Aesthetic Medicine: Growing Your Practice (2009) Tác giả: Marie Czenko Kuechel Nhà xuất bản: Thieme Medical Publishers part2

Section II: What
I amnot alawyer. Myjob is to help ensurethesuccess ofyour practice. You
don’t need to be a lawyer, and you don’t need to hire a lawyer to tell you
that even with informed consent, the potential still exists for risk, for an un-
happy patient, or for adverse events or unexpected outcomes. What a
lawyer will not tell you, however, is somethingessential to your success: in-
formed consent is not only a valuable a risk management tool but also a
measure of patient satisfaction.
If you have done your job in communication and education and the patient
is candid and unwavering, commitment in writing to the points discussed
and the traditional elements of an informed consent should not be an issue.
Informed consent works in your favor with educated, informed, and con -
dent patients. You aredisclosingeverythingfullyto your patients and asking
that they fully disclose all of their intentions for treatment and compliance.
Patients will respect the fact that as much as you need to honestly disclose
information for their understanding before treatment, you expect the same
of them. By doing this, you are helping to ensure that your patients respect
your responsibilities and accept their own.
Ap p lyin g In form ed Con sen t
There are numerous publications and standards that de ne the law and let-
ter of informed consent. It is so vast a topic, with so many variables, that in
itself it is acomprehensiveguideto an essentialcomponent ofthesuccess of
your practice.
Recommended resources for informed consent include publications of the
medical societies of your specialty. Most pharmaceutical and medical de-
vice companies provide sample informed consent documents and releases
speci c to their products. Ask your sales and practice-support representa-
tives for thesedocuments. Most sources willo er singledocuments or com-
pendiums ofsampleinformed consent documents. Your best option is to re-
quest software containing these documents, allowing you to personalize

Chapter 8: What De nes Risk?


forms to your individual practice needs. Reasonable standards in informed
consent documentsarebest set bysomeoneother than you. You de nestan-
dards that apply to a particular case, but you do not de ne all of the stan-
dards that exist across your specialty or for a particular procedure.
Personalize informed consent by including vital practice branding informa-
tion on documents. Trackthesedocuments in an overallchecklist ofpatient
information. Keep these documents organized, updatethemas needed, and
track your updates in a personal compendium of practice forms.
Take as much time as necessary to explain and present informed consent
documents to your patients. Take the time to question the patient’s com-
prehension ofdocuments. Takemoretimeto explain documents to patients
with questions. Have a witness present. Let the patient know that informed
consent is not simplyameans to protect yourselfor your practice, but is for
thebene t ofthepatient, to verifythat heor shefullyunderstands what may
be very comprehensive variables and outcomes of treatment.
CH ECK, P LEASE
It’s an all-too-common scene: The patient coordinator who was warm, invit-
ing, and attentive during the earlier consultation suddenly, in presenting the
informed consent form to the patient, begins reciting in a rapid- re, robotic
manner, scribblingcheckmarks down theside of her document as sherattles
through her list, looking up brie y after each point for a compliant nod.
Consider the image you have just painted for your patient, who has been
nurtured and attended byyour sta , and nowthat heor sheis readyto accept
treatment, is rushed through the informed consent process.
Processes exist for good reason. Take thetime to giveyour patient proper
attention, in this and every phase of your relationship. Your continued suc-
cess in practice depends on it.

Section II: What
IN P RACTICE: Wh at a Girl Wan ts
She was atinything, verynervous about consultingwith the physician about
breast augmentation, with her boyfriend standingguard. I sat quietlythrough
this bizarre consultation, where the boyfriend expressed images of what he
expected she would look like, and where she said little unless directly asked
by the physician. The surgeon did all the right things: he reminded the man
that the woman was his patient and he needed to focus his attention on her
wants, needs, and questions. Hetried hard to get answers fromher about her
wishes, but she always deferred to her boyfriend. When it came time to mea-
sure her for implant size, the boyfriend was vocal—nothingcould be too big.
The surgeon clearly de ned what he felt was the largest size appropriate for
this tiny woman’s gure and safe for him to implant. The boyfriend ques-
tioned the limits. The only thing that anyone was in agreement about was
that breast augmentation would, in fact, bene t this woman’s gure if that
was what she truly wanted for herself.
Finally, I chimed in. I asked the man if he would please join me in the
next room where I might show him di erent implants and photographs of
the resulting appearance. The physician could do the same in the examina-
tion room with his patient, and we would see if there was consensus. I took
the time to show him photographs of horri c large-volume implant results,
which can readily be found online. I told him if he really loved this woman,
he would never allow her to do this to her body or her life. And then I did
one more thing: I turned the tables. I asked if he would ever allowher to dic-
tate what he would do with his body. I then led the boyfriend to the recep-
tion area and asked him politely to wait.
Thepatient coordinator was stunned and shocked. Shethought that I had
crossed the line. No, I told her, what I did was educate someone who was
heavily in uencing a patient in the practice. It would have been easy at this
juncture to dismiss this case and these two people, but the boyfriend would
readily nd a surgeon somewhere who would listen to him and maim her.
In the meantime, thephysician had some qualitytimewith his patient. He
learned that she had previously been in an abusive relationship. Her current
boyfriend truly loved and cared for her, and while she wanted the implants
and wanted to pleaseher boyfriend, shewas indeed nervous. Shedidn’t want
to be dis gured; she didn’t want her disapproving family to censure her fur-
ther for something that would look unnatural or obvious. She was worried
about surgery, because she was a single mom and afraid that if something
went wrong, she would not be there for her child.

Chapter 8: What De nes Risk?


Thephysician and I met in thehallway, and helooked at mewith anguish.
What now? Should he dismiss the case? Should he refer her for counseling?
He was a seasoned surgeon, but ustered by the events at hand.
I advised him to follow the process that never fails.
We met the boyfriend and the patient, spellingthings out clearly: She was
a good candidate for augmentation. The surgeon explicitly stated her safe
and reasonable augmentation options. He de ned her experience, obliga-
tions as a patient, anesthesia options, the outcomes, and potential adverse
events. He followed allthe proper procedures. He told this couple there was
a waiting period required for her to consider her options, and that she was
free to call back or come back at any time. He then looked at the man and of-
fered his hand and said, “Every man who truly loves a woman, whether his
girlfriend, his daughter, or his mother, will give her what she wants.” He put
his hand out to the woman and said, “Onlyyou can decideifthis is what you
want.”
When they left, we were all sure we would never see either of them again.
Two weeks later, the doctor called me. Guess who had arrived in his o ce,
this time with her boyfriend’s mother? After the two women sat through the
entire consultation together, she booked the procedure precisely as the sur-
geon had recommended.
W H EN TO SAY NO
There are no absolutes as to when you must say “No” to a patient. In every
case it is inevitably your judgment and the judgment of your sta who also
have a perspective on the patient that will in uence your decisions. How-
ever, there are common warning signs that a patient might not be one you
elect to treat:
A patient with unrealistic goals
A patient with unrealistic expectations
A patient with emotional disorders
A patient who is not self-motivated
Acasein which resultscannot besafelyor reasonablyachieved

Section II: What
A case that might put an individual’s health at risk
A case in which the patient clearly does not comprehend the
procedure, the likely outcome, or potential adverse results
Acasein which thepatient isclearlynot goingto becompliant
Body dysmorphic disorder (BDD) is well documented in mental health
studies, particularly in relation to aesthetic procedures. BDD is a condition
whereby one has an unhealthy obsession with perceived or minor aws in
appearance. The growth ofcosmetic medicine, includingnonsurgicaltreat-
ments, has increased the number of elective procedures available and the
number of conditions that individuals seek to treat. It has led to a popula-
tion segment that somehavedescribed as “appearanceobsessed.” But there
is a di erence between patients who are frequent consumers of cosmetic
medicine services and those who have a diagnosis of BDD. BDD involves
more than an active interest in cosmetic procedures; BDD patients undergo
those procedures without ever achieving satisfaction. Additional indicators
of BDD include extreme grooming habits, such as overplucking brows or
pickingskin, avoidingmirrors or constantlylookingin them, and the use of
excessive makeup or clothing selected to camou age imagined defects.
Unfortunately, many of these signs are subjective. As there is no absolute
variable for saying “No” to a patient, there is no absolute variable for deter-
mining when the patient’s desires for improvement are unhealthy without
evaluation by a quali ed mental health professional. Your instincts and
judgment will ultimately help you determine whether you can treat the pa-
tient or must refuse care. Refusing treatment is not simply a means of pro-
tecting this individual from unnecessary or unwarranted procedures; it is
essential for protecting your practice from exposure to a troubled patient
who will never be satis ed with the results.
Saying “No” has its negative consequences. A truly unhealthy patient may
feel anguish, anger, or despair, and will blame you. Your decision to refuse
treatment must be cautiously determined and your message carefully deliv-
ered. Although it may be reassuring to a healthy person to hear, “You are
beautiful, and I would not change a thing; I never mess with perfection,” to
an unhealthy person this is simply not acceptable or comprehensible.

Chapter 8: What De nes Risk?


Continued
RELATIVE WISDOM: Th e Very Best Cu stom er
In every designer boutique or specialty store, and even in some auto dealer-
ships, there are customers who buy everything, and return everything.
Whether shoes, dresses, handbags, or sports cars, the customer takes them
homeand afewweekslater returnswith an explanation that theitemsdon’t t,
don’t match, aren’t good enough, are too good, and countless other excuses.
These chronic shoppers cost your business time and money, but in good
timesand bad theyaretherebuying, and eventuallytheydo keep someoftheir
purchases. In their minds, thesepeoplefeeltheyareyour verybest customer.
Relativewisdom: Aestheticproceduresarenot likeretailgoodsthat can be
tried on (experienced) or returned if the customer changes his or her mind.
Theyare not like abad hair color that can be corrected, or abad lipstickthat
gets wiped o and tossed away. They are not a bad entrée that can be sent
back to the kitchen, or a bad landscape design that can be uprooted and
planted again. If you have patients who regularly elect services, are chroni-
cally unhappy with the outcomes, and often negotiate revisions, you do not
have your very best customer—you have a signi cant potential for risk.
TH E IMP ORTANCE OF P ATIENT SELECTION
Jack P. Gunter, MD, FACS
Although Dr. Gunter focuseshispracticesolelyon rhinoplasty, themeasures
he uses to identify good candidates apply to any aesthetic procedure.
One of the key factors in obtaining a successful result is patient selection.
The idealpatient is one who has realistic expectations. The patient must un-
derstand the di culty of the operation and know that the goal of the surgery
is a signi cant improvement and not perfection. Perfection in rhinoplasty is
seldom, if ever, achieved.
He or she must also understand that the ideal nose is one that looks natu-
ral, is in balance and harmony with the other facial features, and has normal
function. A nose that looks good on one person may not look good on an-
other who has a di erent bone structure, di erent skin thickness (thick skin
will not drape as well as thin skin), and di erent spatial relationships of
anatomic structures—the eyes, brows, lips, and mouth.

