Hitting a Nerve

A recent article in Cell & Bioscience suggested that regular coffee consumption can reduce the risk of COVID infections.

The study does make some interesting points about the benefits of coffee’s different polyphenols and antioxidants and their effects on different COVID variants. Most of it is based on lab data, although one section, using serum from coffee versus water drinkers, did find that it was more effective at inhibiting the virions. Caffeinated versus decaffeinated didn’t matter.

Block_Allan_M_AZ_web.JPG

I’m not saying coffee doesn’t impair the virus. The data are worth looking at. But the majority of adults in North America, Europe, and pretty much the entire planet drink coffee on a regular basis. A large number of them still caught COVID. Would they have had worse cases if they didn’t drink coffee? Maybe, maybe not.

The problem here is that, as always, preliminary data like this get pushed into mass media, making it sound like “COFFEE CURES COVID!!!” Never mind that that’s not what the article said, but it sure gets clicks and retweets and FaceBook “likes.”

Suddenly fringe groups are claiming the coffee cure was there all along, and hidden from them by the evil government-pharma-medical cartel. Others claim the research is flawed because of this or that. The signal gets drowned out by the noise.

Definitely, food can be a medicine. Look at all the benefits proven of the Mediterranean diet. Coffee may help, especially if we can identify and isolate the specific components that reduce COVID risk. But, as they always say at the end, the study is preliminary and further research is needed.

Once or twice a year, an adult with epilepsy comes in, waving a copy of the ketogenic diet around and upset that I never tried it on them — again proof of the evil government-pharma-medical cartel that I’m in league with. I calm them down and explain the diet in detail. Maybe 50% of them decide to go ahead with it. In 25 years of practice, my record for an otherwise normal adult sticking with it is 5 days.

You don’t have to go too far back to remember Linus Pauling, an absolutely brilliant scientist, but not the best of nutritionists. With two Nobel prizes behind him, he took a stab at medicine in the 1970s, arguing that megadoses of vitamin C worked for the common cold. While it may be good for us, and certainly most people like orange juice, but those claims about the common cold never panned out. In fact, we’re no closer to curing it now than we were then.

Just because something seems promising in early studies doesn’t mean it will pan out. It might, but this doesn’t mean the “truth” is being maliciously hidden by an evil cartel. It just means we have (as always) more to learn.

I’ll still drink my single cup of coffee every weekday morning. I’m a creature of habit, and heaven knows I need the caffeine. If it also boosts my immune system, so much the better.

Besides, we still have that universal antimicrobial called chicken soup.
 

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

A recent article in Cell & Bioscience suggested that regular coffee consumption can reduce the risk of COVID infections.

The study does make some interesting points about the benefits of coffee’s different polyphenols and antioxidants and their effects on different COVID variants. Most of it is based on lab data, although one section, using serum from coffee versus water drinkers, did find that it was more effective at inhibiting the virions. Caffeinated versus decaffeinated didn’t matter.

Block_Allan_M_AZ_web.JPG

I’m not saying coffee doesn’t impair the virus. The data are worth looking at. But the majority of adults in North America, Europe, and pretty much the entire planet drink coffee on a regular basis. A large number of them still caught COVID. Would they have had worse cases if they didn’t drink coffee? Maybe, maybe not.

The problem here is that, as always, preliminary data like this get pushed into mass media, making it sound like “COFFEE CURES COVID!!!” Never mind that that’s not what the article said, but it sure gets clicks and retweets and FaceBook “likes.”

Suddenly fringe groups are claiming the coffee cure was there all along, and hidden from them by the evil government-pharma-medical cartel. Others claim the research is flawed because of this or that. The signal gets drowned out by the noise.

Definitely, food can be a medicine. Look at all the benefits proven of the Mediterranean diet. Coffee may help, especially if we can identify and isolate the specific components that reduce COVID risk. But, as they always say at the end, the study is preliminary and further research is needed.

Once or twice a year, an adult with epilepsy comes in, waving a copy of the ketogenic diet around and upset that I never tried it on them — again proof of the evil government-pharma-medical cartel that I’m in league with. I calm them down and explain the diet in detail. Maybe 50% of them decide to go ahead with it. In 25 years of practice, my record for an otherwise normal adult sticking with it is 5 days.

You don’t have to go too far back to remember Linus Pauling, an absolutely brilliant scientist, but not the best of nutritionists. With two Nobel prizes behind him, he took a stab at medicine in the 1970s, arguing that megadoses of vitamin C worked for the common cold. While it may be good for us, and certainly most people like orange juice, but those claims about the common cold never panned out. In fact, we’re no closer to curing it now than we were then.

Just because something seems promising in early studies doesn’t mean it will pan out. It might, but this doesn’t mean the “truth” is being maliciously hidden by an evil cartel. It just means we have (as always) more to learn.

I’ll still drink my single cup of coffee every weekday morning. I’m a creature of habit, and heaven knows I need the caffeine. If it also boosts my immune system, so much the better.

Besides, we still have that universal antimicrobial called chicken soup.
 

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

A recent article in Cell & Bioscience suggested that regular coffee consumption can reduce the risk of COVID infections.

The study does make some interesting points about the benefits of coffee’s different polyphenols and antioxidants and their effects on different COVID variants. Most of it is based on lab data, although one section, using serum from coffee versus water drinkers, did find that it was more effective at inhibiting the virions. Caffeinated versus decaffeinated didn’t matter.

Block_Allan_M_AZ_web.JPG

I’m not saying coffee doesn’t impair the virus. The data are worth looking at. But the majority of adults in North America, Europe, and pretty much the entire planet drink coffee on a regular basis. A large number of them still caught COVID. Would they have had worse cases if they didn’t drink coffee? Maybe, maybe not.

The problem here is that, as always, preliminary data like this get pushed into mass media, making it sound like “COFFEE CURES COVID!!!” Never mind that that’s not what the article said, but it sure gets clicks and retweets and FaceBook “likes.”

Suddenly fringe groups are claiming the coffee cure was there all along, and hidden from them by the evil government-pharma-medical cartel. Others claim the research is flawed because of this or that. The signal gets drowned out by the noise.

Definitely, food can be a medicine. Look at all the benefits proven of the Mediterranean diet. Coffee may help, especially if we can identify and isolate the specific components that reduce COVID risk. But, as they always say at the end, the study is preliminary and further research is needed.

Once or twice a year, an adult with epilepsy comes in, waving a copy of the ketogenic diet around and upset that I never tried it on them — again proof of the evil government-pharma-medical cartel that I’m in league with. I calm them down and explain the diet in detail. Maybe 50% of them decide to go ahead with it. In 25 years of practice, my record for an otherwise normal adult sticking with it is 5 days.

You don’t have to go too far back to remember Linus Pauling, an absolutely brilliant scientist, but not the best of nutritionists. With two Nobel prizes behind him, he took a stab at medicine in the 1970s, arguing that megadoses of vitamin C worked for the common cold. While it may be good for us, and certainly most people like orange juice, but those claims about the common cold never panned out. In fact, we’re no closer to curing it now than we were then.

Just because something seems promising in early studies doesn’t mean it will pan out. It might, but this doesn’t mean the “truth” is being maliciously hidden by an evil cartel. It just means we have (as always) more to learn.

I’ll still drink my single cup of coffee every weekday morning. I’m a creature of habit, and heaven knows I need the caffeine. If it also boosts my immune system, so much the better.

Besides, we still have that universal antimicrobial called chicken soup.
 

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

Making eye contact is important in human interactions. It shows attention and comprehension. It also helps us read the nuances of another’s facial expressions when interacting.

Although the idea of video phone calls isn’t new — I remember it from my childhood in “house of the future” TV shows — it certainly didn’t take off until the advent of high-speed Internet, computers, and phones with cameras. Then Facetime, Skype, Zoom, Teams, and others.

Block_Allan_M_AZ_web.JPG

Of course, it all still took a back seat to actually seeing people and having meetings in person. Until the pandemic made that the least attractive option. Then the adoption of such things went into hyperdrive and has stayed there ever since.

And ya know, I don’t have too many complaints. Between clinical trials and legal cases, both of which involve A LOT of meetings, it’s made my life easier. I no longer have to leave the office, allow time to drive somewhere and back, fight traffic, burn gas, and find parking. I move from a patient to the meeting and back to a patient from the cozy confines of my office, all without my tea getting cold.

But you can’t really make eye contact on Zoom. Instinctively, we generally look directly at the eyes of the person we’re speaking to, but in the virtual world we really don’t do that. On their end you’re on a screen, your gaze fixed somewhere below the level of your camera.

Try talking directly to the camera on Zoom — or any video platform. It doesn’t work. You feel like Dave addressing HAL’s red light in 2001. Inevitably your eyes are drawn back to the other person’s face, which is what you’re programmed to do. If they’re speaking you look at them, even though the sound is really coming from your speakers.

Interestingly, though, it seems something is lost in there. A recent perspective noted that Zoom meetings seemed to stifle creativity and produced fewer ideas than in person.

