Harvard Study: Most Physicians Will Be Sued

New England Journal of Medicine: Most doctors in America will be sued at some point during their career.

A Harvard study released yesterday in the New England Journal of Medicine has found that physicians who perform high-risk procedures, including neurosurgeons,  obstetricians, and thoracic surgeons, face a near certainty of being named in a malpractice case before they reach age 65.

Yet a relatively small number of claims, about 22 percent, result in payments to patients or their families.

Authors of the study, which examined 15 years of data, said it highlights the need for changes in malpractice law so that doctors and patients can resolve disputes before they resort to litigation, which often costs both parties money and heartache.

“Doctors get sued far more frequently than anyone would have thought, and in some specialties, it’s extremely high,’’ said Amitabh Chandra, an economist and professor of public policy at the Harvard Kennedy School and an author of the study. “In some sense, the payment is the least important part, because you can insure against it, but you can’t insure against the hassle cost.’’

The study looked at malpractice claims data for nearly 41,000 physicians from 1991 to 2005. The researchers found that 7.4% of physicians had a malpractice claim against them each year and that 1.6% had a claim that led to a payment each year.

Chandra and his coauthor, Dr. Anupam B. Jena of Mass. General, said they hope their study will dispel the fear that many doctors have of big payouts. Their study found just 66 claims that resulted in payments exceeding $1 million. Average claims by specialty ranged from $117,832 in dermatology to $520,923 in pediatrics.

So how can you lessen your chances of being sued by an unhappy patient even further?

Previous studies have shown that patients are less likely to sue when they receive an apology and explanation from their doctor.

Brian Rosman, research director of Health Care for All, said everyone will benefit if patient- doctor communication is divorced from legal proceedings and could actually inprove the quality of care. That would allow doctors and hospitals to deal more directly with the root cause of an error.

One medical society has been working with Beth Israel Deaconess Medical Center, using a $273,782 federal grant, to design a plan for a system that would encourage apologies and compensation, when justified, in Massachusetts. The plan is set to be released this fall.

It seems that nearly universal support exists for a system that encourages doctors to apologize and prevent the escalation of an unwanted outcome into a malpractice lawsuit.

Of course, this wall of scilence goes up on both sides. As soon as an unhappy patient contacts a lawyer they're instructed to have no further contact with the doctor to prevent anything that might mitigate damages or obstruct the lawsuit, like an admission to the doctor that they didn't follow instructions or a 'softening' of their stance as the identify with the physician as a person.

When I was running Surface Medical we ran in to this very problem many times.

Have you been in a lawsuit? Have you ever appologized to a patient?

Tips For A Smooth Medical Clinic Contest On Facebook

Facebook is becoming a necessary marketing arm for successful medical clinics.

By Cary M Silverman, MD, MBA

There are several reasons a medical practice should consider setting up a Facebook fan page:

• It's free.
• It gives you another way to communicate with potential patients through updates that will appear on their news feeds.
• You can promote events and services in your office.
• You can boost your SEO.
• You can promote brand awareness for your practice.
• Facebook can act as a funnel to your main practice web site.
• You can build a community for your patients.

Once you decide to set up a fan page for your practice, the next task is to build a fan base. A Facebook contest is an excellent way to achieve this goal. These contests offer several benefits:

• A highly cost effective way to build a database.
• 50% of online users enter a contest once a month.
• Contests can be highly targeted.
• Creates positive brand awareness for your practice.
• Patients can further spread word about the contest to all their friends.

Make Your Idea Social “Well my contest is on Facebook – so it’s social, right?” Wrong. Your Facebook fans are more excited to participate in a contest where they can help determine the outcome, than one where you pick the winner. Furthermore, when you require voting or involvement of some sort, that means your fans must find friends to join in their quest to win (hence “social word of mouth marketing”).

Keep it Simple

Do you fill out every field of surveys you get trapped into taking? Didn’t think so. Contests are the perfect way to gather important information about your fans (remember to tell them how you intend to use it), but only ask for the essentials so that you don’t miss out on any entrants. Remember that users will give you more information if you make it enjoyable, functional, and easy.