Section II: What
Although all of these factors may seem obvious to a surgeon, they are not
always that apparent to the patient and sometimes, after a lengthy explana-
tion bythe doctor, the patient stillmaynot understand. One ofthe main rea-
sons for this is the information the patient has been bombarded with over the
past decade. Television shows such as “Extreme Makeover” and various
plastic surgery marketing e orts (all the gimmicks the media is highlighting)
have led many people to believe that plastic surgery involves just a “nip and
atuck” and that you can go in that morning, haveacomplete makeover with-
out anyrisks, with verylittlebruisingor swelling, and bebackon thestreet in
a week or so looking marvelous. There is more to it than that.
Although the risks with plastic surgery are low, there are risks with every
type of surgery, and patients should be made aware of these. The complica-
tion I worry most about is for the patient to be expecting me to give him or
her a better result than is possible. When this happens, it is usually because I
didn’t prepare the patient adequatelyor the individual didn’t listen or didn’t
take my remarks seriously.
When surgeons feel their patients do not understand the information set
forth, and they’ve done their best in trying to explain it, they should inform
their patients that they are uncomfortable performing the surgery because
theyareconcerned that theymaynot beableto achievetheresult thepatients
are expecting.
There is nothing more di cult to take in hand, more perilous
to conduct, or more uncertain in its success than to take
the lead in the introduction of a new order of things.
— NICCOLO MACHIAVELLI
INVITING RISK
Your market and prospective and current patients are not the only sources
for risk. Your practice may invite added risk.
Medical research, when conducted ethically, properly, and with the right
motivations, leads to improved treatment options and outcomes for pa-
tients. Valid studies and the resulting ndings deserve to be shared with
other physicians in journals and at symposia. The patients who elect know-
ingly to participate in such research must be fully educated; research is the
TH E IMP ORTANCE OF P ATIENT SELECTION—con t’d

Chapter 8: What De nes Risk?


origin of informed consent. If you are not conducting research, there is no
acceptable reason to invite added risk to your practice, but there are unin-
tended ways that it happens.
WARNING SIGNS
You evaluate your prospective patients as good candidates; likewise, others
are evaluating you to con rm that you are a good provider. This includes
patients, sta , peers, and referralsources. This assessment is ongoing; it oc-
curs through every phase of an individual’s relationship with your practice.
What de nes a good provider? It is someone who is quali ed, reputable,
and meets the standards that apatient would expect. Beingagood provider
does not necessarily mean that you are this patient’s best choice; it means
that you are a valid and viable option. You and your practice may be unin-
tentionally raising red ags through inappropriate messages, attitudes, out-
look, and clinical issues.
Maintaining a positive client/patient relationship throughout the patient’s
cycle and succeeding in practice requires that you constantly monitor for
and recognize any warning signs—and correct them quickly. When you do
not recognizethe red ags that others perceivein your practice, you riskbe-
ing labeled for your shortcomings, and you may be disregarded as a poten-
tialprovider, discontinued as aprovider, or remembered as less than agood
provider. As timeand trends changetheneeds oftarget populations, clients,
and patients, your practice must evolve to meet those needs. Continuing to
be alert for red ags is as important as continuing to evaluate changes in
your market and the consistency of patient satisfaction.
In a p p rop ria te a n d Risky Messa ges
Sometimes a message, born of aggressive marketing or consultation strate-
gies, is perceived as inappropriate. Other times unintentional or poorly
thought-out messages from your practice invite risk or signal your market
and patients that you and your practice are risky business.
An inappropriate message is generally de ned as one that either implies
guaranteed results or violates tasteand ethics. This can occur with messages
inside or outside the practice, whether they are verbal or printed or come

8

Section II: What
fromthe actions ofaprovider or sta member. Theyare counterproductive
to your success. Your market, patients, peers, and possibly even your sta
will question your credibility.
The greatest potential for disseminating an inappropriate message occurs
when a provider compels rather than interests, sells rather than educates,
and convinces rather than measures patient comprehension. Catchyphrases
that draw attention to the practice and call individuals to act on their exist-
inginterest areperfectlyacceptable. What is not acceptableis pressure, gim-
mickry, and manipulative messages that play on emotion.
P RESSURE TACTICS
Pressure tactics urge individuals to act based on conformity, taking advan-
tage of their insecurities and creating a sense of urgency. Pressure is the
message that everyone is doing it, and you must not be left out. Those who
use pressure tactics view each patient as a sale rather than recognizing pa-
tient interactions as a privilege of one’s vocation. Pressure is urging some-
oneto do somethingbeforean opportunityexpires, or beforethereis an un-
pleasant result.
GIMMICKRY
Gimmickry is using a catchy phrase or cliché to persuade an individual
to act. It involves such tactics as a sale, a bonus, a special deal, or special
feel, or even bait and switch. Gimmickry used in an aesthetic practice puts
volume and revenue above patient satisfaction. It involves an unsubstan-
tiated promise with an unattainable result. It is claims made about a magic
potion or device with no credible supporting evidence, endorsements by
self-proclaimed celebrities, and seals of approval by obscure professional
organizations. Using spurious credentials and false board certi cations or
credentials that are not recognized by the American Board of Medical Spe-
cialties is deceptive, and in some states illegal to use in advertisements.
M ANIP ULATIVE M ESSAGES
Manipulative messages twist facts and data to make a provider appear more
credible or to elevate a deceptive value. They may use terms and descrip-
tions that are contrived and cannot be validated. Manipulative messages

Chapter 8: What De nes Risk?


takeadvantageofnaïveclients; theydo not generateful lled patients. These
catchy phrases promise a “miracle lift,” “face lift in a jar,” “face lift without
surgery,” or they claim to “erase your wrinkles forever” or make someone
“look years younger in minutes.” Like gimmicks, they are deceptive
and unethical, because you simply cannot deliver on them.
IN P RACTICE: Not Me
The physician had purchased the newest, hottest device in aesthetic medi-
cine. The company was spending a great deal of money on advertising and
promoting this as a nonsurgical alternative that mimicked surgery. I asked
the physician why he would o er such promises to his patients, and he care-
fully told me, “The device has merit, and with proper patient selection and
good education, we have happy patients.”
When I reminded him that his message was not the only message his
patients might encounter about the device, he repeated, “The device has
merit, and with proper patient selection and good education, we have happy
patients.”
I sat in on a consultation with him and a patient who was speci cally in-
terested in this device. He focused on her goals: What did she want to
achieve? As he explained that this would not produce what he thought she
expected, she seemed dismayed. As he explained what she could achieve
fromthis devicecompared with what shecould achievefromother treatment
modalities, namely surgery, she really became upset.
“Doctor, you advertised that this device could give me the same results as
surgery, without surgery, and now you tell me that you cannot accomplish
this. That is false advertising.”
The physician said that he had never advertised such a thing. Other doc-
tors may have, the device company may have, but he had not.
Shereached in her handbagand pulled out amagazine. Thephysician de-
nied that he had ever advertised in that publication. She opened the maga-
zine with the device company’s ad marked, and his name and practice loca-
tion were listed in the ad.
The lesson here: The message projected by those you do business with
must be congruent with your standards, ethics, and business practices.
Never allowanyoneto advertiseon your behalf, and makeit clear that no one
should ever use your name without your express permission. Cooperative
advertising with device or pharmaceutical companies is bene cial, but only
when you are aware of and approve the message, and to whom and how it is
delivered.

Section II: What
Ap p rop ria te Messa ges
Appropriate messages build image and credibility. They carry longevity in
your market, with your patients, and all of those in contact with your prac-
tice who pass them on and thus generate referrals.
ATTITUDE
Your attitude as a provider of aesthetic medicine may change during your
business life cycle, just as the attitudes of your patients are likely to change
somewhat over very long cycles. Attitudes are how you view your practice
and patients at the moment, relative to how you view your commitment to
practice and ful ll desire. Attitudes may be conscious or unconscious and
are visible not only to your target population, patients, sta , and peers, but
also to known and unknown sources and resources.
When noninvasive treatment of the aging face was rst being o ered, per-
haps you were skeptical. It may have taken some time before you accepted
such treatment as appropriate to your practice mix. Once you accepted this
as a component of your practice, did you regard these noninvasive proce-
dures with less seriousness or candor than invasive procedures that carry
greater risk? Of course not—all treatments, all patients should bene t from
a consistent attitude of goals, education, and comprehension.
Regardless of the treatments you provide and the reasons for which you
provide them, your attitude and the attitudes of your sta members must
be consistently focused on what your patients and your market would ex-
pect ofaskilled provider and ahigh-qualitypractice. When you areful lling
the personal desires of another person through medical treatment, your at-
titudes must:
Center on the individual patient
Respect the patient’s desires rather than imposing your per-
sonal views
Demonstrateyour commitment asacaringprovider byacting
with serious conviction in every case
Be consistent inside and outside your professional life

Chapter 8: What De nes Risk?


