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

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s V: Why
Fees P d v y g a v y h gh f ha g d a d -
d. W h v v ha a m d y a , y may
d y gf f mpa . W h f ha a m-
d y a , h may adj m d ay h g h f
m a pa d. t h h g y m y. i add , d -
d f a h d f g a p d v y m v g a .
t h m va w h p m a d pa ag f p a v
a .
Direct Expense c a , p a v , a d a a a d p a
( d g v y, pp , a d h d p a a xp ) a
y y g a va a h p g f m a h v g p d v y
g a a h v g v g a . A p v mpa v q
ha y a f y p a a d m m z y d xp .
Overhead Y p a a xp a , p a v , a d -
a f —a adm a v xp a d d —a d d v -
h ad. s m a a f v h ad a y d , h a p a
mm a , pa d a ma a , a d add d am ; h
a , h a , a , a d ax . t h xp y -
a m f h h g ha d v d a z a d pp y a d a d
m a d m q a d (d a q a y) a d h q a -
d. exp y d a w y a d.
P a g a a ma y a h v d a p g wh h:
t a g a ad v a d
c v a d ad p d v y
P d v y ad v
r v q a d m fg ( v a v a d
f m v ) a d (g v a xp )

c hap 1 : Why D Y P a ? Y b , Y G a

1
n g a a d y m w h a h v g h g a f .
H w v , g a a d d a v a h p wh h h y a
a h v d. t h y a d d h d :
u ma p a / g a
n v (wha y wa f af a xp a pa d)
G v (wha y w d d v
xp a d ma h m y y xp ma )
P d v y( h am f v w a a d -
h f d d a h v v g a )
c v a d (h w ma y p p y w d
a , h w f )
t a (h wma yp p y w d m g h gh y
d d a m )
t h ma g a a h p v d f h p a mp y wha
h y wa h p a a h v a a m d a v a d a . i
m a h may d d m f v , h may .
r v , h w v , w v a y d h v va f y p a a a
p . i w a d wha y p a y ga m
f m y . c d a f h fa a y d y ma
p a / g a a d y v g a . A a p v d , y a
h g a f v y , a ap p , y a
h a pa d.
i a x g p a m d , g a may a d y mp v-
g p f ma . i a w p a , g a may a d m g- m
p j f d ga a d ha mm d a . i ap a -
g a h a h pay mp , g a may a d
a m a f mp v d p f ma a d g- m g w h.
J a p a h d m d d af a h , g a h d
a d m f a d y a da d h mp . Y m d
y g a ywha y w h a h v y a d wha -
a f y ma , ma y, a d p d v y.

s V: Why
Ma crom a n a gin g
A h gh y m a xp a h m d a p a y y p a , y
d y d a d h ad a f h a f h y
p a . emp w y a ga d p a ama d a
ma ag y , p a h m. u y m p v d g v
am v a d ma ag g ama v ; h h pp f
wha m a v v p p p a h w d a a g .
P rod u ctivity
P d v y h m mp a d f a q a h a h p a -
p a . i ’ a h m va a . Fa f va a y d :
Y p a m x
Ava a p d v y f d v f
A a p d v y f d v f
A h v a pay . t h y h d d d pa a y f m
pay v a p a ha wh y a h . t h a
y v g a . Ava a p d v y a g d v d
h a m f h a y d v p d a p v d
v . t h d :
Y , h p v d
emp y h a a h a , d a , a d ma ag
h ap wh p v d p a v ha d y g -
a v
A y a a p
A a p d v y wha a f a h mp y wh d y g -
a v g a h m h h p v d g v . i a y
p a , h fa a hav a g a mpa d d p d v y
f a h d v d a a d h p a a a wh .

c hap 1 : Why D Y P a ? Y b , Y G a


i a ma p a , a pp a h p ma y p v d may a
p v d p a v a w a a a . A a g p a may hav
v a d v d a f g a h f h f . t h ma p a may
hav m va d p d v y g a p v p d , w h w -
p xp a p g a . t h a g p a may hav f w p d v y
g a p v p d , w h h gh p xp a p g a . Wha
ma m , h w v , h z f y p a h a f y
g a ; wha ma ha y max m z y p a ’ p d v y.
t h f y p a p d v y q a d d a h m fmax-
m m m ava a f a d v y a h v p v d a d
v f . D ’ y mp h d v d a p d v y fa v-
f p d v y g a . A mp a f p d v y
y ha m a g wh a a d v . t a a v
q h f w g:
ea h v p v d ha max m mp d v yd d f
a h v f h h f . t h , m p d y
h a d v f , w d ha p v d ’ max m m
p a f d v d a v .
n v v ( h a a ) ha a d d max m m
p d v y m a ( a v m ). sa v m ( )
m p d y p g w d ha f ’ max m m
v p a .
t h m fmax m mp d v y, wh a a d v , h max-
m mp a y p a ha g a v . t h y g ,
v f xp .
Reven u e
Y ma m y y g f h v y p v d a d h p d
y , a d ha m y d w h y p a p a h -
a d ma y p a f . M y , m y . i a m-
p q a ha g v a y .

s V: Why
Pa w pay y y m f h m a :
Cash: G g d, x p wh g m ’
p a d p h . i ’ a y, wh a pa
pay a h, f a mp y av d d g a a -
a . t h a y . i ’ a y h d a h
pa d f v w h w f a m , h a p -
d d h o r , ha d a pp , p
a d m d ma a , wax g, a d ma ag . c a h m
a v g a a ywh d payf a
m ; f h mp y p h m y, y
v a w a h va f y v y. M a a
w hya d f wa a y a , h a h g a
w h g d a h. H w v , y a a h
a h f m y p a . Pa w m m wa pay
w h a h f v , av d d , av d a y a
f h a a . ify g z m f w a a
a a h w, a g f a a .
Checks: P a h a d , a h gh
a m h ma p f a a day. t h a y f
p a h ha a g w a w mm -
d a d p f f d y a . t h d adva ag
ha f f d a ava a h pa ’ a , y w
d . t h a away a m , a d w y
m y wh y wa g pa d f y m g -
. A w g h a af m fpaym p a ma
p ag h fd g ag a p -
ag f a a y paym . exp ha f pa d
a h m f v a d ha d p f g y a day
f g y. D a p yf d h ,
d a p p a h y p a .
Credit and debit cards: M , wa d , a g, a d -
v a am g h a y pa may
a d a d. t h a a add yf y a w
a y m , h y a m w h a f d g
(f h d a d mpa y). i aïv h
ha h w h d a d d a d : d y h f

c hap 1 : Why D Y P a ? Y b , Y G a


ampa , a d y may f a amm
d y h a xp y p a . i ad-
d h f , d p d ha g p a y
. u happy d - dd pa hav w
d p ha g a av d pay g. Wh h
, y d ’ g pa d. e a yp a w h
d a d : y a d y pay a
h am h d a d, a d ma h g a .
Gift certi cates: Y p a m d a pamay
g f a . t h p a f g g f a g
. i a w h apa a v a p d -
a am g v . l aw ga d gg f a g f
a d a d h xp a va yf m a a . i g a ,
v a w g f a d f g a p -
d , a d v m g f a a p p -
d — h p may d may a
app p a a d da , a d a a y w v w d a
v a d h g f -g v w app a d.
Patient nancing: o p a d, a d p a g a y
a gp g am pa h gh- m h
a g y. b g v h f d g , adm a-
v m , a d f pa d, h a va j dgm ma
gpa a gf f h h d d , a h ha
h a d f d a . s a m , d a p y wh
pa a g d a d wha a d f y
p a .
Barter: Q d p q h d p p . Y
p v d my a v , a d i’ f pa y ,
p m y pa my a , d y a a a g m ,
a y y h d . t h q m , d a
h p a h p v d ? ba a a ,
a w h g a h y a d g axa -
m . A h gh a a y, d ’ d m h h va f
y v — a f wha h y a w h. s f
a p v d a d v d a y g a y x-
p . P p a gf a a , a ya a y-
f y m d w aw d.

s V: Why
M y- wha y f h v p v d d a d p d d. i
m h g y m a f da y. A da y g y ma a
a a , a p v d mp a a g da a. W h da y g
y ’ d pa , h a a h a a ap d y fa g
. F m da y g y a ha h d f y m p d v
day p d a d p d a . F m h y a p a a g m
p d v y. A d f y y, y m gh v d m wh h
day a a d m p d v a , mp y h d f
m y pa h d v ma p ha .
M y- y fd g . i v v m h m ha wha
yp a y d d v h ad: , , a a , ma g, a d ap-
a q pm .
Cost of treatment: t h f a m d g -
m f h f a m h a a h m-
p a , f m, y g f d ma , a d -
g - pa ag d h m a f p ; h a a y a a
a h p d p f m d. t h g d v m a
d d a f a m ; h w v h w y a a
ha a a a y m ma .
General supplies: G a pp d ga z , d ,
d pa , a h , g v , a d h d p a . i ’ d -
a d m m g d y a g h a
a m , ma , a d f m ha d a g a pp y
a g a m .
Back bar: c a , v m h m a , ma q , ma ag
, a d a p d d d g h f a -
m . t h m y m y a d may a f
wa a a y a g f h f , ma a a v ya d
a f h f a p d . e h ma a g a
app y a h a m , ma a p d -
p d g h yp f a m , d h a pa f
v h ad, h way, a m m d
a d p a v y.

c hap 1 : Why D Y P a ? Y b , Y G a

7
Complimentary treatments: Wh h g a w a -
m , a m f a , a a ha -y , a a h- p f
a y h a , mp m a y a m y m -
h g. r d h a d mpa wha mp m a y a -
m y h va h y g y . c mp m a y
a m a a mp a pa fd m a g h va f
a m , a gwa g a d f a m , g
w a m , a d h w g fav wa d. i fav m-
p m a y a m add d va fa m ha d .
Discounts: P d m a way d d f h f
p ;d m d d a a h- . Y m hav
am a f h wm h d y y p a
d m wh h h y a yhav va , a g a g -
a d a .
M y- a d wha y payp v d a d a . t h a m -
p m d f mp a , a d m a am g h m d :
Hourlywages: Wag a pa d f m p - , wh h
p d v a m . t h m f h a
xp v m d , a h m y -
p d v m . Wh pay gwag h yf p v d f
m m d , ma a h j d p d
d add p f m g p d ha a -
a h p a .
Commissions: c mm a pa d p d a . i
h a pay a mm m wh v a
pa a p a m . Y ’v wmad am d a a -
m a mm d y; h a a , a pa f d g h ,
ava a , a a , a a a a a . t h f
y m mm gp d . H gh m-
m a yp a y pa d f mm - y m d ;
w mm a mm y p d w h h y
wag . c mm a d v d a am a d. c m-

s V: Why
m a d v p p , mp f a , a d p-
. c a f y d h a h p f mm
y mag a d y a a d d m wh h m-
m a v a d va , p .
Direct percentageor set fees: D p ag f a
m mm w h a ha w h mp y . t h
p v d v a d p ag f h v -
d, a f f p a m p v d d. o h
a may a a y ma h a d pay y a
d p ag a f .
Wh h m y- m y- , a g d a m mp a ha
mp ya a gf — h mp a ha a f a a ma -
a w y ma m mp a d a h w y
p a m m d . t a g d a p v d a a wh h
d v p a d v p y, p d , p g, d fy a d ga ,
a d ma va d d . t a g d a a a f
a g va .
R EVENUE E QUATION
G v h mp f y v q a . i q
mp y a h m y y g : v f p a a . i ha va
a g xa y wha y p a ’ max m m p a p —
a way a d a , a max m m. A h gh y g a f g v
may y max m m, y v g a m app p a yd d y
y ma p a g a . Y ma p a g a may g a a
a am f v f y f, may mp y a p d -
v a y a . Wha v y ma p a g a , y ’
g v h m a f m g ha g a .
G v h d d d f a h v p v d v f -
a d mp d g v f h p a . A x-
p d y a d a v m d d d f m h
v g a d y ha f d m v . t h
p a v , h d v d a f a h v f .
t h , f m h m f v y d d a p a v h ad a -

c hap 1 : Why D Y P a ? Y b , Y G a


v a v f h p a . t h q a , g g w h p d -
v y h gh v , a f w :
sPP sF er F r V r P c G n
t h m f p v d p d v y (sPP), m p d y
s v f (sF), m
exp d y a d h v f (er F),
p
sa ( a v m [r V]), m p d y
F ( a p [r P]), m
exp a d f g d (c G) d a d d y
h v f
t h m f a h f ’ v m adm a v v h ad ( x-
p ), , d p a , a d ax y v . t h va f
ga g v v f a h p v d a w a va a f:
W a p d v y
A m a a f a a d w h p d v y
H gh m a a d xp am g p v d
H gh d p p a p a v h ad
r v w f h m w d a ywh h y hav fa d m
y v g a ; w h w wh h v q a y f
h . if y a d h , y w hav d y a a g y p a -
g a . Y maya mp y a gp d v yg a w h-
a a , y may a mp y g xp
w h a . e h d hav a ga v mpa v f a f y
xam d f h f h h fa a d h a a d a a d .
i y ha a g a a d p j f p d v y v w
p y m . b a p d a . by m g h g a
g a am f v a d xp , m y ha y
w p v d p d a .

