“The little blue book” has been an office standard as long as I’ve been in practice. Every practice has a dog-eared copy in a drawer somewhere that’s constantly being pulled out to look up hospitals, other doctors, and pharmacies.

As small as it is, it’s pretty useful in the daily flow of my office routine.

So I’ve never griped about my annual payment of $39.90 to get two copies of it. In a world of expensive and unused textbooks and coding guides, this little thing is indispensable. It generally seemed a lot more reliable than Google. It even became a running office gag, where when it showed up my medical assistant would yell “THE NEW BLUE BOOKS ARE HERE! THE NEW BLUE BOOKS ARE HERE!” imitating Steve Martin in “The Jerk.”

Until now.

Sadly, 2016 was apparently the year I ordered my last copies. The publisher’s marketing people inform me that the paper version has been discontinued, and I can now get the digital version for only … $500 per year.

Thanks, but no thanks.

I have nothing against digital editions. In fact, if it was the same price as the paper one, I’d get it. If I were a big practice that needed, say, 50 copies for the staff, the $500 per practice fee is a deal, compared with the $998 I’d pay for 50 paper copies.

But for my dinky little two-person practice? The difference between $39.90 and $500 just isn’t worth all the advantages a digital version may offer. For that kind of money, I’ll use Google.

This is another part of a gradual, and disturbing, trend in medicine: ignoring small practices. Large corporate practices are worth a lot more in sales than little one-to-three doctor groups, so companies, such as “ the little blue book ,” have no incentive to tailor their products to us. We have become medical persona non grata.

I understand this is a business decision. It’s not specifically directed at me.

Yet …

I’ve been in practice for almost 20 years now, and buying two copies of the LBB is something I’ve done annually, in good and bad economic years. I’ve supported the publisher because it was a good product at a fair price. Sadly, they no longer find my little practice to be worth the effort or profit margin.

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

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