Thenuances ofyour attitudes arewhat de neyour identityand brand. The
core of attitudes, as listed on p. , is the basis by which others will judge
you.
Although somepatients maycometo you actingon atrend in aesthetic med-
icine, theystillaretryingto ful llapersonaldesire(ifnot, theyare not good
candidates). You must, in everycase, focus on that individualand his or her
desire; not the trend, not your desire, not your preference, not even your
expectation, but on the individual you are face to face with.
Ifapatient comes to aphysician to eliminatethespider veins on her legs, he
or she should not suggest taking care of the lesion on her nose as well, un-
less sheexpresses that desire. Thelesion might not bother her, but theveins
do. Addressingsomethingother than thepersonaldesirethepatient has ap-
proached you for, even though it may be relevant, may not be appreciated.
Theexception to respectingindividualdesireslies in extremes. Ifapatient’s
desire is extreme, you have the right to decline providing treatment. Ex-
tremes have their opposites. There are cases where a patient’s desire may
seem inconsequential to you. However, if the individual has taken the time
to engage you to ful ll desire, it is not inconsequential to him or her.
You took an oath to treat human life with dignity. But you do not practice
life-saving medicine; you practice life-enhancing medicine. Whatever the
treatment or procedure, whether it involves aminor or major improvement,
you must still treat the patient’s desire to enhance his or her life with con-
viction and respect for the patient’s need. In doingso, you willdemonstrate
your commitment as a caring provider. You should require that those on
your sta support you in demonstrating this commitment.
Do not think that your attitude and the attitudes of those who work for you
are onlyrelevant within your o ce. Mygrandmother used to say, “Ears and
eyes are everywhere,” and from personal experience we know there is wis-
dom in those words. Always demonstrate respect, consistency, and dignity
in your role as a physician, no matter how private and con dent you may
feel at any moment. You never know when an o hand, ippant remark or

Section II: What
an unconsidered act may resurface. Such a transgression can re ect badly
on your status as a respected, digni ed provider of aesthetic medicine. You
must be one who upholds the privacy and highly personal nature of his or
her profession in every way, at all times.
CASES OF ATTITUDE
Consider these brief incidents and you will understand the need for moni-
toring red ags and attitudes.
The trend for Botox therapy is an indication of how quickly populations
interested in aesthetic treatment can act. Regardless ofthe millions of people
who have become Botox devotees, all good candidates who seek wrinkle re-
duction byinjection are doingso out ofpersonal desire. Perhaps theyare in-
uenced by the current trend, but they are not acting on the trend. (If one is
actingsolelybased on atrend, heor sheisnot agood candidatefor treatment.)
I was shocked when I heard a provider in consultation tell a client, “Wel-
come to the club.”
Just because everyone is doingit, do not depersonalize it. Apatient wants
to undergo treatment to attain his or her own personal goals. Always focus
on the individual.
Respecting individual desire requires nesse to make a distinction be-
tween respectingindividualdesireand ful llingpersonalgoals. For example,
manybreast augmentation patients are women who havecompleted their cy-
cle of child-bearing and want to restore breast volume lost from pregnancy.
These women may very well bene t from a tummy tuck also. Believe it or
not, I know a surgeon who made it a policy to recommend some other form
of body contouring in conjunction with any aesthetic breast procedure. He
believed in up-selling.
Up-sellingis ne, and it is awayto growyour business, but it willback re
when a client comes to you with one very speci c desire and you, uninvited,
o er other suggestions for improvement. When you fail to respect that indi-
vidual’s desire, you heighten your patient’s sense ofcaution. Clearlyidentify
desire in consultation, and your attitude and ability to respect individual de-
sire will be perfectly clear.

Chapter 8: What De nes Risk?


If you trivialize anything, you and your practice may be viewed as uncar-
ing. This applies to your sta as well. For example, an assistant to one of the
kindest, most caring providers I have ever known went to inject a patient
with local anesthetic. She basically took a stab and stated, “bull’s-eye.”
In another instance, a patient came into an aesthetic provider’s o ce.
While in the waiting room, the patient had an asthma attack. Rather than of-
feringassistance, the receptionist asked the individual to wait in the hallway,
so as not to disturb other waiting patients with the coughing and wheezing.
In yet another example, a postoperative patient was devastated at the ini-
tial appearance of scars following her face lift. When she expressed this con-
cern to the provider, rather than suggest appropriate cosmetics or o er car-
ing assurance and reiterating the aftercare and time necessary for wounds to
properly heal, the provider simply responded, “Don’t worry, they will fade
in time.”
These are among countless examples of inappropriate attitudes. They
may seem rather harmless to you, but they can quickly bring into question
your mindset as a provider in a practice committed to the highest quality of
care and experience in every case. If you and your sta approach the care of
every patient with an attitude that conveys commitment to the individual at
all times, there is little likelihood that red ags will wave.
You must project a consistent, caring attitude both inside and outside your
professional life; this is something that many people overlook, not just in
aesthetic medicine. The wayyou speakofyour practice and the service you
provide must remain constant. The way you regard and speak of patients
must always remain focused on protectingtheir privacyand their trust, even
when they allow you to use their likeness to educate others.
Whether you are out to dinner, playing golf, at the grocery store, or at little
league, someone may recognize and overhear you if you are indiscreet, and
they may pass along what you say. The person who overhears you may be
connected to the patient you are speaking about, or may be a prospective
patient.

Section II: What
RELATIVE WISDOM: P rocess of Elim in a tion
My mom called one day to tell me that a friend of hers had been diagnosed
with breast cancer and was researching the surgeon her physician had rec-
ommended. My mother was well aware that I knew the man personally, and
she knew how I felt about him. But being the good mom she is, she didn’t
want to convey my words for me, so she had her friend call me.
“Marie,” the friend asked, “what do you know about this surgeon?” I
replied that I knew he was board certi ed, on sta at the hospital, and had
been in practice years.
“But what do you know about him? Your mom tells me you are ac-
quainted.”
“Yes, we are,” I responded.
“So tell me about him.”
I didn’t know what to tell her about him. Quite honestly, he could be a
brilliant surgeon, but my personal opinion was that he was pompous, arro-
gant, and self-absorbed and didn’t give the courtesy of a hello when he
passed someoneheknewat church, at the club, or at school. Hewas aboveit
all and rude.
Relative wisdom: Howdo the peoplein your communityviewyou, inside
your practice as well as outside? Your behavior may be the source of your
being eliminated from consideration without your ever knowing it.
O UTLOOK
Agood outlookis one ofreality, candor, and compassion; it emphasizes the
positives rst and respects the personal desires of others. The practice of
aesthetic medicineis about enhancement, not change. Likewise, theoutlook
of your practice can be enhanced, but it should not change. You don’t be-
lieve the glass is half full one day, and half empty the next. You don’t use a
low-keyapproach one day, and aggressivelymarket your business the next.
You don’t change a tasteful private practice one day to a franchised store-
front drop-in clinic the next. Why? Because change implies that something
iswrong, and somethingthat is wrongis ared ag. You willalienatethepeo-
ple you have served and confuse the people who seek your services.

Chapter 8: What De nes Risk?


Your outlook should be:
Realistic: Do not promise something you cannot achieve,
whether in clinical outcome or in a life-altering change.
Candid: Do not omit detailsfor anyreason; fullyinformyour
patients and never gloss over the realities, such as pain, risk,
and possible unfavorable outcomes.
Compassionate: Demonstratethat you possessemotions; are
here to help and to endure. Failure to care for your clients
and patients, their quality of experience, their satisfaction,
and their quality of life, could be a warning sign.
If your outlookis focused on anythingother than thepersonaldesires ofthe
individuals you educate and treat, you raise a red ag. Your goal may be to
generate revenue, your brand may emphasize new high-tech modalities,
your image may be upscale or holistic, but your outlook must still project
your commitment to ful lling patients’ desires.
I always wonder about the people behind the practices that project ashy,
inappropriate messages suggesting “the best results,” “your dreams come
true,” and “we can change your life.” One of my favorites was found in a
telephone directory: “A substantial discount will be o ered on all services,
and together we will stimulate the economy.” The author of this statement
was merely stimulating his imagination.
Providers disseminating such messages are desperate to succeed; they are
short on ethics, and their outlook is barren. They will use any gimmick or
buzz to get people in the door. They are less than frank in discussions with
potential patients, then deny culpability when the results fall short of ex-
pectations. If you do not believe that these people invariably fail, pay atten-
tion to how often such messages appear and disappear, much like these
practices do. They constantly change, because they do not work.

Section II: What
IN P RACTICE: A Star Is Born
I often invite or recommend physicians for appearances on television pro-
grams to educate consumers about aesthetic procedures. I carefully screen
these physicians, educate them about the expectations of participation, and
o er assistance to coach, rehearse, and support any phase of the agenda.
I was preparingfor asegment of The View that had come up veryquickly,
and in my haste to pull it all together, I did not have the chance to carefully
interview a replacement physician who had been recommended by a tech-
nology company to demonstrate their device. This doctor, I was assured,
was well versed and experienced with television. Little did I know that she
was also relentless in her desire to become a star.
As everyone arrived in the dressing rooms, the physician began to ques-
tion not only her contribution to the segment, but she also questioned the
whole segment. She began to speak of alternative procedures, and had the
audacityto bringa competitor’s product, suggestingshe should present it as
well. Rehearsal began and the physician not only missed the mark—she left
her manners and her common sense elsewhere. She disrupted the crew, the
lighting, and thestaging. Shequestioned thecandidacyof her patient, whom
she had personally invited to demonstrate the procedure. While we were re-
hearsing, her sister, mother, four friends, and her young son all arrived on
the set, without ever asking or informing anyone of their arrival, and then
told thecrewsheexpected they’d havefront-rowseats. Finally, I had to act—
I told her that her portion of the segment was being cut because we simply
did not have time.
Later that day someone back in the green room came to me and said,
“She’s one doctor I’ll never go see.”
The lesson here: No matter where you go, what you do, your attitude,
your outlook, and the resulting red ags accompany you.
Clin ica l Issu es
Your credentials and your experience are of little value unless your patients
aresatis ed, and patient satisfaction is in clear jeopardywhen clinicalissues
raise red ags. Clinical issues are those where you fall short in the expecta-
tion or image of a compassionate physician.

Chapter 8: What De nes Risk?


D ISORGANIZATION
You are being trusted to ful ll the personal desire of another through med-
icaltreatment that is nite, delicate, and possiblyirreversible. Ifyou or your
sta are perceived as disorganized in handling paperwork, process, or in
anyother way, it is likelythe patient will question your attention to detail in
the treatment process.
LACK OF P REP ARATION
Patients expect you to be prepared with the knowledge and tools necessary
to respond to their needs. It is as simple as your sta knowing to whom to
direct a question. If you are not prepared to respond to a simple question,
how can a patient expect you to be prepared for the unexpected during
treatment?
Q UICK JUDGMENTS
You may need to make a quick judgment in the event that something unex-
pected occurs, but what is the perception when you makeaquickjudgment
of personal desire or recommended treatment? The perception is that you
regularly make snap decisions and this may be a warning signal to a pro-
spective patient. Aesthetic medicine should not involve instant judgment,
just as it does not involve triage.
P OOR P RACTICES
What do you convey when you fail to wash your hands before touching a
patient? This says that to you, hygiene is not important. Fail to knock on
the door before enteringaroom? You are indicatingthat HIPAA(and com-
mon courtesy) is irrelevant to you. These mayseemlikeminor o enses, but
they are indicators of major transgressions.
RECKLESS P RACTICES
Ared agofanykind willnot beforgiven or forgotten, and is rarelyisolated.
Most practitioners who fall victim to these danger areas are practicing reck-
lessly. In thepracticeofful llingindividual, deep, personaldesires, you must

