Aesthetic Medicine: Growing Your Practice (2009) Tác giả: Marie Czenko Kuechel Nhà xuất bản: Thieme Medical Publishers part3

S cti II: What
IN P RACTICE: Ju st My Frien d s
H was a v ry high–pr l physicia with multipl c s a d a c sta tly
full sch dul . H was i d ma d f r i j cti s, las r tr atm ts, a d ski
car , a d with g d r as : his r sults w r xc ll t, h had gr at rapp rt
with pati ts, a d th practic s tti gwas a upscal cli icalbut c mf rtabl
vir m t. H was s busy that it was tim t hir a xt d r, b caus
pati ts w r havi g t wait t l g f r app i tm ts. H hir d s m
fr m th utsid , b caus h c sid r d his curr t sta t b t valuabl
assisti g him. H did ’t wa t t trai a y f th m t p rf rm i j cti s
a d th hav t hir a w p rs t assist him.
Aft r m ths f th “right” p rs b ard, a w ma wh had p r-
f rm d i j cti s at a m dical spa f r s m tim a d claim d a f ll wi g f
h r w sh c uld bri g t th practic , h tic d his i j ctabl busi ss
was st ady, but his purchas s f ur t xi s a d d rmal ll rs w r dispr -
p rti at lyhigh. Aft r car fulacc u ti g, i fact th r was agr at disparity.
Pr duct was ith r b i g wast d r st l , b caus th umb rs just did ’t
match. Aft r i v stigati a d qu sti i g, th urs -i j ct r admitt d,
“I’v b taki g pr duct h m t i j ct at my h m , but th y ar just my
fri ds.” Stu d, th d ct r did t h w t r sp d. I did.
Th xt day th urs -i j ct r arriv d at w rk t d th p lic waiti g
t arr st h r f r th ft. Sh had b st ali g m dical pr duct. Lat r, sh
w uld b charg d with practici g m dici with ut a lic s : f th
“fri ds” sh had b i j cti g w r pati ts f th practic , r did sh
btai i f rm d c s t, a d sh did t mai tai charts th m.
Th l ss h r : Lay d w th law with physicia xt d rs. M st ar
thical, r sp sibl i dividuals wh u d rsta d th ir valu a d r l i y ur
practic .
NEVER ON A SUNDAY . . .
Th physicia ’s busy c r practic was adjac t t h r busy ski spa. H r
c was p M day thr ugh Thursday; th ski spa was additi ally
p Friday, Saturday, a d Su day. Th c had ph umb r,
th ski spa a th r. o Friday, Saturday, a d Su day, if a pr sp ctiv pa-
ti t call d th practic , that pati t had t l av am ssag t b r tur d

Chapt r : What Is Y ur M d l?


M day. Th physicia was ag r t gr w th tra c t h r c a d w
ski spa, but stra g ly, this arra g m t did ’t s m t b th r h r r h r
sta , r did th y r aliz th impact it had p t tial w pati ts.
I ask d th physicia ab ut h r sta : w r th y u iqu t ach tity, r
w r th y familiar with a d w rki g i b th th practic a d th ski spa?
“W ar fully i t grat d,” sh t ld m .
“H w ft d p pl callth practic a d g t tra sf rr d t th ski spa?”
“ev ry day.”
“What happ s t th p pl wh call th practic Friday, Saturday, r
Su day wa ti g t r ach th ski spa?”
“Th y l av a m ssag .”
“Wh ar th m ssag s r vi w d?”
“M day.”
“H w ma y spa m ssag s d y u g t?”
“Alm st .”
I r d a xp rim t. F r w k, sta w r t f rward th practic
calls t th ski spa wh th ski spa was p a d th c was cl s d. If
th callwas t r lat d t th ski spa, th pati t was t b c ct d t th
c r practic ’s v ic mail. If th call was urg t, th sta m mb r was t act
th pati t’s ds (sta w r fullyi t grat d). If it was r lat d t th ski
spa, th sta m mb r was t act acc rdi gly a d k p a c u t f pr cis ly
h w ma y calls w t t th practic , i t d d f r th spa Friday, Satur-
day, a d Su day.
o w k lat r, th physicia call d m , b sid h rs lf: “W had calls
c m i Fridayal that w r i t d d f r th spathat w r g i gt th
practic . I d b tt r y ll w pag s ads, I d cl ar r i f rmati my
w bsit , a d I d t adv rtis that th spa has its w umb r.”
“n , y u d ’t,” I t ld h r. “Th p pl calli g th ski spa ar calli g
b caus th y k w y u a d th r putati f y ur practic , a d th y hav
c ct d t it. Y u’v cr at d a str g bra d f r y urs lf, a d th ski spa
is r lat d t y ur bra d. Y u d ’t d m r m ssagi g t disti guish th
tw ; y u d c sist t s rvic that s rv s b th.”
Th physicia disagr d with m but agr d t us h r sta r s urc s al-
r adyat w rkrath r tha xp d m r r s urc s f r mark ti gf r m ths;
th sh w uld r p rt back t m r gardi g th tra c. Tw m ths lat r I
h ard thi g. Tw w ks aft r that, I call d h r. “S rry f r t f ll wi g
up,” sh t ld m . “W ar s busyat b th th practic a d th ski spathat I
did ’t hav tim t l t y u k w it’s w rki g b autifully, a d it did ’t c st
m a xtra dim .”

S cti II: What
I think it’s very important that whatever you’re trying
to make or sell or teach has to be basically good. A bad product
and you know what? You won’t be here in 10 years.
— MARTHA STeWART
P erson a l Service
Y u ar a physicia . Th s rvic s y u pr vid ar f a highly p rs al a-
tur . I s m cas s, y u may v pr vid m dical p rs al s rvic s.
n matt r which m d l y u us f r y ur practic , h w v r, th pri cipl s
f ll w d i p rs als rvic i dustri s ar ss tialt y ur pati ts’ xp ri-
c a d v rall satisfacti . P rs al s rvic s ar r ct d i th way y u
d liv r tr atm t:
Usi g cli ical m a s t arriv at a physical utc m with ut
th xp ri c f li g m dical
Practici g m dici with a t am f tal t d, d dicat d i di-
viduals wh practic th thics f d liv ri g m dical s rvic
with th pri cipl s f d liv ri g p rs al s rvic
D liv ri ga xp ri c that iswh llybas d p rs alful-
llm t
TAKING TH E “CLINICAL” O UT OF YOUR M ODEL
Y u pr vid a m dical s rvic . I a sth tic m dici , that s rvic is bas d
a d t ful ll p rs al d sir , t a m dical d t impr v ’s
h alth r lif c diti . Th r f r , alth ugh cli ical p rati s must up-
h ld all f th high st cli ical sta dards f car a d practic ma ag m t,
y ur cli ts/pati ts must t f l as th ugh th y ar i a cli ical s tti g r
a p rati that ful lls d, t d sir . With a y practic m d l, if y u
xp ct y ur a sth tic s rvic s t thriv , y u sh uld p rat as th ugh a s-
th tic s rvic s ar th primary r th ly fu cti f th practic .
Th ua c s that di r tiat a a sth tic practic , th tru p rs al s r-
vic l m ts, must b c sist t a d pr s t i all cas s.

Chapt r : What Is Y ur M d l?

3
If y ur c ds a fac lift, will a pati t f l y u ar th
b st ch ic t p rf rm h r? If y ur sta m mb rs ar
u k mpt, willap t tialcli t f ly u u d rsta d th valu
h r sh plac s p rs al app ara c ?
If y u c duct c sultati s i a cli ical xami ati r m,
will y ur cli t b c mf rtabl a d ca did ab ut his r h r
g als? Will h r sh f l th s tti g appr priat t th f s
paid f r l ctiv s rvic s?
If y u xp ct y ur cli ts t ll ut pap rw rk, d y u x-
p ct th m t w ar r sit pap r whil d i g s ? D s y ur
c pr vid th pap rw rk a clipb ard with a p at-
tach d byam talc rd? D y u f ar that th l ss fap will
hav a impact y ur b tt m li ?
Wh a cli t l av s with pap rw rk, is it g ric, r d s
v ry it m c sist tly carry y ur bra d? Is a sh af f l s
pap rw rk ha d d t th pati t, r is it c mpil d i a
bra d d f ld r r v l p ? If t, y ur imag may c m
acr ss as b i g l s ly rga iz d.
Wh cli ts/pati ts call with qu sti s, h w l g d s it
tak y u r a pati t c u s l r t r sp d? Is that m r r
l ss tim tha it tak s that i dividual t c tact a th r
pr vid r?
A alyz th s thi gs, th thi k ab ut th xp ctati s th cli t may hav
bas d what h r sh is payi g f r y ur s rvic s. K w that u l ss th
cli ical utc m fwhat y u ca pr vid is vastlya d vid tlysup ri r t
th c mp titi , y ur b st adva tag is a vastly a d vid tly sup ri r p-
rati .
N ONMEDICAL SERVICES
S m a sth tic practic s d ’t simplyapplyp rs als rvic pri cipl s t a
m dical practic ; th y ha c th m dical practic by addi g tru -
m dical s rvic s. Ma y practic s ca a d d thriv with ut th m, s m f-
f r but d ’t disti guish th m, a d still th rs mak a p i t f calli g att -
ti t th p rs al s rvic s pr vid d.

