Creating A Steady Stream Of Patients

Being successful in any clinical practice depends on a steady flow of patients.

To be able to get a steady stream of patients, one cannot rely solely on luck. There must be a plan to achieve a single goal. To some, it may be to make a sale, to make money, or to make connections. Whatever line of business you're in, a steady flow of patients is important to achieve success.

Dov Gordon was kind enough to share his thoughts on the matter and he has summarised in 5 simple steps keep your patients coming. 

Make a list of problems you can solve. Before you start selling, of course, you need to know what you're selling, whether it be a service or a product. Identify what you can do, what you can offer, or what problems you can solve. In that list, identify which can generate attention from prospects. You can only get the attention of prospects using two things, you're offering a result that they want that they don't have, or you're offering to solve a problem they have that they don't want. Answer those two and you will certainly get the prospect's attention...not curiousity, but attention.

Make a hand-raising offer that begins to solve the patient's problem. This step is needed in order to build trust with your prospects. Your prospective patients should be able to trust you and what could be more helpful than you providing free services or products? You see a lot of these around. Businesses offering freebies, websites giving away free stuff, free webinars and the like. The key ingredient here is that the offer being given should begin to solve the patient's problem or give him or her a result that he wants.

Choose your words wisely. When I say words, I'm not refering to the keywords you use for SEO. The words you choose should be able to offer the same thing yet make it appealing to your prospect. Have you heard the story about the blind guy holding the sign "I'm blind, please help me." and the woman who changed the sign to "It's a beautiful day, but I can't see it." Both are making the same offer which is a chance to make a difference to the blind guy. But which sign do you think would be getting more notice?

Get your hand-raising offers noticed. This can through a lot of ways, i.e. social media, paid advertising, paper advertising, etc. There is no right or wrong choice here though. Each of has its own strengths and every expert of each would say that you need them. However, just like a plumber whose expertise lie on plumbing and may not have expertise in the architecture of a home, these experts are certainly experts in their own field. However, this is only a piece of the whole thing.

Make an irresistable paid offer. Now this is where it all boils down to, making the sale. Now that you've got the prospect's attention, you've already solved his problem partially, be ready to position yourself to closing in that prospect by polishing up on sales conversations or closing arguments. Take for example a programmer who made a free software with partial features. He would readily be in the position to close the sale by providing instructions in the software itself to avail of the full package. Answer the patient's final question of why should I get the whole thing?

Follow these steps and you can rest assured a steady flow of patients.

Starting Your Writing Career As A Physician

A pitch for the Harvard Writers Course for Physicians...

If you are reading this, you are probably interested in writing. You may be formulating an idea or completing a manuscript. You may have published or are hoping to. You probably started out like me: eager to write, but not knowing what to do with a finished piece.

A few years ago I started writing a book. Once I thought it was finished, I sent it off to a few publishers. Luckily my narcissism was intact as I got one polite but crystal clear rejection after another. I thought writing was the tough part. In reality, I had no idea how to publish a book. So off I went to a course on how to publish your book offered by Harvard Medical School’s Department of Continuing Medical Education. There I met some remarkable people, listened to their stories, and shared my ideas.

Afterward, I received an email from Dr. Julie Silver, course director. To my astonishment, she liked my ideas but pointedly asked if I had ever worked with a writer. She explained that a “writer” guides the writing process while the “author” (me) provides the content. My education began.

While recently visiting Freelancemd.com, I saw the headline, “Doctor, you should write a book…or should you?” The blog outlined five questions requiring a “yes” if you should write a book, and then some of the cool things that could happen if you did. I thought, “Hey, I learned all of this at Julie’s course.” And then I read, “If you do decide to write a book, where do you start?

Taking Dr. Silver’s course, Achieving Healthcare Leadership & Outcomes through Writing & Publishing (March 14-16, 2103; www.harvardwriters.com), really changed my life. I have now published two books and had many amazing experiences along the way.

Writing can be fun, but getting your work read can be stressful. Too much stress and your cortisol levels go up, making it harder to think clearly. Too many rejections may anger you, making it even harder to think clearly! What can you do? Get more information. Knowledge is power, and a course provides knowledge about the writing process and the publishing industry. Plus you will meet really cool people who have similar goals: to get your ideas out to other people. Stress fades when you have others to share your ideas and experiences with.