8

Section II: What
focus on what is positive, ful lling, and most advantageous. You do not x
or correct becausethereis technicallynothingwrong. You improveand you
enhance—make this your rst objective, and then be candid about pain,
risk, possible unfavorable outcomes, and where alternatives may fall short.
IN P RACTICE: Rep ortin g Risky Bu sin ess
I received a call from a physician who was clearly distraught about a woman
who came to see him. She had received cosmetic injections from a quali ed
provider. She had horrible complications that included necrosis, and she
wanted help. When the physician asked if her treating physician had ad-
dressed her complications, shestated, “Not really. Hetold methesewerethe
potential outcomes we discussed, and he has stopped taking my calls.”
Biopsy revealed the woman had not been injected with the brand she was
told would be used; she was not even injected with a recognized substance.
The doctor was calling me because the physician who had treated this
woman was acolleague, clearlypracticingrecklesslybyusingan imported or
illegal substance, and the doctor wanted my opinion on whether this physi-
cian should bereported to thestatemedicalboard, to thehospitalwherethey
were both on sta , and to the state and national medical societies to which
they both belonged.
Hewas veryupset for thewoman, but equallyupset that someone hecon-
sidered a close colleague would act so recklessly. The problem, he told me,
is that those who report the dangerous, illegal, or unethical practices of oth-
ers are often treated as whistle blowers; theybecome pariahs. Those who of-
fer expert testimony in clear cases of negligence are blackballed, and those
who take the high ground often su er repercussions from their actions. He
knew what was right, but he wanted to stay anonymous.
Here is the advice I o ered him and that I would give anyone in a similar
situation: I am not a lawyer. I would suggest that you give the woman who
presented in your o ce the information she needs to contact the FDA, the
state medical board, the hospital, and your professional organizations to re-
port her adverse events. In addition, I would ask you to weigh what you feel
is more important: preventing this physician from harming anyone else and
potentially damaging the reputation of the specialty in your community, or
beinghopefulthat somehow, sometime, some waythese practices willcome
to an end. Consider your oath to the practice of medicine, the ethics you ac-
cepted when you were accepted into membership of your professional soci-
eties. Then only you can decide if you too wish to report these actions.

Chapter 8: What De nes Risk?


UNDERSTANDING RISK
Judgment and an inherent senseofethics arethegreatest defense against in-
appropriatemessages; observation is thegreatest enforcer ofthis. Whileyou
observe messages around you and identify those as inappropriate, others
are also observing you and your messages. Through this observation, you
realize that even the smallest questionable element can bring irrevocable
damage to an image.
Take a moment to look at your practice from the outside in: observe what
you and your practice do and the messages you convey. Howdo you de ne
and maintain your image, identify the needs and expectations of your audi-
ence, and recognize risk? These factors cross over in an intricate weave of
di erent people, communication styles, and perceptions. The result of that
weaveis your success. When elements aretightlywoven with littlevariation,
your practice is strong. When elements are looselyor inconsistentlyjoined,
your practice is weak. Weakness in any one area is a weakness that will per-
meate the practice and threaten your success.
Observeeverythingand everyonein your practiceon aregular basisthrough
theeyesofyour patients. Roleplay, as uncomfortableand elementaryas that
may seem. Be the patient with unrealistic goals; position yourself as a con-
sumer reading one of your ads or visiting your website. Sit through the
process of informed consent with your patient coordinator and make him
or her sit through the process too. Sometimes we all need to walk in an-
other’s shoes. As you look for potential red ags, look too for opportunities
to improve, grow, and evolve.

(Trang không có chữ)

Where
Where s r th pl . Th “wh r ” f y r pr t r q r s
j r y, t t th pl y tr v l t . Th phys-
l l t wh r y pr v s rv s s p rt t r -
t f y r g l t f y r p t ts’ xp r .
Wh r y pr t s th t s. Th s—th j r-
y th t — r f th rk t g
ss g sv t lt br g gp t ts, lt t lys ss, t y r
r.
SECTION III
9 Where Will You Practice?
10 Where Will You Connect?
11 Connecting Outside Your Practice
12 Connecting Inside Your Practice

(Trang không có chữ)

WhereWillYou
Practice?
I was going to have cosmetic surgery
until I noticed the doctor’s o ce was full
of pictures by Picasso.
— RiTa Ru d n eR, c o med ia n
CHAPTER 9

Y pr t p rf r l t v pr r s th t f s s lf-
pr v t, s lf- h t, s lf-f l ll t. Y r p t ts h s
th s pr r s t k th s lv s l k f lb tt r b t th s lv s.
Th l tr t ts y pr v y r s lt p , s f rt,
x ty t st th l ts f th p t t’s h l ty. Wh r y pr t , -
l g th phys l l t , th f r sh gs, th f t s f y r f -
l ty, st b ppr pr t , s f l l t s w ll s v t g,
f rt g st t . Wh th r y r j st st rt gy r pr t , r -
l g r r l t g, s r g g t ll t s t y r pr t ,
r s ply v l t gh ww lly r pr t sp rf r g r wh t y ght
pr v , t s ss t l t r g z th t wh r y pr t s p rt t
sp t f y r g .

S t iii: Wh r
RELATIVE WISDOM: Th e Road Less Traveled
V t s r sy t pl , w th ll th p t r s, v s, r v ws, r t gs
v l bl l . Y t g g t w st t lw ys v k s tw k y f l-
gs: x t t t .
W w r h g w t r t r s rt f r s q t t w y fr
th w rl . Th st t h f b l s r v ws w s r by
tr st fr s. Wh w rr v w w r thr ll : th s rv , th s t , th
pp rt t s t r l x r t r r t w r j st p rf t f r s. W sp t f w
ys l g g th b h, sh g th sh r , w t h g th s s ts,
j st j y g v ry t f r R&R— t l r l f h s w y
t th b h. W w r th P c st fm x , t w ss sp t
th t th r h s h w w r t f th j gl t th rth, w
r v r, t th . n w h w s th b h, p r pt . Th
st f th r s rt q kly l r th b h l s t, th th r t s
r l t r v th r l . Tw h rs f v l t r l -wr gl g
sp t l sr pt q t v t f r y, b t th br h f r p
t th r . V t rs w r fr t w lkth b h th t ght. Th y
w r fr t w lk th b h r sh th xt y. Th y w r fr t
h k thr gh th j gl —wh l bl th ? Wh t h b th p rf t
xp r p r s q kly xp t ly t r t p r th t
rr wh t sh l h v b p rf t v t .
R l t v w s : R g r l ss f h ww lly r s r h y r l t , h w
p rf t th y b l , h w p bl gr s y r st r , th -
xp t w ll r. it w ’t b r l s th b h, b t t l
b r th b l g, h rr th t str ys h fth ty, r
t t r g y th t p s p t ts p t t l l ts. i th
s w lk s sp lls, ps t p t ts sr pt th , r st t
r yw ft fr th r st r t xt r. a lw ys xp t th xp t ,
b s pr p r s p ss bl t t th h ll g .
LOCATION
Th r s s h r t y r pr t f l ty th ts phys l r ss.
T ys t s l t f r sth t pr t s t l t t lb l -
gs r h sp t ls; sth t pr t s r f l t s th r th h s-
p t ls l b l gs. Th s l st r fr ts, lls, q t r w
h s s, skys r p rs, h t ls r s rts, t ss l bs. Y r s t y b

c h pt r 9: Wh r W ll Y Pr t ?


s l t f r ts r h t t r r t s, b t wh t v r l t y h s
r ts pp r , y st r f lly s r ss, t l t s, g , l ght,
pr v y, ghb rs, h z r s, r str t s.
Access
H ww ll p t ts r h y r ? ifth y r r v g, th r st b p rk-
g. if th y r t k g p bl tr sp rt t , th r st b l s pr x ty
t tr sp rt t st ps. if th y r h pp , th st b b rr r
fr . a ss ls r q r s th t y r b l rly rk , b t w th t
g r sh s g s th t pr pt y r p t ts t s k b k r f r try. Br k
rbs r ys w lks, tr shr bs r b g v ll h g g v r th
r, h vy h r -t - p rs r ll l ttl th gs th t h b t ss.
it s ls ss t lt s r ss t y r t rg t rk t. ify r l t
st t p rt f t w th b l f th t y r p t ts w ll ppr t th
q t, k rt th y r w ll g t k th tr p. if y p
j t t t ss t r t p t l z th rk t, k rt y r p -
t ts r ’t r q r t x gl w th s l j st t g t t y r
r.
a ss fr y r t j t s, lsp s, r s rg ry t r
r h sp t l r ls p rt t t y r q t . if y p r t w y fr
y r , y h v tw l t s t tr pp t ppr pr t ly
t v t s rv y r p t ts. c s r ss s f rg y:
h w r ly rg y s rv s r h y r p t t, h w st t s
th h sp t l? a rg t s t t r s lt fr r th j st th r y
pr v ; t r y t , y y, w th p pl wh r t y r
p t ts.
a ss s y r s p r t v . H gh, rr w st rs, l g w ts f r
l v t rs, rk b s ts, v l t pp r l v l h gh-
r s b l g h b t ss f r p t ts wh h v phys l r t l
bst l s t v r .
c s r t th t ss t t t h l gy s r l v t f -
t r t y. if y r s p p rl ss, ll y r p t ts pt th s? a r
th y bl t s th t h l gy? d y pr v lt r t v th s f r
th s wh t?

S t iii: Wh r
Utilities
el tr ty w t r r ss t l, b k p g r t rs f r p w r f l r s
r v t l. T l ph s, th i t r t, s r ty, f r s s, s t ll t
r bl t s r r q r t l t s. J st s p rt t s h v g
ss t th s t l t s s v l t g th t s r f r th s t l-
t s. is th fr str t r p t t r y f r f t r gr wth, r y
t v st pgr ?
W t r st b fr sh, l , t st l ss, rl ss, r y r r str
l s ll l k l ll. Th w t r q l ty st b ppr pr t f r y r
l ry st r l z t r q r ts, r y w llh v t b g t f r b ttl
st ll w t r. el tr ty st b s st t, p t t , s t
t s pp rt ll th t h l gy l q p t y w ll h v . o v r-
l r ts r t w r g g xp s v q p t. o tl ts
th t r p r l t s r t gr s s rv f l r s. c -
s r wh th r y r l t s w r pr p rlyf r ph h gh-sp i -
t r t s rv . c h k w r l ss s rv v l b l ty q l ty; f ll ph s
’t w rk s st tly, y ght h v h ppy p t ts. m r v r, y
l h v l t ss t y r w st phys xt rs.
Im a ge
Th s t y h s w ll pr j t ts w g , th t y r t, -
pl t, r tr t y r pr t ’s g . if y r l t r,
wh t th ss g s th p pl y r p t ts t t w th
v y? if y r h sp t l, wh t s th pr x ty t th r pr v rs,
s rv s, p t ts? a r th s pr t s r t w th y r w ?
i g s r t th b l g’s r h t t r s g , th v ws
r l k f v ws. if y st bl sh y r l l t , -
s r th g f th s t , s w ll s f th s rr g b s ss s. L t-
g str p ll r q t sh pp g r r s v t g s f r y r r t l
s rv s, f th t t r ttr ts p pl y r rk t y r p t ts.
H w xp s w ll y r p t ts b wh th y t y r ? W ll
th y f l v l r bl wh th y w lk t f y r , s wh t br s
b t ft r j t ? W ll th y b ppr h s v wh th y w lk
t y r th t th y ght b s by q t s wh fr q t
rby b s ss s?