S cti II: What
P rs al s rvic s such as c sm tics, massag th rapy, c ci rg s, r th
T w Car that d liv rs y ur pati ts h m aft r a pr c dur ar ss -
tial. Additi ally, p rs al s rvic s:
Have an impact on revenue: Th y may g rat r v u r
add t y ur c st f p rati s r i v stm t i i v t ry.
Th ymay ccupyspac a d r quir utiliti s, i sura c , mar-
k ti g, r th r ss tial xp s s s that th y may b pr -
vid d a d appr ciat d.
Enhanceyour mission: C sm ticsw r i tr duc d i m dical
practic st h lp i dividualsdisguis birthmarks, scars, ac ,
r t lltal p sttr atm t sig s such as pall r, r d ss, a d
bruisi g. Th y hav v lv d with sci c a d impr v d f r-
mulati st b c m a i t gralpart fth a sth ticpractic ,
t lyf r c rr cti a d cam u ag a d f r c mpl ti gth
full a sth tic xp ri c f r y ur pati t, but als f r mai -
tai i gr sults, pr t cti gth pati t’s r juv at d, y uthful
app ara c , a d urturi g th ski .
Create opportunity: Wh th r t impr v y ur pati ts’ x-
p ri c r y ur abilityt s rv th m r t i vit a waudi-
c t y ur s rvic busi ss, m dical s rvic s must
cr at pp rtu iti sf r y u t gr wwith ut havi ga gativ
impact y ur r s urc s, y ur imag , r y ur pati ts’ x-
p ri c .
Nurture ongoing relationships: What v r th p rs al s r-
vic , wh th r it is br wwaxi g r bi f dback, p rs als r-
vic sthat byth ir atur willb r p at d byahappycust m r
k p y ur c r s rvic sc ti uallyvisibl t thatcli t/pati t,
thus cr ati g a gr at r pp rtu ity f r y ur si gl gr at st
s urc f r cli ts: r f rrals.

Chapt r : What Is Y ur M d l?

5
RELATIVE WISDOM: Tattoo You
It mad s s . Th physicia was k w f r his g ius with las rs a d
his ability t r m v tatt s, t fr m ga g m mb rs but fr m futur
sp us s, ladd r-climbi g x cutiv s, a d maturi g y u g adults wh r al-
iz d that a visibl tatt th ck w uld t b asy t xplai t a futur
mpl y r, l v r, r child. o th ip sid , th physicia ’s m dical spa f-
f r d p rma t c sm tics: tatt s f r y br ws, y li r, lip li r. H w-
v r, h did ’t k w this; his spa ma ag r had d cid d t c tract ut f r
th s s rvic s. This bifurcati mad abs lut ly busi ss s s .
R lativ wisd m: Th tr d i adju ct s rvic s t pay r practic s is
gr wi g s much that ma y f th s practic s gm ts d v l p a bra d a d
id tity fth ir w . What is criticalis that missi s r mai c gru t. Th
cli icalsid fth practic a d a yadju ct p rs als rvic s must hav acir-
cular r lati ship i which th m tiv s a d m ssag s ar shar d, v wh
bra d a d id tity tak i dividual charact ristics.
M r v r, wh a adju ct p rs al s rvic b c m s fully i d p d t,
it is l g r ac mpl m t, but rath r a utsid r s urc . Th c cti
b tw cli ical p rati s a d adju ct p rs al s rvic s must b visibl ,
l gical, a d must b r lativ t v ry : d ct r, sta , a d pati ts. Wh
missi s ar c gru t a d c sist t, th succ ss f tity f ds th
th r, thus buildi g r v u a d succ ss.
CONCIERGES
It’s abigt rmi m dici th s days: concierge. What it m a s i th w rld
fm dici is that th pati t pays apr vid r a a ualf f r all c ssary
s rvic s a d r f rrals, p t tially with additi al charg s f r sp ci c tr at-
m ts, a d th pr vid r agr s t ha c d s rvic : h us calls, aft r-h urs
car , wait tim s, add d privacy, a d a fully p rs aliz d xp ri c i
which th pati t d s t f l lik a m dical cas but a tru i dividual. I
a sth tic m dici , pr vidi g c ci rg s rvic s is v lvi g as a c c pt. It
is th ultimat i p rs al s rvic t assist y ur pati ts i v ry asp ct f
th a sth tic xp ri c .

S cti II: What
But i r ality, c ci rg s rvic s simplyr ct c mm s s a d c mm
c urt sy:
Y ur pati ts sh uld v r b k pt waiti g l g. This is t
a c ci rg practic ; it is a b st practic .
H us calls r pr p rativ i -p rs ch cks y ur pati ts
wh r c v r at h m ar appr priat , sp cially wh pa-
ti tsmay t wa t t b s i public r hav limit d m a s
t trav l.
F r pati ts wh trav l dista c s t s y u—wh th r y u
ar th cl s st g graphicch ic , th pr f rr d ch ic , prac-
tici g i a ch ic d sti ati , r simply the ch ic , r gard-
l ss f wh r y u practic —pr vidi gth mwith i f rmati
ab ut g tti gt , stayi gat, a d j yi gy ur l cati issim-
ply g d h spitality.
Assisti g pati ts with trav l arra g m ts, wh th r f r th
day f tr atm t, aft r surg ry, r t c m i f r p st p ra-
tiv f ll w-up is a graci us additi al s rvic .
C rdi ati gp st p rativ ds, wh th r th s ar f r ski
car , garm ts, am iti s, r aplac t r c v r, isg d prac-
tic . It is i appr priat t p rf rm a las r tr atm t a
cli t’s ski , th s d that p rs h m with i structi s
stati g, “Apply baki g s da c mpr ss s a d a c ati g f p -
tr l um j lly f r days.” eith r pr vid th i structi s far
i adva c s th cli t ca pla acc rdi gly, r s d th
cli t h m with th it ms h r sh will d f r th ir p st-
pr c dur c mf rt.
Y u mayf lthat c ci rg practic s ar xc ssiv f r m st fy ur pati ts
r ar simply t right f r y ur m d l. H w v r, d ’t v rl kth valu r
d s m pati tsmayhav : k p l r f rralt ac ci rg s rvic will-
i gt l ar y ur busi ss, k wy ur xp ctati s, a d s rv y ur pati ts.

Chapt r : What Is Y ur M d l?


IN P RACTICE: No P ain , No Vain
It’s ac mm sight: Pati ts graspi gth ha ds f urs s whil t ars str am
d w th ir fac s a d physicia s d th ir w rk. W m l avi g th a sth tic
physicia ’s c with ic packs, livi g f r days with visibl bruisi g. Pa-
ti ts wh say, “I’ll v r d that agai ; it hurt lik h ll.”
I was visiti g a practic wh r all th s sc ari s w r play d ut. Wh
th physicia a d I sat t g th r, I ask d: “Why d ’t y u d m r t k p
y ur pati ts c mf rtabl ?”
“That’s th pric f va ity,” h t ld m .
“Why d ’t y u all w th m s m xtra tim t r lax aft r tr atm t with
ic i th xami ati r m rath r tha shu i g th m ut th d r?”
“Th y ar busy, th y wa t t g t back t lif , a d I d th r m,” h
t ld m .
“D y u advis th m f th p t tial p sttr atm t cts a d h w t
av id thi gs lik bruis s wh th ycallt b katr atm t, r y ur w b-
sit , r at a y tim b f r y u actually p rf rm th tr atm t?”
“Th y w ’t pay att ti , a d bruis s ar par f r th c urs . Plus pa-
ti ts appr ciat th ir utc m s b tt r if th r is s m r ally u attractiv
tim i b tw ,” h said.
I c uld t b li v what I was h ari g, but th , I was t surpris d wh
I l k d at th physicia ’s r t ti l v ls a d sp t s m tim talki gt his
sta . R t ti was l w, a d th sta w r w ll awar that h was k w as
th “pai ful pr vid r.” I c uld ’t disagr ; his ma r pr v d it.
At th d f th day, th physicia , sta a d I sat d w t g th r t dis-
cuss thi gs. I d ’t lik putti g p pl th sp t, but this tim , it was war-
ra t d. W discuss d th lack f r t ti as a s rvic failur ; w discuss d
h w th physicia was p rc iv d am g his pati ts, a d thus i th c m-
mu ity; w discuss d th m a s t mak it b tt r. Pai was t ss tial t
th utc m r th xp ri c , w all agr d— xc pt th physicia .
S v ral m ths lat r, h call d m . His practic was d w , a pr vid r
fr m acr ss t w was p i g a c xt d r, a d h d d h lp. H
was i s arch f a aggr ssiv mark ti g blitz t x his appar t pr bl m.
Myadvic t him: mark ti gc uld t c rr ct his lack fu d rsta di ga d
s rvic f r his pati ts. H d d t x his s rvic m d l, which might
v tually r pair his r putati , achi v a b tt r r t ti rat , a d mak
him th pr vid r f ch ic i his mark t. I v r h ard fr m him agai . Th
w rd is that h is w pai fully r tir d.

S cti II: What
Reta il
Th g ds that y ur practic s lls t c mpl m t, supp rt, r ha c th
s rvic s y u pr vid must b ti d t y ur s rvic m d l, but als hav s m
v ryi d p d t charact ristics: r tailr quir s appr priat acc u ti ga d
i v t ry, i cludi gth c ll cti fsal stax. I s m practic s, r tailg ds
ar th ly“sal ” which c mmissi sca thicallyb paid. Th yr quir
a i v stm t i i v t ry, typicallycarrya %markup, a d r quir cl s
i v t rym it ri g(as a yr tail fu cti d s) s that st ckavailabl f r
cli t/pati t d ma d ca b acc u t d f r a d mai tai d i su ci t
qua titi s. R tail pr duct sal s ar ha c d by display, but th y i vit
th ft. Pr ducts ca b sampl d r t st d, wh r as th pr c dur s a d s r-
vic s y u pr vid ar ft v rydi cult t pr s t i a xp ri tialf rmat.
Ch oosin g P rod u cts
Alth ugh r tail practic s hav disti ct di r c s fr m y ur s rvic s ct r,
r tail it ms must b i t grally a d i timat ly a part f y ur s rvic m d l if
y u ar g i g t i clud th m i y ur practic . Cli ical ski car r c sm -
c uticals ar pr ducts that y ur pati ts/cli ts purchas fr m y ur prac-
tic bas d :
exclusivity—th y ca t b purchas d xc pt thr ugh th
physicia .
exp ctati —th pr ducts y u s ll pr vid a disti ctly b t-
t r r di r t r sult tha pr ducts purchas d ls wh r .
Sci c —th r s arch b hi d th pr duct is c sist t with
m dical r s arch sta dards, t sti g, a d appr val.
Pr ducts must b ch s bas d quality, u iqu pr p rti s, cli ically
pr v b ts, as f us , saf ty, bra d r putati , a d v d r supp rt.
R taili gi a a sth tic practic i v lv s much m r tha apati t’s simply
ch si gapr duct; it r quir s that th physicia r physicia xt d r r c-
mm d th c rr ct pr duct t tr at r pr v t ski c diti s, pr t ct
h ali g r h althy ski , pr v t r r v rs th cts f agi g, a d c ur-
ag r wal. T day v pr ducts s ld i th drugst r t ut th s b ts