0

s V: Why
RELATIVE WISDOM: Ad ju stin g
t h a w d m v h a w . o g g h m v
m a a d g y y p p , y a dy, a d f z
ga - ad v ag ; w w hav m p x ma wh y a p -
ha a g a f w a app , a p a f f v h , d a
mf a y ph d g a v d j f y a d y pa y,
a d v d y a f h m v g .
A a m wh h a a g a v , m v h a a
add g . Why? Adj m . A av am xp v , a d h a
am h f v . t h h g p p j y d
wh h y wa a g m m w. Am gm a , y gha
g f m g am g ma a p a h v a f w
h d ad . b h h a hav d j h pp , g g f m
p a g h ma g h xp v am ha p p j ya d
a w g pay f . t h h w mp : h ma h a f
a$1 , a x ya d mf f af wd a m . G wha
m g, ga d f m d , a a am gad
a d am g y g fam ? t h x y h a . A a f h add d
a d am , h a d f w - hav d ad wh a -
g d h a m xp . t h a pay
f ; y v y p adva . t h a
wa f J M a s h ; a v m y a f h
m v . t ag dg av d h h a , a d ad a d gg -
g h m v f aga . H w d d h a m a ?
t h m p d y va a d wh h y w ma g a d -
g m y. c m w a ady xp v , why p
a h a d m h g f h p ? r a y a a a a h -
a d, why ma h m m pa a d ha g a m ?
t h f d a d a m v a a add p, why w ap h x-
p ?
r a v w d m: r v w y g a , j p p wh y fa
h , d fy pp y. D ’ m y a h m , f -
w h d . l a pa , d d m g aph , a
y pa , a d ga h f d a a xp a a d va . r v-
mayhav fa a a ff w p d gp f m d, h gh
xp , a d a p h a f h fa . if y hav a h a a
wh h mpa , a d y hav q a a v p f m y v y -
m , y j m gh d ha y a y v ; a
v m d ha w h p y a a y g a .

c hap 1 : Why D Y P a ? Y b , Y G a

1
Continued
IN P RACTICE: Measu rin g Up
Y a a p a f a h m d wh app p a y a d,
d, q pp d, a d h a ; y v ha y v f wh y a a d
h p a y hav , w a a yf w— y a w g.
Wh y a a d h p a y p a w y fd aw
g a a . Y m a h , v , a d ma d. D g
h q ( xp ).
A y g, agg v p a wa m g h g a f v ;
h y w wh w h a h. H w v , h m d mm y y a
h m . Af h y a p a , h d d d ha m h g a
h d d m a m xp : m adv g, a h, m -
d a a , d y g . sh m a d v y h g x p h w -
; wa h y h g h wa w g xp d , a
h f ha a w y h w d. sh d d h a h w
d w d d h h w w h mm a a d
a h. i add , h a d ama a y a , av g ya -
f a a d pp a .
i a d wha h g a w , wha h wa d h p a a a , a d
h w h xp d w h h a d ha w d m a
a d v a y a a pa pay gf f v . sh d m h y
w d m h gh f a . t ha g h a , i d h h d d
a h m a v y a h a d ma a a h p w h p a
f g phy a , a d h p a d d ma a mm a
a d g dw w h x gpa f h f a . “n m ,” h d m .
H p a wa f a h had a a .
s h w w : sh wa g a g f , h wa y. s w
d a v . c v a h p a w g a . P d -
v y, h w v , wa w v m , wh a a a d adm -
a m wa h gh.
t h a a h mm y mp a . F , a , v -
a d , p d v y, a d v a a a d a d -
d p d . t h y a a y m xp f ap a a d m . if y d
va a a d m a a h mp d v d a y a h j v w h
m , y a y v h a f y h fa . Add -
a y, y may ma a adj m ha a f h mp d m
y g a a h ha a .

s V: Why
IN P RACTICE: Measu rin g Up —con t’d
s d, wh y d g a , y p a yhav m a f -
f y p a a d m a f p a g d y a a
p v d , h g g a f g a g v y p a .
t h d, wh y d mp w h ma ag h my ad ma d -
a f y ha y a f d pa a , y m
y a y p a .
W g a f h p a a d p a , f d a a wha v-
wa g a d f m p d v y, a d ha f a -
, a a d m . r g a v w f a h m a d h p -
v d ’ ma m a f : a a v p a , a a a d w ad,
a d a p v , d a f h f .
o y g a a d a h m a f m a g y v
am, f w ga y mw h p y p y g h p fy
m y, m a d v . t h a a , h y a h f da-
f ma g adj m , d a d g wh h g a g g
w , g g ad.
t a , f xamp , h ma ; j m a f h w h
my p d g a a y g v m p d . u mp y-
m , a , a d m p d g d x a . Wha a
y d x ? Wha m y m a a “ ap h ” v w, w y,
m h y, a d a a d a ?
Per provider: s g a a d g a v , m f
p d a d d a
Per procedure: s g a a d g a v , y m f
p d a d d a
Per source: s g a a d g a , h m d a h
pa am y (y w a h a f m y w y
a h h gh d , fa - -fa q y)
Comparatives: t h pa 1, , a d y a ; h pa 1, , , a d 1
m h ; h pa 1 w
Method: H w d d y h ? (if y hav y ha g d
p a f wa , h pa am f f wa , add d m v d
p d , adj d a a f p d , h w
hav a mpa y m )

c hap 1 : Why D Y P a ? Y b , Y G a


Continued
Y may d ha h d- f- h -m m a y p ha d w -
gy m yw h ma gy m y. Y may d ha d a a -
d d h g a aga wa d f y p a ; a why. Y
may d y a m y m a y hav
m m . i a a q a d p a f w m m h p f
y , a d a y yaf wm m ad h da a, a h d ,
a d ma adj m , j y m gh ad h da a f y w
p f , d h d , d wh h y d y m y
g w w wh h y a wa , a d ma h adj m a y
m a p y g a .
RELATIVE WISDOM: I Will Rem em b er You
ea y h a gpha fmy a , i had h pp y v v d
w h p f a f a a d g w m hamp f h
gam , a d f f . Wa Pay wa f h m. Wha i m m m
a Wa wa h day a a g a f h c h ag b a ,
h day g w h p p . i g w p h mm y Wa a d
h m , wh h a d h w f , c , a d h h d . Wh h h -
d w y g, i a ad g h m h g amma h a y.
Wh my n h a wa j a a y, i w d Wa f a h
wh h da y w d d w h “m mmy a d m ” w m
a . Wa v fa d m a a h d, h aha d h , h d
p a d , ma ma a . H wa a p va p , a ma f f w
w d , h . H wa a y y f wh h
wa h d, f h wa m h h d. “sw ,” a Wa wa
am d, had a g a am ha m m d a d g v g h a
h d; h gav h a h d.
Af h m f m f a , Wa wa a f ma ,
a a , a a , a d a a . i 1 Wa d v p d a f -
h a g a d d p a y d d a v a p a . D gh wa
h am g f h d p a y d d ga . i h a f wm h
f h f , h d d m f h p a ; h am a -
ad f ga d a . o ga d a a h p w d av h
f , p hap h d h p av h v f h h v y f w w
h had f a h.

s V: Why
t h day h d d, h h m j d w h f m , i had my w
m m f Wa , a d h i ga h g a h w Wa w d
m m d. ev day, v yf a gam , v ys p b w , v y m
my d h n m b a Pay j y, i p a d h f h ma
wh gav m h f h m f h .
t day Wa ’ ga y h d ma w h h d. o h d,
h ga y g h h d f h v y d f - ha g g
a d f -g v g pp y a ga d . i h g m -
f ga d a p g am h y, a d v day. l g af
h f a d a , a h y w , Wa w ma a h , a
hamp f f .
r a v w d m: Y v w wh y w h f , f wha
a . Y may v y w m m d f y pa , f y
w , f y a d h w a h y ama , q a yy may -
m m d f wh y a d f m d . l v y f f h w y
wa m m d, wha y wa a h v .
RELATIVE WISDOM: I Will Rem em b er You —con t’d

Client andPatient
Goals
The pain passes,
but the beauty remains.
— PIeRRe-AUg USTe Ren o IR, PAIn TeR
CHAPTER 17
T m asur succ ss s l ly by achi vi y ur w als v rl ks th hi h-
st purp s f y ur practic : ful lli th p rs al d sir f th rs f r ap-
p ara c ha c m t. Y ur pati ts c m t y u with th h p f im-
pr v d app ara c , f b auty. Th path t achi vi that b auty f r y ur
pati t i v lv s a i v stm t f m y, tim , a d t l ra c f pai . Suc-
c ss is t m asur d by y ur pati t i th b auty achi v d r th abs c
fpai al , b caus as R ir s l qu tly xpr ss d it, th pai pass s.
Why ar p pl m tivat d by app ara c ? Tim a d a ai w h ar ab ut
studi s that illustrat discrimi ati a ai st p pl with c rtai app ara c
traits, ab ut vari us p rc pti s f what b auty is, a d ab ut th r lati -
ship b tw attractiv ss a d succ ss. Is th r valu i such r s arch?
Th r c rtai ly is valu i u d rsta di th ral c c pts f app ar-
a c i ur cultur as w ll as i th r cultur s, but such r s arch ca t
h lp y u u d rsta d th i dividual m tivati s f y ur p t tial pati t
p pulati . U d rsta di th ir m tivati s is ss tial t s rvi th ir
ds a d c mmu icati y ur abilityt m t th s ds. Y ur succ ss as
a pr vid r is as much a m asur f practic als as it is a m asur f:
Cli t/pati t als
Th ir acc pta c f y u as p t tial pr vid r t ful ll th ir
p rs al d sir s

S cti V: Why
Th ir acc pta c f th s rvic s y u r c mm d, a d all f
th utc m s a d risksass ciat d with apr c dur , thr u h
i f rm d c s t
Satisfacti with th s rvic y u hav pr vid d a d th tir
xp ri c with y ur practic
Acc mplishi all fth s thi s may t b c tralt h wy u d y ur
practic als, but it is ss tial t h w y ur cli ts/pati ts vi w y ur suc-
c ss. Wh th r y u m t y ur practic als f r v u , tra c, r c v r-
si is t appar t t y ur cli ts/pati ts, r is it imp rta t t th m.
Th y will t ch s y u bas d y ur ability t achi v th s als; what
th ys a d m asur y ur succ ss byis th satisfacti y u ar abl t pr -
vid t th m a d th rs.
Physical Satisfaction Alth u h a pl asi , attractiv utc m is th ulti-
mat al f r th pati t’s physical satisfacti , th pr c ss f r achi vi
that al a d th physical xp ri c als c tribut t satisfacti . Pai ,
r c v ry tim , s cial d w tim , a d s lf-c sci us ss ar als fact rs i
th pati t’s t tal xp ri c . Wh th r th d sir d physical cha is
achi v d imm diat ly r tak s tim t d v l p, a d wh th r th cha is t
th xt t th pati t h p d f r r is withi th ra that is acc ptabl t
th pati t ar all fact rs i th physical satisfacti y u ca pr vid y ur
pati t.
C sid r t lyth pati t’s b dy, but als th physical vir m t th
p rs is i duri c sultati , tr atm t, a d r c v ry. Ar th sur-
r u di s warma d s ft a ai st th ski ? Is th pati t t uch d i as th-
i , c d t ma r, r with ha ds that ar c ld a d clammy? Is th pa-
ti t mad c mf rtabl whil sitti a d lyi d w ? D s s m sp ak
r assuri ly t f r stall a xi ty? D sta m mb rs d all th y ca t all vi-
at th pati t’s disc mf rt? o r will th wh l xp ri c b r m mb r d
i a ativ li ht f r its disc mf rts rath r tha f r its p sitiv utc m ?
Fr m a physical p rsp ctiv , y ur pati t wa ts t l k y u r, happi r,
a d l ss scarr d, as w ll as m r attractiv , rmal, pr p rti at , u iqu ,
r c v ti al. Y ur pati t’s physical ds f r this pr c dur must b
c sid r d as r pr s ti m r tha just th al utc m ; y u must fac-
t r i th p rs ’s r as f r wa ti that physical cha .