c h pt r 9: Wh r W ll Y Pr t ?


o rr t tr s t pr t r r r s rts, sp s, s l s. B t
s h l t p r y r g by k g sth t l k l ss
pr f ss l, r pl t ly l? d s th g f y r l t
pp r t p- rk t, th r by s r g gp t t lp t ts? o r s th l -
t t f sh bl , th s s pp t gp t ts wh xp t r l-
g t s tt g?
Ligh t
c s r th t r l l ght r l k f t y r l t . Th r s th g
r w l g, w r g, tt r g t th pp r th th -
b fs ft t r ll ght. ify r l t th s rt, h w v r, th h t
s b t g thr gh y r w ws ll y w ll b t h rsh v t g.
W w v r gs s ft g l s p g y b pt . c s r
th tr st f l ght g; y ’t w t y r p t ts t f l th y h v
w lk t f rk th t r t yl ght, r v v rs .
Y ght t b bl t tr l th l ght g pt s r s, b t
s r th v r ll ll t f y r s t . H llw ys, l v t rs, v s-
t b l s s w ll s r v w ys, p rk g l ts, w lkw ys, fr t b k
rs sh l b w ll l t r g ll h rs f b s ss p r t .
P riva cy
a lth gh y r y b p bl r , y st pr v pr v y f r
y r p t ts. d s s r ty r q r th t y r p t ts t fy th s lv s
b f r t r g th p rk g l t r b l g? c ghb rs w t h thr gh
st r fr t w ws t s wh s t r gth pl st s rg ’s ? S
p t ts y t b r b t w lk g thr gh tr
b gs by th rs; s y skf r pr v t tr th t sh l b -
ss bl ppr pr t . Wh t s y r p t t s r xp r thr gh
th t b k tr ? F r x pl , f y r pr v t tr s th b k r
xt t j t r l l s t, k rt th l s t s lw ys l s , rk ,
w th t r.
c s r th f t f r s s ts y r . d
th y f st r pr v y, r xp s y r p t ts? d w lls f gl ss xp s th
p pl y r r pt r , r s tr t t r s? L ght gl ss
r b t f l w l g wh th y r bv sly s r f r pr v y.

S t iii: Wh r
Neigh b ors
my gr t- l P t r s t s y, “c h s y r ghb rs r f lly. Y
st l v w th th v ry y.” Th r s w s th s w r s, b t y
y h v l ttl tr l v r wh y r pr t ’s ghb rs r , r r -
xp t ly, wh y b y r ghb r. F r x pl , f th r r v -
t l ts r y r l t , t wh t th t l s z f r
wh t t yb s f r th f t r . ifth r r j g s, sp s, r
st r s f r l s , t s w s t s r wh ght v . a phys
s g -y r l s st r fr t sp b g t b l b t f l
l sp , ly t h v r st r v xt r. a lth gh y
y t h v th b l ty y r l s t pr ppr v w ghb rs, k
rt y h v s r b s ss sr pt l s y r l s .
L k w s , y yw sh t h v p t t r l s s th t y r l t
y r th ly p r tt pr v r f y r sp lty. a phys
ll , f r s th t th sp h h gr t w th h v t
p t t r t pr t th sp th y h w s t th r . d ’t l t th s
h pp t y .
n ghb rs r ls p rt t t pr v y s f ty. c s r th p pl
y r b s ss ghb rs y ttr t. c s r th t s y r b s ss
ghb rs r p f r b s ss wh t th y r g wh y r t
-s t .
H a za rd s
Y r l t y h v bv s h z r s th t b s ly r t , r l -
t t h z r s th t y s v r ly r s t t . S w st b
l r fr w lkw ys; h r ls sh l b v t p t . if
y r r -pr r , h rr ll y, pl , r th h gh st
p t l ght g-pr v ll y, k rt y h v th r ght s f typr -
t s pr r s pl .
Th q p t y s ly y t s l k h z r , b t th wr g
h s s h v s b ly. Str t p l s pr t s st b

c h pt r 9: Wh r W ll Y Pr t ?

9
pl s th t g r s r gs r l k w y v s r s bl
wh t s . F r x pl , l s r th t s tt r h s
k y ts l k s h z r . n l s s lp ls th l k b t f
x t r wh r str t p r t s ts w th s ll h l r s
t w t g t h pp .
el tr l r s th t r ss th r, l w-h g g l l ght g, p
b t r l s t rs, lw st r t lp r ls. exp r r
xt g sh rs, t rg y ph b rs, v br k l g
t l s r l gg t l ts st b rr t . H v pr r s pl f r r -
t fy g th s tt rs t pr v t tr bl b f r t rs. R g l rly sp t
y r pr p rty s t f r h z r s.
Restriction s
it s ss t l t k w wh t s s t p r tt f r y r l t
b s y r l s , l l r , ghb rs, z g, l l st t r g -
l t s r v ts. R str t s y l th h rs f p r t s w ll
s th typ s f pr r s th t y y r y t b p r tt t p rf r
-s t . c s r ls ss s th t r str t y r b l ty t gr w r w -
s z y r phys l sp f ss ry. m st y r l t r b l , r s
th r x b l ty t xp r s l b k?
ACCREDITATION
a lth gh t s t r q r f v ry r v ry sth t sp lty, -
r t t f r y r s v ry p rt t. Wh th r th a r a ss -
t f r a r t t f a b l t ry S rg ry F l t s (a a a a SF), a -
r t t a ss t f r a b l t ry H lth c r (a a a Hc ), J t
c ss th a r t t f H lth r o rg z t s (Jc a Ho ),
r m r , r t t str t s t y r p t ts th t th s l t
ts sp st r s f r h s f ty. d ’t s plypr p r f r sp -
t r v w; l v th g l s pr t s v ry y, th v t
f y t w r v t, y r s tt g w ll b s r , y r st pr -
p r , y r p t ts th b st p ss bl t s f r th r s f ty.

0

S t iii: Wh r
ACCREDITATION
Alan H. Gold, MD, FACS
a lth gh sth t s rg ry h v v ry p s t v l f - lt r g b ts
f r r p t ts, t s t w th t r sk. W s ss th s r sks b ts s
t gr l p rt f r s lt t s, th s tt rs r ppr pr t ly f
gr t r t r p t ts.
T b s ssf l th h ghly p t t v v r t f sth t -
s rg ry, t s r t l th t y t ly str t y r sth t
v s rt stry thr gh y r s rg l r s lts, b t y st ls pr v
th b st p ss bl p t t xp r v r t th t str t s
y r t t t p t t s f ty. W th st sth t s rg ry w p r-
f r -b s r b l t ry s rg l f l t s, th b st w y t -
s r th s f ty f y r p t ts str t th t t t t th s
thr gh r t t .
Th r t l p rt f f l ty r t t h s l g b r g z
by pl st s rg s, t lly l th t v l p th a r a ss -
t f r a r t t f a b l t ry S rg ry F l t s (a a a a SF) 9 0.
i r s p bl , rg z t l, g v r t l k wl g t th t -
r t t w s r t lt s r gth h gh st l v l fs f ty q l ty ll
sp ts f th tp t t s rg l xp r l t xp s f th t r-
g z t ’s f s s th a r S ty f r a r t t f a b l t ry
S rg ryF l t s, t l v rs ght fth f l t s f llsp lt s. o th r
t l r t g g s, s h s th Jc a Ho th a a a Hc , ls b -
g t f s rts b l t ry f l ty r t t . i 99 c l f r
b th rst st t t t r t t f r ll tp t t f l t s th t
st r s t r g r l sth s , pr f ss l rg z t s,
s h s th a r S tyf r a sth t Pl st S rg ry th a r
S ty fPl st S rg s, s t th t th r b rs p r t ly
s h r t f l t s. u f rt t ly, s f th s wr t g, ly 2 st t s
t s s rt f r t t , th v st j r ty f b l t ry s r-
g ry f l t s r r t p r t p t f y p r r -
v w sp t pr ss.
T b s ssf l y r sth t s rg l pr t , y
st k t t t l f l gl r g fyy r t h q s r
l r w s t pr v th b st p ss bl r s lts f r y r p t ts. S -
l rly, y st ppr t th t t g s f ty q l ty y r b -
l t ry s rg ry f l ty s ls y pr ss. Wh l th b s s f pr t
s rg l r yr st t, t s r t lt rp r t v s
t h l gy h g s st r s f r t y r pr t t r t th

c h pt r 9: Wh r W ll Y Pr t ?


rr t st t fth rt t s r th s f ty fy r p t ts. Th st r -
l bl w y t s s thr gh r t t by, g g pl
w th, r g z r t g rg z t th t h s v l p th syst s
t t v ly t r pl t th l t st v s tp t t r
l v ry th t r tly b t y y r p t ts.
Th r r yf t rs th t tr b t t th s ss fy r pr t ;
v s bl str t t t t p t t s f ty thr gh r t -
t s r t l .
ACQUISITION
T y th r r s y pp rt t s t q r y r l t s
th r r pr t ls. a t t l s g p r h s gw r th st
pr v l t pt s; t yth lt r t v s l s, t -
sh r s, rr g ts wh r by y t p y f r sp , b t r -
tr t t p y p r t g fy r f s f r th b l tyt s sp . Y st
b t s b t l ws th t r g l t w rsh p s rg l g st
t rs. Wh t v r q s t rr g t y p rs f r y r l t ,
th r r thr ss t lv r bl s y st t v rl k: f s b l ty, l g lr -
v w, g.
d r g th q s t ph s f y l t , th phys - w r sh l
s r t lyth pr t ’s t s, b t st ls l kt th f -
t r . G ls b s ss pl f r , 2, , 0 y rs t th f t r r s-
s t l t f r l t g s th t w ll f v r th pr t ’s s ss w ll
s r th b l tyt s r th f s t q r l t w th -
g th t b st s ts y r pr t y r p t ts’ f rt xp t t s.
F ea sib ility
B f r tt g t y l t , y sh l r t th s rv s f r-
h t t t ss ss th f s b l ty fth l t , sp llyth sq r f t g
ppr pr t t y r s; ss ppr pr t t l l st t r g l t s
f r lf l t s; t l t s; str t . Y y s v r th t l -
t y r s r g t s pp rt y r t l tyr q r ts r w l
ss t t xp s v lt r t s t br g th s t p t f r l
.

