a long form to report the problem. I fill it out and send it in and then get a second one back to clarify an answer from the first form. And so on.

Ignoring the forms won’t get you anywhere. They keep mailing them and calling until you return them. For MS drugs, this has happened twice to me in the last few months, with similar stories.

A patient gets a common (and well-documented) side effect, like chest pain after taking a triptan, and decides to report it to the manufacturer, which treats it like something previously unknown and sends me the dreaded paperwork looking for more information. Dispatching the paperwork quickly by writing, "It’s a triptan. This is what they do!" is not an acceptable answer. Trust me, I tried it.

Years ago, I saw a patient who took an overdose of a drug that is well known to cause seizures. Of course, he had a seizure. A friend of mine worked for the drug’s manufacturer at the time (although in another division), and I mentioned the story to him in a passing conversation about my weekend on call.

This was a big mistake, as he was then obliged to report it to his company, which of course sent me a 14-page form looking for more details than I had any idea of. So, with my lesson learned, now I don’t mention any of his current company’s products to him. It’s safer that way.

I have nothing against gathering new drug data or the paperwork that is involved. But to gather information that’s already well established? That’s a waste of everyone’s time.

Paperwork is never welcome, but it’s a part of this job. There are always forms – MRI approvals, patient disability, drug preauthorizations – a never-ending stream of paper in our allegedly paperless society. I can live with this.

What drives me nuts is unnecessary paperwork, often created for me by a well-meaning patient. My most hated are the multipage Food and Drug Administration forms that show up from time to time.

Let’s take Mrs. Smith, who has multiple sclerosis (MS). She’s on an injectable interferon. After 2 years, she has her first MS relapse since starting it. This is to be expected. Anyone who does this for a living knows that the medications only reduce, but don’t stop, relapses.

Besides calling me, she (for reasons I never understand) decides to notify the manufacturer. Now, Pharma Inc. is stuck with this knowledge and treats it as an adverse drug reaction. I don’t know why, but it does. So now it’s required by the FDA to send me a long form to report the problem. I fill it out and send it in and then get a second one back to clarify an answer from the first form. And so on.

Ignoring the forms won’t get you anywhere. They keep mailing them and calling until you return them. For MS drugs, this has happened twice to me in the last few months, with similar stories.

A patient gets a common (and well-documented) side effect, like chest pain after taking a triptan, and decides to report it to the manufacturer, which treats it like something previously unknown and sends me the dreaded paperwork looking for more information. Dispatching the paperwork quickly by writing, "It’s a triptan. This is what they do!" is not an acceptable answer. Trust me, I tried it.

Years ago, I saw a patient who took an overdose of a drug that is well known to cause seizures. Of course, he had a seizure. A friend of mine worked for the drug’s manufacturer at the time (although in another division), and I mentioned the story to him in a passing conversation about my weekend on call.

This was a big mistake, as he was then obliged to report it to his company, which of course sent me a 14-page form looking for more details than I had any idea of. So, with my lesson learned, now I don’t mention any of his current company’s products to him. It’s safer that way.

I have nothing against gathering new drug data or the paperwork that is involved. But to gather information that’s already well established? That’s a waste of everyone’s time.

From the starting gun each day, there’s a never-ending stream of electrons flying between my secretary, assistant, and me – ongoing exchanges about test results, refill requests, patient calls, etc. If I’m away from the office, I answer them on my phone, but I always answer.

After hours my iPhone is the connection to the practice. Patient calls route to me when we’re closed. If my assistant is working late, I answer her questions as they come in.

Last week, one of my kids had to leave school due to illness, and the call (fortunately) came in when I had an empty hour in the schedule. So I went to get him.

While driving to his school, I suddenly realized I’d left the phone on my desk. It was a strange feeling. For the first time since opening my practice, I can’t remember being more than a few feet from my phone. A million thoughts raced through my head: What if an urgent call comes in? What if an ER needs to reach me? What if I have a wreck and can’t reach anyone? Should I go back for it?