Real Original

This one should be a given, but you’d be surprised how many times organizations run extremely similar campaigns back-to-back. Fans don’t want to enter the same contest or participate in the same campaign over and over again on Facebook, and if you don’t catch their attention, they sure won’t tell their friends about it. The greatest Facebook contests are the most creative and memorable ones (just don’t over-do it and forget to keep it simple).

Know the Rules

If Facebook catches you doing something illegal they will delete your page and ban your practice from using the platform. So remember first and foremost that you must run your contest on a third-party application. We use Shortstack, which is fully customizable and affordable. Others include: Offerpop, Wildfire, and many more. You cannot require Facebook users to submit any content or take any action on Facebook itself (i.e. posting a photo to your page’s wall, liking, commenting, or re-posting content, etc.). You cannot announce a winner on Facebook which is actually a good way to drive people to your blog or website. Here are the current Facebook Promotions Rules and Guidelines so that you can remain compliant (they are always changing, so be watching).

It Starts In-Office

What better access do you have to potential Facebook fans and contest entrants than your own office? In a past contest we ran on EyeCare 20/20's Facebook page called “The Eyeball Challenge”, we started by attracting the patients in the clinic. We filled a large glass jar with candy eyeballs, posted a photograph of it on our Facebook contest tab, and directed fans to guess how many eyes were in it in a commenting section on the tab. The winning guess would receive a pair of sunglasses. This way people who knew us both offline and online could participate.

We had in-store signage at the front desk with a call to action and QR code taking patients right to the Facebook page to enter. We trained the entire staff to know what the contest involved, rules, and prizes so that they could urge patients to submit their guesses. We also designed takeaway collateral pieces so that those without smartphones could be reminded to enter when they got home.

This was an exciting way for us to inform our patients that we were on Facebook, and for some was their very first introduction to the social network. [As a side note: remember to speak in laymen’s terms, and be prepared to assist novice Facebook users.]

Come With All Guns A’ Blazing

Just as it helps us to have all parts of our bodies to perform at our highest level, our social media presence and success depends on the coordination of many factors. Plan your contest launch with a timeline marked with a dedicated email blast to your current database (don’t hide this in a regular email, give it its own special delivery date, if you are able to, without inundating your recipients). Be sure to include Twitter updates (reaching out to influencers in your niche, or local organization/people), digital and social media press releases, maybe an image or interchangeable banner linked to the tab, and utilization of any other platforms or people that you have at your disposal.

The Buddy System

Join forces with another party (maybe a prize sponsor). Bring traffic from their website, stores, brand name, etc. to increase traffic to your contest tab. Maybe a few months later you can offer to sponsor a contest for them. You can even offer your contest as an on-site giveaway at a major community event where people must enter on Facebook, and you announce the winner at the end of the event. Get creative. Just remember that the buddy system expands your network exponentially. It’s Okay to Spend a Little $

Facebook ads are a very effective way to gain not only entrants, but fans in general. When we initiated an advertising campaign for EyeCare 20/20, we increased our fans by more than 60%. And our contest entries quadrupled! Ads can be tricky, so play around with titles, ad copy, images, landing pages, and your bids until you get the right combination. These ads are great for local practices and organizations, so set a little money (and time to monitor) aside to find out what will work best for you! Converting New Fans to Patients

Some people become so consumed with getting new fans in running their contests that they forget to focus on bringing in potential leads. Focus on spreading the word with your current patients, local places where your target market can be found, and use ads that involve ad copy that will catch the eyes of prospective patients. Although numbers are important for establishing credibility and providing an audience for your later initiatives, remember to make each fan count.

Effects of a Campaign

Although your campaign may not make the Top Ten Promotions of All Time list… remember to take with you what you learned. Yes, you are going to get those few fans who are “Contest-Hoppers”, liking you, winning or losing, and then unsubscribing. Prepare to lose a few fans, but not to worry, the majority will remain with you. Remember to thank all of your participants, maybe even post a few examples from your entries (if you have permission in your rules), and continue to speak in your fun voice, building anticipation for your next campaign as soon as your current one ends to keep fans engaged.

Bonus Point: When overwhelmed, Get some Help

Sounds like a lot of work? Trust me – it’s worth it! For years, we did all our social marketing at EyeCare 20/20 in house. When we saw how much time and energy we were expending we decided to seek the aid of a professional online marketing team. We still spend a lot of time with our social marketing, but having this professional support has helped you to attain social media perfection. There are many excellent ones out there.