Chapt r : What Is Y ur M d l?


a d m r . As a m dical practic strivi g t satisfy y ur pati t, if y u ca -
t c d tly s ll a pr duct that ca acc mplish what is pr mis d, y u
sh uld t s ll it. If it is s ld i a drugst r r d partm t st r arby,
mak c rtai y u ca c mp t f r d llars b f r y u i v st i i v t ry.
o c cli ts us a d ar satis d with r tail it ms, th xp ctati is that
th ywill c ti u t purchas th mfr my u. This cr at s a g i gr v-
u str ama d bri gs th mbackr gularlyas acust m r t purchas m r
pr ducts. Th s r p at d visits t y ur practic ar pp rtu iti s f r mai -
tai i g visibility a d c ti uity f y ur r lati ship with th cli t.
R tail ca b a vital s rvic c mpl m t a d busi ss c mp t i a a s-
th tic practic , but f r th s wh s ll r r c mm d it t pati ts, trai i g
is as critical as trai i g f r th pr c dur s r d i y ur practic . D sig-
at sp ci c p rs lt sta y ur r tail p rati s r ful llth r tailfu c-
ti i additi t th r r l s. F r th r tail sid f th practic t succ d,
y u must c urag a d i sist sta ducati a d trai i gi b th pr d-
uct k wl dg a d sal s t ch iqu . Putti g pr duct th sh lf a d x-
p cti g that th cli t will ask ab ut it is i ctiv . Practiti rs must d
pp rtu iti s t r c mm d pr ducts; sal s supp rt sta must xpa d
this r c mm dati a d sugg st c mpl m tary pr ducts as w ll.
Sellin g Skin Ca re
T day s lli g ski car i y ur practic d s t b gi a d d i y ur
practic . Ma ypractic s ar f cus d -taili g—s lli gpr duct th I -
t r t. Ify u ar g i gt fra chis asit y u ca d sig t match y ur w
bra d, atur k y p rati y u ca build t b y ur w , r ch s t build
ar taili g d av r fr mth gr u d up a d i y ur w i -h us r tail p-
rati s, h d th s cav ats:
D t s ll pr scripti -str gth pr ducts u l ss y u hav a
pati t r c rd, a i - c visit, a d apr scripti l f r
th pati t.
D t s ll pr ducts y u ar t familiar with r w uld t
r c mm d t pati tst tr at asp ci cc diti r ful lla
sp ci c fu cti .

S cti II: What
D highlight pr ductsbypr bl ma d s luti a d bypr d-
uct typ a d bra d, a d d list c mpl m tary a d c ict-
i g pr ducts. D ’t s ll s m a pr duct that r sults i
distr ss i st ad f a s luti .
D highlight bra ds. C sum rs l k f r r c g iz d a d
w ll-k w am s.
D c ll ct data th s wh purchas li a d c mpar
th s with data c ll ct d ab ut cust m rs wh purchas i -
c . If li sal sar ca ibalizi gy ur i - c sal s, y u
ar l si g a valuabl ass t f r taili g: th tra c that bri gs
p pl i t y ur d r f r pr ducts and s rvic .
Ski car , c sm tics, a d at-h m d vic s, wh th r m cha ical r light
bas d, ar all valuabl xt si s t y ur practic , but th y ca t s ll
th ms lv s, a d if th y ar misus d r misguid y ur pati ts, th y tar ish
y ur imag rath r tha cr ati g valu .
SKIN CARE IN TH E AESTH ETIC P RACTICE: To Sell
or Not to Sell
Gene Colón, Esq.
A pati t walks i t a d rmat l gist’s c f r a c mbi ati las r-p l-
i j cti r gim . Aft r th pr c dur s ar c mpl t d, sh l av s with sp -
ci c p stcar i structi s a d a small bag f targ t d ski car pr ducts f r
h m us . S u d familiar?
G ar th days wh a “ siz ts all” a sth tic pr c dur ll d th
bill. T day savvy c sum rs with l ss tim th ir ha ds d ma d a m r
gl bal a d p rs aliz d appr ach t y u g r-l ki g ski . Th tr d is
cl ar: p pl wa t mi imally i vasiv tr atm ts that ar ski -typ sp ci c,
i cludi g th r l va t a cillary t ls t mai tai th s i - c r sults at
h m . Pati ts ar als wtaki gam r activ r l i this s arch f r y uth.
Th l g r th y ca mak th r sults f th pr c dur last, th b tt r.
Giv th trust, k wl dg , a d c v i c stablish d i th physicia -
pati t r lati ship, wh b tt r t pr vid th s r l va t t ls t achi v p-
timal r sults tha th d ct r wh is p rf rmi g th i itial i - c pr c -
dur ? Disp si g pr ducts has b c m a atural xt si f th practic .
I fact, th s a sth tic physicia s hav alr ady b disp si g th r ki ds

Chapt r : What Is Y ur M d l?


f pr ducts (s rvic s, advic , pr scripti s, surg ri s, a d s ) t tr at
th ir pati ts. It is ly l gical that ski car w uld f ll w as a acc ptabl
pr duct t b disp s d.
Whil I am far fr m adv cati g a cart bla ch capitalistic attitud r -
gardi g this busi ss m d l, I d b li v c rtai t ts must b mai tai d
t sur th thics f this strat gy. First a d f r m st, th b st i t r st f
th pati t must always b th param u t c c r . Av id ac rciv sal s at-
m sph r i th c . S c d, th r sh uld b g d sci c t supp rt th
pr duct’s b ts. With s ma y pti s availabl t day, pati ts sh uld x-
p ct cr dibl cli ical data b hi d th pr ducts r c mm d d by th ir d c-
t rs. Fi ally, a y a cial i t r st sh uld b discl s d. F r g d m asur , I
w uld r c mm d mai tai i g r as abl prici g a d ri g a m y-
back guara t .
I t day’s cultur , pati ts xp ct a -st p sh p (c sultati , a sth tic
tr atm ts, a d h m car pr ducts). As l gas th w ll-b i g fth pati t
c m s rst, th r is r as that disp si g ski car pr duct ca t r -
mai a imp rta t a d valuabl part f this dy amic. ev ry wa ts a
happy pati t. C sist t a d l g r-lasti g r sults ar ss tial. A d i t -
day’s c my, s lli g ski car pr ducts is th prud t thi g t d .
WH AT’S MY LINE?
Privat lab li g f ski car pr ducts has b c m a tr d i a sth tic prac-
tic s. S m physicia s hav put th ir am s a d hav b a part f th
r s arch f r mass-mark t d pr duct li s s ld at Saks Fifth Av u a d
n rdstr m, a d wat CVS a d th c r r gr c ry. ev ryphysicia s ms
t wa t a b ttl r jar t lab l his r h r w . H t l chai s hav l g had lit-
tl b ttl s f shamp a d ski car pr ducts privat ly lab l d with th ir
bra d s that patr s wh hav f rg tt t pack th s it ms hav th m t
us a d tak h m , r mi di gth mwh r t stayagai . I m dicalpractic ,
h w v r, th g al fch si gg ric pr ducts a d putti g ’s w bra d
th lab l gat s th tir p i t f ri g ski car i y ur practic :
pr ducts ar s ld th pr mis that th y hav sci ti cally pr v valu
a d gr at r b t tha mai str am r g ric pr ducts. Putti g y ur am
a pr duct impli s that y u hav b a part f th d v l pm t, a d sci-
c b hi d that pr duct. Putti g y ur am a g ric ski car li is
thi g l ss tha d c ptiv , thi g m r tha s lf-s rvi g.

S cti II: What
IN P RACTICE: Mod el Data
It’s afamiliar m d l: as lid a sth tic practic with lyth s r st rativ pr -
c dur s that ultimat ly hav a sth tic g als, with a add d surgical ski
car c mpl m t a d r bust r tail ri gs. Ma y practic s hav this all i
l cati ; th rs hav sat llit s t xt d surgical a d ski car s r-
vic s furth r i t th mark tplac .
o visiti g a practic i a bustli g suburba ar a, th physicia - w r
was c c r d: his thr practic s gm ts, surg ry, c sm tic m dici , a d
r tail, s m d disc ct d. I fact, a r vi w f practic data sh w d that
ski car s rvic s a d r tailw r fr qu t d bycli ts wh w r t asubs t
f his surgical pati ts, a d th surgical pati ts rar ly w r patr s f th
ski car s rvic s.
I m t with th physicia a d sta t discuss th pr bl m, th s urc f
which I c uld fully pr dict. Th physicia did t k w what ski car was
r d, s h did t r c mm d d a y. A sth ticia s abid d strictlybyhis
“ pushysal s” rul a d did t discuss tr atm ts th ydid t admi ist r.
Th urs s p rf rmi g las r a d i j cti tr atm ts w r “s busy” th y
did t hav tim t gag th ir pati ts i a discussi f th r s rvic s,
v if th pati ts xpr ss d a d sir f r th m. This was a disc ct d
practic with a l t f xcus s, s I laid ut a v ry sp ci c multist p pla :
Th physicia r c iv d a bri g all th ski car pr ducts f-
f r d a d s rvic s pr vid d by th a sth ticia s. H r c iv d a
“pr scripti pad” listi gall fth s s rvic s t k p i his p ck t,
r c mm d, ch ck , giv t th pati t, a d pass th m al g t
th ski car sta t c mpl t th s rvic a d th sal . Ifth physi-
cia r c mm d d it, pati ts w uld buy it.
A sth ticia s w r giv a i -s rvic s ssi cli t ducati ,
t s licitati . Th y w r taught t qu ry th i t r sts a d g als
f th ir cli ts a d t m ti th pp rtu iti s th physicia pr -
vid d t ful ll th ir c sm tic g als b y d ski car . Th y w r
giv appr priat , practic -bra d d lit ratur that d d a s r-
vic i layma ’s t rms. Th y w r giv acc ss t th physicia ’s
pati t c rdi at r, if sh was availabl , t m t with a cli t wh
was i t r st d i a pr c dur , r t sch dul a c mpl m tary
c sultati with th pati t c rdi at r ifsh was t availabl at
th m m t.