An interesting study compared neural response signals of people seeing a presentation on Zoom versus the same talk in person. When looking at a “real” speaker, there was synchronized neural activity, a higher level of engagement, and increased activation of the dorsal-parietal cortex.

Without actual eye contact it’s harder to read subtle facial expressions. Hand gestures and other body language may be out of the camera frame, or absent altogether. The nuances of voice pitch, timbre, and tone may not be the same over the speaker.

Our brains have spent several million of years developing facial recognition and reading, knowing friend from foe, and understanding what’s meant not just in what sounds are used but how they’re conveyed.

I’m not saying we should stop using Zoom altogether — it makes meetings more convenient for most people, including myself. But we also need to keep in mind that what it doesn’t convey is as important as what it does, and that virtual is never a perfect substitute for reality.
 

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

Making eye contact is important in human interactions. It shows attention and comprehension. It also helps us read the nuances of another’s facial expressions when interacting.

Although the idea of video phone calls isn’t new — I remember it from my childhood in “house of the future” TV shows — it certainly didn’t take off until the advent of high-speed Internet, computers, and phones with cameras. Then Facetime, Skype, Zoom, Teams, and others.

Block_Allan_M_AZ_web.JPG

Of course, it all still took a back seat to actually seeing people and having meetings in person. Until the pandemic made that the least attractive option. Then the adoption of such things went into hyperdrive and has stayed there ever since.

And ya know, I don’t have too many complaints. Between clinical trials and legal cases, both of which involve A LOT of meetings, it’s made my life easier. I no longer have to leave the office, allow time to drive somewhere and back, fight traffic, burn gas, and find parking. I move from a patient to the meeting and back to a patient from the cozy confines of my office, all without my tea getting cold.

But you can’t really make eye contact on Zoom. Instinctively, we generally look directly at the eyes of the person we’re speaking to, but in the virtual world we really don’t do that. On their end you’re on a screen, your gaze fixed somewhere below the level of your camera.

Try talking directly to the camera on Zoom — or any video platform. It doesn’t work. You feel like Dave addressing HAL’s red light in 2001. Inevitably your eyes are drawn back to the other person’s face, which is what you’re programmed to do. If they’re speaking you look at them, even though the sound is really coming from your speakers.

Interestingly, though, it seems something is lost in there. A recent perspective noted that Zoom meetings seemed to stifle creativity and produced fewer ideas than in person.

An interesting study compared neural response signals of people seeing a presentation on Zoom versus the same talk in person. When looking at a “real” speaker, there was synchronized neural activity, a higher level of engagement, and increased activation of the dorsal-parietal cortex.

Without actual eye contact it’s harder to read subtle facial expressions. Hand gestures and other body language may be out of the camera frame, or absent altogether. The nuances of voice pitch, timbre, and tone may not be the same over the speaker.

Our brains have spent several million of years developing facial recognition and reading, knowing friend from foe, and understanding what’s meant not just in what sounds are used but how they’re conveyed.

I’m not saying we should stop using Zoom altogether — it makes meetings more convenient for most people, including myself. But we also need to keep in mind that what it doesn’t convey is as important as what it does, and that virtual is never a perfect substitute for reality.
 

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

Making eye contact is important in human interactions. It shows attention and comprehension. It also helps us read the nuances of another’s facial expressions when interacting.

Although the idea of video phone calls isn’t new — I remember it from my childhood in “house of the future” TV shows — it certainly didn’t take off until the advent of high-speed Internet, computers, and phones with cameras. Then Facetime, Skype, Zoom, Teams, and others.

Block_Allan_M_AZ_web.JPG

Of course, it all still took a back seat to actually seeing people and having meetings in person. Until the pandemic made that the least attractive option. Then the adoption of such things went into hyperdrive and has stayed there ever since.

And ya know, I don’t have too many complaints. Between clinical trials and legal cases, both of which involve A LOT of meetings, it’s made my life easier. I no longer have to leave the office, allow time to drive somewhere and back, fight traffic, burn gas, and find parking. I move from a patient to the meeting and back to a patient from the cozy confines of my office, all without my tea getting cold.

But you can’t really make eye contact on Zoom. Instinctively, we generally look directly at the eyes of the person we’re speaking to, but in the virtual world we really don’t do that. On their end you’re on a screen, your gaze fixed somewhere below the level of your camera.

Try talking directly to the camera on Zoom — or any video platform. It doesn’t work. You feel like Dave addressing HAL’s red light in 2001. Inevitably your eyes are drawn back to the other person’s face, which is what you’re programmed to do. If they’re speaking you look at them, even though the sound is really coming from your speakers.

Interestingly, though, it seems something is lost in there. A recent perspective noted that Zoom meetings seemed to stifle creativity and produced fewer ideas than in person.

An interesting study compared neural response signals of people seeing a presentation on Zoom versus the same talk in person. When looking at a “real” speaker, there was synchronized neural activity, a higher level of engagement, and increased activation of the dorsal-parietal cortex.

Without actual eye contact it’s harder to read subtle facial expressions. Hand gestures and other body language may be out of the camera frame, or absent altogether. The nuances of voice pitch, timbre, and tone may not be the same over the speaker.

Our brains have spent several million of years developing facial recognition and reading, knowing friend from foe, and understanding what’s meant not just in what sounds are used but how they’re conveyed.

I’m not saying we should stop using Zoom altogether — it makes meetings more convenient for most people, including myself. But we also need to keep in mind that what it doesn’t convey is as important as what it does, and that virtual is never a perfect substitute for reality.
 

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

Christmas, like New Year’s Day, Thanksgiving, birthdays, and anniversaries, is one of those times that we use to mark where we were and how far we’ve come.

I’m in a mixed marriage, so we celebrate both Hanukkah and Christmas. Twenty-five years ago I was a newly minted attending neurologist, not even 6 months out of fellowship.

Block_Allan_M_AZ_web.JPG

My wife was pregnant with our first child and had invited my Jewish family over for Christmas dinner. This was our first December in our first house and she wanted to do something special for them.

Being the low person on the totem pole, it was my first Christmas on call, covering for myself and two other neurologists.

So I was driving. A lot. My wife was on her own to get things ready, and I was hoping to be home for dinner.

It was, as always seems to be the case with holidays, quite busy. I was up long before dawn to start, driving a circular route to cover four hospitals scattered around Phoenix. At least the roads were empty.

At some point the planned pattern breaks down as new consults and urgent patient status changes happen. You try to start by going from A to B to C to D for rounds, but within a few hours I was going from A to B to C, then back to A, then D, then B, then A again, and so on. All the while I was returning patient calls. Wash, rinse, repeat.

At some point I dialed my wife to see how she was doing and she gave me a list of last-minute things she needed picked up (which included some dairy products and more Christmas lights for her tree). I found a small store that was still open. For the rest of my day on call a grocery bag full of dairy products was carried from hospital to hospital with me, being put in the doctor’s lounge refrigerator with my name on it (this is Phoenix, even in winter you can’t leave it in the car). This added another trip from C back to A when I realized I’d left the groceries there.

I got home a few minutes before my family came over, after 14-15 hours of driving between hospitals. I was putting up the new lights when they came in. Fortunately I wasn’t called back in that night, and turned things over to my call partners in the morning.

Now? Since early 2020 my hospital days are behind me. My kids have their own lives, jobs, and school, but still all came over to see us.

I didn’t have to leave the house. I spent most of the day in a robe and pajamas, working at my desk on this and that, sometimes wandering to another table to futz with my current jigsaw puzzle or chat with my kids or go soak in my hot tub.

In 1998 I weighed 50 pounds less (still working on losing it), had no kids, or dogs. Now I’m in another house, have three grown kids, and in the interim have enjoyed seven awesome dogs (currently only one). My wife still invited my family over for Christmas dinner, but now it’s my mom and uncle. My dad and aunt are gone.

The changes are mostly good, though, as with all passages of time there is sadness and loss. When all is said and done I wouldn’t have done much differently even if I could.

I’m lucky, and I know it. Regardless of what you celebrate, it’s a good time to take stock of your blessings. To quote Sheryl Crow, “It’s not having what you want, it’s wanting what you’ve got.”

Happy New Year to all.
 

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

Christmas, like New Year’s Day, Thanksgiving, birthdays, and anniversaries, is one of those times that we use to mark where we were and how far we’ve come.

I’m in a mixed marriage, so we celebrate both Hanukkah and Christmas. Twenty-five years ago I was a newly minted attending neurologist, not even 6 months out of fellowship.

Block_Allan_M_AZ_web.JPG

My wife was pregnant with our first child and had invited my Jewish family over for Christmas dinner. This was our first December in our first house and she wanted to do something special for them.

Being the low person on the totem pole, it was my first Christmas on call, covering for myself and two other neurologists.

So I was driving. A lot. My wife was on her own to get things ready, and I was hoping to be home for dinner.

It was, as always seems to be the case with holidays, quite busy. I was up long before dawn to start, driving a circular route to cover four hospitals scattered around Phoenix. At least the roads were empty.