Chapt r 17: Cli t a d Pati t g als

7
Wh valuati pati t als a d satisfacti , y u must c sid r:
Th visibl utc m
Th pati t’s physical xp ri c a d vir m t, b f r ,
duri , a d aft r tr atm t a d r c v ry
Th pati t’s physical t l ra c s a d limitati s
Th pati t’s physical d sir s
Th physical vir m t i which th pati t xp ri c sa
r ti , ac sultati , ducati , ph t raphy, tr atm t,
a sth sia, sur ry, r c v ry, a d f ll w-up visits
Emotional Satisfaction Wh th r a i dividual’s d sir is pur ly t l k
y u r, fr sh r, r just alittl b tt r, r t r st r al st app ara c , t im-
pr v th scars f i jury, t ras th physical si s f pr a cy r w i ht
l ss, t c rr ct a s br k i a f tball am , r t ras a a tatt ,
y ur pati t’s als f r th physical utc m always carry a m ti al
c mp t. Y u must l ar t ly ab ut y ur pati t’s m ti al aspira-
ti s, but als his r h r m ti al stat . S m may b fri ht d; s m
mayb aïv ; s m mayb xc pti allym d st; th rs mayb c mpl t ly
u r alistic r may purp s ly i r th m ti al issu s that ar ti d t
th ir physical wa ts a d ds. evaluati a pati t’s m ti al ds i -
clud s:
F li s, curr t a d d sir d
exp sur t i f rmati
exp sur f s lf
Privacyfr mth i itialp i t fc tact thr u h t th xam-
i ati r tr atm t r m
exp ctati s, wh th r xtr m , r al, r acc pti
I u c : Wh a d what th pati t l ks t f r supp rt, r
t dimi ish th ativ asp cts f th xp ri c
Stability:Wh th r thisp rs ’s m ti sar c sist t, c -
tr ll d, a d h althyr sp s s, r wh th r his r h r r acti s
s m xc ssiv r xtr m

S cti V: Why
Experiential Satisfaction Th c urs ftr atm t is t m asur d as
si l v t; it is a s ri s f xp ri c s t achi v th ultimat al. At a y
p i t y u may fail t m t y ur pati t’s ds a d xp ctati s, r sulti
i a s rvic failur that mak s th v rall xp ri c l ss ful lli tha it
c uld hav b .
exp ri tial satisfacti c mpass s th wait tim s, th music, th t f
v ic s—th t tal physical a d m ti al xp ri c wrapp d t th r. It
i clud s th am u t ftim c ssaryt c ct with th c r th um-
b r f c cti s that d t b mad . It i v lv s th pap rw rk, duca-
ti , a d simplicity r c mpl xity f v rythi y ur pati t c u t rs i
y ur practic . M asuri y ur pati t’s xp ri tial j ur y thr u h y ur
practic r quir s:
A awar ss f th physical a d m ti al fact rs th pa-
ti t c u t rs
A m asur f th purp s a d succ ss f ach c cti i
th pati t’s xp ri c
Th impact f s m xp ri c s v r th rs i i u ci
th pati t’s v rall satisfacti a d ability t achi v als
Speci c Satisfaction Sp ci c ds a d als ar imm diat ; th s may
b as simpl as cha i a app i tm t tim b caus f a c ict, r as
c mpl x as d sp rat lywa ti amaj r pr c dur w, f r s m k w r
lat t r m tivati physicala d/ r m ti alr as . Sp ci c ds ar th
imp rativ fth m m t a d may r may t b imp rta t wh w i hi
th v rall satisfacti f this pati t’s xp ri c i y ur practic . Sp ci c
ds may b l r m mb r d r asily f r tt , maki th ir ultimat
si i ca c li ibl . Th lywayt m asur wh th r sp ci c ds ar
ful ll d is t ask th pati t, “Did w m t all f y ur ds t day?”
Sustained Satisfaction A sustai d d may b h w l th physical
utc m y u ca achi v f r y ur pati t will last; it may b h w l y u
will b i practic t ful ll y ur pati t’s ds. Sustai d ds may i -
v lv th m ti al a d physical supp rt a d vir m t a d th privacy
th pati t xp ri c s ach tim h r sh c m s t y ur c , r k wi
that y u will always hav v i h urs t acc mm dat a busy pati t’s

Chapt r 17: Cli t a d Pati t g als


sch dul . Sustai d ds aris v r th c urs f y ur r lati ship with
y ur pati t, a d th ly way t k w wh th r y u ar abl t m t sus-
tai d ds is by m ti th ds f th pati ts y u r tai .
U l ss y u u d rsta d a d satisfy a m asur f cli t/pati t xp ctati s,
wh th r physical, m ti al, xp ri tial, imm diat , r thr u h ut y ur
r lati ship, y ur practic als will v r b achi v d.
If y u w r t d cli t/pati t m tivati a d als (acc pta c , i -
f rm d c s t, a d satisfacti ) i t rms f qua tity r plac a um ric
valu satisfacti sh uld always qual 100%. Wh satisfacti is t
c sist tlyachi v d, th r is a r at r p t tialf r dissatisfacti , disc -
cti , r risk. I practic , matt r h w skill d y u ar , satisfacti will
t always b acc mplish d, but y u must striv t pr vid it.
EDUCATION
T m t pati ts’ als y u must t ach th mwhat t xp ct, what th y d
t k w ab ut th pr c dur , a d what ca h lp th m t b b tt r pati ts
a d hav saf r utc m s. With ut ducati , y ur pati ts simply ca t
l itimat ly acc pt what y u r, r ca y u acc pt th r sp sibility t
pr vid a s rvic .
educati i clud s all th l m ts f a pati t’s xp ri c :
I itial c tact a d scr i f th pr sp ctiv pati t’s r a-
s f r c tacti y u.
excha f i f rmati ab ut th pr sp ctiv pati t a d
his r h r als, a d ab ut h wth practic w rks t achi v
th s als.
Ac sultati t l ar m r ab ut a th r. Pati tsmust
xpr ss th ir als, shar th ir xp ctati s, hist ry, a d
h alth, a d askqu sti s. Th pr vid r must list a d shar
what th pati t ds t k w ab ut th practic , th pr -
c dural pti s, th xp ri c , a d th xp ct d utc m .
Th physicia must a sw r th pati t’s qu sti s a d pr -
p s a pla f tr atm t that will l ad t acc pta c , r t.

00

S cti V: Why
Acc pta c is th f rmal pr c ss f i f rm d c s t a d
subs qu t tr atm t. It is th pati t a r i t f ll w di-
r cti s as iv a d a r i t u d r th tr atm t as
pr p s d.
Y u ca c tr l - - ducati i y ur c a d thr u h writt r
l ctr ic i structi s pr vid d byy ur c . H w v r, pati ts mayals
b ath ri i f rmati utsid y ur c v r which y u hav littl c -
tr l. Th r is f lpr f syst m, but th r ar s m v ry imp rta t st ps
y u must tak t sur that y ur ducati al rts hav th b st p ssibl
cha c t l ad t acc pta c :
Pri t d r l ctr ic i f rmati sh uld t c ict; it must
b up t dat , c sist t, a d cl ar.
educati sh uld b cust miz d t th pati t, y ur practic ,
a d y ur pr f r c s. Us li drawi s, w rk sh ts, a d
di ital m a s fc ll cti r c v yi i f rmati , such as
ph t raphs r l ctr ic ima i . D cum t y ur di s
a d shar y ur r c mm dati s cl arly with th pati t.
Tim li s sh uld b us d wh v r p ssibl t h lp put th
tr atm t pr c ss i t pr p r p rsp ctiv . This is sp cially
imp rta t ifth pr p s d pr c dur r quir stim f r r sults
t b ptimal, r multipl tr atm ts ar typically d d.
Qu sti s a d a sw rs must b d cum t d. Add f ll w-
up qu sti s t sur clarity. Track th v rall tr d f
qu sti s y u r c iv ; th s that c m up fr qu tly mayb
t pics that y u sh uld str th i y ur c sultati dis-
cussi s.
D tails ar imp rta t t th pati t a d t his r h r ultimat
satisfacti with th pr c ss. Th tim t t ll a pati t what
h r sh ds f r aft rcar i t rms f arm ts, ski car ,
di t, r b havi r cha s is b f r th pr c dur . Th par-
ticulars fth tr atm t pr c ssa d th p sttr atm t cts
may s m r uti t y u but ar tir ly w t th pati t.
Th r is thi m r disc c rti tha t hav s m thi
u xp ct d happ a d th t l ar that it ist b xp ct d.
ev mi r d tails c u t i th pati t’s v rall xp ri c .

Chapt r 17: Cli t a d Pati t g als

01
What v r v hicl s y u us t ducat , matt r h w ma y visits r h w
much tim it tak s, d t s kacc pta c u tily u hav fully ducat d th
pati t.
IN P RACTICE: H ow An n oyin g
I am utt rly surpris d by h w ma y practic s d t pr scrib r r c m-
m d a a tiitchi cr amf r p stpr c durala d sur icalpati ts wh will
xp ri c th itchi s.
Afri d c d d that sh wa t d abr ast au m tati a d tummytuck
wthat sh was pla i m r childr . I av h r af w am s fphysi-
cia s i t w t c sid r a d t ld h r t pl as ask m a y qu sti s, but t
c mmu icat m r with h r d ct r tha with m . As I t ll fri ds wh ask
my advic , I am t a d ct r, a d I d ’t play TV; I’m just th r -
p rt r.
Af ww ks lat r myfri d call d, xcit d t hav sur rysch dul d. Sh
shar d a l t ab ut h r xp ri c , a d sh had a l t f qu sti s.
o w k aft r h r sur ry sh call d m , d sp rat . “My ch st a d my
br asts itch s badly I wa t t t ar away at th ski . I k w that s m tim s
stitch s ca itch wh th y ar h ali , but this is my tir ch st. It’s mad-
d i . What is i ? C uld I b all r ic t my impla ts?”
My rst st p was t xplai t my fri d what was i , a d t r
h r s m c mf rt i c mpr ss s a d cr ams. I pr vid d th r assura c sh
d d ab ut th h rribl itchi . n xt I visit d h r a d r vi w d allth ma-
t rial th sur had iv h r. n wh r did it say a ythi ab ut itchi ,
sh t ld m , a d sh was ri ht. My xt st p was t c tact th physicia ,
wh was t acli t fmi —just s m i t w wh I k whad th cr -
d tials a d tal t t tr at my fri d, a d wh sh ch s at my su sti ,
but with ut sp ci c advic . H was happyt r c iv mycall, tha k d m f r
th r f rral—a d th h was ’t s happy, b caus h t k th fr advic I
av him as a criticism: “I su st that y u t y ur mat rials up t dat a d
r aliz that f r v rypati t wh is ’t fully ducat d, d spit th p rf ct ut-
c m fr m th pr c dur , y u hav cr at d a l ss tha p rf ct xp ri c .”