Chapt r : What Is Y ur M d l?

3
Th t -busy urs s w r giv s m dir cti a d w r mad
awar that th y w r , i fact, th missi g li k that c ct d ski
car s rvic s t th physicia , a d th physicia t ski car s r-
vic s. each urs r c iv d a pr scripti pad lik th giv t
th physicia , a d all w r r quir d t att d th a sth ticia i -
s rvic s ssi . Pr pr c dur a d p stpr c dur pr t c ls i -
clud d tw v ry sp ci c thi gs that t k th urs s ly a m -
m t: aski gwhat th pati t’s sp ci c g als f r app ara c w r ,
a d aski g wh th r all ds a d qu sti s had b addr ss d.
As I t ld th urs s, “What ca w d f r y u?” a d “Is th r a y-
thi g ls w ca d f r y ur r r c mm d t day?” ar v ry p -
lit a d simpl practic s.
Af wm thspass d, a d that datab ga t sh wastr gc cti am g
th practic s gm ts. Th d ct r was happy, th sta w r happy, th pa-
ti ts w r happy. But s v ral m ths lat r, data agai d m strat d a dis-
c ct. It did ’t tak l gt disc v r th r as : th pr scripti padsw r
i ctiv b caus th ski car pr duct ri gs had s m cha g s. Th
d ct r st pp d usi g th m, a d th urs s st pp d usi g th m. Th d ct r
i tr duc d s m ws rvic s, a d th ski car practic add d a sth ticia s.
n th ught t trai , r trai , r updat . ev ry l st thusiasm.
Th m ral h r is simpl : M d l data d t s lf-p rp tuat . M d l b -
havi r, m d l thusiasm, m d l updat s, a d m d l c mmu icati must
c ti u a d v lv t r mai ctiv .
RELATIVE WISDOM: Mu st You Ad d a Med ical Sp a?
My s A dy l v s t sh. It’s his u dyi g passi . n matt r wh r w g ,
matt r th w ath r, if y u ask him what h wa ts t d , h wa ts t g
shi g. o summ r day A dy a d his babysitt r d cid d th y w r g i g
shi g. Wh th y arriv d at th fav rit shi g h l i ur ighb rh d,
A dy c u t r d a ld r g tl ma shi g with w rms, t lur s. A dy,
r sp cti g th ld r ma ’s maturity, b ga t dig f r w rms. H gath r d
s m , sh d with th m, a d caught thi g. A dyr tur d h m a d put his
shi g r d a d buck t th pati a d h ad d i sid t wash f r di r.
Th xt m r i gI was chagri d t disc v r that th r was bird p p all
v r th glass pati d rs, all v r th pati . A dy’s w rms had b f dd r
Continued

S cti II: What
f r th birds. As my y u g sh rma a d I w r cl a i g th m ss, h
l k d at m a d said, “M m, I gu ss this is f th s l ss s that y u
d ’t d t d what v ry ls is d i g.”
R lativ wisd m: Y ur practic m d l sh uld t b dictat d by what
v ry ls is d i g. Y u sh uld d what suits y u b st, w rks w ll f r
y u, y ur pati ts, a d y ur mark t. Y u d ’t d t build a m dical spa
b caus v ry ls is buildi g . I cludi g th s rvic t uch s, th
right am iti s, a d d sirabl s rvic s ca happ i y ur practic , a d with
a multitud f m d l a d bra ds. If y u try t f ll w s m ls with ut
r s archi g th pti s, y u might d up with taki g y ur bait, a d
a m ss t cl a up lat r.
RELATIVE WISDOM: Mu st You Ad d a Med ical
Sp a?—con t’d

What DoYour
PatientsExpect?
A successful practice is one with the ability
to ful ll need and nurture realistic expectations;
it does not distort or build expectations, and it
must not deny them. A practice weak on accepting
this reality is indeed a weak practice.
CHAPTER 7
You and your practice arede ned. You haveidenti ed your targets and rec-
ogni ed the competition. Your identity is clear and consistent in image,
brand, mission, and operations. Nowyou must nd awayto linkallofthese
factors to the needs and expectations of those you serve or potentially may
serve. What do your patients need and expect fromyou, your practice, your
medical services, and your service model?
In the practice of aesthetic medicine, client/patient needs are based on the
personal desire to enhance appearance. Patients may expect that this en-
hancement in appearance willalso enhancetheir con denceand perception
of self and that improved image and con dence will have a positive impact
on their lives. What is variableis just howtheir lives willbeenhanced and to
what degree. However, your patients’ needs and expectations are not sim-
ply for the services you will provide, the manner in which they are deliv-
ered, and their expectations for outcomes. Needs and expectations are far
more complicated.

Section II: What
In terest
Interest isessentialto bringaprospectivepatient to you. Interest occursout-
sidethepractice, when thesubject isatarget audiencemember who isdrawn
to you by your own external marketing e orts or as a referral from another
physician, a professional connection, or one of your patients. Interest may
also return a current patient who wants additional or di erent services.
Ed u ca tion
Education about potentialmedicalsolutions to aprospectivepatient’s goals,
about your practice, your credentials, services, and the nuances that di er-
entiate your practice from others occur at multiple points. Externally, edu-
cation occurs through resources such as your website, other patients, phy-
sicians, or professionals who know and will speak candidly about your
services. Internally, education occurs through initial conversations or cor-
respondence and ultimately a consultation. Patients need and/or expect to
be educated before making a decision.
Com p reh en sion
Comprehension is essential to formali ing the physician/patient relation-
ship. Thoroughly and honestly evaluating how well your client compre-
hends his or her own needs and expectations allows you to make the ap-
propriate recommendations for treatment to achieve those goals, and to
what degree. Comprehension allows the patient to con dently accept your
recommended course of treatment and all the attendant experiences, obli-
gations, and potential positive or adverse outcomes that may result.
Comprehension is best achieved though objectivity, sensitivity, listening
skills, and candid, careful dialog between you and those within your prac-
tice who willbe involved in this patient’s administration, care, or decisions.
In u en ce
In uence comes in many forms, may be apparent or latent, and can a ect a
patient’s interest, education, and comprehension at varyinglevels. In uence
can behealthyor toxicto your relationship with thepatient; it can comefrom
family, friends, and other providers. In uence may strengthen or alter the

Chapter 7: What Do Your Patients Expect?

7
patient’s decisions. Media news or features and social media such as blogs
and ratings can shape the patient’s decisions. Social status and social pres-
sure can be persuasive. Such in uences cannot be controlled or prevented,
but through a strong and forthright relationship with your patient, positive
in uences can be reinforcing, and negative in uences can be di used.
You r Ma rket
As interest, education, and comprehension are essential to the process of
treating your patients, so too is understanding precisely who you must at-
tract. Your market can generally be de ned by one or more of these cate-
gories, each with special needs:
Medical: Medical patients come to you for a cure for a dis-
ease such as skin cancer, for treatment of an anomaly, or for
some other need that is not solely based on improved ap-
pearance. Patientsmaycometo an aestheticpracticefor med-
ical needs because they trust a particular provider, are in-
uenced by others, or hope that the aesthetic provider can
produce a more aesthetically pleasing result.
Restorative: Patients may come to your practice in need of
restoration to a more normal appearance or function after an
injury, a trauma, or disease such as breast or skin cancer. In
recent timesrestorativeneedshavealso been de ned asthose
that return a patient to his or her former appearance, such as
a face lift to restore a youthful appearance. The most impor-
tant distinction tomakeisthat onecategoryofrestorativepro-
ceduresisrecogni ed and generallyreimbursed byhealth care
insurers;theother ispurelyfor cosmeticneeds. Correction of
a constricted scar or reconstruction of a breast lost to cancer
is restorative. A face lift, although it restores a more youthful
appearance, is purely cosmetic.
Cosmetic: Cosmeticsurgeryre ectsthepatient’sdesiretoim-
prove, re ne, re nish, renew, or restore some aspect of ap-
pearance. Whether this involves a simple facial peel, an in-
jection of a ller, laser hair reduction or skin resurfacing, a
face lift, breast enhancement, or body contouring, the desire
and the outcome are purely for improved appearance.