This course steered me in the right direction. I learned about the formula for self-help books, publishers’ requirements for memoir and for science books, and creating a 30 second “elevator” pitch. I met publishers, editors, writers, and agents. I learned the impact of social media and how to build my “platform.” I learned to “show” not “tell.” In essence, I learned to become a better writer, to get my ideas across, and to build the infrastructure to get published.

But more, I had a chance to meet people who are remarkably creative, passionate about their work, and have a message of hope to deliver. I will be at the course in March. Hope to see you there.

About: Dr. Joseph Shrand is an Instructor of Psychiatry at Harvard Medical School, and the Medical Director of CASTLE, a new intervention unit for at-risk teens. Dr. Shrand is triple Board certified in adult psychiatry, child and adolescent psychiatry, and a diplomate of the American Board of Addiction Medicine. He is the author of two books, Manage your Stress: Overcoming Stress in the Modern World and Outsmarting Anger: 7 Strategies for Defusing Our Most Dangerous Emotion

Watsi.org - Crowdsourcing Medical Care For People In Need

Crowdsourcing is changing the way that new organizations can be funded. Watsi.org is an example in healthcare.

You may hear more about Watsi in the near future.

Right now their run completely by donations but that could well change. They've also become the first non-profit to make it into Y-Combinator, a premier technoloty accelerator in San Francisco.

Visit Watsi.org

Here's what Paul Graham of Y Combinator says:

After about 30 seconds of looking at the site, I realized I was looking at one of the more revolutionary things I'd seen the Internet used for. Technology can now put a face on need. The people who need help around the world are individuals, not news photos, and when you see them as individuals it's hard to ignore them.

I've seen what happens—at Airbnb for example—when the Internet's ability to connect people peer to peer enters a domain that had previously been dominated by narrow channels. Historians will probably identify this as one of the most powerful forces at work in our time. And Watsi is this force applied to a big lever.

Working at a higher resolution also enables Watsi to offer a much higher level of transparency. At Watsi, 100% of your donations directly fund medical treatments. Watsi.org is separately funded. They pay all their operational costs from their own funding, and none from your donations. They even eat the credit card processing fees. So when you donate to Watsi, you never have the uncomfortable feeling that lots of your money will be eaten up by administrative costs. Your money has impact you can measure.

Developing Your Portfolio Career

Building a more satisfying career as a physician.

Years ago at an American Academy of Pediatrics meeting, I attended a session called something like “Non-Clinical Careers for Physicians.” While I don’t remember all the details of the presentation, what stuck with me was the extent of dissatisfaction of such an array of physicians: young and old, male and female, PCP and sub-specialist.

Now, some 20 years later, I think I have finally figured out a solution to the problem that nettled that audience years ago. Or at least I’ve found the solution for me. It’s called a “portfolio career”. What’s that, you say? Well, a portfolio career is one which combines multiple employment situations, exploits one’s various talents, culminating in a more satisfying work experience than would be possible just focusing on one area of expertise. Anton Chekov may have crafted the first portfolio career as a physician-writer back in the 19th century. He famously said, “Medicine is my lawful wife and literature my mistress.” Since his time, many doctors have carved side careers in publishing. Atul Gawande, surgeon and New York Times best-selling author says, “You can be a doctor and be most anything else.”

My portfolio career looks like this: I spend about a half to two thirds of my time as a physician. I am in private practice with one other pediatrician and moonlight in my local ER a few days a month. The rest of the time I write. Fiction, essays, book reviews, clinical reports. You name it, I’ll write it. I blog. I pen a syndicated health column for parents. I write conference coverage for national magazines. I’m called upon regularly to comment about medical developments in the news and how current events impact children.

You, too, can craft a portfolio career in writing. If you’ve always wanted to write, if you think you have a book in you, if you have years of experience and pearls of wisdom to share, I have a piece of advice for you. Come to the Harvard Writers’ Conference in March 2013. You will meet editors and agents, publishers and publicists, fellow doctors and dramatists, all interested in finding (or being!) the next Malcolm Gladwell.

You’ll also meet me! After the publication of my memoir Crash: A Mother, a Son, and the Journey from Grief to Gratitude (Globe Pequot Press Sept. 2012), Julie Silver invited me to present The Examined Life: Writing and the Art of Medicine at next year’s conference. I am thrilled. I’ll be talking about how I came to the conference in 2009 with a book proposal and an idea for a memoir and left with a real live contact in the publishing world and ultimately achieved representation and sold my memoir. I’ll also talk about real concrete steps you can take right now toward that portfolio career in writing.