02

S cti V: Why
ACCEP TANCE
Y ur mark t, cli ts, a d pati ts all hav di ri i t r sts, ducati al
ds, a d l v ls f c mpr h si . Whil th s di r am i dividuals,
th y ar c sist tly th thr thi s that cli ts d t mak a i f rm d
d cisi t u d r tr atm t:
1. I t r st i th ms lv s a d a sp ci c al r tr atm t t -
ha c th ir app ara c
2. educati ab ut th pr c ss, pr c dur , risks, a d r c v-
ry—th xp ri c —a d th alt r ativ s
. C mpr h si fth ir als a d allth i f rmati c s-
sary t acc pt what is p ssibl , what it will tak t achi v
th s als, th xp ct d utc m , ass ciat d risks, th p -
t tialf r a u xp ct d utc m , a d th atur fthat u -
f r s r sult
R alistic als a d xp ctati s ar th tw thi s that y u must b abl t
d cum t a d u d rsta d ab ut y ur cli t/pati t t ful ll d sir s. Fur-
th r, y u must av id a y i appr priat m ssa s wh c mmu icati
y ur valu .
Acc pta c m a s that th pati t has a r d t u d r th tr atm t r c-
mm d d bas d :
C d c i y u
U wav ri p rs al d sir
P rs al m tivati t act that d sir , t bas d i u-
c by th rs
A c sist t xp ctati f r th utc m

Chapt r 17: Cli t a d Pati t g als

0
Did a cli t/pati t ch s y u b caus y u r th tr atm t at th l w-
st c st? o r th b st a ci ? Ar th cl s st t h m ? B caus s m -
ls claims y u ar th b st? Th ly r as cli ts/pati ts sh uld
ch s y u t u d r a l ctiv pr c dur t alt r th ir app ara c is b -
caus th y f l y u ar th m st quali d p rs t p rf rm th pr c dur
a d t m t th ir xp ctati s i th c urs ftr atm t. If t, acc pta c
is t 100%, a d y u ar at risk.
Is th cli t/pati t abs lut ly c rtai this is what h r sh wa ts? Is h r
sh fully c mmitt d t s m thi that may b irr v rsibl ? If t, acc p-
ta c is t 100%, a d y u ar at risk.
Is th cli t/pati t m tivat d ly by his r h r u i u c d d sir , t
by sp usal, family, r p r pr ssur , t by tr ds r a d t c f rm t
th rm? If s , y u ar st p cl s r t 100% acc pta c a d st p
furth r fr m riski u ful ll d pati t als.
D s th cli t/pati t cl arly a d c sist tly xpr ss th sam r alistic
d sir d utc m ? D s h r sh fully a d c sist tly u d rsta d a d ac-
c pt th pr c ss c ssary t achi v that utc m ? If s , y u w hav
100% acc pta c . If t, y u sh uld t pr c d u l ss y u f l that th
risk f a u ful ll d pati t is l ss imp rta t tha th r v u tr ati this
pati t will pr vid y ur busi ss.
C mpl t a d u qu sti d acc pta c is ss tial, i th ry. H w v r, i
practic it is a chall . Y u h p that y ur cli ts/pati ts ar si c r i
what th y xpr ss, but th y may t b . Ca y u always r c iz such i -
dividuals? n . It is f r this r as that y u must f ll w stablish d pr c ss
a d pr c dur f r tr ati th pati t, such as c mpl t i f rm d c s t.
It is als why y u must car fully valuat th pati t’s physical, m ti al,
a d xp ri tial ds s that y u k w h r sh si c r ly acc pts all that
th tr atm t tails, a d s that y u ca b c d t f what it will tak t
fully satisfy this pati t.

0

S cti V: Why
IN P RACTICE: P rice Versu s Service
I ft l ctur ab ut th di r c s am bra ds a d th xp ctati s
th s bra d am s carry. F r xampl , hi h- d r tail st r s carry cl thi ,
p rs al car it ms (c sm tics), t ls a d ad ts, a d v f d. Walmart
carri s cl thi , p rs alcar it ms, t ls a d ad ts, a d v f d. What
mak s th $ 00 j a s at a luxury st r di r t fr m th $ 0 j a s at Wal-
mart? Th lab l, th fabric, th quality fc structi , r wh r th it mwas
c struct d? Th xclusivity r th mass availability, th s rvic that s
al with th sal f th s j a s, a d v th mark ti ? Th l ssy cata-
l a d chic display, r th stack f f ld d Wra l rs?
Y ur practic may b l ss r m r di r t fr m th rs tha a luxury
st r is di r t fr m Walmart.
o pr vid r’s f sch dul was th hi h st I had v r s f r c rtai
s rvic s that ar k w t hav a rally acc pt d f ra , such as c s-
m tic i j cti s. H was tryi t r w this part f th practic a d r lat d
his i j cti f s t his sur ical f s. W discuss d at l th that h did ’t
d t c mp t with th “Walmart-styl ” sh ppi mall fra chis m dical
spas f th w rld, but that by prici his tr atm ts t hi h, his s rvic
m u w uld b r j ct d bypati ts wh c uld t th sam tr atm t with a
similar xp ri c ls wh r , alth u h with f w r am iti s, a d t p r-
f rm d by a physicia .
H ar u d that his utc m s w r u parall l d (physical). His practic
a rd d r at r am iti s i privacy a d c mf rt ( xp ri tial). His r la-
ti ship a d th tim h sp t with pati ts was a imp rta t p rs al
t uch, a d his pati ts acc pt d this ( m ti al). H f lt th r was ab-
s lut ly pr bl m with his pati ts acc pti th w f structur , a d if
th y dislik d it, th y w r fr t ls wh r .
I c u t r d that h d d t c sid r wh th r v r tim pati ts w uld
c ti u t acc pt payi m r tha what th y k w th y w uld pay ls -
wh r . W uld th valu f th ir i ls wh r f r th ir i j cti s xp s
his practic t th s f th r physicia s a d l ad t a l ss f r t ti ?
I ask d that v r th xt w k th sta m mb rs wh a sw r d th
ph c duct a simpl study, l tti m k w h w ma y curr t pati ts
d lay d b ki th ir i j cti app i tm ts wh th y h ard th w
pric s, a d l t m k wh wma ypr sp ctiv pati ts calli f r i j cti s
did t b k. At th d f th w k, w r vi w d th umb rs. Th r was
a small p rc ta f w a d xisti pati ts wh b k d tr atm t d -
spit th hi h r rat . Th r was a hi h r p rc ta f pri r pati ts wh
did t b k tr atm t, d spit th ir pri r xp ri c . Th b tt m li : H
was l si t ly r v u , h was als l si l yal pati ts.

Chapt r 17: Cli t a d Pati t g als

0
Th l ss h r : What v r y ur s rvic m d la d what y u b li v y ur
pati ts ar willi t acc pt, c sid r what has valu . Sur ry is a much
m r i v lv d xp ri c tha a i j cti , a d th utc m s a d xp ri-
c ar hi hly variabl am practic s a d sur s. A limit d pr c dur
such as a i j cti has f w r variabl s, r quir s l ss tim , a d is m r c -
tai d, but is th l ss a imp rta t xp ri c f r th pati t. Y u ca -
t r lat y ur f sch dul f r sur ry t a f sch dul f r a i j cti r
th r pr c dur that ca b m r asilyc mpar d am pr vid rs. U d r-
sta d what physical, m ti al, a d xp ri tial l m ts y ur pati ts ar
willi t acc pt, a d th mak th xp ri c sp ci c t that tr atm t a d
what has valu . Ki hl’s lip balmpurchas d at ahi h- d d partm t st r r
at a dru st r is a Ki hl’s lip balm f r which y u will pay $ . Th j a s at a
luxury st r ar t th j a s at Walmart. Acc pta c must hav valu .
Accep tin g Resp on sib ility
Wh y u a r t tr at a pati t, y u ar acc pti r sp sibility f r th
cli ical utc m a d f r d av ri t ful ll th pati t’s physical, m -
ti al, a d xp ri tial ds. It may t b y ur busi ss t l ar why a
marri d w ma d s t wa t c mmu icati s s t t h r h m , wa ts t
pay ly i cash, a d will t divul h r sp us ’s c tact i f rmati f r
m r cy purp s s. But will sh b fully satis d with y u a d y ur s r-
vic swh h r marria failsd spit h r a sth tic ha c m ts, r b caus
sh had th c d c t lur al v r aft r h r a sth tic ha c m ts? Y u
ar t a i t r ist. If y u a r t tr at a w ma wh d sp rat ly wa ts a
fac lift but sh uld t u d r ral a sth sia f r h alth r as s, r a
m rbidly b s i dividual wh thi ks lip sucti will r shap his lif , ar
y u r ady t acc pt th r sp sibility f r what th utc m s may b ?
Y u ar t th d partm t fchildr a d familys rvic s, r afamilyth r-
apist, but will y u all w a i dividual t sti t ss tial family ds t
ful llhis r h r p rs al als? D y u acc pt r sp sibilitya d t llth pa-
ti t “n ,” r d y u try t d a way t addr ss th p rs ’s d sir s with-
ut causi a cial hardship?
Th r ar c u tl ss tim s wh y u must ch s t draw th li , wh r
y u f l it is t y ur ri ht t jud , r wh y u f l that this p rs ’s d -

0

S cti V: Why
sir is s str that y u must v rl k th cav ats a d a r t satisfy this
p rs ’s d f r app ara c ha c m t. Whyd it? Y u ca w i h r v-
u (m y f r y u) a d d sir (th als f th pati t) a ai st risk, a d
acc pt th r sp sibility that c m s with it. But if s m thi s wr ,
will th fact that y u cr ss d th li t mak s m happy b a acc pt-
abl r sp s ? Thi k t ly f th impact this p rs ; thi k f
h w a adv rs utc m w uld a ct y ur th r pati ts, y ur sta , y ur
family, a d y ur c mmu ity. n v rth l ss, th r ar cas s i which y ur
c mpassi a d y ur passi f r maki th rs happyl ads y u t r sp d
t a pati t wh s d is s c mp lli that y u f l y u ca t l t this
p rs d w . Th y u hav thr ch ic s:
1. Acc pt th r sp sibility t r a alt r ativ if xists,
a d d xplicitly why th pati t’s als ca t b m t.
2. Acc pt th task f r fusi tr atm t a d disapp i ti th
i dividual, a d r a si c r xpla ati why, r simply
stat y u ca t m t this p rs ’s als.
. Tak th cha c , acc pt r sp sibility f r y ur acti s a d
y ur pati t’s als a d xp ctati s, a d h p f r th b st.
H w d y u ch s which path t tak : I tuiti ? exp ri c ? Car ful
c sid rati ? A calculat d quati t bala c risk, utc m s, a d r -
wards? Acc pti r sp sibility is th cas i pati t satisfacti a d
i practic wh r th r is si l c rr ct a sw r. Cl arly, th r is a lik li-
h d th pati t will t al ss skill d pr vid r wh is willi t r tr at-
m t. But th r ca b a m a s t arriv at a a sw r that is c rr ct f r y u
a d y ur practic , a d ultimat ly f r th pati t:
Y u ar t th lyi dividualwh has c u t r d thispa-
ti t i y ur practic a d has a pi i this pati t’s
alsa d satisfacti . Discr tly t th rs’i put, but r aliz
y u hav t mak th d cisi a d acc pt r sp sibility.
Talk t a m t r, a c ll a u , a p r. B bj ctiv , l k f r
i put, but r aliz y u hav t mak th d cisi a d acc pt r -
sp sibility.