Section II: What
Childor adolescent: Aprospectivepediatricpatient hasneeds
and expectations similar to those of an adult patient and re-
quiresthesameattention to interest, education, and compre-
hension. However, all of these factors are at far di erent and
divergent levels based on age, health, maturity, and even the
condition for which the patient has come to you. In uence
by parents in these cases can range from demanding to en-
couraging to forbidding treatment. Legally, you must have
the consent of the parent or guardian to treat a child or ado-
lescent. Ethically, you must havetheabsolutebest interestsof
your patient in mind at all times.
Adult: Legallycapable ofmakingtheir own decisions, adults
can be your easiest or most di cult patient population, be-
cause their needs and expectations can be straightforward or
highlycomplex, unyieldingor highlyinconsistent, and wholly
self-motivated or highly in uenced.
Senior: In thegrowingsenior population, therearesomewith
spending power, some without. Some have explicit needs,
whileothershaveunrealisticneeds. Treatingseniorsrequires
the same level of caution as for treating any other patients:
carefullydiscussinterests, educatethem, and ensurethat they
completely comprehend the procedure, its potential, and its
pitfalls.
Indigent: You may have patients who are unable to pay for
treatment. These patients maycome to your practice oftheir
own volition, or you mayinvitethemor travelto themasare-
sult of your personal philanthropic endeavors. Indigent pa-
tients deserve respect and proper cautious care, and they to
require interest, education, and comprehension of their op-
tionsand opportunities. However, you maychoosenot tomix
this population with your general patient population.
Critical: Criticalmaymean lifeor death, or it maymean now.
You mayencounter patientswho need your servicesimmedi-
ately, even if that time is inconvenient for you. Response to
complications must be swift. If this is your patient, it is im-
perative that the response be immediate for a trauma or in-
jury, or thepatient should bepromptlyreferred and cautiously

Chapter 7: What Do Your Patients Expect?


followed. Consider apatient with disrupted sutures, onewith
a laceration from an accident, and one with a ruptured im-
plant. All deserve immediate attention from you or someone
you trust to treat this patient.
Di cult/demanding: Dealing with di cult or demanding
patients requires a very special set of variables.
– Observation: Observe patients early in the relationship
to assess which individuals may become di cult or de-
manding;sometimesit issimplybest to avoid themin your
practice.
– Removal: Remove the patient from negatively in uencing
anyone else in your practice, but don’t engage the patient
alone; always have a sta member present and silent.
– Inquiry: Ask speci cally what has transpired to cause the
individual to be upset, on edge, or in despair, and listen.
– Resolution: O er a solution if you have one, o er your
apologies if you don’t, o er a refund if you must. It is bet-
ter to avoid thedi cult or demandingpatient and to di use
the di cult or demanding situation than to expend valu-
able resources of time, energy, and identity in trying to
“win.”
Ineligible: Some patients simply are not appropriate candi-
dates for treatment. Whether they are poor candidates for
emotional, physical, or nancial reasons, you have the re-
sponsibility to decide and communicate when it is either not
possible or not appropriate to treat a patient.
– Do not accept a patient who you know may risk severe -
nancial hardship to pay for cosmetic procedures.
– Do not accept apatient with an emotionaldisorder that in-
dicates the need to deny treatment.
– Do not accept a patient with unrealistic hopes or expecta-
tions that aprocedure willbethemiraculous life-changing
event thisperson needsto saveamarriage, attract aspouse,
or become a movie star.

Section II: What
INTEREST
Theonlymeans of linkingyour practiceto an outsidetarget audiencemem-
ber is e ective communication, which may be direct, or linked through
sources and resources. Outside your practice, the interest ofyour target au-
dience is de ned through research. (Sources for researching your popula-
tion areprovided in Chapter 3.) Knowingtheinterests ofyour target patient
base is essential to helping members of that audience uncover or heighten
awareness oftheir own needs so theycan act on this need bycomingto your
practice.
Interest does not de necommunication, but it does shapeexternalcommu-
nication strategy by attaching the content of your message to what interests
your target audience. To be e ective, you must keep your tone consistent
with thetoneofother lifestyleinterests ofthetarget audience. For your mes-
sageto bereceived, you must deliver it directlythrough mediathat areread-
ilyaccessible and e ectivelyused bythe target audience or through sources
and resources that you trust will carry your message forward and maintain
the integrity of the message. In blending what you learn about the interests
of your target audience and the needs that prospective patients may have
and by conveying your identity and your services, you have three speci c
goals:
Visibility: You want toreach alarger poolofpotentialpatients
or individuals who may be referred to you. Then, if they are
interested, people must be able to locate you.
Awareness: You want tocommunicateinformation about your
services to abroader potentialpatient population and to pre-
vious patients who may have become inactive in your prac-
tice. You must also inform current patient referral sources
about the services you provide, giving them the opportunity
to pass along information.
Consistency: Every time, every place, through every referral
sourceor resourceyour practicehasto reach prospective, ex-
isting, or inactive patients, your brand, image, and mission
must be consistent.

Chapter 7: What Do Your Patients Expect?


Research garners the interests of a target population, not an individual.
Once an individual enters your practice, communication is based on that
person’s interests. His or her interests arespeci c and personaland require:
One-to-onecommunication: Patient to practice, practitioner,
or sta —essentialto learningtheinterest not just for apartic-
ular service, but in general for this patient. Learning the pa-
tient’sserviceinterestsisessentialto makingquali ed recom-
mendationsto ful llhisor her goals. Learningthegeneralin-
terest of this patient helps you know more about his or her
lifestyle and intentions, as well as more about the population
of people interested in your service. This valuable research
can help you improve and expand your outreach to your tar-
get audience.
Consistency of intent: To be certain the interests of the pa-
tient aresincereand strong. Peoplehavebeen known toact on
a whim to ful ll a eeting interest for a cosmetic procedure.
Aesthetic medicine is not a eetinginterest; its results can be
permanent.
Consistencyofservice: Each encounter your patient has with
your practice will shape his or her experience and can
strengthen or weaken his or her interest in you as aprovider.
If a patient loses interest, there may be a variety of reasons:
Anxiety: Anxiety is a perfectly normal reaction to the un-
knowns of an aesthetic procedure. Through education the
patient’sanxietycan bealleviated but willnever resolvecom-
pletely.
Medical conditions: Whether temporary or not, illness can
supersedeaperson’sdesiretoundergoan aesthetictreatment.
When illness does not impair the abilityto ful lltreatment at
a later date, the patient’s interest must be kept fresh through
communication.

Section II: What
External in uences: Family, friends, media, and money can
all work against patient desire, and you cannot control these
in uences or may have no knowledge of them. The strength
of your patient’s desire and internal in uences—your e ec-
tive education and the patient’s comprehension—will deter-
minewhether externalin uencesor personaldesireprevails.
Ifthepatient isaminor, parentsor legalguardiansarenot ex-
ternal forces; they are essential to your relationship with the
patient. In any other case, your obligation is to your patient.
Interest can wane when too much time passes between points of communi-
cation with apatient. Ongoingcommunication between your practiceand a
patient who is agood candidateand demonstrates asincere interest in treat-
ment is critical to this patient’s accepting treatment.
Growinginterest is shared interest. Patients excited about ful llingpersonal
desiressharetheir excitement with those theyknow. Patients with excellent
results lead others to develop adesirefor their own ful llingexperience. Fe-
male patients are more likelyto sharethejoyofful lled desire than malepa-
tients are. Men tend to bemuch moreprivateabout their interest and needs;
they will rarely share their interest, and when they do, it is only with a very
few close friends or family members. The value of growing interest is that
when it is nurtured and maintained byyou and your practice, it can translate
to your single greatest resource for new clients: referrals.
In th e In terest of Ma rketin g
Marketing by de nition is the process required to price and package your
goods or services, attract a market, and sell to them. That may include a
number of strategies, of which advertising is just one. Advertising, a web-
site, a seminar, cultivating referrals, or any other marketing tool to help at-
tract an interested audience is an ethical and valuable tool for your practice.
It is unethical to make false claims, whether through adver-
tisingor on your website. Ifyou arethebest, you’d best prove
it. If you are a “top doc,” you’d best not have paid for that
title.

Chapter 7: What Do Your Patients Expect?

3
It is unethical to entertain a group of people in an informal,
nonmedical setting and on that same occasion, to provide
treatment to individuals in that group. A proper process of
interest, education, and comprehension requires a consulta-
tion and informed consent. And thereisno “two-drinklimit”;
ethical providers have a ero tolerance policy for treating in-
dividuals who have been drinking or are under the in uence
of any recreational drug or drink.
It isunethicalfor aphysician to payfor referrals, whether from
patients, hairdressers, or image consultants.
It’s appropriate to show gratitude; it is not appropriate to have patient-
funnelingreferralfeearrangements with anyone. Pharmaceutical rms’rules
don’t allowrepresentatives to incentivi etheir relationship with you bypay-
ing you to recommend or prescribe their product over another. Act by the
same rules. There’s been a practice of websites recruiting physicians who
will “pay per lead.” Don’t do it, unless you know that lead was genuinely
interested, appropriately quali ed, and did more than simply go shopping.
In aNovember articlein theAmerican Medical News, published bythe
AMA, attorneySteven Harris wrote: “TheAmerican MedicalAssociation’s
Codeof MedicalEthics provides that a‘payment byor to aphysician solely
for the referral of a patient is fee splitting and is unethical.’”
The conventional wisdom is to follow the ethics of your profession and of
your specialty such as the codes of ethics of ASAPS, ASPS, AAFPRS,
ASDS, AAD, AAOPRS, or anyother quali ed professional organi ation to
which you belong or endeavor to belong.
What you do as an ethical provider/proprietor ofaesthetic medicine to gain
patientsis to communicateyour brand, image, mission, and theservices you
provide. You do not tout your services; you educate clients and patients
about howyou can ful lltheir personaldesirefor appearance enhancement.
A patient’s decision to come to your practice for a treatment confers on you
the responsibility to ensure that the patient fully comprehends the service
you will provide, how treatment will be administered, and at what mone-
tary, physical, and emotional cost.