2

S t iii: Wh r
Lega l Review
n v r s g l s , p r h s , t -sh r gr t, r y rr g t
w th t pr p r l g lr v wby r l st t tt r y. Y r tt r ysh l
l k t th t ls f th tr s t s w ll s th l b l ty, r str t s,
v ts th t r w th . L l r t t pr v ts
ll w s st b l rly , l g w th ss ss ts, t x s, r str -
t s, tl ss th r v t l t ls. it y t k w ks s v r l v r-
s s f th l g l gr t t s r pt bl rr g t. c -
t r g l rly w th y r tt r y, v r h s t t t sk q st s.
F in a n cin g
F g st b rr g t ly f r th p r h s r b l - t f y r
l t , b t ls f r ll th f r sh gs q p t th t w ll g t th t
f l ty. Wh th r y r b l g, r l g, r s ply r r t g, b
r f l h w h y v st sh t th ts t, h w y r l r l s
p y ts r , wh t sh w w ll b r q r t v r q r-
g y r f l ty s w ll s k p g y r pr t p r t l. B s t r-
st r t s, b rr w g pp rt t s, v st t pp rt t s t t ,
t s p ss bl t s t f r l f r v st t l v r g g. Y
st w rkw th t t, b k r, v st t v s r y tr st, t
ll b r t t th b st p ss bl rr g t f r y . Y sh l ls
b w r th t y y b sk t s r l s w th y r p rs l ss ts.
a lth gh th s s pr t , t p ts t ly y r pr t b t y r
pr v t l f t r sk f y xt y rs lf t f r.
DESIGN
d s g p ss s h r th l r p l tt , rtw rk, r. a
t v s g st t k t t th sp y w ll , h wy w ll
t gr t th sp , th w y wh h y r pr t w llf t h r ,
wh t y w t th t r f l tyt l k, f l, s l k . B w r f
s g f r s g ’s s k : rbl rs r l v ly, b t th y r l , l ,

c h pt r 9: Wh r W ll Y Pr t ?


b sl pp ry. a l g t b t x bl l y t h r pp rt -
t s t gr w pt w th th s f tpr t. i ppl -w t g-r
pts, b t ly f r pr t s th t lr y h v th b l ty t tr l
s h l s, s r p t t pr v y, t v ly s t .
Th s g sh l r sp t ll th ss t ls f y r l t — ss, t l -
t s, g , l ght, pr v y, ghb rs, h z r s, r str t s. it st ls
pr j t th g f v t g, pp l g s tt g th t w ll r w p t ts t
y f r sth t s rv s. d s g b th st v l z sp t f
y r t r pr t , b t p g y r b s ss l l t , t
y ls b th st r str t v .
i w ’t t ll y wh t l r t p t y r w lls, b t i w ll t ll y th t y r
s g st:
Focus on your patients: Th r sh l b str t s
s ght, s , r s ll. Y y l k P ss r W rh l, th
s ll f g r s, r th s s fs ls s , b t s r
h w th s th gs y r l t t th v l t st s f y r
p t ts.
Re ect your image, not your life: P t r s f y r f ly r -
y fth s y l v f r l v , b t th ysh l v r
b v s bl t y r p t ts, f r th s k f y r f ly’ss f ty.
Y y b v g lf r, b t f y r w t g r l ks l k
st p th PGa t r, y r p t ts y f l th y st b
g lf rs t t w th y . Y y l v sl k, -
l st r s , b t sk g y r p t ts t s t l w,
l ryl h rs ght b l ttl -p tt g. F
h ppy th t s f t l, styl sh, f rt bl .
Preserveprivacyandsupport modesty: P t tssh l v r
b sh fr r t r v r s st t s f r ss
thr gh th rr rs. c l lph t gr phy yb ss t l
f r y r p rp s s, b t r l z h w f rt bl th s s f r

S t iii: Wh r
p t ts. G v th r b s t w r, t p p r g w s
r p s. d ’t wh l p t ts g r ys r wh l h rs
th gh p bl sp s. d s g v r t th t g v s p -
t ts s s th t y v l th r pr v y th t th r v s t
w ll b h l w th s r t .
Account for safety and upkeep: S l l s l
w st sh l b pr p rly h l k pt fr p t ts’
v w. St l ss st l s ks t rs r sl k sy t
s f t, b t th w t r st s th r v r- pp r t
h r t l . a w t rf ll k p th try y b
l v ly p f l, b t f t r q r s st t w t r t st g
ltr t t k ll th lg r ttr ts th g rs f v s t g
h l r , t s str t .
Exude comfort and warmth: W r g bl k ts l th r
x t t bl s th pths f J ry r r l x g. S ft
t rryr b st v r p t t yst g f r ss r -
f rt bl , w r , l x r s.
Beconsistent and dynamic: d s g sh l v r k v ry
r y r l k r l t t th xt, r t y r p -
t ts. B t s g st ls b x bl t ll w lt p rp s
pt s gr wth f r w s s r t h l g s.
Endure: Y r s g sh l h v l f sp f t l st 0
y rs. a v th s f tr y l rs styl s th t w ll
q kly pp r t .
L t s g yh v f r l ss p rt th th l l t
f y r pr r s, b t th y tr b t t y r p t ts’ xp r s
t th s wh h y w ll b s r r ll . Y s l t th
p pl y r t f r th r b l ty t t w th y r p t ts pr -
v tr t t s rv ; y st pt s g f r y r pr t th t
t w th pr v f rt t y r p t ts.

c h pt r 9: Wh r W ll Y Pr t ?


DESIGNED F OR SUCCESS
n l t , pr t s f t s t h v rg y t
pl sp llyt l r f r th l t th p pl th . Wh th r
y t r rg y f l l t r , t r l s st r, -
t, r t f v l , y st s r th s f ty f ll p rs s y r
pr s s, f th rs wh t r y r pr t th v t f rg y,
f ll t sp t y r pr t .
W th r f r st gh s t f s bl t pr t h rr s, st r s,
t r s, b t t p t rg s r s . Y sh l v l p
pl th t sp lly s:
Wh s t bl f r p t ts wh t t s r ss ry t
pr t t th r s f ty pr v y
Wh s t bl f r ll th r v ls th pr s s,
wh th r th y r st r v s t rs, f r t t g l w f r -
t r rg y s rv s
Wh s t bl f r t b k ps h w th s w ll b
g s th ts, h rs, r ys f ll w g
rg yt t t p t ts;wh s t bl f r th rg y
t ts f r y v l wh y b j r r s bl
Wh s t bl f r t s, q p t, th r t s
th t b r lyst l r ss fy r pr s s s t s r
Wh r v ls st b r l t , wh th r t ly, f r
f w ts, r t l y r s p r t l g
Wh t r s wh r t s s f t s k sh lt r t’s -
t , r wh t s s f t r t r
i t , y sh l r g l rly h k th p r b l ty f s f ty q p t,
s h s r xt g sh rs, g r t rs, l r s, t b k p syst s.
S h l s f ty h ks fth pr s s f r h z r s r bst l s s h s w -
ws th t r st k, rg y x ts th t r bl k , r q p t th t
v rh ts st b t t . P r s f ty r lls, wh th r
f lly x t r s ply v rt l xp r , w ll s r th t st r pr -
p r f r y v t l ty.
W th t th v ry b st s f ty pr t s v ry f t f y r pr t , y
s ply t w ll t s .

S t iii: Wh r
IN P RACTICE: P lan for th e Fu tu re
a wly f r pr t p rt rsh p w s pl g t p tr ly pr -
h s v f l ty t t sth t th t r f t w . Th
s t w s r th h sp t l, j t t q t h t l, w th ll th s-
s ry fr str t r ; th phys s w r thr ll w th th l t th y h
f . Th r w s b k tr th t w s s ly ss bl f r p t t pr -
v y, b t f lv w fth tyfr v ryw w, f b l s b t q s
sh ps t th str t l v l b l w. Th y w r s g r f r th s g l p-
p rt ty th t th y t w t t w st t. Th y sr g r -
v th y w r g v t s r l tt r f t t, p rf r f s b l ty st y,
h r l wy r, t k th t t f ll w ll pr t s r s. i st , th y
t ly s g 0-y r l s w th t l pt s.
Th phys s s g b t f lly pp t pr t t r. n x-
p s w s sp r s g r t s; th f l tyw s st g. H w v r,
sh rtly ft r th y v t th s gr wl t , th yf th s lv s
w th v ry s r s pr bl : th q t h t l w s s l r z ,
sh rt r r th skys r p r w s r str t . Th phys s
w r f w th r g ths t y rs f l s s w lks, tr ks
bl k g th r b l g tr , h vy str t s , ly t b
f ll w by b l g th t w l bl k th r v ry v w.
Th yw gh th s bst t l xp s f br k gth r l s h v gt
r l t r try gt s bl s th f l ty. u f rt t ly, th r l l r w s t
w ll gt g t t , th r l s w l t ll wth t s bl t. T f r-
th r w l ws, th yl r th t th yw r s h ghlyl v r g th t th y
l t r t v . Th y t t l s p t ts, b s
l g t t th b l g s r s lt f str t tr r t th b l g
w th t p ss gth str t r ws. Th ytr t r t th s s t , b t
s th b l g xt r w t p, th r p t ts st pp g. Th pr -
t l f r b kr pt y, th phys s w t th r s p r t w ys.
Th r l fth s st ry: B r f l wh r y t r rs. Y r r s r s
st b s f r th pr t l s w ll s th pr tty. i v st g f s b l ty
st y w l h v r v l wh t w s tr sp r g xt r, v st g
l wy r t pr t t th r t r sts w l h v v r th l t t s f
th r l s .

c h pt r 9: Wh r W ll Y Pr t ?