Chapt r 17: Cli t a d Pati t g als

07
Talkwith th pati t ify u b li v h r sh hasth abilityt
s parat his r h r d sir a d th str th fthat d sir fr m
th r aliti s fth situati . B bj ctiv , l kf r i put, but r -
aliz y u hav t mak th d cisi a d acc pt r sp sibility.
R aliz that acc pti r sp sibility is t ab ut d ali with u r alistic
als r p r ca didat s. It s much d p r, t d t rmi i h w r
wh th r y u ca satisfy this p rs withi y ur practic : th ducati , th
xp ri c , wh th r y u ar abl t m t his r h r als, r cha his r
h r als, r simply acc pt th r ality that y u ca t acc mplish what this
p rs xp cts r wa ts. equally imp rta t, h w y u ca ducat this p r-
s s that h r sh d s ’t l av y ur c ly t b i jur d, r at th
v ry l ast u ful ll d, at th ha ds f a l ss thical, l ss skill d pr vid r?
SATISFACTION
A pati t’s j y a d c d t smil wh th r sults f a a sth tic tr at-
m t b i t tak shap ar a si i ca t m asur f satisfacti . But th
ly tru m asur f satisfacti li s i dir ct f dback fr m ach pati t.
I s m cas s, this is v lu tary; i th r cas s, accr ditati , c rti cati ,
a d risk-ma a m t issu s r quir that this b m asur d with f rmal sur-
v ys. I ur pr vid rs t m asur th satisfacti f v ry pati t. Surv ys
ar b c mi i cr asi p pular, b caus th y ca b asily tra slat d i t
qua titativ data f r b chmarki a d th r c mparis s.
Wh th r y u us asatisfacti surv y r admi ist r i dial with y ur
pati t, wh th r y u au satisfacti thr u h c v rsati r i um-
b rs, m asur satisfacti i v ry cas .
H wca apractic f l c d t that it is achi vi satisfac-
ti if satisfacti is t dir ctly m asur d?
H w ca a practic impr v its s rvic t cli ts/pati ts
if it ca t id tify that xp ctati s ar m t i all ar as f
p rati s?
Why sh uld a practic b c c r d wh pati ts d t
r sp d t satisfacti surv ys r qu sti s?

0

S cti V: Why
Quit simply, ask a d y u will b t ld. If y u d ’t ask, y u’ll b u ssi
ab ut th si l r at st measure f succ ss f r y ur practic : cli t/pati t
satisfacti . T d t rmi that y ur practic is achi vi satisfacti am
cli ts/pati ts r quir s a dir ct r sp s that quali s such satisfacti . A
pati t’s failur t r ply is t a utral m asur ; it is i fact a ativ .
Why? Wh y u hav pr vid d tr atm t t ful ll a i dividual’s d p st
p rs al d sir , h r sh will lik ly b v ry v cal ab ut satisfacti a d i-
th r v cal r sil t ab ut disapp i tm t. Rar ly is s m with ut a
pi i ab ut th utc m fa app ara c - ha ci tr atm t. Ifth i -
dividual is i d d utral, it is caus f r c c r . n rt f y ur practic
t build a d r w ca succ d with ut a s lid, r liabl , a d v cal m asur
fpati t satisfacti . Why? Pati t satisfacti tra slat s t pati t r f rral
a d pati t r t ti , a d as stat d pr vi usly, r f rral is th si l r at st
source f succ ss i y ur practic .
C v rs ly, wh pati ts ar t fully satis d, th y may b v cal ab ut
th ir tr atm t xp ri c simply as a m a s t v t th ir disapp i tm t.
Just as p sitiv w rd fm uth r r f rralis y ur r at st s urc f r buildi
a succ ssful practic , ativ w rd f m uth is y ur r at st liability. I
fact, criticism ca b much l ud r tha prais . If y u d t m asur satis-
facti , y u may t k w wh r it p t tially xists r falls sh rt.
Ask ach i dividual y u s rv ab ut his r h r satisfacti i v ry ar a f
y ur practic , i cludi c mmu icati , ducati , sta , p rati s, ad-
mi istrati , c mf rt, privacy, charact ristics that d y ur bra d, cli i-
cal utc m s, a d v rall xp ctati s. Y u will us this i f rmati t ad-
dr ss a y sh rtc mi s dir ctly with th cli t/pati t t try t r s lv
dissatisfacti , a d y u maytur ap t tial ativ i t a p sitiv . D t r-
mi wh th r this was a is lat d sh rtc mi r has ccurr d with th r
cli ts/pati ts a d r quir s c rr cti . C ti u d m asur m t f satis-
facti is a c ssarya rmati fth valu a d validity fy ur practic . If
y ur valu is qu sti abl r satisfacti is l w, y u must id tifyth caus
a d c rr ct th situati .
Bu ild in g a Su rvey
Th utc m fa ysurv yisam asur i quality r qua tity. Th validity f
that m asur r quir s tw thi s: a valid umb r f r pli s, a d a valid m a-
sur f th r pli s. Th r ar s v ral di r t ways f c ducti a surv y.

Chapt r 17: Cli t a d Pati t g als

0
In Person Th r is b tt r way t l ar s m thi tha t ask. F d-
back has valu if y u d ’t d cum t it. Y u sh uld t t d f siv
wh pati t critiqu s f y ur practic ar t l wi . Pay att ti : lis-
t a d b rat ful f r h st f dback.
Electronically Th r ar a ym us surv ysit s that all wy ur pati ts
t l av f dback ab ut y ur practic ; th r ar als d ct r-rati sit s that
y u ca c ura happy pati ts t visit. Th tr ubl with d ct r-rati
sit s is th y ar hi hly ptimiz d, s if a u happy pati t d cid s t us
this m th d, th c mplai t will b wid ly distribut d li .
Alt r ativ ly, y u maych s t build y ur w l ctr ic surv y, wh th r
f r v rall satisfacti r f r cli ical studi s. SurveyMonkey.com is just
f s v ral i xp siv a d asily pr ramm d m a s t cr at y ur w
surv y. Th cav at is that it is asy t t carri d away with xt siv sur-
v ys. K p it t pic sp ci c, asy, a d bri f, r will r sp d.
By Mail Pap r surv ys ar asy t s d a d hav th pati t ch ck r -
sp s s, but s m has t tabulat th r sults. R adi th s c mm ts
ca b li ht i , but w uld ’t y u rath r h ar th s c mm ts rst
ha d?
Overthe Telephone Calli with surv yqu sti s r just t askpati ts
bri yf r f dbackca b a valuabl d av r, but it ca als b a yi ,
sp cially wh it happ s tim a d a ai aft r v ry visit.
Buildi a surv y a d usi it ctiv ly d t r quir that y u b a statis-
ticia . H w v r, y u must d v l p a surv y that is us r fri dly, with c m-
parativ m asur s, a d that y u us c sist tly. Pati ts ar m r lik lyt
r sp d ifth yar assur d that th ir r sp s is bli d d. B i y ur surv y
byid tifyi what it is: a i dividualiz d m asur y ur practic has d v l-
p d t mai tai c sist cya d ai pati t f dbackt pr vid ac sis-
t t, hi h-quality xp ri c . Put y ur l a d am it. Stat y ur prac-
tic ’ss rvic missi , a d i dicat that th surv yis a imp rta t m a s f r
y u t m asur wh th r y u ar m ti y ur missi a d achi vi pati t
satisfacti . This, al with a asy-t -c mpl t f rmat, will mak it m r
lik ly that pati ts will c mply with this v lu tary surv y, a d y u will r -
c iv a valid umb r f r pli s which t f rmulat r sults.

10

S cti V: Why
Th asi st m a s f r cat rizi r sp s s is t pr vid a um rical r
rati scal that is c sist t acr ss all ar as qu ri d; f r xampl , “Rat
y ur satisfacti with th i f rmati a d ducati y u r c iv d ab ut
y ur pr c dur : 1 thr u h ( r p r thr u h xc ll t).” It all ws tabula-
ti , a d aquick la c willid tifywh r satisfacti is l w. I additi , it
is quicka d asyf r pati ts t r sp d t ; th r f r th yar m r lik lyt
c mpl t it. But i its lf, a slidi r um ric scal d s t all w c m-
m ts r th d tail d f dback that ca h lp t id tify sh rtc mi s.
D xactly what y u will ask, b i c rtai t c v r ach ar a f y ur
practic .
Communication: Isit acc ssibl a d u d rst d? Hasit pr -
vid d all th i f rmati a pati t xp ct d? If s , it is c-
tiv .
Education: Is it acc ssibl a d u d rst d? Has it pr vid d
allth k wl d pati ts d d t mak a i f rm d d ci-
si ? If s it is ctiv .
Sta : Ar th y h lpful, c urt us, a d supp rtiv ? D th y
fully r sp d t pati t ds withi a r as abl am u t f
tim a d with cl ar, c mpl t r sp s s? D th yd th ir
bli ati t th pati ts a d ful ll th s ? Th pr vid r
sh uld b i clud d i thism asur . Y u maywish t id tify
allpr vid rsi dividually, asw llaspati t c rdi at rsa d
cli icalsupp rt sta . Alth u h th xp ctati isthat th pa-
ti t k ws wh was i v lv d i his r h r car , i dicat di-
r ctly th surv y wh th pati t is ask d t valuat .
Operations: Is pr c dur cl ar a d tim ly v ry ccasi
th pati t a s y ur c ? Is th l cati a d facility
c v i t a d i viti ? Thism a s v ryfacility, i cludi
y ur c , sur ical facility, p st p rativ r c v ry car fa-
cility, a d a y l cati utsid y ur c that y u rally
r f r pati ts t i c ju cti with car .
Administration: Isit rd rly, c cis , cl arlyc mmu icat d,
a d acc ssibl ? I clud utsid admi istrativ s rvic s, such
as pati t a ci , wh r appr priat .

Chapt r 17: Cli t a d Pati t g als

11
Comfort: D y ur c , c sultati r m, xami ati
r m, a d sur ical facility m t th sta dards f c mf rt th
pati t xp cts?
Privacy: D s th pati t f l that y u, y ur sta , a d y ur
physical p rati valu a d pr t ct i dividual privacy?
Characteristicsbywhich you de neyour brand: W r th pa-
ti t’s xp ctati s f y ur practic m t, bas d h w y u
hav d d y ur practic a d its quality f s rvic a d x-
p ri c ?
Clinical outcomes: W r th cli ical utc m s bas d d-
ucati a d i f rm d c s t m t? W r cli ical utc m s
bas d p rs al als m t?
Overall expectations: W r v rall xp ctati swith th c l-
l ctiv tr atm t xp ri c m t?
R sp s s t th s qu sti s willh lp y u d t rmi wh r y ur practic is
c sist t, wh r y u d impr v m t, a d wh r y u xc l. I v ry
cas that y u ar abl , imm diat lyaddr ss l wsatisfacti dir ctlywith th
pati t. First, r s lv a ydissatisfacti ifp ssibl a d/ r d m strat y ur
c mmitm t t satisfacti . S c d, r tai this pati t as ap ssibl r f rral
s urc (if that pp rtu ity still xists), r at l ast av id a u f rtu at situ-
ati i which th pati t br adcasts dissatisfacti thr u h p t tially
dama i cha ls.
Th fact rs m asur d by th rati scal ca b l t rm r cyclical. Th
scal all ws y u t asily c mpil r sults i a d d cycl , ivi y u th
ability t c mpar c rtai p ri ds f tim a ai st th rs.
Al with qu sti s that m asur satisfacti a rati scal , surv ys
sh uld dir ctly r qu st sp ci c f dback by all wi spac f r c mm ts.
M st c mm ts will c m fr m pati ts wh ar xc pti ally pl as d a d
th s wh ar t satis d. B th hav valu .
First, d t rmi wh th r c mm ts ar is lat d r r p ati , p sitiv r
ativ . Th c mm ts d t hav t b fth sam atur , just th sam
valu . n xt, r sp d dir ctly t th ativ c mm ts imm diat ly. D