Section II: What
IN P RACTICE: In terested ?
I was visiting a practice when a sweet elderly woman came in for a consulta-
tion. Duringher visit, she pulled an ad she had clipped fromthe localpaper;
the headline read, “ Years Younger in Minutes.” Clever marketing.
The ad was not run by this physician’s o ce, but by a medical spa at the
busiest mall in town. The sweet lady didn’t like going to the mall; it was
crowded and busy, and she felt pushed around, so she came to this physi-
cian, recogni ing his name as the one who was treating her daughter with
cosmetic injections.
Thephysician was earnest in his responseto her interest; he educated her
so that she could fully comprehend that no treatment could result in her
looking years younger in minutes. She weighed her options, looked a
littlesad, and before shecould sayanythingmore, hesaid, “Callmewith any
questions you have, but please don’t visit this spa; they will simply be taking
your money.” As she reached for her wallet, he stated, “There is no charge
for this visit.”
I commended the physician for his actions. Taking her money for a con-
sultation was pointless, and could harm the relationship he had with the
woman’s daughter. Then, beingwho I am, I grabbed mybag, mycoat, thead
(which also touted themost naturaland undetectable results), and asked one
of the o ce sta to point me in the direction of the mall.
For a woman in her forties, I am pretty well kept. I have had my share of
injections, peels, and laser treatments. I walked into the medicalspawith the
ad in hand and asked, “Hi, who could I speak to about looking years
younger? I’ve got minutes.”
The girl behind the desk was eager to introduce me to Stella, a woman of
with ahealthyshellac ofmakeup and longfake nails. First Stellaasked my
age. “Howold do I look?” I asked. Shegiggled and promised methat instead
of looking like 3 , I’d look like . This place was awesome; by just walking
in the door, I looked years younger.
Within minutes, Stella had recommended that I have a particular type
of thread lift (with aproduct no longer on themarket), askin-tighteninglaser
procedure, skin bleaching, and a series of injections to ll out parts of my
face, melt the fat in other parts of my face, and vitamin injections that would
“foolmyblastocysts into formingmore collagen.” This is what Stellao ered
to make me look years younger. “Wow, all of that will make me look
years younger? In minutes? What’s theprice tag, and howsoon can I sign
up?” I asked.

Chapter 7: What Do Your Patients Expect?


Stella promptly told me she would have to see how much time the nurse
had on her schedule, because this stellar package would take about hours.
“Your ad says minutes! I don’t have hours.”
“I know,” Stella told me. “You really didn’t believe that, did you?”
“I did,” I told her. “This is false advertising.”
Stella went to get the nurse, who came and o ered me a % savings be-
cause of the misunderstanding if I had the treatments that day. She had time
now. “Shouldn’t the doctor examine me?” I asked. “Will I need someone to
drivemehome? Areyou quali ed to performsurgery, becausewouldn’t put-
ting threads under my skin mean incisions of some kind? Are there risks?
Side e ects? Can I head back to the o ce, because I just ducked out for
lunch and wanted to look years younger in minutes.”
“You ask a lot of questions,” the nurse told me. “You must not really be
interested.”
When I returned to theo ce, I shared my ndings with thephysician and
we led a complaint with the state medical board. I called the city licensing
department to learn whether this business was indeed licensed to perform
medical procedures in this town. The physician called me 3 weeks later: the
medical spa was closed.
The lesson here: Be careful about the interests you attract, the promises
you make, and the manner in which you do business. At worst, you’ll be ex-
posed; at best, inevitably or quickly, people will lose interest.
You know, nothing is more important than education, because
nowhere are our stakes higher.
— ARNOLD SCHWARzENEGGER
EDUCATION
Thestakesarehigh in thepracticeofaestheticmedicine; thereforethemeans
by which you educate your patients and the e ectiveness of that education
are critical to success in your practice. Outcomes are important, as is edu-
catingyour patient on everyoption, everyaspect, everyexpected result and
potentially adverse event of the treatment. Motivation is important, but not
as important as your learningabout your patient’s motivation for the proce-
dure. Service is important, but not as important as knowing your patient’s
expectations for service and de ning what you can and cannot provide.

Section II: What
Interest is essential to reaching people; education is essential to in uencing
a person’s decision to select you to perform one or more services.
Ed u ca tin g You r Ma rket
The education you provide your target population or prospective patient is
an education about you (your image, brand, and mission). It de nes you by
the basics: credentials, services, a liation, and geography. It also provides
procedure-speci c knowledge. The conduit may be advertising, your web-
site, directories, referringphysicians or patients—thesources areunlimited.
It must always convey your image, brand, mission, and tone. If you use in-
consistent messages and materials to educate those who do not yet have a
one-to-one relationship with you, you willonlyconfuse themand inevitably
lose credibility.
Ed u ca tin g th e In d ivid u a l
The most signi cant education occurs in direct conversation with a pro-
spective or current patient and your referralsources. Patient education lasts
inde nitely, from the moment the individual contacts you until you or the
patient elects to discontinue the relationship.
Individual education can be simply de ned:
Begin with apersonalintroduction to thepracticethat a rms
your image, brand, and mission.
Followwith ageneraldiscussion oftheoptions your practice
can o er to ful ll the patient’s wants or needs.
Ifthepatient decidesto proceed with therecommended treat-
ment, thoroughly explain the procedure and experience, his
or her obligation to follow the guidelines provided preoper-
ativelyand postoperativelyto optimi ehealth and avoid com-
plications, and the expected and potential outcomes.

Chapter 7: What Do Your Patients Expect?

7
The rst two areas of education—personal introduction and general educa-
tion—must be concisely addressed at the initial points of contact. An initial
phone call should do more than schedule a consultation; it must:
Answer generalquestionsthat enableyou to better screen the
prospective patient, or schedule a subsequent call to accom-
plish this two-way educational experience
Provideencouragement to facilitatetheconsultation process:
what the patient is to expect and what is expected of him or
her
De ne the policies and parameters of a consultation and the
practice, iftheprospectivepatient schedulesor inquiresabout
schedulingaconsultation, includingthelength oftimeacon-
sultation typically takes, the cost involved, directions to the
o ce, and collection ofnecessarypatient data(whether com-
pleting forms or logging in)
When initialcontact does not immediatelyresult in theprospectivepatient’s
scheduling a consultation, the response must still connect the individual
with the practice:
An o er to provide practice background or speci c proce-
dural information
Direction to resources, such as a website, and speci cally
what on the site is relevant to the client’s initial interest
An invitation to contact the o ce at any time with further
questions
An o er to follow up with the prospective patient (after a
short but reasonable length of time) to ensure that the infor-
mation provided was adequate and understood, to allow the
individual to ask further questions or express additional in-
terest, and to extend an invitation to schedule a consultation

Section II: What
RELATIVE WISDOM: Never Say “No”
How many times have you called or entered a business and inquired about a
speci c product, such as a speci c vintage of wine? You call the local cellar,
enter your favoritewinestore, or sit down at your favoriterestaurant wanting
aparticular variety, label, vintage, and the sommelier says, “No.” He doesn’t
ask what you like about that variety or label or why you prefer the speci c
vintage, does not o er you somethingequallycrisp or simplymore valuable.
He just says “No.”
Relative wisdom: How many times has someone called your o ce asking
ifyou provide some unusual(or even common) procedure, and amember of
your sta simplysays “No.” If you and thesta takethetimeto answer ques-
tions with questions, you may be welcoming a new patient, and the patient
will appreciate that your o ce took the time to o er a newcomer the educa-
tion that led to a satisfying result.
Con su lta tion
The greatest component of education is consultation. At this stage, the in-
dividual already has some knowledge of you, your services, and your mis-
sion—knowledge that contributed to this individual’s electing to consult
with you. If the individual does not have some knowledge of you, the prac-
tice has missed the mark on education when scheduling the consultation.
Patientsaresavvy; theymayhavesomeclinicalknowledgeoftheprocedures
that are appropriate to ful ll their goals. This knowledge may have been
gained from media, other providers, or even a referral source. Their infor-
mation maybevalid or not;it maydrivethepatients’expectationsor not. For
theprovider, aconsultation iscommonlythe rst opportunityto gain knowl-
edgeabout patientsand what bringsthemto you. After sinceregreetingsand
introductions, perhaps breaking the ice with a little small talk, the consulta-
tion should quicklyfocus on thepatient’s personaldesiresand his or her ex-
pectations of your ful lling his or her goals. Although most patients are ea-
ger to discuss their personaldesires and theoutcomes theyhope to achieve,
it remains essential that the provider directly ask about the following:
The patient’s personal desire or intention for aesthetic med-
ical treatment

Chapter 7: What Do Your Patients Expect?


The patient’s expectations for the physical outcome of aes-
thetic medical treatment
Thepatient’sexpectationsfor personaloutcomes(howheor
she expects this procedure to a ect his or her life)
The patient’s preferences for treatment, such as surgical or
nonsurgical
The patient’s limitations in resources or time, or, if appro-
priate, any health limitations
The patient’s questions
The answers to these questions will allow you to determine whether the in-
dividual’s goals and motivations aresincere and wellde ned, that his or her
physicalexpectations can besafelyachieved, and that personalexpectations
are rational. This information will allow you to determine whether you
should pursue the relationship and recommend a speci c course of treat-
ment and alternatives to meet this patient’s goals. Next you can progress to
ageneral reviewof health. Health historyfurther quali es agood candidate
for a procedure based on individual physical characteristics and general
health. At this stage a health history may only disqualify a patient for a par-
ticular procedure; it is not used to qualify the patient. You may now con -
dentlymake recommendations about the procedure or procedures you rec-
ommend, the options to your recommendations, and thedi erences among
the options.
INF ORMED CONSENT
The next phase of consultation, which may or may not occur at a subse-
quent meeting, is the process of informed consent. Education in this phase
is clinical, and should detail the following:
A physical assessment of the client’s condition and goals for
improvement, including an evaluation of general health
The procedure and special techniques you recommend to
achieve the patient’s stated goals
The preoperative expectations you have of your patient, in-
cluding medications, following a pretreatment regimen, and

Section II: What
avoiding certain activities, such as smoking, sun exposure,
antiin ammatory medications, and so on
The physician’s and patient’s expectations and preferences
regardingsurgery, includinglocation, anesthesia, time, com-
fort, and immediate recovery
The recovery involved, including how soon the patient will
go home, hisor her obligationsfor posttreatment careand be-
havior, theimportant signsofcomplications, and precautions
necessary to ensure proper healing
How results are expected to present or develop and the time
necessary for nal results to be evident
Potential adverse events, how these can be identi ed, how
the patient must respond, and the options to resolve those
events
How soon the patient can resume daily activities and feel
comfortable in a public setting
Important aftercareiftreatment requiresmultiplestagesor to
maintain and preserve good outcomes
When the patient has accepted treatment based on this comprehensive ed-
ucation ofeverydetailinvolved in ful llinghis or her personaldesires to im-
prove appearance, the educational phase of the consultation has been e ec-
tive. If the patient chooses not to undergo treatment after this detailed
education, you may allow the patient more time for consideration, encour-
age the patient to ask more questions, follow up accordingly, or simply ac-
cept the patient’s decision.
However, education does not cease when an individual becomes a patient.
Information will be communicated frequently between the practice and pa-
tient and the patient and practice. Following a procedure, you will want to
learn about the patient’s perceptions of and satisfaction with the treatment
experience. This information is essentialto measurequalityand to progress
in patient care and operations.