So join me for the conference that helped shape my career as a physician-writer. March 14 th to 16th in Cambridge. You won't regret it!

About: Carolyn Roy-Bornstein's essays and short stories have appeared in many medical and literary journals and anthologies including JAMA, The Writer, Brain,Child, Literary Mama, Kaleidoscope, Archives of Pediatrics & Adolescent Medicine, The Examined Life and several editions of Chicken Soup for the Soul. Her flash fiction won third place in a Writer's Digest Short Short Story competition. She teaches writing workshops at venues from the University of Iowa to Grub Street Boston. Read more at www.carolynroybornstein.com.

The 90/30 Conundrum: How To Change Medicine (If It's Even Possible)

Guest post by Aaron Schenone

Is it possible to change the healthcare industry?

I recently read an article entitled “Rebels at Work: Motivated to Make a Difference” a conversation with Lois Kelly. In her research she refers to the 90/30 conundrum where 90% of respondents agreed activating creative thinking can improve culture and drive innovation, yet only a third of those respondents were satisfied with innovative individuals’, the so called rebels, ability to provide that outcome.

Her research goes further defining these innovative individuals as creative, curious risk takers that aren’t driven by monetary gain, but by the ability to make a difference. They aren’t afraid to call out problems or be the first to do things differently. She also found people are uncomfortable with these individuals who challenge the status quo, circumvent the rules, question organizational leaders, and initiate projects without permission. Too often leaders react by throwing these habitual truants into the trapped box with the label “Rebel” on it.

It’s no surprise that innovative individuals gravitate to the world of entrepreneurship, starting their own organizations where they can create a culture that not only understands their purpose, but more importantly can provide an outlet for their ideas to make a difference in the world. We intuitively know some of these types of individuals such as Steve Jobs, and Richard Branson, but these individuals are in every industry and industry leaders are starting to recognize their value. People like Carmen Medina, former CIA Deputy Director of Intelligence, who supported the creation of a novel and dynamic approach to searchable actionable intelligence through a program affectionately called Intellipedia.

In medicine many of our innovative medical students and residents have had similar frustrations often being misunderstood and thrown into the trapped box with the label “Cowboy” on it. We feel misunderstood, locked out and all too often make an early exit from the very organizations and patients who need our ideas the most. I believe the 90/30 conundrum is a reflection on the challenges innovative people and organizational leaders have had in attempting to build trusting, productive relationships. It’s something that as innovative minded medical students and residents many of us have been battling since we sat in our first years of didactic lectures. We continue to ask whether actionable change is possible in such a large numbers driven industry.

Today, I believe it is possible to make actionable change in the healthcare industry. But to get there we must first gain the trust of our leaders. We must prove we’re not just cowboys without a cause; we’re passionate activists ready to drink H. Pylori to prove there’s a better way.

About: Aaron Schenone Third Year Medical Student in St Louis, studying clinical research in oncology

I Have Fallen In Love With Patient Care Again

What I love to do is encourage patients to get more involved in their medical care and their well-being by easy to use methods that have great impact.

Yes, it's true. I have for a long time loved the practice of medicine. A few years into practice, I realized the importance of my role as a primary care and the tremendous impact I have on my patients. I started practice post-residency with one of the hardest group of patients (in my opinion) working for the country health department. I knew that if I survived beyond my first year at the health department, I could pretty much make it anywhere, so I set my mind to make a difference and stick to principles of healing, health and well-being all the while, also practicing the art of medicine. Some days were a big challenge but it was a great experience. In fact, things went so well -- I lasted 6 years there making a huge impact on the lives of the patients I served and they in the same way, making an impact on me.

From there, I went into private practice which was also a great learning experience. Only thing, though, was I felt that I was on a hamster's wheel, expending so much energy into providing care for my patients but not seeing the corresponding on my investment because of decreased re-imbursements, malpractice insurances, taxes and overhead and the typical other things that needed to be paid. I knew after few years of doing this that if I continued things this way, the joy of medicine will be snuffed and sucked right out of me. So I had 2 options. One was re-evaluate if I wanted to continue with the profession or choose some other nonclinical path....(but I really liked patient care), OR create a way in which come decreased re-imbursement or overhead or salaried position or whatever, I was financially to do what I really loved. 