At some point the planned pattern breaks down as new consults and urgent patient status changes happen. You try to start by going from A to B to C to D for rounds, but within a few hours I was going from A to B to C, then back to A, then D, then B, then A again, and so on. All the while I was returning patient calls. Wash, rinse, repeat.

At some point I dialed my wife to see how she was doing and she gave me a list of last-minute things she needed picked up (which included some dairy products and more Christmas lights for her tree). I found a small store that was still open. For the rest of my day on call a grocery bag full of dairy products was carried from hospital to hospital with me, being put in the doctor’s lounge refrigerator with my name on it (this is Phoenix, even in winter you can’t leave it in the car). This added another trip from C back to A when I realized I’d left the groceries there.

I got home a few minutes before my family came over, after 14-15 hours of driving between hospitals. I was putting up the new lights when they came in. Fortunately I wasn’t called back in that night, and turned things over to my call partners in the morning.

Now? Since early 2020 my hospital days are behind me. My kids have their own lives, jobs, and school, but still all came over to see us.

I didn’t have to leave the house. I spent most of the day in a robe and pajamas, working at my desk on this and that, sometimes wandering to another table to futz with my current jigsaw puzzle or chat with my kids or go soak in my hot tub.

In 1998 I weighed 50 pounds less (still working on losing it), had no kids, or dogs. Now I’m in another house, have three grown kids, and in the interim have enjoyed seven awesome dogs (currently only one). My wife still invited my family over for Christmas dinner, but now it’s my mom and uncle. My dad and aunt are gone.

The changes are mostly good, though, as with all passages of time there is sadness and loss. When all is said and done I wouldn’t have done much differently even if I could.

I’m lucky, and I know it. Regardless of what you celebrate, it’s a good time to take stock of your blessings. To quote Sheryl Crow, “It’s not having what you want, it’s wanting what you’ve got.”

Happy New Year to all.
 

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

Christmas, like New Year’s Day, Thanksgiving, birthdays, and anniversaries, is one of those times that we use to mark where we were and how far we’ve come.

I’m in a mixed marriage, so we celebrate both Hanukkah and Christmas. Twenty-five years ago I was a newly minted attending neurologist, not even 6 months out of fellowship.

Block_Allan_M_AZ_web.JPG

My wife was pregnant with our first child and had invited my Jewish family over for Christmas dinner. This was our first December in our first house and she wanted to do something special for them.

Being the low person on the totem pole, it was my first Christmas on call, covering for myself and two other neurologists.

So I was driving. A lot. My wife was on her own to get things ready, and I was hoping to be home for dinner.

It was, as always seems to be the case with holidays, quite busy. I was up long before dawn to start, driving a circular route to cover four hospitals scattered around Phoenix. At least the roads were empty.

At some point the planned pattern breaks down as new consults and urgent patient status changes happen. You try to start by going from A to B to C to D for rounds, but within a few hours I was going from A to B to C, then back to A, then D, then B, then A again, and so on. All the while I was returning patient calls. Wash, rinse, repeat.

At some point I dialed my wife to see how she was doing and she gave me a list of last-minute things she needed picked up (which included some dairy products and more Christmas lights for her tree). I found a small store that was still open. For the rest of my day on call a grocery bag full of dairy products was carried from hospital to hospital with me, being put in the doctor’s lounge refrigerator with my name on it (this is Phoenix, even in winter you can’t leave it in the car). This added another trip from C back to A when I realized I’d left the groceries there.

I got home a few minutes before my family came over, after 14-15 hours of driving between hospitals. I was putting up the new lights when they came in. Fortunately I wasn’t called back in that night, and turned things over to my call partners in the morning.

Now? Since early 2020 my hospital days are behind me. My kids have their own lives, jobs, and school, but still all came over to see us.

I didn’t have to leave the house. I spent most of the day in a robe and pajamas, working at my desk on this and that, sometimes wandering to another table to futz with my current jigsaw puzzle or chat with my kids or go soak in my hot tub.

In 1998 I weighed 50 pounds less (still working on losing it), had no kids, or dogs. Now I’m in another house, have three grown kids, and in the interim have enjoyed seven awesome dogs (currently only one). My wife still invited my family over for Christmas dinner, but now it’s my mom and uncle. My dad and aunt are gone.

The changes are mostly good, though, as with all passages of time there is sadness and loss. When all is said and done I wouldn’t have done much differently even if I could.

I’m lucky, and I know it. Regardless of what you celebrate, it’s a good time to take stock of your blessings. To quote Sheryl Crow, “It’s not having what you want, it’s wanting what you’ve got.”

Happy New Year to all.
 

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

In the last 3 months I’ve had an odd uptick in calls for foot-drop. Some of them said they’d seen other neurologists and were hoping I could help them, others that they wanted to see a specialist in foot-drop. Most called in, a few even showed up at the office wanting to be seen that day.

Now, I have nothing against seeing patients with foot-drop. It’s a relatively common issue in my field. But I’ve never claimed to be a “specialist” in foot-drop. I don’t even do my own EMG/NCVs anymore, except for the occasional carpal tunnel syndrome case.

Block_Allan_M_AZ_web.JPG

So where were all these people coming from?

All of them had previously seen good neurologists, had the correct work-up, diagnoses, and treatment, but just hadn’t had the outcome they wanted. Now they were showing up at my little office, telling my staff that I was their last hope.

All of them had the common thread that they weren’t sent by my regular referral base. Instead, they found me on “the Internet.” Of course, none remembered where. This isn’t easy, as there are hundreds of physician listing and review sites out there. But, because of the number of calls, and the abuse that my staff and I were getting when people found out I wasn’t some magical foot-drop guru, I decided to try to find out.

After a few days of searching in my spare time, I finally had it. A site called MediFind lists me as being “advanced” in treating foot-drop, to the extent that it’s at the top of my “Areas of Expertise.” The site also says I handle “Autosomal Dominant Partial Epilepsy with Auditory Features” (no, I don’t. Try the epilepsy centers in town), “Familial Neurocardiogenic Syncope” (no), and narcolepsy (definitely not, try a sleep specialist).

I have no affiliation with MediFind. In fact, I’d never heard of them until I began tracking down this issue. How they came to have such incorrect information about me I don’t know, perhaps pulled from insurance billing data, or patient reviews, or a Magic 8 Ball.

But the foot-drop issue had, oddly, become a problem. My staff was having to tell people who called in with it that I wanted to see their previous neurology records so I didn’t waste their time. People being told I wasn’t some Ivory Tower foot-dropologist often became abusive and nasty, something I won’t tolerate (5 years ago this was rarely a problem, now it’s frighteningly common). People who made it as far as seeing me (a few when this began) were livid when I looked through their records and said I had nothing to offer that their previous neurologist(s) hadn’t done. I was accused of false advertising, misrepresenting myself, etc, even though I had nothing to do with why MediFind put that up.

So I wrote to MediFind, using the email info on their page. I told them I didn’t specialize in foot-drop, and didn’t even handle several of the other conditions on their page. I asked them to take those things out, or (preferably) simply delete my listing from their site.

I got an automated reply thanking me for writing to them and saying their team would look into it. That was almost a month ago. I haven’t heard back, and the listing is, as of this writing, still up.

Like the “once in, never out” issue with a wrong diagnosis in the EMR, erroneous professional information on the Internet probably isn’t going to go away. The computer algorithms that create such listings have no interest in correcting their errors, and so the frustration for these patients, my staff, and myself, is going to continue for a while. It’s a waste of time for them and us.

And, as this point, I doubt there’s much I can do about it.
 

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

In the last 3 months I’ve had an odd uptick in calls for foot-drop. Some of them said they’d seen other neurologists and were hoping I could help them, others that they wanted to see a specialist in foot-drop. Most called in, a few even showed up at the office wanting to be seen that day.

Now, I have nothing against seeing patients with foot-drop. It’s a relatively common issue in my field. But I’ve never claimed to be a “specialist” in foot-drop. I don’t even do my own EMG/NCVs anymore, except for the occasional carpal tunnel syndrome case.

Block_Allan_M_AZ_web.JPG

So where were all these people coming from?

All of them had previously seen good neurologists, had the correct work-up, diagnoses, and treatment, but just hadn’t had the outcome they wanted. Now they were showing up at my little office, telling my staff that I was their last hope.

All of them had the common thread that they weren’t sent by my regular referral base. Instead, they found me on “the Internet.” Of course, none remembered where. This isn’t easy, as there are hundreds of physician listing and review sites out there. But, because of the number of calls, and the abuse that my staff and I were getting when people found out I wasn’t some magical foot-drop guru, I decided to try to find out.

After a few days of searching in my spare time, I finally had it. A site called MediFind lists me as being “advanced” in treating foot-drop, to the extent that it’s at the top of my “Areas of Expertise.” The site also says I handle “Autosomal Dominant Partial Epilepsy with Auditory Features” (no, I don’t. Try the epilepsy centers in town), “Familial Neurocardiogenic Syncope” (no), and narcolepsy (definitely not, try a sleep specialist).