Chapter 7: What Do Your Patients Expect?


Beyond ful lling patients’ speci c desires, the practice must maintain com-
munication with every patient by providing educational updates about the
practice and its providers, innovations in treatment, and overall health con-
cerns. Such communication will maintain your visibility with a satis ed pa-
tient and will o er two very signi cant resources to grow your aesthetic
practice: new or repeat services to this existing patient and the potential for
referral of new clients. It is a message that cannot be repeated enough: re-
ferrals are your single greatest resource for new clients.
P H OTOGRAP H S AND F EES
There are two uncomfortable moments in the patient’s pretreatment expe-
rience in your o ce, whether during a consultation or in a preoperative
visit, that are nevertheless essential to your ability to ful ll a patient’s needs
and expectations. These are the need to obtain clinical photographs and to
discuss fee quotes.
Taking preoperative photographs heightens the patient’s vulnerability: the
patient is documented, potentiallyunclothed, for theveryconcern heor she
has come to you. Be sensitive to this. Carefully explain the need for photo-
graphs, both for you and for the patient: these images can be used to show
computer simulations of the results that may be achieved, and photos will
later allow the patient to see the progress or result after treatment. Do not
ask robed patients to parade down a hall to a photo room. Let no one make
ippant remarks or use humor to break the ice; use compassion. Do not
show patients preoperative photographs unless they ask or unless you feel
this will assist in explaining potential outcomes or procedural options. Do
giveeverypatient aconsent formand allowhimor her to elect whether pho-
tographs can be used for the education of other patients and other physi-
cians, for media use, or any other purpose. Follow up before you use those
photographs with a consent speci c to the occasion and use. If you cannot
reach the patient for consent to this speci c use, do not use the photo-
graphs. Fee quotes are the moment of truth for many patients.
Never should the physician de ne the fee; this is a business transaction that
should be conducted by a quali ed support person with whom the patient
is familiar. This sta member should sit down next to thepatient, not across

Section II: What
a banker’s desk, and review all fees, associated policies, the means for pay-
ment, and answer all the patient’s questions speci cally. This is a critical
moment where all attention must be on the patient, not on ringing phones,
o ce disruptions, pressure tactics, or small talk. Fees must be communi-
cated after consent is obtained and before treatment is performed. Patients
maybe nervous, but iftheyare hesitant, theymust not be pushed. Apatient
should be allowed all the time he or she needs to consider the fees. The fee
quoteshould bedated and thetimeframefor which it is valid speci ed. The
patient is invited to follow up at any time, and a team member should make
contact with the patient after a short but appropriate time frame.
RELATIVE WISDOM: Feed in g th e Ch ild ren
The year will long be remembered as the year of the mortgage crisis.
As the result of more than a decade of free and easy loans, tens of thousands
of loans were going unpaid, and banks were closing as a result of these de-
faults.
We were having dinner with friends, a family who for years owned the
bank in the town where I grew up and where we now live, when the subject
of loans gonebad cameup. Cautiously, our friend, nowrunningthebankhis
great-grandfather founded with multiplesuccessfulbranches, proudlystated
that at their bank there were no bad loans, no foreclosures. Business was
solid. When I asked his strategy for this success, he stated solemnly, “My
grandfather taught us all that banking was a relationship business, that you
must never make aloan that willprevent someone fromfeedingthe children.
To this day, I teach myloan o cers to reviewcredit histories, consider down
payments, but get to know the people you will lend money to, and never
make a loan that will prevent someone from feeding his or her family.”
Relative wisdom: Patient nancing options abound for anyone who truly
desires an aesthetic procedure. My dear friend, Mary, who has spent more
than two decades with her patients in her husband’s practice, once told me
that it is important to get to know your patients completely and never to
agreeto scheduleaprocedurewhen you knowthat payingfor that procedure
will prevent someone from feeding the children.

Chapter 7: What Do Your Patients Expect?

3
FREE CONSULTATIONS
I do not believe that physicians should provide consultations free of charge.
Your time has value. If the case were a medical case, you would bill the in-
surer. If the case is aesthetic, you must charge the patient. Consultation fees
servetwo purposes: ( ) Theytactfullyeliminateclients who arenot yet ready
to commit to aesthetic medicine but are still “shopping,” and ( ) they attach
value to the time a provider spends in clinical review with a client.
There are exceptions, and you must de ne those based on your practice
limits and preferences. Complimentary consultations to friends or medical
colleagues who you know are serious and complimentary consultations to
existing patients are just two examples of situations in which you may elect
not to charge the patient for the consultation.
When business is slow, services are new, or the physician has time, com-
plimentary consultations by the physician are still a poor choice. My prefer-
ence is for anurse or patient coordinator to handle theconsultation; this per-
son can e ectively screen and educate a prospective patient free of charge,
rather than the physician’s spending hours in consultations that take time
awayfromother productiveservices and do not generate revenue. However,
no one—no one—but thephysician who willprescribethetreatment and per-
formthe treatment or delegate it to an appropriate extender must askfor and
accept theconsent ofthepatient for treatment. For surgery, it is thephysician
who must ask for and accept consent for any patient on which he or she will
operate. Furthermore, one physician must not accept patient consent for an-
other physician who will perform the surgery.
Thereareno cookie-cutter solutions; there is no set formulade ningcon-
sultation scheduling or charges. De ning a formula that is right for your
practice must maximi e the time a provider has available to provide services
and generate revenue, and balance time in consultation with that variable.
Consultation fees may vary based on the services sought by a patient, an es-
tablished relationship with the client/patient and the type of consultation
(initial or comprehensive). However you choose to structure and charge for
consultations, your policy will be de ned by:
The abilities and preferences of sta who provide support in con-
ducting consultations. A physician who is impatient or di cult to
understand when educating patients will need a strong individual
to conduct consultations.
Continued

Section II: What
FREE CONSULTATIONS—con t’d
What is acceptable practice for your market—not the geographic
region whereyou practiceor what thedoctor down thestreet prac-
tices, but what is acceptable for your practice, time, and your pa-
tients’ expectations.
In addition to policy that de nes the structure and fees of a consultation,
your practice must de ne appropriate protocols for every type of consulta-
tion. Identify and assign consultation responsibilities to sta , but do not di-
lute the patient’s experience with too many people and contacts. Empower
others to take responsibility for speci c nonclinical items of the consultation
agenda to make the most of provider time.
IN P RACTICE: Wh om to Ed u cate
This is a lesson for every kind, personable, and skilled provider of aesthetic
services. Referralsources are your best means for growingyour practice, but
only when they are properly educated.
I was visiting a very busy cosmetic dermatologist whose days were so
lled that patients gladly waited at length to see her. Nothing seemed to run
on schedule.
The physician insisted on performing her own consultations—perfectly
acceptable. It was only when I sat in on several that I learned her downfall.
A lovely lady of 7 -plus came in with horrible sun damage to her skin.
She had been referred to the physician by another dermatologist in town
who only handled clinical cases. My client listened carefully as the woman
explained how she disliked the spots on her skin. My client explained care-
fully that she could be treated with lasers, a peel, skin care, or a combination
of procedures. The dermatologist explained what each entailed, the bene ts
and cautions, and the cost. The patient was pu led. “Won’t my insurance
pay for this?” No, the physician told her. These are cosmetic procedures.
The patient proceeded to ask a lot of questions, take a lot of notes, and
then toward the end of nearly a -minute visit asked, “Will my insurance
payfor this visit with you?” Thephysician told her not to worry, therewould
be no charge. Then the physician moved on to the next room, and on and
on as her busy waiting room recycled patients waiting longer and longer to
see her.

Chapter 7: What Do Your Patients Expect?


The physician and I sat down late that evening to discuss the day, and I
asked about the many people referred by the clinical dermatologist’s o ce
and how many of them actually accepted treatment. The physician stated
that this was her best sourceofreferrals, so much so that sheoften treated his
wife free of charge. So we ran a referral report, only to nd that in the past
months, ofthenearly patients referred bythedermatologist, onlysixhad
accepted treatment. Moreover, because these prospective patients were re-
ferred by a colleague, my client rarely charged a consultation fee. I had more
questions: When was the last time the clinical dermatologist visited my
client’s practice? When was the last time she updated him on technologies
and opportunities she had to o er his patients? When was the last time she
visited the clinical dermatologist’s practice to see what he o ered?
Several weeks later, the physician called me. She had visited the clinical
dermatologist and together they sat down over lunch. She began to educate
him about her newest procedures, but he stopped her. “Those are all cos-
metic; they are not important to me.” But they were the reason he was refer-
ringhis patients to her, or so she assumed. “No, I don’t refer themto you be-
causeyou o er cosmetic procedures. I refer themto you because I knowyou
have the patience to meet with them.”
When she explained to him that these no-cost consultations were costing
her a lot of time and money, he was surprised to hear that his patients were
not accepting treatment. “When I refer my patients, I don’t tell them these
are cosmetic procedures that insurance won’t pay for. I want them to go see
you and be happy. I expect the cost is not much more than their deductible,
anyway.”
The lesson here: It is as important to educate your referral sources as it is
to educateeach individualpatient. Keep your referralsources up to date, and
keep an eye on the reason, validity, and value of the referrals they send you.
You may nd that those referral relationships are costing you a lot of time,
patience, and money.
COMP REH ENSION
Interest is what you useto communicate with your market and to maintain a
relationship with patients. Education is what is necessaryto convert interest
into action—thewillingness ofan individualto undergo an aesthetic medical
procedure in your practice. Comprehension results from e ective commu-
nication and education and ultimatelyleads to happypatients, based on out-
comes and the entire treatment experience.