12

S cti V: Why
this f r th sam r as s y u w uld addr ss l w satisfacti . Th d t r-
mi wh th r sp ci c c mm ts ar r p at d. If p pl tak th tim t
c sist tly r th sam c mm ts, p sitiv r ativ , y u hav id ti-
d a str tr d. Build th p sitiv a d c rr ct th ativ .
Pati ts ar r quir d t c mpl t si i ca t am u ts f pap rw rk, a d
surv y r sp s s ar v lu tary, but f r y ur practic th y ar just as ss -
tialas a y th r f rms c mpl t d byth pati t. emphasiz th imp rta c
f this t l t ha c th t tal quality xp ri c that th pati t ca a -
ticipat i all visits t th practic . Sh w appr ciati f r ca d r a d th
tim tak t c mpl t th surv y. Activ ly us th satisfacti surv y t
build a succ ssful practic f satis d pati ts.
IN P RACTICE: You r Da ily P u lse
H w d y u l ar what y ur pati ts wa t? Ask.
H w d y u l ar what y ur pati ts xp ct? Ask.
H w d y u l ar what y ur pati ts will dur ? Ask.
H w d y u k w what y ur pati ts ar thi ki , f li , what
th ir m tivati s ar ? Ask.
H w d y u k w what y ur pati ts xp ri c ? Ask.
H w d y u k w if y ur pati ts hav qu sti s? Ask.
H w d y u k w if y ur pati ts will r f r y u? Ask.
H w d y u k w if y ur pati ts ar happy, fully satis d? Ask.
Th patt r h r is t m a t t b sarcastic r arr a t. It is ui . Ify u
wa t t k w s m thi , ask.
A practic that was d i w ll i vit d m t c sult with th m. Th
physicia had just hir d a w practic ma a r a d f lt th r was a r al dis-
c ct i th way sh was f cus d practic ma a m t a d cli t s r-
vic . As ma y f us will d , h c mpar d his xp ri c with this w, v ry
quali d practic ma a r t his pri r xp ri c s i lif .
Sh wa t d data, l ts f it, t track thi s a d ru a ti ht ship. H was
succ ssful a d happy i practic , a d h f lt h did ’t d data; th smil s
a d happi ss f his pati ts a d a h althy ba k acc u t w r all that h

Chapt r 17: Cli t a d Pati t g als

1
d d t k wh was d i w ll. H f lt surv yi pati ts was a uisa c .
As I sp t tim with th practiti r a d th practic ma a r, I l ar d th y
b th had th ir str ths, a d v ry valid p i ts. H w c uld I bri th s tw
tal t d i dividuals t th r t u d rsta d a d appr ciat a th r?
Wh y u wa t t l ar s m thi , what d y u d ? Y u ask. H w w uld I
h lp th s tw l ar ab ut ach th r? Thr u h th v ryr as th practic
xist d: a pati t.
I had th practic ma a r d s m thi sh had v r d : shad wth
d ct r f r th day i v ry c sultati , i v ry p st p rativ ch ck. Sh
saw h w h w uld l a i t a pati t, mak y c tact a d say, “T ll m
what qu sti s y u hav .” “T ll m what y u hav l ar d.” “Hav I iv
y u v rythi y u d t k w, v rythi y u cam h r t s m f r?”
“Is th r s m thi m r that y u d?” “I wa t y u t b happy.” Sh
walk d ut f th r m impr ss d. “What I l ar d i th r I c uld v r
l ar fr m umb rs,” sh stat d.
I sat d w with th physicia a d practic ma a r a d had th m
thr u h s m v ry simpl umb rs. By la ci at r c t xp s s, sh
f u d that th c st f pr vidi c rtai tr atm ts had up, but th f
sch dul had t. Sh f u d that a xp siv d vic th practic l as d had
l st its lust r a d was t v payi f r its lf. Sh c duct d a surv y f
past pati ts t d ut that las r just did ’t m t th xp ctati s f r ut-
c m s that w r purp rt d i th m dia a d by th ma ufactur r. Sh was
smart, a d sh c ll ct d data t l ar why wa t d that tr atm t a y
l r. H r m a s f d i s was id tifyi a pr bl m b f r it had a bi
impact th b tt m li .
Th tru valu a d validity f pati t satisfacti is that it will i vitably
mak r br ak y ur practic a d that y u must l k at it, m asur it, a d ask
f r f dback at v ry appr priat pp rtu ity. If th physicia w r t a
mast r at aski , c cti , a d s rvi his pati ts, th practic w uld t
hav b succ di . Ifth practic ma a r c uld t d th s urc f r a
d w fall i tr atm t f a sp ci c pr c dur , th practic was l si pa-
ti ts, m y, pp rtu ity, r a umb r f th littl thi s that i vitably
c tribut t succ ss.
Pati t satisfacti is t d t rmi d thr u h asurv y r a umb r al .
It is t m asur d by a smil al . It is part f th daily puls i all th littl
thi s that happ i y ur pati t’s xp ri c withi y ur practic : i th
physical a d m ti al, i acc pta c , a d i articulati satisfacti r th
lack fit fr mwhich y u must askqu sti s, mak m di cati s, r w, a d
l ar .

(Trang không có chữ)

Safety:
TheUltimateGoal
Even if you’re falling or you’re struggling
There is still beauty, in what we do
So que sera, let’s go sailing on
There’s a wise man in everything
— DIDo , “FEEl S l IkE FIr E”
CHAPTER 18
In the p actice f medicine, as in any the business, things can g w ng.
Events can ccu that a ect the safety f y u patients and any pe s n n
the p emises. If safety is b eached, the e is p tentia t ub e f y u busi-
ness. P actice safe y, and be p epa ed f any event.
Safety is vita t y u success. I am n t a physician, s I wi n t add ess
c inica safety. If it we e up t me, n ne w u d be pe mitted t p actice
utsidehis he specia ty, and eve y new u d behe d t thehighest stan-
da ds f t aining, b a d ce ti cati n, and acc editati n. It w u d be much
easie t escind the medica icense f any ne gui ty f c inica ethica
ma p actice, whethe an incident ccu ed f m intent, ma ice, b atant
stupidity. This chapte is n t f th se wh p actice ec ess y; it is f
p vide s wh be ieve in acting ethica y and esp nsib y and p tecting
thei investment in thei p actice, eputati n, and the pe p e they se ve.
Even if y u have unstinting standa ds f c inica safety, is and dange sti
p se a th eat t the success f y u business eve y day, ften simp y by
chance. The wise physician wh p ans f success a s deve ps safety
st ategies.

Secti n V: Why
DATA
The detai ed inf mati n y u have ab ut y u patients is an inestimab e e-
s u ce f y u p actice. It c ntains p ivate and sensitive inf mati n and
thehist y fy u e ati nship with thesatis ed patients wh a ey u m st
va uab e asset in g wing y u p actice—th se wh wi p tentia y etu n
f additi na epeat se vices may efe the patients t y u p actice.
Such inf mati n is essentia in devisingschedu es, acc unts eceivab eand
payab e, supp y de s, messages, and invent y f p ducts. These data
he p y u p ject futu e app intments and f mu ate st ategic p ans, c n-
t acts, insu ance, and c edentia ce ti cates.
Data can be st ed n pape , e ect nica y in inf mati n techn gy sys-
tems, b th. Data may be in active use, in temp a y st age, may be
a chived. H wd y u eep y u datasecu eand accessib e, and which data
a e vita ?
A datamust besecu e yst ed with safe, p edictab ebac up
dup icati n.
Vita data must be maintained and accessib e, with safe, p e-
dictab e bac up dup icati n.
Eme gency data must be c ected, cu ent and secu e, with
safe, p edictab e bac up dup icati n, and must be imme-
diate y and easi y accessib e t mu tip e individua s in the
p actice.
Stora ge a n d Secu rity
In the b in f an eye, whethe th ugh a p we su ge a simp e technica
g itch, a f y u data can be st, c upted, bec me inaccessib e; this
wi inevitab ydis upt thep actice’sdai y utine. Datast age equi esm e
than en ugh m n the se ve ; it is h w the data a e st ed and the means
by which data a e accessib e. If y u have m e than ne p g am t enc m-
pass y u schedu ing, patient data, e ect nic medica ec ds (EMr ), e ec-
t nicp esc ipti ns(Er x), nancia , ma eting(such asy u website, ify u
a e the h st), and the ey data, if this is a in ne p g am, y u must
have bac ups f the system and data, as we as the temp ates and p efe -

Chapte 8: Safety: The U timate G a


ences. When weighing the time and c st f bac ing up, c nside that if the
wh e system g es d wn, a signi cant am unt f time may be equi ed t
b ing it bac up as we as t ma e the data pe ati na . In additi n t p -
tecting y u data, y u must ca efu y c nside wh has the abi ity, access,
and expe tise t eva uate and upg ade y u IT functi n, inc uding secu ity
and bac up. This may be a sta membe a t usted utside es u ce.
It is p udent t st e a chivedup icatedata -site. In the event that y u
ce systems and cati n a e n t pe ati na (such as afte a e, hu i-
cane, b izza d, any unexpected event), having c mp ete, cu ent bac up
data avai ab e -site wi faci itate y u getting up and unning in an the
cati n.
If y u eep pape ha d c py es, st e them in a ep f, wate p f
st age system; d n t h use them in the same cati n as y u e ect nic
bac up. Instead f t ying t manage a this n y u wn, esea ch data-
management and st age c mpanies. Y u’ be su p ised h w ec n mica y
and swift y they can a chive y u data.
Secu ity inv ves m e than passw d p tecti n n y u wi e ess system,
n speci c p g ams acc unts. Secu ity n y u data and n y u st -
age system must be abs ute. If hac e s can access etai and c edit ca d
c mpanydataand stea what theyneed, imagine h wdamagingit w u d be
if the pe s na ec ds f y u patients we e pi ated f p t, even
w se, f pub icity. Have ewa s and pass c des, and f equent y update
changepassw ds. I i et tatetw th ee e evant passw ds, which
is a itt e easie than a ways ma ingachange. A th ugh this mayseemanui-
sance t pe ati ns, the g eate nuisance w u d be t have y u va uab e
data i ega y accessed and st en. If y u e wi e ess c nnecti n t y u
patients within y u ce, ma e ce tain the netw they can access is dif-
fe ent f m the netw y u use f y u p actice pe ati ns.
Licen ses a n d Certi ca tes, Accou n t Nu m b ers,
a n d P a ssw ord s
Active icenses and ce ti cati n and acc editati n d cuments f y u p ac-
tice as wh e and f eve y p vide in y u p actice must be cu ent and
ept in an accessib e but safe, ep f p ace. C nside the dange if s me-

8

Secti n V: Why
ne acqui ed st e y u DEA numbe . Neve a w these d cuments t
expi e, and eep t ac f expi ati n dates s the e is n ush t enew.
Acc unt numbe s and thei passw ds a e equa y vita t eep cu ent, ac-
cessib e, and safe. l imit the access t acc unt numbe s and high ysensitive
d cuments t need-t - n w pe s nne , and d n t a w these numbe s
passw ds t be ca e ess y j tted d wn n P st-its at w stati ns n
ha d d ives.
keep an e ect nic e with scans f d cuments and a dup icate e ect nic
e n ap tab e datast age medium, as we as apape c pythat inc udes
vita inf mati n, such as icense numbe s and c ntact numbe s f state
medica b a ds icensing ganizati ns. It’s un i e y that s me ne wi
questi n the va idity f y u c edentia s, but c edentia s identity can be
st en physica y e ect nica y. Acc unts can be easi y tampe ed with
accessed t stea vita inf mati n. A catast phic event that causes damage
t y u ce c u d i epa ab y damage imp tant d cuments acc unt
statements n which acc unt numbe s and passw ds may be f und. keep
cu ent c pies safe, secu e, and -site.
l icenses and ce ti cates a e vita t the egitimate pe ati n f y u p ac-
tice; s t is a supp ting d cumentati n, such as pe ati na and ac-
c editati n manua s. Maintain these digita ys theya e easyt update, but
eep them in p int s that if data systems g d wn y u ce faci ity is
disp aced, y u have a the pe ati na inf mati n y u need t pe ate
seam ess y and successfu y. The same is t ue f c edit ca d acc unts, sup-
p y acc unts, ban acc unts, insu ance, uti ities, anything that is imp tant
t the day-t -day pe ati n f y u business.
In Ca se of Em ergen cy
Data equi ed in case f eme gency (ICE) a e vita t have n hand and up
t date f eve y patient, emp yee, and c nt act ass ciated with y u
p actice. If s me ne has an accident eme gency hea th p b em, wh m
wi y u c ntact? Di ect eme gencymedica te eph ne numbe s and 9 in-
f mati n a e essentia t summ n he p, and this inf mati n sh u d be
p sted by a the ph nes in y u p actice. A s essentia a e the pe s na
c ntact data f patients and sta .