I have no affiliation with MediFind. In fact, I’d never heard of them until I began tracking down this issue. How they came to have such incorrect information about me I don’t know, perhaps pulled from insurance billing data, or patient reviews, or a Magic 8 Ball.

But the foot-drop issue had, oddly, become a problem. My staff was having to tell people who called in with it that I wanted to see their previous neurology records so I didn’t waste their time. People being told I wasn’t some Ivory Tower foot-dropologist often became abusive and nasty, something I won’t tolerate (5 years ago this was rarely a problem, now it’s frighteningly common). People who made it as far as seeing me (a few when this began) were livid when I looked through their records and said I had nothing to offer that their previous neurologist(s) hadn’t done. I was accused of false advertising, misrepresenting myself, etc, even though I had nothing to do with why MediFind put that up.

So I wrote to MediFind, using the email info on their page. I told them I didn’t specialize in foot-drop, and didn’t even handle several of the other conditions on their page. I asked them to take those things out, or (preferably) simply delete my listing from their site.

I got an automated reply thanking me for writing to them and saying their team would look into it. That was almost a month ago. I haven’t heard back, and the listing is, as of this writing, still up.

Like the “once in, never out” issue with a wrong diagnosis in the EMR, erroneous professional information on the Internet probably isn’t going to go away. The computer algorithms that create such listings have no interest in correcting their errors, and so the frustration for these patients, my staff, and myself, is going to continue for a while. It’s a waste of time for them and us.

And, as this point, I doubt there’s much I can do about it.
 

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

In the last 3 months I’ve had an odd uptick in calls for foot-drop. Some of them said they’d seen other neurologists and were hoping I could help them, others that they wanted to see a specialist in foot-drop. Most called in, a few even showed up at the office wanting to be seen that day.

Now, I have nothing against seeing patients with foot-drop. It’s a relatively common issue in my field. But I’ve never claimed to be a “specialist” in foot-drop. I don’t even do my own EMG/NCVs anymore, except for the occasional carpal tunnel syndrome case.

Block_Allan_M_AZ_web.JPG

So where were all these people coming from?

All of them had previously seen good neurologists, had the correct work-up, diagnoses, and treatment, but just hadn’t had the outcome they wanted. Now they were showing up at my little office, telling my staff that I was their last hope.

All of them had the common thread that they weren’t sent by my regular referral base. Instead, they found me on “the Internet.” Of course, none remembered where. This isn’t easy, as there are hundreds of physician listing and review sites out there. But, because of the number of calls, and the abuse that my staff and I were getting when people found out I wasn’t some magical foot-drop guru, I decided to try to find out.

After a few days of searching in my spare time, I finally had it. A site called MediFind lists me as being “advanced” in treating foot-drop, to the extent that it’s at the top of my “Areas of Expertise.” The site also says I handle “Autosomal Dominant Partial Epilepsy with Auditory Features” (no, I don’t. Try the epilepsy centers in town), “Familial Neurocardiogenic Syncope” (no), and narcolepsy (definitely not, try a sleep specialist).

I have no affiliation with MediFind. In fact, I’d never heard of them until I began tracking down this issue. How they came to have such incorrect information about me I don’t know, perhaps pulled from insurance billing data, or patient reviews, or a Magic 8 Ball.

But the foot-drop issue had, oddly, become a problem. My staff was having to tell people who called in with it that I wanted to see their previous neurology records so I didn’t waste their time. People being told I wasn’t some Ivory Tower foot-dropologist often became abusive and nasty, something I won’t tolerate (5 years ago this was rarely a problem, now it’s frighteningly common). People who made it as far as seeing me (a few when this began) were livid when I looked through their records and said I had nothing to offer that their previous neurologist(s) hadn’t done. I was accused of false advertising, misrepresenting myself, etc, even though I had nothing to do with why MediFind put that up.

So I wrote to MediFind, using the email info on their page. I told them I didn’t specialize in foot-drop, and didn’t even handle several of the other conditions on their page. I asked them to take those things out, or (preferably) simply delete my listing from their site.

I got an automated reply thanking me for writing to them and saying their team would look into it. That was almost a month ago. I haven’t heard back, and the listing is, as of this writing, still up.

Like the “once in, never out” issue with a wrong diagnosis in the EMR, erroneous professional information on the Internet probably isn’t going to go away. The computer algorithms that create such listings have no interest in correcting their errors, and so the frustration for these patients, my staff, and myself, is going to continue for a while. It’s a waste of time for them and us.

And, as this point, I doubt there’s much I can do about it.
 

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

I don’t like EMR systems, with all their requirements, click boxes, endless cut & paste abuse, and 20-page notes that say nothing.

But I am a fan of what computers have brought to medical charts.

When I started out in 2000, I had no patients, hence no charts. I had the advantage of being able to start from scratch — there was nothing to convert to digital. So, from the beginning, that’s how I went. Back then, of course, everything came to the office as paper. It had to be scanned in, then named, then placed in the right computer file.

Block_Allan_M_AZ_web.JPG

But it was still easier than amassing paper records. At that time I subleased from a doc who’d been in practice for 15 years. His charts were all paper. Charts were neatly filed on shelves, everything was initialed, hole-punched, and put in the right section (which involved pulling out other stuff and putting it back). A few times a year, his staff would comb through the charts in front, and anyone who hadn’t been seen in 2 years would have their chart moved to a storage room in the back. Once a year they’d pull the charts of anyone not seen in 7 years and a company would come in and shred those records.

After 23 years, I still have it all. The whole thing takes up a little over 50 gigabytes on a hard drive, which realistically is nothing these days. Electrons don’t take up much space.

The majority of the charts — those that are more than 7 years old — I’ll probably never need to access, but it still happens sometimes. People call in and say they’ve moved back to Phoenix, or need to see a neurologist again, or need the records for insurance reasons, or whatever. My staff is also spared from moving charts to a storage room, then to shredding. Since they don’t take up any physical space, it’s no effort to keep everything.

And they aren’t just at my office. They’re at home, on my phone, wherever I am. If I get called from an ER, I can pull them up quickly. If I travel, they’re with me. My memory is good, but not that good, and I’d rather be able to look things up than guess.

This, at least to me, is the advantage of computers. Their data storage and retrieval advantages far exceed that of paper. In my opinion EMRs, while well-intentioned, have taken these benefits and twisted them into something cumbersome, geared more to meet nonmedical requirements and billing purposes.

In the process they’ve lost sight of our age-old job of caring for patients.

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

I don’t like EMR systems, with all their requirements, click boxes, endless cut & paste abuse, and 20-page notes that say nothing.

But I am a fan of what computers have brought to medical charts.

When I started out in 2000, I had no patients, hence no charts. I had the advantage of being able to start from scratch — there was nothing to convert to digital. So, from the beginning, that’s how I went. Back then, of course, everything came to the office as paper. It had to be scanned in, then named, then placed in the right computer file.

Block_Allan_M_AZ_web.JPG

But it was still easier than amassing paper records. At that time I subleased from a doc who’d been in practice for 15 years. His charts were all paper. Charts were neatly filed on shelves, everything was initialed, hole-punched, and put in the right section (which involved pulling out other stuff and putting it back). A few times a year, his staff would comb through the charts in front, and anyone who hadn’t been seen in 2 years would have their chart moved to a storage room in the back. Once a year they’d pull the charts of anyone not seen in 7 years and a company would come in and shred those records.

After 23 years, I still have it all. The whole thing takes up a little over 50 gigabytes on a hard drive, which realistically is nothing these days. Electrons don’t take up much space.

The majority of the charts — those that are more than 7 years old — I’ll probably never need to access, but it still happens sometimes. People call in and say they’ve moved back to Phoenix, or need to see a neurologist again, or need the records for insurance reasons, or whatever. My staff is also spared from moving charts to a storage room, then to shredding. Since they don’t take up any physical space, it’s no effort to keep everything.

And they aren’t just at my office. They’re at home, on my phone, wherever I am. If I get called from an ER, I can pull them up quickly. If I travel, they’re with me. My memory is good, but not that good, and I’d rather be able to look things up than guess.

This, at least to me, is the advantage of computers. Their data storage and retrieval advantages far exceed that of paper. In my opinion EMRs, while well-intentioned, have taken these benefits and twisted them into something cumbersome, geared more to meet nonmedical requirements and billing purposes.

In the process they’ve lost sight of our age-old job of caring for patients.

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

I don’t like EMR systems, with all their requirements, click boxes, endless cut & paste abuse, and 20-page notes that say nothing.

But I am a fan of what computers have brought to medical charts.

When I started out in 2000, I had no patients, hence no charts. I had the advantage of being able to start from scratch — there was nothing to convert to digital. So, from the beginning, that’s how I went. Back then, of course, everything came to the office as paper. It had to be scanned in, then named, then placed in the right computer file.

Block_Allan_M_AZ_web.JPG

But it was still easier than amassing paper records. At that time I subleased from a doc who’d been in practice for 15 years. His charts were all paper. Charts were neatly filed on shelves, everything was initialed, hole-punched, and put in the right section (which involved pulling out other stuff and putting it back). A few times a year, his staff would comb through the charts in front, and anyone who hadn’t been seen in 2 years would have their chart moved to a storage room in the back. Once a year they’d pull the charts of anyone not seen in 7 years and a company would come in and shred those records.