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A Surgeon’s Nightmare- The Other Side Of Medical Tourism

Guest post by Samuel Bledsoe MD

There is an element of a gamble inherent in the medical tourism industry as it currently exists.

An interesting thing happened to me at work the other day.  It was Friday afternoon, and I received a call from a primary care doctor. The phone call began with, “I’m really sorry about this, but I have a surgeon’s nightmare in my office.”

This is not a good way to begin a conversation.

He began to tell me about the patient. This particular woman had a Lap Band placed several years ago. For one reason or another, she decided that she would like this converted to a different procedure. She drove by my hospital to get to the airport, hopped on a plane and flew over hundreds of other well-qualified bariatric surgeons in order to reach a surgeon in Mexico where she had her Lap Band removed. She then returned 6 months later and had a sleeve gastrectomy. This is where things go bad.

The patient developed a leak from the staple line on her stomach after the procedure. She was taken back to the operating room for her third procedure where she was washed-out and large drains were placed. Amazingly, four days after the procedure, she was released from the hospital with the large drains still draining gastric secretions, a feeding tube in her nose, a prescription for oral antibiotics, and instructions to find a bariatric surgeon where she lived to finish taking care of her. At this point, she was stable and doing well. As one of two bariatric surgeons in the community, I was asked to consider taking care of this woman.

My answer, after much thought, was a refusal. I did review this woman’s extensive medical record and even spoke with her personally on the phone to try to give her some advice. One thing she said still rings in my ears, “I thought if I had any problems I could just come back here and someone else could take care of me.” I recommended that she return to Mexico until she was well. This, I was told, was impossible. I did ask my office to attempt to find help for this woman.  After my nurse spent most of the day on the phone, talking with almost a dozen different doctor’s offices around the state, there wasn’t a single bariatric or specialty surgeon in the entire state willing to accept her as a patient. Ultimately, the best advice we could give her was to go to the local county hospital emergency room for care.

Lest I be thought of as heartless, if this woman or any other patient were sick or in dire straights or needed quick intervention, I would have treated her to the best of my ability regardless of where her surgery was performed. All doctors would do the same. But a patient who is currently stable and safe, presents a unique dilemma.  Don’t I have the right to choose them just like they had the right to not choose me in the first place?  Am I required to treat every surgical disease that presents itself to me?  Shouldn’t I be allowed to help them find a higher level of care?

On the one hand, I do feel for this woman. She will never find a surgeon who will willingly take her on as a patient.  Before she is finished, she could rack up a serious hospital bill.  Although she was doing fine at the time of our conversation, I was extremely concerned about her health. She seemed genuinely sorry about her decision to leave the country and was certainly very nice. On the other hand, this places the accepting surgeon in an impossible position. Who is better able to take care of this woman’s complications than the original surgeon? Who do you think she will sue if she decides she can’t pay her hospital bill or she becomes disabled or she loses her job, and she discovers that the surgeon in Mexico is legally untouchable?

I admit to being a little frustrated towards the presumptuousness of this woman. Did she call and ask me or another surgeon if we would help in the event of complications? Who did she expect would manage her lifetime needs of follow-up after this procedure? If I’m not good enough to do your relatively straightforward original surgery, then why would you think that I would be good enough to manage the highly complicated post-operative care that is required?

However, my biggest complaint is with the current system of medical tourism. A foreign hospital system profits from American patients, and when there’s a complication, they ship them back quickly and dump them out at the local American ER. The foreign physician is immune from lawsuits by virtue of the fact that they are out of the country. The medical tourism company that linked the patient and doctor bears no responsibility since they are simply a mediator. The foreign hospital simply washes their hands of the mess that they’ve created. It’s the local doctor, the local hospital, the local medical establishment, and the local economy that pays the high price.  And most unforgivable, the patient may pay the highest price of all. Excuse me for saying, but there has to be a better solution.

Medical tourism is a newly coined term for a very old practice.  In 430 B.C, the Temple of Asclepius was built in Epidaurus, Greece. This temple was a healing shrine where the sick and infirm would travel from all over the world to spend the night in this temple. During their sleep, the cure for their ailment would be revealed in dreams. The following day the dream would be interpreted by priests who would then implement the cure. The original Hippocratic Oath contained this invocation, “I swear by Apollo the Physician and by Asclepius… .”