Chapte 8: Safety: The U timate G a

9
A th ugh patients a ways c me st, accidents, eme gencies, and adve se
events may ccu in y u ce that d n t inv ve pe p e. Devices fai t
functi n, safetyequipment, inf mati n techn gies, even uti ities can ma -
functi n g d wn, suspending y u pe ati ns and th eatening p actice
p ductivity at any time. If the e is a p we fai u e, gene at s fai (because
they haven’t been tested?), and the ph ne system is e ect ic, h w wi y u
c ntact the uti ity a gene at se vice? H w wi y u c ect the data f
upc mingapp intments and c ntact patients t eschedu e? An inabi ityt
c mmunicate with y u patients may n t n y inc nvenience and ann y
many individua s; it can a s cast d ubt n y u p actice’s abi ity t antici-
pate and hand e unf eseen events.
FACILITY AND P ROP ERTY
Whethe y u wn ent y u faci ity, and whethe y u a e the wne , a
c nt act , an emp yee f the p actice, the safety and secu ity f y u
patients and p actice a e c se y tied t the safety, secu ity, and functi na
status fy u ceand su gica faci ities. Vi ent weathe accidents such
as es that can dest y a bui ding a e bey nd y u c nt , but p viding
f the we -being f a individua s n-site is in y u c nt .
Secu rity
Ifint ude s b eint y u h mewhen y u we e n t p esent, whethe they
dest yed st e y u p ssessi ns simp y b e in t cause damage,
y u w u d fee vi ated. If s me ne b e int y u h me when y u we e
inside, y u w u d fee y u safety th eatened. The same is t ue if the secu-
ity f y u faci ity is b eached; the secu ity f y u p ace f business must
be maintained whethe the e is any ne n-site n t.
A a m systems a e n y dete ents. They must have a fai -safe bac up sys-
tem in case f p we inte upti ns and be m nit ed 2 h u s a day. A -
th ugh theya eimp tant t an ve a secu ityp an f y u ce, equa y
essentia is the need t secu e d ugs, medica devices, equipment, and y u
data. These must be c ed and p pe y st ed when n t in use. l abe ing
a d ug cabinet is simp y inviting s me ne wh has b en in t exp e the
c ntents. In additi n t a a ms and c s, s me secu ity systems inc ude
came as, but these a e fn useifthe came as a en t maintained. With any

2

Secti n V: Why
secu ity system, a panic butt n sh u d be avai ab e in mu tip e cati ns
within the cet a e t eme gencyse vices ify u and sta membe s a eun-
ab e t use thete eph ne an eme gencyis in p g ess. The idea p acef
a panic butt n is within easy each f the individua wh m nit s the f nt
d .
It is c itica t test the secu ity systems egu a y. o ften secu ity, e, and
panic a a ms a e tied t gethe in ne system and pe ated th ugh a ph ne
ine. In theevent fa e, exp si n, p we fai u e, wi thesystemw ?
Y u must have c s as we as a a ms and a e ts t secu e y u ce.
Access
keep ca efu t ac f wh ente s and exits y u ce th ugh f nt bac
d s. C eaning c ews, maintenance sta , de ive y pe p e, mai ca ie s,
bui ding manage s, and y u sta must a be ca efu y t ac ed if they have
access t a e in the ce when y u a e n t. Eve y ne, inc uding th se
wh se vice y u ce in y u absence, must eep d s that a e n t at-
tended c ed at a times and eep a d s c ed when the ce is
c sed. A sta membe sh u d be designated t eep t ac f wh has eys
t speci c d s, st age, medica devices, and wh has access and pass
c des t speci c data. If an emp yee eaves y u p actice, thei ey ac-
cess device must be ec aimed.
In pub ic a eas, du ing egu a business h u s, nea y any ne has access t
y u ce. T daym e than eve , bui dings have m e s phisticated secu-
ity measu es, but this may n t p tect y u f m s me ne wh t u y wants
t gain access t y u p actice t dis upt pe ati ns cause ha m. The
f nt d sh u d be m nit ed c ntinu us y when it is un c ed, and a
wind wsh u d be p siti ned next t in the f nt d s that pe p e en-
te ing can be seen bef e they step int the faci ity.
F the safety and p ivacy f y u patients, maintain a st ict p icy that f-
ce h u s a e by app intment n y. Schedu e maintenance and sa es ca s
by app intment, and imit access (such as a pa ticu a day f ca s). If y u
have a etai segment t y u p actice and invite the pub ic t st p in at wi
f p ducts se vice, ma e ce tain ce h u s a e de ned and that y u

Chapte 8: Safety: The U timate G a

2
a e adequate y sta ed t have at east ne pe s n t mind the st e, and an-
the t mind the p actice. If the etai pe ati n is pen when the p actice
is n t, ma e ce tain the e a e distinct means t eep the p actice c sed t
individua s wh sh u d n t have access.
H a za rd s
S ippe y s, bstac es in f nt fd ways, b en ights cei ingti es,
defective a a ms equipment, chipped mi s, sp inte ed c unte s a
p se haza ds. l ea ing t i ets, att ing pipes, a cing e ect ica switches,
f ayed e ect ica c ds a ea dange us. l eavingequipment medicati ns
un c ed unattended is a se i us haza d. Medica equipment and bi -
haza d mate ia s must be p pe y abe ed, st ed, disp sed.
Se ving a c h at a functi n n the p emises is a haza d, whethe y u a e
t eating individua s n t. The pe p e y u se ve may get in the ca and,
ega yint xicated n t, maycausean accident. Ifasta membe is d iving
and texting ta ing n a ce ph ne wned by y u p actice and an acci-
dent happens, y u may be iab e. If a vehic e wned by the p actice is in-
v ved in an accident, y u may be iab e.
Haza ds may seem t ivia pe fect y inn cu us unti s me ne gets hu t.
r egu a y su vey y u faci ity f unsafe situati ns, pe f m egu a safety
chec s, and add ess p event dange us c nditi ns. Ma ece tain y u f-
ce p icy de nes h w t dea with haza ds and h w t av id them. Even if
the haza d is n t within y u c nt , such as a dange us inte secti n in
f nt fy u bui ding inadequate ightingin a stai we , b ingit t the at-
tenti n f th se wh d have the auth ity t add ess this, and wa n th se
wh may n t be awa e f the haza d.
Eq u ip m en t
Ste i ize s, ase s, ights, tab es, te eph nes, e extinguishe s—y u ce
and su ge y cente a e ed with equipment. Fau ty equipment is a haza d.
Equipment that is n t tested egu a ycan je pa dizesafety, pa ticu a yifit
is designed f safety, such as a gene at e extinguishe . Even a c ee
ma e in y u ce that is ve heating p esents a safety is t s me ne.

22

Secti n V: Why
It is a g d p icy t maintain a g f testing, se vice, and maintenance f
a vita medica , t eatment, and pe ati na equipment. Y u d n’t want t
nd ut the ase is mis ing afte y u patient deve ps sec nd-deg ee
bu ns. Y u d n’t want t ea ize y u d n’t have a Banyan Stat kit afte
s me ne passes ut. Y u d n’t want t ea n the bac up gene at has n
fue the gas ine is n t w ing when the p we g es ut. Y u d n’t want
t add ess the bu ned- ut pa ing t ights afte s me ne gets mugged.
Even if y u a e n t esp nsib e f the gene at the pa ing t ights,
ta e the esp nsibi ity t get th se wh a e esp nsib e t act immediate y,
and ta e the p ecauti n f m nit ing a equipment and its se vice. A des-
ignated sta membe sh u d be esp nsib ef f wingup n such detai s
as n tingthat a ight xtu e’s bu bs a ebu ning ut t fast, and gettingthat
xtu e chec ed.
Ma in ten a n ce
A physician d es n t pe f m maintenance in his he ce, but th se
wh d p vide y u safety chec s and maintenance must unde stand y u
standa ds and expectati ns f the c ean iness f the and mi s, and
the e iab efuncti n fthe ights and equipment. Thedesignated sta mem-
be sh u d m nit this and see that acti ns a e d cumented and ep ted
acc ding y. Set standa ds high, be bse vant, and ma e ce tain that th se
wh a e given these esp nsibi ities ea ize the se i usness f eeping y u
p pe ty and faci ity we maintained.
RELATIVE WISDOM: Slow, Ch ild ren P la yin g
We’vea seen thesigns n the ad that wa n us “s ippe ywhen wet,” “cu ve
ahead,” “n pa ing, e ane” “s w, chi d en p aying.” I have a f iend
wh wns a ma tia a ts cente whe e the pa ents egu a y d p chi d en
at the cu b and g ab ut thei e ands. l cated in a busy st ip ma , pa ing
is a ways an issue, s pa ents egu a y pu up t the cu b that states, “n
pa ing, e ane” t d p and pic up thei chi d en.
It was the ve y st wa m sunny day f sp ing and just as c ass times we e
changing. As usua , the pa ing t had a ine fpa ents’ca s waitingt d p
and pic up students. Ap ice ce decided that dayt sta t givingtic -
ets t th se wh dis beyed the “n pa ing, e ane” sign, and the pa ents

Chapte 8: Safety: The U timate G a

2
we efu i us. It caused a u y fpa ents z minga und ingf ap ace
t pa t av id a tic et whi e they c ected thei chi d en. S me wa ed t
the sidewa t c ect thei ids; the s simp ypa ed and waved and ca ed
the ids t thei ca s.
Then it happened. The sc eech f ti es, the ud thud that ma es y u
hea t st p beating, and thesc eams fpanic. Whi ethe ce was busyw it-
ing tic ets and pa ents we e scu ying t get thei chi d en, s me ne new t
the a ea, just st pping in t the sushi estau ant next d t pic up s me
dinne , hit a chi d as he stepped f m in f nt f a ca pa ed at the cu b that
was beingtic eted bythe ce . Afte that incident, thesch imp emented
asystem: n d ppingstudents at thecu b; pa ents had t sign thei chi d en
in and ut. But the sch did m e—they pe suaded the ma wne t p st
mu tip e signs stating, “s w, chi d en p aying.”
r e ative wisd m: The unf eseen can happen inside utside, when
y u thin a is safe and secu e. The safety f y u patients and any ne visit-
ing y u ce is c itica ; y u must thin n t n y ab ut y u faci ity, but
ab ut the b unda ies, c id s, d iveways, and st eets that ead t it.
H UMAN SAF ETY
Y u p actice exists t se ve pe p e wh have aesthetic desi es. Y u want
them t have safe, happy, and fu ing expe iences. But pe p e by natu e
a e unp edictab e. Unf eseen intenti na unintenti na acti ns by pe -
p e may put eve y ne n the p emises at is —as we as je pa dizing y u
p actice. Safety is fundamenta t y u c ntinued success. Being cava ie
ab ut estab ished p ecauti na yp cedu es may esu t in at ta dis upti n
f y u abi ity t p actice.
A th ugh y u cann t c nt the s’ behavi , y u can estab ish y u ex-
pectati ns f y u emp yees and c nt act s, pub ish p icies t p tect
th se y u se ve, and set an examp e fh wt esp nd app p iate yin any
unanticipated event. A th ugh it’s easyt sayy u must bep epa ed f any-
thing, it is di cu t t be p epa ed f eve ything, pa ticu a y when the un-
p edictab e human e ement is inv ved. P an and p actice h w t esp nd,
and in the un i e y event y u must esp nd, the enti e team wi be bette
p epa ed.