After 23 years, I still have it all. The whole thing takes up a little over 50 gigabytes on a hard drive, which realistically is nothing these days. Electrons don’t take up much space.

The majority of the charts — those that are more than 7 years old — I’ll probably never need to access, but it still happens sometimes. People call in and say they’ve moved back to Phoenix, or need to see a neurologist again, or need the records for insurance reasons, or whatever. My staff is also spared from moving charts to a storage room, then to shredding. Since they don’t take up any physical space, it’s no effort to keep everything.

And they aren’t just at my office. They’re at home, on my phone, wherever I am. If I get called from an ER, I can pull them up quickly. If I travel, they’re with me. My memory is good, but not that good, and I’d rather be able to look things up than guess.

This, at least to me, is the advantage of computers. Their data storage and retrieval advantages far exceed that of paper. In my opinion EMRs, while well-intentioned, have taken these benefits and twisted them into something cumbersome, geared more to meet nonmedical requirements and billing purposes.

In the process they’ve lost sight of our age-old job of caring for patients.

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

I’m a general neurologist. I consider myself a jack of all (or at least most) trades in my field, and a master of none.

In the April 2023 issue of JAMA Neurology there was an editorial about neurology training, with general neurology being renamed “comprehensive neurology” and a fellowship offered in practicing general neurology.

This seems rather silly to me. If 4 years of residency (1 of internship and 3 of neurology) don’t prepare you to practice general neurology, then what’s the point of residency at all? For that matter, what difference will renaming it do?

Block_Allan_M_AZ_web.JPG

Imagine completing a 3-year internal medicine residency, then being told you need to do a fellowship in “comprehensive medicine” in order to practice. Or at least so you can add the word “comprehensive” to your shingle.

The authors bemoan the increasing number of neurology residents wanting to do fellowships and subspecialize, a situation that mirrors the general trend of people away from general medicine toward specialties.

While I agree we do need subspecialists in neurology (and currently there are at least 31 recognized, which is way more than I would have guessed), the fact is that patients, and sometimes their internists, aren’t going to be the best judge of who does or doesn’t need to see one, compared with a general neurologist.

Most of us general people can handle straightforward Parkinson’s disease, epilepsy, migraines, etc. Certainly, there are times where the condition is refractory to our care, or there’s something unusual about the case, that leads us to refer them to someone with more expertise. But isn’t that how it’s supposed to work? Like medicine in general, we need more general people than subspecialists.

Honestly, I can’t claim to be any different. Twenty-six years ago, when I finished residency, I did a clinical neurophysiology fellowship. From a practical view it was an epilepsy fellowship at my program. Some of this was an interest at the time in subspecializing, some of it was me putting off joining the “real world” of having to find a job for a year.

When I hung up my own shingle, my business card listed a subspecialty in epilepsy. Looking back years later, this wasn’t the best move. In solo practice I had no access to an epilepsy monitoring unit, vagus nerve stimulation capabilities, or epilepsy surgery at the hospital I rounded at. Not only that, I discovered it put me at a disadvantage, as internists were referring only epilepsy patients to me, and all the other stuff (which is the majority of patients) to the general (or comprehensive) neurologists around me. Which, financially, wasn’t a good thing when you’re young and starting out.

Not only that, but I discovered that I didn’t like only seeing one thing. I found it boring, and not for me.

So after a year or so, I took the word “epilepsy” off my card, left it at “general neurology,” and sent out letters reminding my referral base that I was willing to see the majority of things in my field (rare diseases, even today, I won’t attempt to handle).

So now my days are a mix of things, which I like. Neurology is enough of a specialty for me without going further up the pyramid. Having sub (and even sub-sub) specialists is important to maintain medical excellence, but we still need people willing to do general neurology, and I’m happy there.

Changing my title to “comprehensive” is unnecessary. I’m happy with what I am.

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

I’m a general neurologist. I consider myself a jack of all (or at least most) trades in my field, and a master of none.

In the April 2023 issue of JAMA Neurology there was an editorial about neurology training, with general neurology being renamed “comprehensive neurology” and a fellowship offered in practicing general neurology.

This seems rather silly to me. If 4 years of residency (1 of internship and 3 of neurology) don’t prepare you to practice general neurology, then what’s the point of residency at all? For that matter, what difference will renaming it do?

Block_Allan_M_AZ_web.JPG

Imagine completing a 3-year internal medicine residency, then being told you need to do a fellowship in “comprehensive medicine” in order to practice. Or at least so you can add the word “comprehensive” to your shingle.

The authors bemoan the increasing number of neurology residents wanting to do fellowships and subspecialize, a situation that mirrors the general trend of people away from general medicine toward specialties.

While I agree we do need subspecialists in neurology (and currently there are at least 31 recognized, which is way more than I would have guessed), the fact is that patients, and sometimes their internists, aren’t going to be the best judge of who does or doesn’t need to see one, compared with a general neurologist.

Most of us general people can handle straightforward Parkinson’s disease, epilepsy, migraines, etc. Certainly, there are times where the condition is refractory to our care, or there’s something unusual about the case, that leads us to refer them to someone with more expertise. But isn’t that how it’s supposed to work? Like medicine in general, we need more general people than subspecialists.

Honestly, I can’t claim to be any different. Twenty-six years ago, when I finished residency, I did a clinical neurophysiology fellowship. From a practical view it was an epilepsy fellowship at my program. Some of this was an interest at the time in subspecializing, some of it was me putting off joining the “real world” of having to find a job for a year.

When I hung up my own shingle, my business card listed a subspecialty in epilepsy. Looking back years later, this wasn’t the best move. In solo practice I had no access to an epilepsy monitoring unit, vagus nerve stimulation capabilities, or epilepsy surgery at the hospital I rounded at. Not only that, I discovered it put me at a disadvantage, as internists were referring only epilepsy patients to me, and all the other stuff (which is the majority of patients) to the general (or comprehensive) neurologists around me. Which, financially, wasn’t a good thing when you’re young and starting out.

Not only that, but I discovered that I didn’t like only seeing one thing. I found it boring, and not for me.

So after a year or so, I took the word “epilepsy” off my card, left it at “general neurology,” and sent out letters reminding my referral base that I was willing to see the majority of things in my field (rare diseases, even today, I won’t attempt to handle).

So now my days are a mix of things, which I like. Neurology is enough of a specialty for me without going further up the pyramid. Having sub (and even sub-sub) specialists is important to maintain medical excellence, but we still need people willing to do general neurology, and I’m happy there.

Changing my title to “comprehensive” is unnecessary. I’m happy with what I am.

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

I’m a general neurologist. I consider myself a jack of all (or at least most) trades in my field, and a master of none.

In the April 2023 issue of JAMA Neurology there was an editorial about neurology training, with general neurology being renamed “comprehensive neurology” and a fellowship offered in practicing general neurology.

This seems rather silly to me. If 4 years of residency (1 of internship and 3 of neurology) don’t prepare you to practice general neurology, then what’s the point of residency at all? For that matter, what difference will renaming it do?

Block_Allan_M_AZ_web.JPG

Imagine completing a 3-year internal medicine residency, then being told you need to do a fellowship in “comprehensive medicine” in order to practice. Or at least so you can add the word “comprehensive” to your shingle.

The authors bemoan the increasing number of neurology residents wanting to do fellowships and subspecialize, a situation that mirrors the general trend of people away from general medicine toward specialties.

While I agree we do need subspecialists in neurology (and currently there are at least 31 recognized, which is way more than I would have guessed), the fact is that patients, and sometimes their internists, aren’t going to be the best judge of who does or doesn’t need to see one, compared with a general neurologist.

Most of us general people can handle straightforward Parkinson’s disease, epilepsy, migraines, etc. Certainly, there are times where the condition is refractory to our care, or there’s something unusual about the case, that leads us to refer them to someone with more expertise. But isn’t that how it’s supposed to work? Like medicine in general, we need more general people than subspecialists.

Honestly, I can’t claim to be any different. Twenty-six years ago, when I finished residency, I did a clinical neurophysiology fellowship. From a practical view it was an epilepsy fellowship at my program. Some of this was an interest at the time in subspecializing, some of it was me putting off joining the “real world” of having to find a job for a year.

When I hung up my own shingle, my business card listed a subspecialty in epilepsy. Looking back years later, this wasn’t the best move. In solo practice I had no access to an epilepsy monitoring unit, vagus nerve stimulation capabilities, or epilepsy surgery at the hospital I rounded at. Not only that, I discovered it put me at a disadvantage, as internists were referring only epilepsy patients to me, and all the other stuff (which is the majority of patients) to the general (or comprehensive) neurologists around me. Which, financially, wasn’t a good thing when you’re young and starting out.

Not only that, but I discovered that I didn’t like only seeing one thing. I found it boring, and not for me.