About: Cary M Silverman, MD, MBA is Medical Director of EyeCare 20/20 in East Hanover, NJ. He specializes in LASIK and refractive cataract surgery. You can read his blog or connect with him on LinkedIn.

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An Interview With Physician & Author Ken Cohn

A Conversation With Physician-Author Ken Cohn

Ken Cohn first came to my publishing course many years ago. Eager to learn everything he could about writing and publishing his ideas, he soaked up the information and shook as many hands as possible. Today, he's a successful surgeon, consultant and author with a new book out titled "Getting It Done: Experienced Healthcare Leaders Reveal Field-Tested Strategies for Clinical and Financial Success". 

When did you start writing and publishing?

Although I had published scientific articles, my first systematic approach to writing and publishing occurred in 2003 when I took the SEAK course on nonfiction writing.  That course helped understand the principles of market-driven writing, of striving to meet and exceed the needs of my readers.  Before, I had viewed writing as a product of scientific investigation.

Why did you write your first book? 

In 2004, I received a call from the editor of Health Administration Press, the publishing arm of the American College of Healthcare Executives.  She said that she was working on a series of books for busy healthcare executives and asked me if I thought that the material from my 2-day seminar, Practical Strategies for Engaging Physicians, could fit into an Executive Essentials format.  When I said that I believed so, she warned me, “Just because you have published articles does not mean that it will be easy.  Writing a book is different.”

My first book, "Better Communication for Better Care: Mastering Physician-Administrator Collaboration", was published March 2005.  Comments from healthcare leaders gave rise to my 2nd book, "Collaborate for Success! Breakthrough Strategies for Engaging Physicians, Nurses, and Hospital Executives", which was published September 2006.  After publication, my editor bragged, “I launched you!”

How has writing and publishing helped you with your work mission?

To quote Francis Bacon, “Writing maketh an exact man.”  Writing has helped me clarify principles of healthcare collaboration, especially its implementation.  It has also brought me into contact with truly dedicated healthcare leaders throughout the US, which has lead to numerous opportunities to speak and consult on challenging issues.  John Eggen, who taught me about book marketing, states that the words “author” and “authority” have the same root.  Especially with the rise in Internet searches, writing a book establishes one as someone who has mastered a body of knowledge.  I recommend writing to all physicians who are considering career transitions.  One can begin by writing essays in a blog and seeing how the writing evolves.

Why did you publish your new book?

"Getting It Done" is a compilation of 16 heroes’ journeys about healthcare professionals who broke down barriers to improve care for their communities.  For example, Dr. Jeff Fried is a medical ICU director who felt that too many people were dying from overwhelming bacterial infection, or sepsis.  By working with healthcare professionals at his hospital to improve diagnosis and institute earlier treatment, he cut the death rate from sepsis by over 50%, without changing or adding a single drug.  Over 200 lives have been saved over the past 5 years as a result of his work.

I have worked in 41 states in the US.  As I traveled around the country and witnessed triumphs like Dr. Fried’s, I became convinced that their results, which were published in journals like Critical Care Medicine, needed to be included in a book which healthcare leaders would read.    

For more information (including chapter summaries) about Dr. Cohn's new book, "Getting It Done: Experienced Healthcare Leaders Reveal Field-Tested Strategies for Clinical and Financial Success", visit http://gettingitdonebook.com/.

How Do You Diversify Your Skills As A Physician?

How Do You Move Into A Nonclinical Job Or Diversify Your Skill Set?

If you are trying to work towards diversifying your career or transition into a nonclinical career, you may wonder if you have the skills necessary for a job outside of direct patient care.

As a doctor, you can do just about anything you want to do.  But it’s not easy to be confident when you don’t know how to proceed and we aren’t taught to ask for help.

When I was trying to do it, I got caught up in how unsure I felt about what I wanted to do and how to actually do it.  As a result, I lost confidence in myself and that was a mistake.   Without confidence in myself, I didn’t have the positive thinking needed for translating my skills and seeing all the opportunities out there.