After about 10 seconds, I continued on my way. I wasn’t on call for the hospital. My assistant, after 15 years of this, knows when to direct someone to the ER. If I have a wreck someone else will have a phone there. It was highly unlikely that anything would happen to require my immediate attention in 20 minutes. And nothing did. I received two e-mails while I was gone, both on routine issues.

I was never a phone person when I was younger. I didn’t get my first cell phone until the day I started in practice in 1998. I didn’t get a phone that could do e-mail until July of last year.

But once you’re acclimated, it’s amazing how hard it is not to have it around. I’m not sure if that’s good or bad, but it is what it is – a genie that isn’t going back in its bottle.

 Dr. Block has a solo neurology practice in Scottsdale, Ariz. E-mail him at [email protected].

From the starting gun each day, there’s a never-ending stream of electrons flying between my secretary, assistant, and me – ongoing exchanges about test results, refill requests, patient calls, etc. If I’m away from the office, I answer them on my phone, but I always answer.

After hours my iPhone is the connection to the practice. Patient calls route to me when we’re closed. If my assistant is working late, I answer her questions as they come in.

Last week, one of my kids had to leave school due to illness, and the call (fortunately) came in when I had an empty hour in the schedule. So I went to get him.

While driving to his school, I suddenly realized I’d left the phone on my desk. It was a strange feeling. For the first time since opening my practice, I can’t remember being more than a few feet from my phone. A million thoughts raced through my head: What if an urgent call comes in? What if an ER needs to reach me? What if I have a wreck and can’t reach anyone? Should I go back for it?

After about 10 seconds, I continued on my way. I wasn’t on call for the hospital. My assistant, after 15 years of this, knows when to direct someone to the ER. If I have a wreck someone else will have a phone there. It was highly unlikely that anything would happen to require my immediate attention in 20 minutes. And nothing did. I received two e-mails while I was gone, both on routine issues.

I was never a phone person when I was younger. I didn’t get my first cell phone until the day I started in practice in 1998. I didn’t get a phone that could do e-mail until July of last year.

But once you’re acclimated, it’s amazing how hard it is not to have it around. I’m not sure if that’s good or bad, but it is what it is – a genie that isn’t going back in its bottle.

 Dr. Block has a solo neurology practice in Scottsdale, Ariz. E-mail him at [email protected].

From the starting gun each day, there’s a never-ending stream of electrons flying between my secretary, assistant, and me – ongoing exchanges about test results, refill requests, patient calls, etc. If I’m away from the office, I answer them on my phone, but I always answer.

After hours my iPhone is the connection to the practice. Patient calls route to me when we’re closed. If my assistant is working late, I answer her questions as they come in.

Last week, one of my kids had to leave school due to illness, and the call (fortunately) came in when I had an empty hour in the schedule. So I went to get him.

While driving to his school, I suddenly realized I’d left the phone on my desk. It was a strange feeling. For the first time since opening my practice, I can’t remember being more than a few feet from my phone. A million thoughts raced through my head: What if an urgent call comes in? What if an ER needs to reach me? What if I have a wreck and can’t reach anyone? Should I go back for it?

After about 10 seconds, I continued on my way. I wasn’t on call for the hospital. My assistant, after 15 years of this, knows when to direct someone to the ER. If I have a wreck someone else will have a phone there. It was highly unlikely that anything would happen to require my immediate attention in 20 minutes. And nothing did. I received two e-mails while I was gone, both on routine issues.

I was never a phone person when I was younger. I didn’t get my first cell phone until the day I started in practice in 1998. I didn’t get a phone that could do e-mail until July of last year.

But once you’re acclimated, it’s amazing how hard it is not to have it around. I’m not sure if that’s good or bad, but it is what it is – a genie that isn’t going back in its bottle.

 Dr. Block has a solo neurology practice in Scottsdale, Ariz. E-mail him at [email protected].