So after a year or so, I took the word “epilepsy” off my card, left it at “general neurology,” and sent out letters reminding my referral base that I was willing to see the majority of things in my field (rare diseases, even today, I won’t attempt to handle).

So now my days are a mix of things, which I like. Neurology is enough of a specialty for me without going further up the pyramid. Having sub (and even sub-sub) specialists is important to maintain medical excellence, but we still need people willing to do general neurology, and I’m happy there.

Changing my title to “comprehensive” is unnecessary. I’m happy with what I am.

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

In one of my favorite fall rituals, I fired up my hot tub. In Phoenix the months for relaxing in one are limited, so I try to enjoy it when I can.

It’s a routine I know well. Remove the coverings it’s been hiding under for the 8-month Phoenix summer. Clean out the dust, dead bugs, leaves. Connect the pipes and hoses, tighten the clamps, and begin filling it with water. A pinch of water softener, a dash of chlorine, plug in the motor, and stir.

Block_Allan_M_AZ_web.JPG

After a few minutes of running, however, I noticed water starting to come out from under the motor unit. That ain’t good. I checked the fittings to make sure everything was in place and tight. They were. So the problem was somewhere inside the motor.

I unplugged the hot tub and went to my computer. Using the ever-popular Google, I looked at diagrams of motor plumbing and wiring, then watched several DIY videos on YouTube.

After about an hour of this I got some screwdrivers, went back out to the hot tub, stared at it for a few minutes ... then I realized I was out of my league and called a repair service.

Part of life is accepting what you can and can’t do.

I’m a neurologist. I hope I’m a decent one. But I’m not a hot tub mechanic anymore than I am a neurosurgeon. Or, as Bones McCoy would have said, “Dammit, Jim, I’m a doctor, not a spa repairman.” Either way, I was out of my league and I knew it. My taking the motor apart – while certainly feasible – was more likely to make things worse.

Unfortunately, not everyone feels the same way. Although I spent quite a few years learning to be a neurologist, it’s amazing how many people feel that, after a similar time on Google, they’re qualified to diagnose and treat neurological (or any medical) conditions. They know what they have, what tests need to be done, and which medications should be prescribed. They only need me to rubber stamp their plan, since their insurance won’t take orders from them. (They often won’t take orders from me, either, but that’s another matter).

While occasionally they’re correct, most of the time I have to politely explain why I disagree with them, or why other possibilities have to be considered and treated. No one is forcing them to follow my plan, but if they aren’t happy with it, they’ll have to find another neurologist. I have to go with my education and experience over theirs. I mean, this is my job. I’ve been doing it for more than 25 years.

I’m sure if the hot tub mechanic showed up and I told him where and how to fix the problem he’d wonder what my qualifications were. I may be right, but I may be crazy (or at least wrong).

Unlike medicine, there’s nothing to keep me from trying to fix the hot tub myself, except my own awareness that I have no practical idea how to do so.

I try my best not to practice outside of my field. Google isn’t going to make me a cardiologist any more than it will let me fix hot tubs.

I’m all for knowledge, but it also has its limits. Why some patients think the Internet is a good substitute for 9 years of education and 25 years of ongoing experience, I have no idea.

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

In one of my favorite fall rituals, I fired up my hot tub. In Phoenix the months for relaxing in one are limited, so I try to enjoy it when I can.

It’s a routine I know well. Remove the coverings it’s been hiding under for the 8-month Phoenix summer. Clean out the dust, dead bugs, leaves. Connect the pipes and hoses, tighten the clamps, and begin filling it with water. A pinch of water softener, a dash of chlorine, plug in the motor, and stir.

Block_Allan_M_AZ_web.JPG

After a few minutes of running, however, I noticed water starting to come out from under the motor unit. That ain’t good. I checked the fittings to make sure everything was in place and tight. They were. So the problem was somewhere inside the motor.

I unplugged the hot tub and went to my computer. Using the ever-popular Google, I looked at diagrams of motor plumbing and wiring, then watched several DIY videos on YouTube.

After about an hour of this I got some screwdrivers, went back out to the hot tub, stared at it for a few minutes ... then I realized I was out of my league and called a repair service.

Part of life is accepting what you can and can’t do.

I’m a neurologist. I hope I’m a decent one. But I’m not a hot tub mechanic anymore than I am a neurosurgeon. Or, as Bones McCoy would have said, “Dammit, Jim, I’m a doctor, not a spa repairman.” Either way, I was out of my league and I knew it. My taking the motor apart – while certainly feasible – was more likely to make things worse.

Unfortunately, not everyone feels the same way. Although I spent quite a few years learning to be a neurologist, it’s amazing how many people feel that, after a similar time on Google, they’re qualified to diagnose and treat neurological (or any medical) conditions. They know what they have, what tests need to be done, and which medications should be prescribed. They only need me to rubber stamp their plan, since their insurance won’t take orders from them. (They often won’t take orders from me, either, but that’s another matter).

While occasionally they’re correct, most of the time I have to politely explain why I disagree with them, or why other possibilities have to be considered and treated. No one is forcing them to follow my plan, but if they aren’t happy with it, they’ll have to find another neurologist. I have to go with my education and experience over theirs. I mean, this is my job. I’ve been doing it for more than 25 years.

I’m sure if the hot tub mechanic showed up and I told him where and how to fix the problem he’d wonder what my qualifications were. I may be right, but I may be crazy (or at least wrong).

Unlike medicine, there’s nothing to keep me from trying to fix the hot tub myself, except my own awareness that I have no practical idea how to do so.

I try my best not to practice outside of my field. Google isn’t going to make me a cardiologist any more than it will let me fix hot tubs.

I’m all for knowledge, but it also has its limits. Why some patients think the Internet is a good substitute for 9 years of education and 25 years of ongoing experience, I have no idea.

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

In one of my favorite fall rituals, I fired up my hot tub. In Phoenix the months for relaxing in one are limited, so I try to enjoy it when I can.

It’s a routine I know well. Remove the coverings it’s been hiding under for the 8-month Phoenix summer. Clean out the dust, dead bugs, leaves. Connect the pipes and hoses, tighten the clamps, and begin filling it with water. A pinch of water softener, a dash of chlorine, plug in the motor, and stir.

After a few minutes of running, however, I noticed water starting to come out from under the motor unit. That ain’t good. I checked the fittings to make sure everything was in place and tight. They were. So the problem was somewhere inside the motor.

I unplugged the hot tub and went to my computer. Using the ever-popular Google, I looked at diagrams of motor plumbing and wiring, then watched several DIY videos on YouTube.

After about an hour of this I got some screwdrivers, went back out to the hot tub, stared at it for a few minutes ... then I realized I was out of my league and called a repair service.

Part of life is accepting what you can and can’t do.

I’m a neurologist. I hope I’m a decent one. But I’m not a hot tub mechanic anymore than I am a neurosurgeon. Or, as Bones McCoy would have said, “Dammit, Jim, I’m a doctor, not a spa repairman.” Either way, I was out of my league and I knew it. My taking the motor apart – while certainly feasible – was more likely to make things worse.

Unfortunately, not everyone feels the same way. Although I spent quite a few years learning to be a neurologist, it’s amazing how many people feel that, after a similar time on Google, they’re qualified to diagnose and treat neurological (or any medical) conditions. They know what they have, what tests need to be done, and which medications should be prescribed. They only need me to rubber stamp their plan, since their insurance won’t take orders from them. (They often won’t take orders from me, either, but that’s another matter).

While occasionally they’re correct, most of the time I have to politely explain why I disagree with them, or why other possibilities have to be considered and treated. No one is forcing them to follow my plan, but if they aren’t happy with it, they’ll have to find another neurologist. I have to go with my education and experience over theirs. I mean, this is my job. I’ve been doing it for more than 25 years.

I’m sure if the hot tub mechanic showed up and I told him where and how to fix the problem he’d wonder what my qualifications were. I may be right, but I may be crazy (or at least wrong).

Unlike medicine, there’s nothing to keep me from trying to fix the hot tub myself, except my own awareness that I have no practical idea how to do so.

I try my best not to practice outside of my field. Google isn’t going to make me a cardiologist any more than it will let me fix hot tubs.

I’m all for knowledge, but it also has its limits. Why some patients think the Internet is a good substitute for 9 years of education and 25 years of ongoing experience, I have no idea.

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

I am not a marketing person. I never will be. I don’t think like one.

A current article on FiercePharma talked about Boehringer Ingelheim’s recent “rebranding,” which involved (among other things) changing the blues in its logo and ads to greens.

Maybe someone else out there would notice that change, but I wouldn’t have if I hadn’t read about it. Nor am I sure what affect it would have on me, if any. But I’m sure they paid psychologists and marketing teams quite a bit to make sure it was a good idea.

Likewise, when AbbVie repackaged Ubrelvy from 10 to a package to 16, the company felt the need to change the design of the sample boxes (which are also now green). I’m pretty sure none of my patients noticed. The only reason I did is because I’m the one who stocks my sample shelf here.