OP ERATIONS
i t t th phys l l t wh r y pr t , th r r lt -
t f p r t l s r t s t y r l t th t tr b t t y r
s ss. Y st ppr h th s p r t l l ts w th s l r s r h,
f s b l ty r v w f th pt s, r f l s r t f y r pr s t
f t r p t ts pr t .
Eq u ip m en t a n d Su p p lies
Fr st r l z t t l v s t p r p p r, v st rr y f y-t - ys p-
pl s s ss t l t y r pr t , t x g t y r r s r s. Th tr
t w r s rv t s r t f rb f tpr ts s r sp s bl ,
b t r p rt t s y r t , y, st r g , y y r
p t ts’ xp r . F r x pl , v s g l t x gl v s r b l g t
b t sk g p t ts b t ll rgy t l t x.
In form a tion a n d Tech n ology
Y w ll r q r b s ss syst s f r t st r g , pr t g t
s h l g, ly t g. S t rs ls r q r t t
q p t. Th s f l tr l r r s (emRs) l tr
pr s r pt s (eRx) s gr w g, th s syst s r ss t l f r th f -
t r . m k rt y r b s ss t h l g s r t gr t , ppr pr t ly
p t , th t ll st b rs r v pr p r tr g t x z th
f t l ty f y r v st t. Wh th r y s f r t l tr -
lly t y r p t ts s y r h th rs, b t k rt th t y r
tw rks t r s r , pr t t , b k p ly.
Telep h on e
Th b st t l ph syst th w rl h s l ttl v l l ss th p pl
wh s t s t v ly. V l s ss t l b t s t pr ry
s t t . Y rs s p rs l s rv , s ’t l t t t
r l y r ph syst ; l v p pl st sw r th ph . n th g s s
-p tt g sb gp rk h l t ly, l st gt th l p g s-
s g , “Y r ll s v ry p rt t t s. . . .”

S t iii: Wh r
H ea tin g, Ven tila tion , a n d Air Con d ition in g
a t p-q l ty h t g, v t l t , r t g (HVa c ) syst s
ss t l t t st y t p r t r s pr v s l t r w. a -
t syst s r fts fr v t b v x t t bl r
rryth s s fy r p r t gr t th r r s fth . HVa c
st b t btr s v .
Secu rity
a l r syst s lyw rkwh th y r bl . i sh k t h w y
s w th xp s v s ppl s f r t l g s, r gs, l v s
s ply h v l k k y. S r ty s p rt t, wh th r th s v -
t r s . P b tt s pr pr gr b rs t l l th r-
t s k y pr v rs y r r ss t l, ll ph b rs
st b rr t.
Clin ica l Sa fety
d t v rl k th p rt f t f st r l z t s t t
q p t pr r s. n sh l l v l w st t th b k
r v r ght xp t th t th s rv w ll byt ll t t. a lw ys
h v B y St t K t, t t xt r l br ll t r (a ed ), pr p-
rly tr st -s t . if s h s r v t y r , y
st t rst s t r wh s v s l v s.
Eq u ip m en t
L ghts, l s rs, s lp ls, s ks— ll q p t st b rr t pr p rly
f t g, st r , s rv .
Ga rm en ts/Un iform s
o pp r l s ts th rr t t f r y r pr t . Pr v str t g -
l s f r r ss s t th x pl y rs lf. n v r w r s l s r bs; l-
w ys h v sp r l th g. n v r gr t p t t w th y r sk, p, r
gl v s . Gr t th ts th st r l p r t r; l t th s y r f
y r s l f l th w r th f y r h sh k . n t gs -

c h pt r 9: Wh r W ll Y Pr t ?

9
Continued
f r s r t th s r t f y r pr t , f r wh h y y r y t
h v th r ty. Th p pl y r pr t wh t r t w th y r p t ts
sh l b s p rs bl tt t v th t t gs r t f r
th t b r bl . Th p rp s f t g s r r f r th p -
t t, t r t h f r th st . Y w t st t b r b r f r th r
k ss s rv r th f r th r f sh h s.
IN P RACTICE: By Design
Th th gs th t i s phys s’ pr t s v r s t z . a
phys v t t h r w , wh h h -s t o R, v g
y. i h t b t h r pr r l t r w rk w th h r pr v sly. i
w s r s t s th s gr w f l ty sh h b lt. Th st w r th r ,
s w ll s th s g r (th phys ’s ght r) th v g ,
l v r s w r g g g. i th t l v r tr g t ks.
i th t l v r th t l v . o t l t f q st s,
s bs q tly t p rs r .
it s s th t th s g r- ght r h l xp r , r
th r h t t (h r ght r’s fr ). Th s th y h pl s f r th
t l t s t s pp rt ss ry l q p t, s h s th l q tr g
th t l v , r w r th r s g t r s f r pr p rly st r g th s
q p t.
Th rs st pp f s t r sp r s k t th
rs ’s st t wh r th t l v w l h v t g . Pr bl s lv , t l
th s g r- ght r w lk by sh t , “Wh p t th s th t r?
n l tt r. n l tt r. Th t th g s h s!”
Th rs w lk t th pr p r t v r t p s h rs lf, ly t
l v ly s t bl , s ft ph lst r h r, r r g, b b
pl t. Sh w lk t sk , “Wh p t l th h r, r g, pl t
th pr p r ?” Th s g r r pl , “i . W r pl y g f g
sh , th c h s l w f sth t s b l . Th r st b l
w r th v rywh r .”
Th s g t gl r. Th r w s b try th x t r s,
ly p st l s ks. Wh r w l s ppl s, tr sh, w st g ? Th -
s g r br ght t l v ly th r- f-p rl r t v tr sh s f r h
r . L v ly gl ss t g r s w r l v r pl xt t th s ks f r
wh h th r w r g rt p t w ls, l v ly t ss b x s, r h s, sh y
h h l rr r.

0

S t iii: Wh r
i w t h h rr r, w r gh wth s g r w l s rv v th wr th
f th g r, wh h l st r g sp , wh r t pl h r
pr t r, f x h , r v P st- t t th l v ly gl ss t bl th t w s
t b s s h r sk. H r sk h l r h , r l ss ph ,
r l ss l pt p p t r. Th w s s pp s t b p p rl ss, th -
s g r s st , s th r w s f r st r g yth g.
Th s w s l r s wh h th r h t t s g r h pt
f f t , th phys h pr v v rs ght r s ght p t
fr h r st l y t ss s.
Th l ss h r : i th v ry rst p rs wh w ll s st th t y r
b s ttr t v s t s f t l, t, s f , ppr pr t . B t f y
t r t w t t b p rt fth s g pr ss, k rt y r -
s g pr f r s y r l l s r v y t q l xp rts
th pl g pr ss.
IN P RACTICE: By Design —con t’d

WhereWillYou
Connect?
A weird combination of isolation and connection
and disconnection; discomfort and awkwardness.
— Ro bIn WIl l Ia mS, a CTo R a n d Co med Ia n
CHAPTER 10
C u ic ti , y ur i ity t c ct with th rs, is th k y t succ ss
i y usi ss r r ti ship. Y ur c i ic utc s y ur i ity t
c ct c u ic t r th st i p rt t v ri s i th succ ss
f pr ctici g sth tic ici .
With ut c u ic ti —w r s th t c ct y u y ur ss g t th-
rs—y u wi t h v tr c i t y ur pr ctic . With ut tr c y u wi t
ttr ct pr sp ctiv p ti ts, with ut c u ic ti i th f r f -
uc ti , y u c t c v rt th s i ivi u s t p ti ts. F i ur t r gu-
r y c u ic t with p ti ts t r t i th i cr s th ir v u s
r f rr s urc s is th p i t t which y sth tic physici s f i t c -
ct succ . Ti y, ctiv c u ic ti c k y ur p ti ts’
tr t t xp ri c p sitiv , v wh th c i ic utc is ss
th p rf ct.
C cti r quir s r th si p y ttr cti g th i t r st f p t ti
c i ts, uc ti g th , r t i i g th . I si r utsi y ur c ,
v ry c cti y u k c h c y ur i ity t thriv . Succ ssfu
c u ic ti r quir s:
Consistency: I y ur r th xp ct ti s y u
v ry ti , v rywh r

S cti III: Wh r
Compatibility: a pti gy ur ss g t th u i c r sit-
u ti with ut iv rgi g fr y ur r
Precision: d iv ri g y ur ss g with th right w r s,
t , v hic , t ppr pri t ti
Manners: ev ifs is i gu p s t, r xp ri-
c isu c f rt , sh u sti c u ic t p it y
Truth: If y u c t si c r , si t
m ki g c cti r quir s:
a sp ci c g , wh t y u h p t cc p ish y ki g
c cti
Usi gth st ctiv ppr pri t v hic s t g t y ur
ss g iv r ct
U rst i gh wt ctsy ur c cti , th c
t cti y ur ss g is sig t c p i th rs
R c g izi g th c st, th xp s v u , th t c u-
ic ti h s pti izi g this
Th st succ ssfu pr ctic s k i t i c cti t v ry p-
p rtu ity c u ic t ctiv y. S y s y th t this is rk t-
i g; it is t. m rk ti gis th ctiviti s c ss ryt xch g pr uct r
s rvic s f r y, r rt r; it i c u s y v ri s such s prici g,
y ur r , y ur s rvic . S y c it v rtisi g; it is t.
a v rtisi g is p i ss g ut pr uct r s rvic is tt pti g
t s f r y r rt r. Th r r , i f ct, y succ ssfu pr ctic s f
sth tic ici th t t v rtis .
m st p p g t th ir i f r ti ut sth tic ici fr t visi ,
g zi s, th I t r t, th r p p . This is t h w th y
pr vi r—this is wh r th y g t th ir i f r ti . Wh r i ivi u s
u ti t y c ct with pr vi r v ri s wi y: it c thr ugh r -
f rr y physici , fri , r f i y r, r thr ugh I t r t ist-
i g r v rtis t. d y u w t t r pr s t gth s urc s th t

Ch pt r 0: Wh r Wi Y u C ct?


th rs r ut i th i c ct with? d y u w t t th
s urc y ur xisti g c i ts p ti ts r c ct with f r iti -
t i i f r ti ? d y u w t t th st ttr ctiv s urc i ir c-
t ry, r th p p c t yr f r th ir fri s t ? Wh t wi it t k t
cc p ish th s g s? Quit si p y, str t gic yt rg t ppr pri t
c u ic ti th t k s c cti th t yi s r su ts.
RELATIVE WISDOM: Coverin g Basis
a chi h fri w s iscussi g his usi ss with . H is succ ssfu
ph r c utic r pr s t tiv sp ci izi gi c r i c c r rugs. I sk hi
ut th t s h us s t succ , t th succ ss f his c i ts—
physici s wh pr scri th rugs h r pr s ts. Th k yt his succ ss, h
t , is i r t fr th t f y ir ct r ti ship: it p s
utu fu t f th r’s s.
I th sk h w h k ws wh t his c i ts’ s r . His r p y i t
t surpris ; it w s i ic tiv f his succ ss. H st t th t h isc v rs
his c i ts’ s thr ugh c u ic ti —quit si p y, y ski g. “I r gu-
r y ir ct y sk y c i t wh t I c f r his r h r pr ctic t i -
pr v p ti t r ti ships. Th sw r is c sist t u i t r : p ti t
uc ti .”
His c i ts—pr ctiti rs f ss ti , t ctiv , ic tr t t—
s th t uc t th ir rk t p ti ts ut th ir c iti s
c r s f r st i fu i gth ir r ti ships. Th si g gr t st t th s
pr ctiti rs , th r th th i ityt pr vi tr t t, is th i ityt
c u ic t with uc t th ir p ti ts.
Fu t t y ur succ ss is th i ity t c u ic t y ur i iti s,
t c i y scri tr t ts s th t p ti ts c k uc t ci-
si cc pt th t tr t t. Ify u t sks wh t h r sh x-
p cts r s, y ur r ti ship c t v c . If y u t ctiv y
uc t p t ti p ti t ut his r h r ch ic t u rg tr t t, y u
c t succ .
P ti ts wh r fus tr t t i tr iti ici y i p ir th ir
h th. P ti ts wh c i tr t t i sth tic ici y iss p-
p rtu ityt h c th ir s s fw - i g. a th ugh y ur ss g s y
i r, th c ity is p ti t uc ti . With ut it, wi ch s
t u rg tr t t, y u wi t h v th pp rtu ity t fu y ur
r ti ship with th s y u s rv .

