Get Your Dopamine Firing

By Craig Koniver, MD

"Elated. Enchanted. Alive."

These are the words that are common to people experiencing a dopamine burst. This is true for those in love as well as those who just deeply connecting to others. What is your dopamine doing these days?

Modern medicine is broken--I don’t need to tell you that. There are too many sick patients and far too many unhappy doctors to think otherwise. We have more heart disease, cancer, diabetes, obesity and depression than ever before. There are more people with autoimmune disease than cancer and heart disease combined. On top of that patients are not happy with their doctors and they are taking these frustrations out on us and our staff.

On the flip side, we too, as doctors are also struggling. The role of the private practice is being destroyed as doctors leave their office settings to work for hospital systems or larger corporations. Many, many of us are dissatisfied with all of the administrative, insurance and government bureaucracy that causes us to wonder what medicine really means anymore. Malpractice premiums are rising at the same time that insurance reimbursements are falling and diminishing. This is why you come to this website, right?

On both sides of the coin, we now have a scenario where our beloved medicine has changed for the worse and both ourselves and our patients are struggling to know what to do next. Throw in the uncertainties related to Obamacare and our anxieties and frustrations are compounded.

It is not hard to trace the roots of the medical system demise--it certainly parallels what has happened with our economy and society over the last century. The industrial mindset has dominated our economy, our school systems, our political systems and our medical system as well. Many of us grew up believing in this system--go to school (obey the rules), get a degree (obey the rules) and then get a job (obey the rules). This industrial mindset that allowed for the factories to make the rules for the workers is exactly what happened in medicine where the doctors set the rules for patients.

Patients wanted this because this is the system that we all believed in. In medicine, this system flourished once antibiotics became a valuable commodity. Now instead of the patient and doctor working together to help heal the patient, the pharmaceutical drug became the holy grail. Doctors became masters of these drugs and the pharmaceutical industry blossomed beyond belief. Of course it was not limited to just antibiotics--soon after, we had hormones and antidepressants and antipsychotics and blood pressure medicine and cholesterol medicine!

We are focused on the wrong product! We as doctors have not spent nearly enough time and energy developing connections to those around us. This includes our patients, but more importantly includes our family, friends and colleagues. We did this to ourselves. Unhappy with medicine? This is what we get when we focus our attention on the wrong product.

What we need to do now is take a step back and pause. Because what truly matters in life is how quickly and how deeply we can form connections with others. That is the product worth focusing on--our relationships.

If you truly want to bring about more satisfaction in your life outside of medicine, than you have to be willing to approach life differently. Simply put, we have been trying to acquire the wrong “things”....sure, money, status, toys are all worth the while, but nothing compares to acquiring real interactions with the people around you.

Did you know that when you form a deep connection with someone the Dopamine in your brain fires as if you were on drugs? Literally. Problem is, we have been trying to get our dopamine fired up from all of these material pursuits in life. No wonder we get bored and disinterested in modern medicine. All that system cares about is managing patients with more meds.

Sure, modern technology is to be embraced and there certainly is a time and place for pharmaceuticals--there can be no denying how great an impact they have made. But to continually blame others (insurance companies, government regulations, patient non-compliance) for the current state of our much maligned system without taking responsibility ourselves is a huge mistake.

We are as much to blame as everyone else involved. We all understand that medicine is not going in the direction we all want, but I feel that we are missing the larger and broader points. Medicine, both in and out of the office, needs a new set of rules for us to follow. We have to start focusing on our relationships in our lives above all else. Outside of the office, we have to be ready to put down our iPhones and listen to our spouses and our children. We have to be willing to start digging in the mud and stop shooting for the stars. In the office, we have to stop relying on drugs and surgeries to define what we do.

Because ultimately our patients and ourselves want the same thing. We want to feel a connection, to have an interaction with our patients and those around us. To view this in any other way is counter-productive.

To help facilitate yourself forming deeper and faster connections with those around you, try the following few, simple ideas: --Use positive words to help set the table for your interactions....remember, people use the same positive words to describe how they feel when they are feeling great

• Mirror the behavior of those you interact with: people seem to be able to reach a deeper level of connection when they talk with those that can mirror how they talk (some people like to talk with their hands and some people like to sit perfectly still when they talk)
• Use body language to your advantage: a small touch on the hand or elbow can go a long way in helping establish deeper levels of connections
• Look into the left eye of the person you are interacting with: the left eye is the receiving eye, while the right eye is the deflecting eye

The sooner you are willing to step up to the plate and start connecting to the people in your world around you, the better you will feel and the more successful you will become. Your dopamine will thank you for it, I guarantee it.

About: Craig Koniver, MD runs a busy Organic Medicine practice in Charleston, SC. He writes at http://organicmedicinenow.com

Submit a guest post and be heard

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.

Submit a guest post and be heard

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.

Submit a guest post?

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].

Spontaneous Drawing For Understanding

By Bernie Siegel MD

As a surgeon I was not made aware, by my training, of the many uses of spontaneous drawings and dreams, as psychotherapists are. What I am about to share stems not from my beliefs but from my experience and my work with patients and their families. I have always been an artist and a visual person. In 1977 I attended a workshop presented by Dr. Carl Simonton and in 1979 one presented Dr. Elizabeth Kubler-Ross. The former led to my first experience with guided imagery and the latter with a spontaneous drawing. Both revealed incredible insights and information about my life, and so I became a believer and returned to my practice, where a box of crayons became one of my therapeutic tools. I was also quite angry about what is not routinely taught in medical school, about the significance of dreams and drawings as they relate to somatic, as well as, psychological factors.

Click to read more ...

New Concierge Medicine Series: Royal Pains

Want to know how to start your own concierge medical practice?

Well, you can attend the Medical Fusion Conference and have a chat with Steven Knope MD, or you can tune in to Royal Pains on the USA Network and see what the media makes of a concierge practice setting up shop in the Hamptons. (I've been to the Hamptons a fair amount and it's prime real eastate for this a as a show... much better than the Jersey Shore.)

Click to read more ...