Abbvie and Boehringer aren’t alone in this, of course. Pharmaceutical marketing is big business. I understand the companies want doctors and patients to know about their products. In that respect they’re no different from General Motors or Kellogg’s.

But pharmaceuticals fall into a different area. Kellogg’s products don’t require a middleman handing you a script allowing you to buy corn flakes, so although the products are sold to the public, they also have to be sold to a person who isn’t buying them – the prescriber.

Not all these ads are bad, of course. At best they raise public awareness of different health conditions and the options to treat them. At worst ... well, currently there are several movies out there about the results of marketing done by the Sackler family and Purdue.

To me, most pharmaceutical ads look the same. They show happy people going about their lives, with the impression being that they couldn’t have done this without the benefit of the drug being marketed.

To a large extent I can’t knock that. Pharmaceuticals are amazing things. They’ve contributed dramatically to human health, life quality, and longevity.

But would I, or most people, notice if the lettering in the ads were blue, green, or yellow? Probably not. Someone with a background in the psychology of marketing would be able to show me data on how different colors affect our perceptions, but I still look at this and wonder if the money could have been better spent.

Maybe that’s why I’m not in marketing. I tend to be on the practical side. The idea of hiring a celebrity to endorse a migraine (or pretty much any) medication would never have occurred to me. I have no idea how much Pfizer paid Lady Gaga to sell Nurtec, but I’m pretty sure it’s a lot more than I’ll earn this year. Probably ever.

Like most neurologists I’m hopelessly left-brained. But I still wonder how much things like this really make a difference.

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

I am not a marketing person. I never will be. I don’t think like one.

A current article on FiercePharma talked about Boehringer Ingelheim’s recent “rebranding,” which involved (among other things) changing the blues in its logo and ads to greens.

Maybe someone else out there would notice that change, but I wouldn’t have if I hadn’t read about it. Nor am I sure what affect it would have on me, if any. But I’m sure they paid psychologists and marketing teams quite a bit to make sure it was a good idea.

Likewise, when AbbVie repackaged Ubrelvy from 10 to a package to 16, the company felt the need to change the design of the sample boxes (which are also now green). I’m pretty sure none of my patients noticed. The only reason I did is because I’m the one who stocks my sample shelf here.

Abbvie and Boehringer aren’t alone in this, of course. Pharmaceutical marketing is big business. I understand the companies want doctors and patients to know about their products. In that respect they’re no different from General Motors or Kellogg’s.

But pharmaceuticals fall into a different area. Kellogg’s products don’t require a middleman handing you a script allowing you to buy corn flakes, so although the products are sold to the public, they also have to be sold to a person who isn’t buying them – the prescriber.

Not all these ads are bad, of course. At best they raise public awareness of different health conditions and the options to treat them. At worst ... well, currently there are several movies out there about the results of marketing done by the Sackler family and Purdue.

To me, most pharmaceutical ads look the same. They show happy people going about their lives, with the impression being that they couldn’t have done this without the benefit of the drug being marketed.

To a large extent I can’t knock that. Pharmaceuticals are amazing things. They’ve contributed dramatically to human health, life quality, and longevity.

But would I, or most people, notice if the lettering in the ads were blue, green, or yellow? Probably not. Someone with a background in the psychology of marketing would be able to show me data on how different colors affect our perceptions, but I still look at this and wonder if the money could have been better spent.

Maybe that’s why I’m not in marketing. I tend to be on the practical side. The idea of hiring a celebrity to endorse a migraine (or pretty much any) medication would never have occurred to me. I have no idea how much Pfizer paid Lady Gaga to sell Nurtec, but I’m pretty sure it’s a lot more than I’ll earn this year. Probably ever.

Like most neurologists I’m hopelessly left-brained. But I still wonder how much things like this really make a difference.

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

I am not a marketing person. I never will be. I don’t think like one.

A current article on FiercePharma talked about Boehringer Ingelheim’s recent “rebranding,” which involved (among other things) changing the blues in its logo and ads to greens.

Maybe someone else out there would notice that change, but I wouldn’t have if I hadn’t read about it. Nor am I sure what affect it would have on me, if any. But I’m sure they paid psychologists and marketing teams quite a bit to make sure it was a good idea.

Likewise, when AbbVie repackaged Ubrelvy from 10 to a package to 16, the company felt the need to change the design of the sample boxes (which are also now green). I’m pretty sure none of my patients noticed. The only reason I did is because I’m the one who stocks my sample shelf here.

Abbvie and Boehringer aren’t alone in this, of course. Pharmaceutical marketing is big business. I understand the companies want doctors and patients to know about their products. In that respect they’re no different from General Motors or Kellogg’s.

But pharmaceuticals fall into a different area. Kellogg’s products don’t require a middleman handing you a script allowing you to buy corn flakes, so although the products are sold to the public, they also have to be sold to a person who isn’t buying them – the prescriber.

Not all these ads are bad, of course. At best they raise public awareness of different health conditions and the options to treat them. At worst ... well, currently there are several movies out there about the results of marketing done by the Sackler family and Purdue.

To me, most pharmaceutical ads look the same. They show happy people going about their lives, with the impression being that they couldn’t have done this without the benefit of the drug being marketed.

To a large extent I can’t knock that. Pharmaceuticals are amazing things. They’ve contributed dramatically to human health, life quality, and longevity.

But would I, or most people, notice if the lettering in the ads were blue, green, or yellow? Probably not. Someone with a background in the psychology of marketing would be able to show me data on how different colors affect our perceptions, but I still look at this and wonder if the money could have been better spent.

Maybe that’s why I’m not in marketing. I tend to be on the practical side. The idea of hiring a celebrity to endorse a migraine (or pretty much any) medication would never have occurred to me. I have no idea how much Pfizer paid Lady Gaga to sell Nurtec, but I’m pretty sure it’s a lot more than I’ll earn this year. Probably ever.

Like most neurologists I’m hopelessly left-brained. But I still wonder how much things like this really make a difference.

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

As I noted in my last column, I recently had a generic cold.

One of the more irritating aspects is that I usually get a cough that lasts a few weeks afterwards, and, like most people, I try to do something about it. So I load up on various over-the-counter remedies.

I have no idea if they work, or if I’m shelling out for a placebo. I’m not alone in buying these, or they wouldn’t be on the market, or making money, at all.

But the placebo effect is pretty strong. Phenylephrine has been around since 1938. It’s sold on its own and is an ingredient in almost every anti-cough/cold combination medication out there (NyQuil, DayQuil, Robitussin Multi-Symptom, and their many generic store brands). Millions of people use it every year.

Yet, after sifting through piles of accumulated data, the Food and Drug Administration announced earlier this year that phenylephrine ... doesn’t do anything. Zip. Zero. Nada. When compared with a placebo in controlled trials, you couldn’t tell the difference between them. So now the use of it is being questioned. CVS has started pulling it off their shelves, and I suspect other pharmacies will follow.

But back to my cough. A time-honored tradition in American childhood is having to cram down Robitussin and gagging from its nasty taste (the cherry and orange flavoring don’t make a difference, it tastes terrible no matter what you do). So that gets ingrained into us, and to this day I, and most adults, reach for a bottle of dextromethorphan when they have a cough.

But the evidence for that is spotty, too. Several studies have shown equivocal, if any, evidence to suggest it helps with coughs, though others have shown some. Nothing really amazing though.

But we still buy it by the gallon when we’re sick, because we want something, anything, that will make us better. Even if we’re doing so more from hope than conviction.

There’s also the old standby of cough drops, which have been used for more than 3,000 years. Ingredients vary, but menthol is probably the most common one. I go through those, too. I keep a bag in my desk at work. In medical school, during cold season, it was in my backpack. I remember sitting in the Creighton library to study, quietly sucking on a lozenge to keep my cough from disturbing other students.

But even then, the evidence is iffy as to whether they do anything. In fact, one interesting (though small) study in 2018 suggested they may actually prolong coughs.

The fact is that we are all susceptible to the placebo effect, regardless of how much we know about illness and medication. Maybe these things work, maybe they don’t, but it’s a valid question. How often do we let wishful thinking beat objective data?

Probably more often than we want to admit.

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

As I noted in my last column, I recently had a generic cold.

One of the more irritating aspects is that I usually get a cough that lasts a few weeks afterwards, and, like most people, I try to do something about it. So I load up on various over-the-counter remedies.

I have no idea if they work, or if I’m shelling out for a placebo. I’m not alone in buying these, or they wouldn’t be on the market, or making money, at all.

But the placebo effect is pretty strong. Phenylephrine has been around since 1938. It’s sold on its own and is an ingredient in almost every anti-cough/cold combination medication out there (NyQuil, DayQuil, Robitussin Multi-Symptom, and their many generic store brands). Millions of people use it every year.

Yet, after sifting through piles of accumulated data, the Food and Drug Administration announced earlier this year that phenylephrine ... doesn’t do anything. Zip. Zero. Nada. When compared with a placebo in controlled trials, you couldn’t tell the difference between them. So now the use of it is being questioned. CVS has started pulling it off their shelves, and I suspect other pharmacies will follow.