Many doctors wonder if they need to go back to school to take the next step in their careers.  While you can never go wrong getting an education, defaulting back to a full time alternate degree program is rarely the best way to go.  It isn’t the “next logical step” to spend more money and time back in school.   However, if you choose to pursue an MBA, MHA, MPH or some other degree, there are many excellent programs, some specifically tailored towards a physician.

But remember this; becoming a doctor gives you a unique skill set that can be translated to fit almost any industry.  Think about how often you’ve dealt with conflict and how often you’ve contributed to increased growth and revenue.  Why is that important?  Does that confuse you?  You’re not alone.  We aren’t trained to think that way in medical school, residency or beyond.   But these are the ways your skills are valued in a non-clinical career and your skills are translatable. 

Here are a few ideas on how to get started or how to move forward if you have already started considering diversification of your skill set and exploration into the non-clinical realm. 

1. Determine if there are associations or societies dedicated towards professionals in the fields you want to explore.  For example, if you are interested in healthcare information technology, make it a point to explore the resources on the Healthcare Information and Management Systems Society (HIMSS) website.  Since you are reading this post, you have already found Freelance MD and you should make it a goal to fully explore all the resources and people available here.
2. Look into certificate programs in the area(s) you find interesting and are the subject of current hiring trends.  Quality, process improvement, leadership and information technology are areas of opportunity right now.  Resources like the American College of Physician Executives are helpful for these opportunities but there are other resources for certificate programs. 
3. Consider the big picture.  I made several mistakes when I was transitioning and I try to help others avoid pitfalls by making sure they take everything into account.  Things like lifestyle, salary requirements, geographic location, etc. are equally important in this journey.  If you don’t consider them, even your perfect job may seem like the wrong thing.  It’s important to set yourself up for success as much as possible by looking at all aspects of your life.
4. Put together a Personal Development Plan (PDP).   Please see a previous post on why is this important and how to do this at http://freelancemd.com/blog/2011/7/5/mid-year-career-strategy.html.
5. Consider nonclinical options and network with other doctors who are also interested in other options.  Not sure where to start doing this?  In addition to Freelance MD, there are resources with information directed specifically at physicians and non-clinical careers.  For example, visit the Physician Renaissance Network at www.prnresource.com. 

6 Simple Tips To Embrace Stock Market Panics

What should you do when the market panics? Embrace the opportunity!

The world seems to be coming to an end, markets around the world have had steep drops, and investors are racing for the exits. But if you've got a sound long term investment plan and you've created a well structured portfolio, you shouldn't be panicking at all. No, you should actually be taking advantage of the market panic.

When I worked in the ER, my colleagues called me a pessimist. Rising malpractice premiums, flat reimbursements, increasing workload…there really weren't any good trends in emergency medicine. Similarly, all you're hearing right now in the financial markets is a bunch of bad news: US debt losing it's AAA rating, Europe's debt crisis, high unemployment, slowing economic growth, and so on. There's almost nothing positive in the news right now. While the skies are covered with doom-and-gloom clouds, here are some great reasons to like (dare I say enjoy?) market panics:

Reason #1: Buy cheap stocks

I love Wal-Mart. I actually get a thrill from buying everything from groceries to jeans for some dirt cheap prices. When it comes to investing, however, it seems counterintuitive to buy when others are selling. “Buy low, sell high” seems so easy to say but so emotionally wrong to do. After all there is a cliché in investing which says that the best time to buy stocks is when there is “blood in the streets.”

When perceived risk is high, stock prices go down because investors need to be compensated more for taking on risk. This means that future expected returns are higher. The problem is that no one knows when those returns will happen. But the point is that market panics allow you to buy at lower prices.

Reason #2: Buy more shares

Suppose you bought 20 shares of a stock for $50 per share for a total outlay of $1000. Then, nine months later the share price is $40, a 20% drop (bear market territory). Assuming you still believe in the merits of the investment, you can now purchase 25 shares for the same outlay. This technique, known as dollar cost averaging, assures you that the average price per share is lower than the average of the two prices because you have bought more shares at the lower price. More aggressive investors can use a technique called value averaging, whereby you buy enough shares to obtain a desired dollar amount. In the example above, to end with an investment amount of $2000, you would actually buy 30 shares of stock at $40. These techniques do not assure you of any gain or avoid losses because the stock price can go even lower, but at least it does assure you of reducing your average purchase price.