S cti III: Wh r
MAKING CONNECTIONS
ev ry ss g c v ys s f r f uc ti . T t rg t p pu ti s,
c i ts, p ti ts, th rs y u vi w s s urc s r s urc s t y ur pr c-
tic , y u c u ic t ss ti i f r ti ut th s rvic s y u pr vi
s th t th rs y t fr y ur ski s. F r x p :
a v rtisi g r ir ct i uc t s y ur t rg t u i c
ut wh t y u th t wi ttr ct th t y ur pr ctic .
br chur s uc t ut sp ci cpr c ur ut y ur
pr ctic . Y u w u surpris t h w y t i c u
pr ctic i f r ti . With ut this, wh t v u s th
r chur h f r y ur pr ctic sp ci c y?
I f r c s t uc t s ut th pr c ss p ti t wi
u rg , its p t ti ts risks, st t ts v i-
ti g p ti t’s tiv ti y ur c it t t qu -
ity c r .
a th ugh th p pu r i k p th pu ic r st f i v ti s i s-
th tic ici , y ur r is t uc t y ur u i c ut wh t y u pr c-
tic i sth tic ici , i s c s s ut wh t y u t pr c-
tic , why. Wh physici r f rs i ivi u t y u, it is y ur j t
uc t this p t ti p ti t ut h w y u c fu his r h r p rs
sir . a r f rr fr th r p ti t y c u ic t rs t
fy u s pr vi r f sth tic ici , ut y u ust uc t th t p rs
ut wh y u r , wh t y u t v i t th t rs t, h wy u
c sp ci c y fu p rs sir .
ev ry ss g ust c sist t r cti f y u, y ur pr ctic ,
y ur i g . T k c u ic ti v u t y ur succ ss, th c t ts
c cy f y ur ss g ust s u . Th ss g ust h v g ,
purp s , ppr pri t t , r tiv c t cti . e ch
ss g ust:
De ne a goal: H w wi th succ ss f this c cti
sur ?
Identify your connection: o utsi r i si y ur pr ctic ,
with wh t v hic s r th s?

Ch pt r 0: Wh r Wi Y u C ct?


Clearlyconveypurpose: Wh t is th ss g sig t c-
c p ish t wh is it t rg t ?
Garner attention through tone: Wh sthis ss g
t p sitiv y ttr ct its i t u i c ?
Present a relativecall toaction: H w y u w t th rs t
r sp t this ss g ?
Goa ls
b f r y u gi t x i h w y u c ct, with wh , f r wh t
purp s , y u ust u rst th g s f c u ic ti . G s
t rg t, s thi g w wish t chi v , utc , s thi g th t sig-
s w h v cc p ish th s g s. l k c r fu y t th ss g s
t s y u us t c ct with y ur rk t, c u ity, p rs, p ti ts,
st , v th ss g s i y ur i t rp rs r ti ships. S s-
s g s y h v si p y c r y g s, s y h v u tip
g s, th rs y h v c icti g g s. Y u ust c ti u us y v u-
t h w w y u r chi vi g y ur g s ki g th sir
c cti s.
I si r utsi y ur c , y ur c cti s ust h v r r sp -
ci c r i ir ct g s:
F i ur t tt i c u ic ti g wi r su t i th f i -
ur t c ct w r i th r futur . (If y u ’t k
y ur s rvic u v i , wi k w wh t y u
r.)
F i ur t ppr ch th s g s h st y cr t s f s c -
cti . (If y u ish r v i th truth, y u wi c st
u t y ur v r city s r sp si pr vi r.)
F i ur t c u ic t g s c sist t y wi r su t i
f i c cti . (U r cu t p st p r tiv
i structi s t th p ti t y f i t c u ic t critic
v ri s.)
G s wh t y u xp ct t cc p ish thr ugh giv c cti .
Purp s is th i t t f y ur c u ic ti .

S cti III: Wh r
VISIBILITY
Y u y ur pr ctic ust visi t th s with wh y u t c -
u ic t . Ify u t k th rt t visi i ir ct ry, usi-
ss c r , w sit , thr ugh v rtisi g, r t pu ic fu cti s, h wwi
th rs k w wh y u r wh r t y u?
ANNOUNCEMENT
a u c t is ppr pri t wh y u h v s thi g i p rt t t
c v y, such s w c ti , iti t y ur st , w h urs, w
s rvic s r pr c ur s, wp ici s, r sp ci c r utt s t isi f r ti
i th p pu r pr ss. d ’t tt pt t i pr ss y u ci g s thi g
trivi , t , r u su st ti t . F r x p , ’t c i t th i g
pr vi r f c s tic i j cti r t h v s i v tiv i j cti t ch-
iqu u ss y u c pr v it.
a u c t with y ur st is qu yi p rt t; f r x p , sh r y ur
v c ti sch u f r c ti uity i y ur usi ss s th t p s c
cc r i g y. T st ify u wi sc i gth Hi y s s th yu -
rst y u w ’t r i y v i . Sh ri g th c st f y ur trip is x-
tr us istr cti g.
SOLICITATION
Y u h v s thi g t s — s rvic r pr uct. H w v r, c r fu
wh t y u s icit, t wh , h w. Y u y k c cti , ut is it
tru y th c cti y u t succ ? Sh ri g y ur s rvic u
w sit r with r f rri g physici s is s icit ti .
E DUCATION
ev ry c u ic ti sh u sig t uc t , wh th r ir ct y,
su t y, p rs y, r t wi u i c . If y u ’t h v t st k y
pi c f v u i f r ti t sh r , r i si t. exp i i g y ur s r-
vic u t st , r f rr s urc s, pr sp ctiv c i ts, p rs sh u f -
cus uc ti g.

Ch pt r 0: Wh r Wi Y u C ct?


N EW S
n ws is f th t, pr vi us y u r p rt , i p rt t i f r ti th t
is f us r i t r st t th rs. It is t s f-s rvi g; i th pur st s s it is
f r f pu ic s rvic . If y u h v v u ws, sh r it. If y u striv
t k ws, c rt i y ur i t ti s r f r pu ic s rvic , t s f-
ggr iz t. R sp i g t tr g y r sh ri g cc p ish t
th t h s tru i g t y ur u i c is ws.
N OVELTY
a v ty is s thi g w, fr sh, i viti g. If y u st ish g f r c -
cti g s v ty, c rt i y u r w i f r ut wh t th t
v tyc cc p ish. Y u y thusi stic ut wtr t t, -
vic , r t ch iqu , ut f r y u pr t th s , k c rt i th t wh t is
cutti g g t y wi ur t rr w, th t it rs v i , giti-
t t f r y ur p ti ts—th n xt big Thi g y tur ut t th
t st f c ift i j r r th xt ip iss v . Y u y wish t k w s
tr s tt r, ut k c rt i y u’r cki gth right tr . H w gwi
th v wit st i y ur pr ctic , wh t t wi it ri gt y u
th s y u s rv ?
COMP LIANCE
C p i c is ss g with tw v ry isti ct fu cti s. Y u w t t c -
u ic t t p ti ts th t y u r c p i t with th high st st r s f
c r thics i y ur sp ci ty, wh th r with Cme r ccr it ti f f -
ci iti s. I iti , y u w t y ur st t u rst c p y with
y ur c p ici s pr c ur s, y o SHa gui i s.
Y u sh u s c u ic t t p ti ts th t th y ust c p y with i -
structi s th t r ss ti f r g utc s s f ty, such s t s k-
i g f r w ks f r surg ry, r f r w ks ft r, r usi g i y su pr -
t cti . S t c r iti s xp ct ti s f c p i c , str t
y ur c it t t c p i c , th rs wi u rst r sp ct
th t c p y.

S cti III: Wh r
P RESSURE
Usi g pr ssur t ctics u r i s cr i i ity. Th y ti it is ppr pri-
t t ph siz urg cy is wh c i ic c iti xists th t wi ct
th p ti t’s utc p t ti y th p ti t’s h th. P ci g pr ssur
c i t/p ti t t ct w c us f prici g r v ty cr t s f s
c cti , wi sur y t r ti ship th t wi f i .
P RICE
Qui pr qu : s thi gf r s thi g. Y ur s rvic h s v i c st. Y ur
p y s th s rvic s y u pr vi sh u ppr pri t y c p -
s t . C cti g with p t ti p ti t pric is v i y wh y u
k w sp ci c y wh t is sir ppr pri t f r th t i ivi u . Try-
i gt c ct pric with u k w v ri sis ik c tchi g utt r i s i
th rk. Ify ur g is t v rtis th st pric , k wth t y u wi cr t
pric w r with s .
VEH ICLES
Th w yi which ss g is iss i t r pr s ts sig i c t p rti
f its v u : u ss ss g is r c iv y its i t u i c , it is
w rth ss. d iss i ti is s t g t ss g fr rigi t r t r -
cipi t with v ryi g v s f ci cy, sp , ttr cti , c st. Th v -
hic s us t iss i t i f r ti c r g fr sic t t ch gi-
c ypr gr ssiv . Th yc c ic r xtr v g t, s t t isur y
r r pi p c , s rv i ivi u r wi u i c .
Th r r thr g r c u ic ti rts ss ti t v rypr ctic f
sth tic ici : c i t p ti t r ti s, utr ch, v rtisi g:
Client and patient relations: Sp ci c ss g s r ir ct
t ctiv i ctiv p rticip ts i y ur pr ctic ; th y r
sig f r visi i ity uc ti , t r t i i ivi u s s
ctiv p ti ts, t c ur g s rvic r p t s rvic ,
t icit r f rr s. a x p is th p ti t uc ti t -
ri r c r pr ctic t ri th t y u p rs yput i t y ur
p ti ts’ h s.