But back to my cough. A time-honored tradition in American childhood is having to cram down Robitussin and gagging from its nasty taste (the cherry and orange flavoring don’t make a difference, it tastes terrible no matter what you do). So that gets ingrained into us, and to this day I, and most adults, reach for a bottle of dextromethorphan when they have a cough.

But the evidence for that is spotty, too. Several studies have shown equivocal, if any, evidence to suggest it helps with coughs, though others have shown some. Nothing really amazing though.

But we still buy it by the gallon when we’re sick, because we want something, anything, that will make us better. Even if we’re doing so more from hope than conviction.

There’s also the old standby of cough drops, which have been used for more than 3,000 years. Ingredients vary, but menthol is probably the most common one. I go through those, too. I keep a bag in my desk at work. In medical school, during cold season, it was in my backpack. I remember sitting in the Creighton library to study, quietly sucking on a lozenge to keep my cough from disturbing other students.

But even then, the evidence is iffy as to whether they do anything. In fact, one interesting (though small) study in 2018 suggested they may actually prolong coughs.

The fact is that we are all susceptible to the placebo effect, regardless of how much we know about illness and medication. Maybe these things work, maybe they don’t, but it’s a valid question. How often do we let wishful thinking beat objective data?

Probably more often than we want to admit.

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

As I noted in my last column, I recently had a generic cold.

One of the more irritating aspects is that I usually get a cough that lasts a few weeks afterwards, and, like most people, I try to do something about it. So I load up on various over-the-counter remedies.

I have no idea if they work, or if I’m shelling out for a placebo. I’m not alone in buying these, or they wouldn’t be on the market, or making money, at all.

But the placebo effect is pretty strong. Phenylephrine has been around since 1938. It’s sold on its own and is an ingredient in almost every anti-cough/cold combination medication out there (NyQuil, DayQuil, Robitussin Multi-Symptom, and their many generic store brands). Millions of people use it every year.

Yet, after sifting through piles of accumulated data, the Food and Drug Administration announced earlier this year that phenylephrine ... doesn’t do anything. Zip. Zero. Nada. When compared with a placebo in controlled trials, you couldn’t tell the difference between them. So now the use of it is being questioned. CVS has started pulling it off their shelves, and I suspect other pharmacies will follow.

But back to my cough. A time-honored tradition in American childhood is having to cram down Robitussin and gagging from its nasty taste (the cherry and orange flavoring don’t make a difference, it tastes terrible no matter what you do). So that gets ingrained into us, and to this day I, and most adults, reach for a bottle of dextromethorphan when they have a cough.

But the evidence for that is spotty, too. Several studies have shown equivocal, if any, evidence to suggest it helps with coughs, though others have shown some. Nothing really amazing though.

But we still buy it by the gallon when we’re sick, because we want something, anything, that will make us better. Even if we’re doing so more from hope than conviction.

There’s also the old standby of cough drops, which have been used for more than 3,000 years. Ingredients vary, but menthol is probably the most common one. I go through those, too. I keep a bag in my desk at work. In medical school, during cold season, it was in my backpack. I remember sitting in the Creighton library to study, quietly sucking on a lozenge to keep my cough from disturbing other students.

But even then, the evidence is iffy as to whether they do anything. In fact, one interesting (though small) study in 2018 suggested they may actually prolong coughs.

The fact is that we are all susceptible to the placebo effect, regardless of how much we know about illness and medication. Maybe these things work, maybe they don’t, but it’s a valid question. How often do we let wishful thinking beat objective data?

Probably more often than we want to admit.

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

I have a cold.

This is nothing new. Like most of us, I’ve probably gotten two or three a year for most of my life. I load up on Tylenol, Sudafed, cough syrup, and ginger ale (I’m not a chicken soup person), and I power through.

I may be sick, but there are patients to see. For better or worse, the idea of calling in sick never seems to apply to the health care profession. So I put on a mask to protect my patients and go ahead with my day.

But, as I blow my nose and accept my fate for the next week, I realize that I haven’t been sick with anything since 2019. Really.

Somewhere, with the masks, extra hand washing, Purell, and some good luck, I’d managed to dodge the rhinoviruses for 4 years.

I have no idea how many times in the last week I’ve told someone “I’d forgotten how much I hated being sick.” Certainly there are far worse things to have (colds are high on the “annoying” but low on the “serious” scales), but it’s odd to find myself back in the familiar pattern of coughing, sneezing, and low-grade fever that used to be a semi-annual occurrence.

So I look at myself in the mirror and wonder if the masks were that bad an idea? Certainly I have my share of patients, usually with immune diseases, who still wear them, and I see people at the store doing the same. There are countries where it was common to have them on even before the pandemic, though that was more for pollution.

I’m still pretty careful about hand washing, but that’s the nature of my job, anyway.

I keep coming back to the mask, though. Obviously, nothing is 100% successful, but certainly it puts a respiratory filter of sorts between us and the world (and vice versa). We use them in surgery and isolation rooms. It’s probably not the only reason I went 4 years without a cold, but it likely helped.

On the other hand, it has its drawbacks. A lot of my patients have hearing issues, and the mask doesn’t improve that. It also limits communication by facial expression, which is always important. It fogs up my classes (during the pandemic it became quite clear that any mask that claimed to be fog-free was lying).

I’m not saying everyone should wear them. This is up to me, that’s up to them.

But, for myself, it’s something to think about.

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

I have a cold.

This is nothing new. Like most of us, I’ve probably gotten two or three a year for most of my life. I load up on Tylenol, Sudafed, cough syrup, and ginger ale (I’m not a chicken soup person), and I power through.

I may be sick, but there are patients to see. For better or worse, the idea of calling in sick never seems to apply to the health care profession. So I put on a mask to protect my patients and go ahead with my day.

But, as I blow my nose and accept my fate for the next week, I realize that I haven’t been sick with anything since 2019. Really.

Somewhere, with the masks, extra hand washing, Purell, and some good luck, I’d managed to dodge the rhinoviruses for 4 years.

I have no idea how many times in the last week I’ve told someone “I’d forgotten how much I hated being sick.” Certainly there are far worse things to have (colds are high on the “annoying” but low on the “serious” scales), but it’s odd to find myself back in the familiar pattern of coughing, sneezing, and low-grade fever that used to be a semi-annual occurrence.

So I look at myself in the mirror and wonder if the masks were that bad an idea? Certainly I have my share of patients, usually with immune diseases, who still wear them, and I see people at the store doing the same. There are countries where it was common to have them on even before the pandemic, though that was more for pollution.

I’m still pretty careful about hand washing, but that’s the nature of my job, anyway.

I keep coming back to the mask, though. Obviously, nothing is 100% successful, but certainly it puts a respiratory filter of sorts between us and the world (and vice versa). We use them in surgery and isolation rooms. It’s probably not the only reason I went 4 years without a cold, but it likely helped.

On the other hand, it has its drawbacks. A lot of my patients have hearing issues, and the mask doesn’t improve that. It also limits communication by facial expression, which is always important. It fogs up my classes (during the pandemic it became quite clear that any mask that claimed to be fog-free was lying).

I’m not saying everyone should wear them. This is up to me, that’s up to them.

But, for myself, it’s something to think about.

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

I have a cold.

This is nothing new. Like most of us, I’ve probably gotten two or three a year for most of my life. I load up on Tylenol, Sudafed, cough syrup, and ginger ale (I’m not a chicken soup person), and I power through.

I may be sick, but there are patients to see. For better or worse, the idea of calling in sick never seems to apply to the health care profession. So I put on a mask to protect my patients and go ahead with my day.

But, as I blow my nose and accept my fate for the next week, I realize that I haven’t been sick with anything since 2019. Really.

Somewhere, with the masks, extra hand washing, Purell, and some good luck, I’d managed to dodge the rhinoviruses for 4 years.

I have no idea how many times in the last week I’ve told someone “I’d forgotten how much I hated being sick.” Certainly there are far worse things to have (colds are high on the “annoying” but low on the “serious” scales), but it’s odd to find myself back in the familiar pattern of coughing, sneezing, and low-grade fever that used to be a semi-annual occurrence.

So I look at myself in the mirror and wonder if the masks were that bad an idea? Certainly I have my share of patients, usually with immune diseases, who still wear them, and I see people at the store doing the same. There are countries where it was common to have them on even before the pandemic, though that was more for pollution.

I’m still pretty careful about hand washing, but that’s the nature of my job, anyway.

I keep coming back to the mask, though. Obviously, nothing is 100% successful, but certainly it puts a respiratory filter of sorts between us and the world (and vice versa). We use them in surgery and isolation rooms. It’s probably not the only reason I went 4 years without a cold, but it likely helped.

On the other hand, it has its drawbacks. A lot of my patients have hearing issues, and the mask doesn’t improve that. It also limits communication by facial expression, which is always important. It fogs up my classes (during the pandemic it became quite clear that any mask that claimed to be fog-free was lying).

I’m not saying everyone should wear them. This is up to me, that’s up to them.

But, for myself, it’s something to think about.

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