Reason #3: Reduce your taxes

If my portfolio is tanking, I may as well let Uncle Sam feel some of the pain. If you sell a stock for a loss, you can deduct up to $3,000 of the loss against your ordinary income. If you're in the 35% federal tax bracket, the $3,000 deduction equates to a tax savings of $1,050. Also, if your losses exceed $3,000 you can actually use the excess losses as deductions in future tax years indefinitely. While tax deductions imply stock losses, they also act as cushions to soften the blow.

Reason #4: Dump your losers

Have you gotten emotionally attached to your investments? Market panics should make you question why you bought a particular stock or mutual fund in the first place. Did you buy the stock because you researched the company’s balance sheets, quarterly reports, and financial ratios? Or did you buy the stock because you overheard a surgeon in the doctor’s lounge boasting about how he made a 50% return in just two months? (If this happens, I suggest you ask him why he’s still working 70 hours a week).

Even if you bought a stock or other investment which has positive returns, bear markets are good times to sell those investments if you should not have been purchased them in the first place. One strategy here is to sell these winning investments and avoid a taxable gain by offsetting those gains with losses from other losing investments.

Reason #5: Gauge your risk tolerance

For most investors risk tolerance is directly related to stock prices: in bull markets risk tolerance increases, and in bear markets risk tolerance plummets. One way to determine your willingness to take risk is to evaluate your emotional response to this year’s bear market. There's no better way to know your true risk tolerance than to lose a truckload of money in a short amount of time. Did you sell and invest in cash, or did you load up on Citigroup as it tanked almost 20% today? Another way is to quantify this risk by determining your maximum drawdown, which is the highest percentage loss you are willing to accept before selling an investment. Determining your maximum drawdown over one, three, and five year periods can help you build a more disciplined portfolio and stick with your investment strategy when the next bear market comes out of hibernation.

Reason #6: Appreciate your job

If you've got a job that's pretty stable, savor it. For example, while there are numerous challenges to practicing medicine today, one thing is certain—the demand for physicians and other health care providers and health care affiliates (pharmacists, PAs, nurse anesthetists, etc.) is strong. In effect, your income is similar to a bond in the sense that there is low risk of default (unemployment). If you're a physician, your period of extended “unemployment” occurs right at the beginning of your career (medical school and residency). If you consider your career as a bond, you can actually take a bit more risk with your stock portfolio. While other professions and industries layoff workers, it seems nearly every week my mailbox is flooded with emergency medicine job opportunities across the US. My investment portfolio may be struggling, but my value in terms of human capital is stable. Market panics should make you appreciate the stability of your career.

And finally remember that stock market panics are a normal part of investing. If you don't have a solid investment plan that's addressed potential losses you could suffer in your portfolio, then you need to get one...now! And that's one way I help my clients stay disciplined during market panics.

Physician = God Complex?

By Dr. Anthony Youn

"I Am God!" proclaimed Alec Baldwin’s Dr. Jed Hill in the 1993 movie Malice. When he revealed his Doctor-God complex, most non-medical viewers were shocked. Doctors and nurses... not so much.

Why do some doctors think they are on par with God?

One night as a third year medical student I was assigned to work with a grizzled, veteran Ob-Gyn doctor for a night of call. At 2 am I went up to the doctor and asked the typical medical student question, "Is there anything I can help you with?" In front of the entire nursing staff he set his face 6 inches from mine, pointed his finger at my face, and said, "There is absolutely nothing, I repeat, nothing you can and ever will be able to help me with." He turned and stormed down the hall. As a medical student, events like this were not uncommon, as there were always certain doctors who took perverse pleasure in making their subordinates feel useless and inferior.

Well, I earned my M.D. and thought that things would change. Now I was a real doctor and other physicians would respect me. Boy, was I wrong. Even with an M.D. after my name I was still a resident, a peon in the eyes of real attending physicians. This was never any more apparent than in the weekly M&M conferences. M&M’s had nothing to do with the tasty candies and everything to do with attending physicians verbally pummeling residents for any complications or deaths that occurred over the last month. Never mind that the patients were the ultimate responsibility of the attendings, or that many of the attendings approved the treatment decisions at the time. Many a time my colleagues entered M&M’s confident resident physicians and exited quivering lumps of self-doubt.