The Greeks weren’t the only ancient people catering to medical tourists.  For thousands of years, pilgrims would travel to Jerusalem to the Pool of Siloam for its healing powers. The Bible notes in John 9 that Jesus used this pool as part of the healing of a man blind from birth.

Even today, there are spas, resorts, and retreats the world over that cater to the sick. In my home state of Arkansas, the city of Hot Springs has been attracting the sick and injured for centuries. Native Americans and frontiersmen would travel there for the medicinal properties found in the superheated baths. Today, thousands of people travel there every year to seek the same healing.

Many nations around the world cater to the American medical tourist. It is estimated that medical tourism siphoned around $15-20 billion dollars from the US economy in 2011 alone. Hundreds of thousands of patients will leave America in order to have their care provided to them. This trend is expected to grow between 15-20% in the foreseeable future. There are a hundreds hospitals scattered at locations ranging from Brazil to Mexico to Thailand to India that have tried to establish themselves as the “go-to” location for medical tourists.

Currently, there is an impressive list of procedures from a wide array of specialties that are offered at institutions that cater to the medical tourist. One such facility, advertises care in the fields of dentistry, orthopedics, ENT, cosmetic surgery, bariatric surgery, cardiac surgery, spine surgery, ophthalmology, oncology and fertility. This only represents a partial list of what is available.  If it’s an elective procedure and profitable, it is probably offered somewhere.

In response to a growing trend in medical tourism in bariatric surgery, the American Society for Metabolic & Bariatric Surgery (ASMBS) published a position statement on global bariatric healthcare. One of their primary concerns is a concern that is shared by many- appropriate continuity of care. This concern is highlighted by the following statement: “extensive travel to undergo bariatric surgery should be discouraged unless appropriate follow-up and continuity of care are arranged and transfer of medical information is adequate.”

Certain procedures, such as bariatric surgery, are unique in the fact that they require long-term follow-up. Also, the likelihood of short-term and long-term complications are significantly diminished with appropriate follow-up. Because of this, the ethics of medical tourism for bariatric surgery has been called into question. (http://www.ncbi.nlm.nih.gov/pubmed/20346442)  

To say it differently, having a colonoscopy or your teeth filled in India is one thing,  To have your hip replaced or your heart bypassed is a different thing altogether.

I would propose three simple solutions to this to improve the current system. First, protect the innocent.  By that I mean, the American physicians and hospital systems who get involved in complications resulting from medical tourism should have immunity from lawsuits. If you CHOOSE to leave the country for elective medical care, you should forfeit your right to unlimited medical compensation from an American physician who is simply trying to fix what someone else broke. This choice involved in medical tourism is in stark contrast to someone who becomes ill or injured overseas and has to have emergency medical care. This would be similar to Good Samaritan Laws found in many states. Second, a system accrediting hospitals and facilities overseas should be further developed. Joint Commission International http://www.jointcommissioninternational.org/About-JCI/ is one such system that has standardized and defined what constitutes adequate medical care and monitors facilities for compliance with these standards. It is the oldest such commission with 450 facilities in over 50 countries. Patients should insist that the hospital where the procedure is going to be performed be accredited by JCI or an equivalent.  Third, patients should be extremely proactive.  They should obtain or confirm insurance coverage in case of complications. They should thoroughly vet both the hospital and the surgeon. They should also ensure that there is a plan in place for adequate follow-up prior to the procedure being performed. They should also obtain copies of all medical records for their physician in their home town.

Don’t get me wrong, I am an Adam Smith capitalist to my core. If a patient believes that they can get better care or cheaper equivalent care in a foreign country, I certainly believe that they have the right to do so. But the patient, the foreign physician, and the foreign hospital system should accept the responsibility for their collective exercise of freedom and enterprise. Complications should be treated to a logical endpoint, and they should be truly stable for transfer back to their local community.  There is an element of a gamble inherent in the medical tourism industry as it currently exists. I do not believe that when the gamble doesn’t pay off, my colleagues, my hospital, my community, and I should be the only ones forced to face the repercussions of someone else’s decisions.

About: Dr. Samuel Bledsoe is a General & Bariatric Surgeon in Alexandria, LA.  He is founder of Bariatric Fuel, a company that manufactures vitamins for patients who have had a surgical weight loss procedure. You can follow his blog at www.bariatricfreedom.com.

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