2

Secti n V: Why
P rotectin g th e P rovid er a n d P eop le
Y u a e vita t y u p actice and need individua p tecti n, as d es any
t ue evenue-bea ing business wne . Y u must get an annua physica ex-
aminati n with ut fai ; n excuses that y u a e hea thy fee we . Add ess
hea th issues immediate y. Y u may be a physician, but emembe t p ac-
tice within y u specia tyand g t c eagues in the specia ties when y u
have hea th issues, as y u w u d expect them n t t se f-t eat in aesthetics.
Ma e ce tain t have adequate ey-man and disabi ity insu ance t p tect
y u p actice and y u fami y if y u a e i bec me unab e t p actice f
a time.
In additi n, y u must p tect y u p actice, sta , and patients f m the p -
tentia is f s me ne wh is eithe abusing p esc ipti n ec eati na
d ugs is unde thein uence fanysubstancethat can m difybehavi
judgment. r and m d ug sc eening is n y a p b em f th se wh have
s mething t hide. It is a sma investment in the secu ity f y u p actice.
P tect y u p actice, sta , and patients f m c ntagi us i nesses; y u can
equi e annua tube cu sis sc eening f sta and enf ce a st ict p icy
that eeps pe p e with easi y c mmunicab e i nesses such as the u at
h me, n t at w .
H EALTH INCIDENTS
Whethe a ca diac event appendicitis, a b ut f ve tig a debi itating
mig aine, hea th incidents can happen unexpected y t y u, y u sta , pa-
tients, visit s. A th ugh the diagn sis and t eatment fsuch hea th inci-
dents a en t pa t fy u specia ty, y u a eaphysician, and y u sta p b-
ab yinc udes t ained medica p fessi na s. Ma e ce tain eve y ne n y u
sta n ws h w t esp nd t a hea th incident. Teach n nc inica sta t
ec gnize the signs f a p tentia p b em and t a e t the app p iate team
membe . If a visit t y u ce wh is acc mpanying a patient de iv-
e ing the mai bec mes i , the sta membe s n hand must n w h w t
dea with the situati n swift y, ca m y, and app p iate y. The p actice f
aesthetic medicineisa e ati nship-based business, s even ify u d n’t p -
videthet eatment t any newh fa s i , f wup with anyindividua wh
has a hea th- e ated incident in y u ce.

Chapte 8: Safety: The U timate G a

2
ACCIDENTS
A th ugh it is t ue that m st accidents can be av ided, pe p e wi stumb e,
s am a d n a hand, have the mishaps. Accidents can happen in
y u ce even if y u have the ve y highest standa ds f safety and faci ity
maintenance. Add ess any accident, n matte h w min , by ensu ing ap-
p p iate ca e f the inju ed individua and ing an accident incident
ep t within y u p actice. In the event this accident bec mes a c n-
tenti us issuein the futu e, asimi a accident happens, havingthedetai s
ec ded can be bene cia t eca the events p ecise y as they ccu ed.
This wi a s he p t nd the cause f the accident and emedy the situa-
ti n bef e it happens again.
E MOTIONAL ISSUES
Em ti na issues can be bvi us, ve y di cu t t p edict. It may be evi-
dent when an individua is anxi us, upset, c nfused, pa ticu a y if y u
n w this pe s n’s usua demean . A pe s n wh has a c inica y diag-
n sed menta i ness may seem pe fect y n ma if eceiving the app p iate
medicati ns but maybe p ne t utbu sts finapp p iate behavi when
he she is n t medicated. If an individua ’s behavi bec mes agitated
e atic, y u must hand e the situati n ca m y, ati na y, and m y t p e-
vent the individua f m ha ming himse f the s. At the same time, y u
must n t et the individua dis upt y u p actice. Y u have eve y ight t
dismiss a sta membe wh has em ti na issues that a ect the ha m ny
and safety f y u ce; y u have eve y ight t dismiss a patient visit
wh se behavi distu bs y u p actice. When em ti na issues cann t be
c ntained, c nt ed, em ved, ca f he p.
INTRUDERS
Anype s n wh wa s int y u p actice maybean int ude : s me newh
is unexpected, unwe c me, and the e t cause adis upti n. Y u mayte an
int ude t eave, that he she is t espassing, but bey nd this, d n’t t y t
hand e matte s n y u wn; ca immediate y f he p. Ma e ce tain a pa-
tients and pe s nsin y u cea esafeand is ated f man inte pe , and
ifp ssib e, eep an eye n thepe s n unti thep pe auth ities a ive, but
ab ve a , eep y u se f and the s safe. I n w f an ce that “buzzes”

2

Secti n V: Why
pe p e in simp y t p event the ent y f int ude s and the need f secu ity
in thei p actice cati n. Y u patients wi n t nd this t be a nuisance if
they n w it is in the inte est f thei pe s na safety.
R ANDOM ACTS
r and m acts a e n t est icted t te evisi n p g ams; they happen in ea
ife, and they can happen in y u faci ity. The secu ity f y u p actice may
beb eached byan addict sea chingf d ugs, an em ti na ydistu bed pe -
s n wh wande s int y u ce, ape s n ma ingab mb th eat, aban
bbe wh has decided t use y u ce as a hiding p ace. Y u have tw
equa y imp tant immediate acti ns: t n tify the auth ities (use that
panic butt n) and t m ve the s t safety if p ssib e. r and m acts a e un-
p edictab e, but ify u eep y u faci itysafe, ify u eep y u awa eness up
at a times, and m int ude s may ch se a m e vu ne ab e ta get.
IN P RACTICE: Don ’t Talk to Stran gers
Ad ct was at as cia functi n when an un n wn man engaged himin c n-
ve sati n. The man int duced himse f and began t ma e sma ta . They
discussed the event they we e at and the W d Se ies, then the st ange
as ed ab ut the d ct ’s ccupati n. He esp nded that he was an aesthetic
su ge n. The man as ed casua y ab ut b east imp ants, ab ut ip sucti n,
and ab ut the pe p e wh unde g these p cedu es, w nde ing whethe it
changes themm ethan physica y. P ud fhis p fessi n and his patients,
the physician t d him that even ve y min p cedu es can have ve y p si-
tive esu ts in se f-c n dence when individua s a e ea istic.
Tw wee s ate , the same man wa ed int the su ge n’s ce and t d
the ecepti nist he was a f iend wh had met the d ct at a s cia functi n;
he d pped a few names f the s wh had been the e, then said he was just
passing by and wanted t say he . He had ea y enj yed meeting the d c-
t . Unsuspecting, the ecepti nist ca ed the d ct , wh came ut t see
the man. The d ct ba e y had a chance t say he when the man pu ed
ut a gun and sh t him.
r and m acts f vi ence happen anywhe e, any time. But this was n t a
and m act. It was ea ned sh t y the eafte that this man had ecent y di-
v ced. His wife had unde g ne p astic su ge y and was m ving n t date
and enj y ife again. The man, in his em ti na dist ess, b amed the p fes-
si n f p astic su ge y and decided t ta e ut his ange and his anguish n

Chapte 8: Safety: The U timate G a

2
this physician, wh was n t even the su ge n wh had t eated his ex-wife,
but ne he met casua y at a pa ty.
C u d this incident have been av ided? The physician might have been
m e cu i us as t why a casua exchange at a ecepti n had esu ted in an
unann unced visit t the ce. The ecepti nist c u d have as ed whethe
the man had an app intment. Eve y ne c u d have been a itt e m e bse -
vant, but the ea ityis that this man newthe ha mhe wanted t in ict, t e-
ta iate f his pe s na ci cumstances against any ne he c u d nd t b ame.
Whi e y u d what y u can t each ut and be visib e am ng the s, with-
ut questi n u w d equi es that we exe cise cauti n when we ta t
st ange s.
The su ge n ec ve ed, but his p actice was neve the same. He didn’t
havethep cedu es and p ans in p acet eep his p acticefuncti ningwhi e
he was disab ed, and g ssip su unding the sh ting a ected his p actice.
He decided t eti e ea y. Th ugh n fau t f his wn, except pe haps a
ac faheightened sense fcauti n, a and mact fvi enceended his suc-
cessfu ca ee .
SAF ETY P RACTICES
Y u p actice must have a p an f any event that may je pa dize the safety
fy u p acticeand th sein thefaci ity. l i eany iabi ity, y u must havein-
su ance t p tect th se wh may be hu t, t est e y u p pe ty and fa-
ci ityand t c ve y u expenses ify u p acticeis dis upted. Insu ancecan
be expensive, but the n y time y u t u y ea ize its va ue is when y u d n’t
have the ight c ve age en ugh c ve age and wish y u did.
A we -deve ped esp nse p an is an the f m f insu ance. Y u must
p nde theimp nde ab ein advance: What happens ifthe eis asudden e
an act f natu e? When must y u evacuate? Whe e wi y u di ect pa-
tients t g ? Wh wi ta e esp nsibi ityf thepatients in thep actice, and
wh wi c ntact th se n thei way t y u p actice t et them n w that
y u have evacuated? H w wi y u acc unt f a pe p e? When wi y u
decide it is safe t etu n? The answe s t a these questi ns must be de-
ned in a c mp ehensive evacuati n p an.
She te is the a te native t evacuati n; y u hun e d wn, c up, and
d n’t m ve. My chi d en’s sch is in the quietest, p ettiest, safest pa t f

28

Secti n V: Why
u c mmunity. Yet because f u unstab e w d, they p actice c d wn
d i s. The chi d en ea n whe e t hide, wh t esp nd t , and h w they
must n t eact. Just as thesch is esp nsib ef th sechi d en when they
a e in the bui ding sch g unds, y u a e esp nsib e f the pe p e in
y u faci ity. Y u t must dete mine what y u c d wn d i wi be, and
ma e ce tain y u ce is equipped with the c mmunicati n, f d, wate ,
and p tecti n necessa y f as ng as y u must see she te f m a st m,
ath eat, adisaste . Dete minewhat wi signa thea -c ea s y u can un-
c and eave y u she te . P actice unann unced safety d i s with y u
sta t ensu e that eve y team membe n ws what his he e is in case
f evacuati n c d wn.
With a the p anning, p cedu es, safety measu es, d i s, insu ance, and
m e, things that can a ect thesafety fy u p acticecan sti happen. H w
d y u esp nd s that y u d n t je pa dize y u success?
React: What immediate acti n must y u ta e? Ca f he p,
c d wn, evacuate, em ve an individua ca m yf mpub-
ica eas. The ea easmany gica and app p iate eacti ns
asthe ea eunp edictab eevents. M st imp tant t y u e-
acti n is ca m, f cus, and st ength.
Act: r emain c mp sed, dem nst ating eade ship, whethe
the situati n esca ates is c nt ed. Begin t give di ec-
ti ns, ta e di ecti n f mthe individua m st capab e and
esp nsib e f ta ing c nt f the situati n. Give inst uc-
ti ns, f c mp ehensi n and c mp iance, eep the s
ca m, and act t b ing the situati n unde c nt .
Regroup: Afte theincident hasbeen es ved, eg up. B ing
t gethe th se inv ved, th se wh witnessed the situati n,
and ma e ce tain eve y ne has thei physica and em ti na
needs met. o e app p iate es u ces if individua s need
fu the assistance. F examp e, ifthe eisa eand y u must
evacuate, when y u eg up et eve y ne n wwhe e and t
wh m they may tu n f he p if they fee anxi us have
hea th questi ns.
Document: Ass n asp ssib e, and am ngasmanyindivid-
ua swh we einv ved asp ssib e, d cument theevent. T y
t emembe detai s that c nt ibuted t the event and such