So what causes some doctors to think they are on par with God? Quite possibly the power to make life or death decisions for their patients gets to some doctors’ heads. Physicians are the ones that, with a pen, can write an order for a patient that saves his or her life. However, while we doctors may have the knowledge of what medication may save a life, do we have the ability to administer that medication? Doctors need secretaries to enter the order into the computer, pharmacists to prepare the proper dosage, and nurses to place the IV and administer the medication. Although we often forget it, we physicians do not exist in a health care bubble. We can’t do it alone. Many doctors still type with one finger at a time, have never used a mortar and pestle, and couldn’t successfully place an IV into a vein the size of a pencil. Yes, I’m talking about me.

I have a message to my fellow physicians. We need to lighten up. Laughter, they say, is the best medicine. I’d love to write a prescription for "Laughter" for the many doctors who take themselves too seriously. While the act of completing four years of college, four years of medical school, and surviving 3-8 years of brutal residency training is something to take pride in, it doesn’t give us carte blanche to treat others as inferior to us. As a plastic surgeon I am reminded every time I operate that I can’t do it alone. I need someone to gown me, plug in the cautery machine, arrange my surgical instruments and supplies, hold the retractors, and even work my iPod. I try to make an effort to thank the staff who support me each day, but admit that there are times I get frustrated and do not treat my support staff the way they should be treated.

The best compliment I ever received from a nurse had nothing to do with surgical skill or knowledge, but was when she said, "Dr. Youn, you’re one of the only doctors who is one of us". I hope I can continue to live up to that statement.

Signature: Anthony Youn, MD, FACS is a board-certified plastic surgeon and author of IN STITCHES, a humorous memoir about becoming a doctor. Dr. Youn's site is at www.institchesbook.com.

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Freelance MD & Spam

Freelance MD gets spammed but hey, so does everyone else.

Unfortunately, success and traffic breeds spam and in this situation the cure's are often worse than the solutions...

Freelance MD is starting to attract a fair amount of spammers who are trying to tap in to a growing physician community for either SEO backlink Google juice or just to get in front of doctors.

There are three solutions we're investigating as a solution:

1. Require users to login to comment.
2. Hold all comments for approval.
3. Prevent users from adding links when they comment.

Require users to login: This one just kills your community. Requiring users to login to comment easily cuts comments by 70% or more in most cases. It's just a tremendous barrier to overcome. It also destroys any benefits that you accrue for SEO purposes. Since everything is behind a firewall and not public, the search engines can't index it so they don't see your site being updated and changing often (which is good).

Hold all comments for approval: This one's just painful. First, it's a huge headache to go through and approve/discard every comment and it only gets worse as the site grows. It also takes away any immediacy with the social reward of seeing your comment go live on the site. In effect, it just slows everything down and makes for a less-than-optimal experience as we try to get people to come back and contribute regularly. Also, while this is common tactic with Wordpress we're not using that system and it's not practical with our current configuration.

Prevent users from adding links: I've avoided this but it is possible to do. We have a number of people who are fairly regular and they always back-linking to their site [ including you ; ) ] and I don't want to prevent that. However, it is an option and we could try it out. I haven't done this so I don't know what kind of drop off would result.

Since you refer to your 'subscription' I'm guessing that you've subscribed to the RSS feed on the site and not just the posts. You're way back in the minority even knowing how to do this so this specific issue of spam showing up in your feed is probably restricted to you... and maybe someone else.

(Believe me, I hate spam with a red-hot passion that could melt glaciers and raise sea levels world wide. Hate it. We check all of our sites and remove spam 3-6 times a day and not just for this site. It is just painful. Medical Spa MD gets about 20x the traffic and a corresponding amount of spam. I would actually bring back crucifiction as a punishment for spammers.)

Ok, so there we are. I see that the only really workable solution would be to prevent people from adding links to their comments. I'd like to hear your feedback on this. Do you think it would prevent people from leaving comments (which is absolutely imperative for success) or is it better to just swat at the flies rather than burn the house down [intentional exaggeration].