Section II: What
Mea su rin g Com p reh en sion
Measuring comprehension at the interest stage is relatively basic:
Qualitative analysis: Are clients who come to you clear on
your brand, mission, and the services you provide?
Quantitative analysis: Where do patients originate from?
How are they referred to you? What are the patient’s goals?
The education process a ords another opportunity to measure compre-
hension:
Isthepatient at easeand con dent with your practiceand rec-
ommendations for treatment?
Doesthepatient elect treatment? Istheelected treatment con-
sistent with the patient’s stated goals? Is the treatment con-
sistent with your optimalrecommendation? Whyor whynot?
A lack of patient comprehension in any instance is a failure by the practice
to fully educate patients and thus is a failure of quality care. A patient’s dis-
satisfaction with acourse oftreatment becauseofdiscomfort, side e ects, or
achieved versus stated outcomes demonstrates a failure by the practice to
communicate e ectively or a failure to ensure patient comprehension. Sim-
ilarly, disbelief or lack of acceptance of complications or adverse events
demonstrates a failure by the practice and provider to fully disclose all pos-
sible complications or risks or to ensure that the patient understands.
F a ilu re of Com p reh en sion
A lack of comprehension, whether from inadequate communication or a
failure to ensure that the patient accepts what has been communicated, is
measured:
Qualitatively: In the patient who is unhappy in either out-
comes or the process necessary to achieve outcomes

Chapter 7: What Do Your Patients Expect?

7
Quantitatively: In the patients your practice is unable to re-
tain, and who will not refer or recommend you to others
If you believe that client-to-patient conversion and the number of proce-
dures you perform in any given period are the only data necessary to mea-
sure your success, you are mistaken. To remain competitive, you must not
only convert clients to patients; you must also convert clients to happy, ful-
lled patients who have been fully informed of the total experience, includ-
ing potential pain and discomfort, the recovery process, and results. Pa-
tients who wereinformed ofwhat to expect, accepted this fromyou, and are
nowhappywith their outcomewillrecommend you to others and willmain-
tain their relationship with you.
Patientswhoseexperienceas awholeis awed becausetheywerenot taught
to expect the things that typically occur during or as a result of treatment,
such as bruising, redness, or discomfort, or patients who simplyarenot sat-
is ed and regret undergoingtreatment areservicefailures. Thedatayou can
collect from these patients are essential to assessing your practice’s success
at providing aesthetic medicine.
You should practice with the expectation that happy patients are a great
sourcefor referrals and that referralis thesinglebest means ofgrowingyour
practice. Consider the impact of unhappy patients: they will vociferously
sharenegativeexperiences and nd opportunities to discredit you, whether
deserved or not, more often than patients who share their good experiences
and refer others to you.
Implement procedures to measure comprehension quantitatively and qual-
itatively at every stage. Review this regularly. Look for trends; look for
strengths. Identifyand immediatelycorrect anyweaknesses. In doingso you
willachieveaconsistencyfor meetingyour needs and expectations: you will
readilyattract prospectivepatients who arewillingto accept theservices you
provide, and you will develop patients who are fully satis ed with the total
experience of your care, who would do it again even if the experience in-
cluded discomfort or unexpected, yet disclosed, potentialadverseoutcomes.

Section II: What
IN P RACTICE: Wh o’s Foolin g Wh om ?
I love watching the experts in action. You learn so much. Sometimes even
they learn a little from their actions.
A young woman was on her nal visit to the o ce the day before her
breast augmentation surgery. The physician made it a practice to meet all of
his patient’s postoperative caregivers if the patient elected to recover at
home. Hedid this because hebelieved heknewhis patients well—and young
women in particular didn’t take the instructions they were given seriously.
“Where is your driver, your caregiver?” the patient coordinator asked. The
youngwoman quicklyreplied, “Mymomcan’t take that much time o work,
but she’ll be here tomorrow.”
The physician instructed the patient coordinator to speak with the pa-
tient’s mother and review all the vital information for the following day. “My
mom can’t take calls at work,” the young woman stated. “Here is her cell
number; call her after pm tonight.” The physician and sta accepted the
young woman’s sincerity and later that evening he made the call. No one an-
swered, and thevoicemailwas ageneric greetingwith onlyatelephonenum-
ber. The physician called the young woman and told her that her surgery
would haveto berescheduled at her expenseif hedid not hear fromher care-
giver before surgery.
The day of surgery arrived, and so did the patient, alone, to the surgical
center. “My mom dropped me o and is just out shopping. She’s totally fa-
miliar with what she needs to do. She’s not worried at all. She’ll be back at
o’clock. You told me I’d be released about that time, right?”
“Well, I am sorry,” the physician told her. “But unless your mom is here
so I can discuss alltherequirements for your recoverywith her beforeyou go
into surgery, you are not going into surgery. It is part of our practice policy,
you signed that you understand this, and you will have to bear the cost for
rescheduling.”
Distraught, the young woman called her mother, who quickly arrived at
the surgical center, quite upset. The physician recogni ed her as one of his
patients, someonehehad treated severaltimes. “I’mangry,” said themother.
“I am your patient, and you know how di cult my work schedule is and the
demands on my time. You know me, and you know I am competent to take
careofmydaughter today. Whymust you insist that I beherebeforeher pro-
cedure? I certainly planned to be here to take her home.”

Chapter 7: What Do Your Patients Expect?


“I didn’t recogni e your name on her caregiver form,” the physician
stated. “I am so sorry.”
“I remarried last year,” thewoman stated. “Who do you thinkreferred my
daughter to you?”
Thephysician thought thepatient was foolinghim, that shedid not in fact
have someone to drive her home. The patient thought the physician was
fooling her; he would never postpone her surgery. And the practice team
were foolingthemselves into believingthat theyknewtheir patients well, but
they certainly didn’t know how this patient had come to them.
P ATIENT NEEDS AND EXP ECTATIONS
Interest, education, and comprehension are essential to attracting and serv-
ingyour patientsin themost generalsense. Howdo you lookat speci cpop-
ulations and assess whether you are meeting those needs and expectations?
P rosp ective P a tien ts
Data are key to discovering how your patients are introduced to your prac-
tice. It’s more than simply asking, “Where did you hear about us?” on a
form with “Check all that apply.” Talk to your patients and learn exactly
what motivated them to want a procedure, what compelled them to seek
your practice, and who or what provided themwith thecontact information
that resulted in that rst call, email, or visit. Reviewtheprospectivepatient’s
educational process: were there many questions, insecurities, inconsisten-
cies, or contradictions between what the patient thought he or she could
achieve and what you might provide? Accurately track patient recruitment,
conversion, lost opportunities, and recovery.
Recruitment occurswhen theprospectivepatient engagesyou
for a consultation and actually appears for the consultation.
Conversion occurs when the patient accepts treatment from
you: distinguish whether conversion isfor therecommended
treatment, or an alternative, or a service unrelated to the ini-
tially stated goals.

Section II: What
Loss occurs when there is no contact, no reply, or no desire
from the prospective patient to engage your practice.
Recovery occurs when a prospective patient you have docu-
mented as a loss, returns for further education or to accept
treatment.
P a tien ts
Individuals who have consulted with your practice in person and who have
accepted treatment (or not) are your patients. The ability to recogni e
where you have met needs or expectations or had service failures is derived
from a combination of data and experience.
Interest ismet when thepatient demonstratesthetrust to pay
for your expert opinion to meet his or her goals.
Education issuccessfulwhen thepatient con dentlychooses
(or does not choose) a course of treatment and can explain
his or her reasoning.
Consent is valid when the patient not only agrees, but is also
compliant and prepared for the course of treatment and tol-
erant of a less-than-perfect experience or outcome.
Feedbackisessentialtoknowyour patient’struefeelingsabout
your practice, the outcomes achieved, and the experience.
Referral is a positive means of knowing that whether this pa-
tient accepted treatment in your practiceor not, that individ-
ual respects and trusts you.
Retention demonstrates that a patient is loyal, accepts the
value of your services, and will return to you rather than try
a cheaper, newer, di erent service option.

Chapter 7: What Do Your Patients Expect?


Lost P a tien ts
Your best lessonsin servicefailurearelost patients. Although welearn bypos-
itive experiences, we growbythe lessons that sometimes are hard to accept:
Trackingenables your practiceto trulydeemapatient “lost”
in interest and from your practice.
Recoveryenablesyour practiceto revisit thepatient you con-
sidered lost.
Dismissed patients are those you must formally inform you
cannot serve. The reason may be one for the record, but
where a patient is at risk, or represents a risk detrimental to
thehealth, safety, and successofyour practice, you must dis-
miss that person.
IN P RACTICE: Case Dism issed
She was known by everyone in the practice as the di cult patient. Whether
she was scheduled for an injection, a peel, her child’s acne appointment, or
for any other reason, she was generally late, failed to arrive and didn’t call,
and becamebelligerent when therewereno appointment times to suit her de-
mands. She wanted to try everything in the practice’s menu of services, was
happy with nothing, but always seemed to return asking for more.
One day, in typical fashion she showed up more than an hour late for a
“quickinjection,” an appointment shehad alreadyfailed to arrivefor weeks
earlier. A member of the sta politely took Ms. Di cult aside and told her
that she would have to wait until the physician could see her. “Sure, I’ll wait
until she’s done with her current patient.” No, she was told, she would have
to wait until there were no patients waiting, because she had missed her
scheduled appointment time. “It’s just aquickprocedure, and I need it now.
I’ll be leaving town next week, and I don’t have time to reschedule, and I am
not going to sit here and wait. If she wants my money, she’ll see me now.”
The sta member pulled the physician aside between patients to tell her
what was transpiring. Suddenlyaloud voice was heard in the reception area.
Ms. Di cult was complaining to another patient, “I don’t know why I come
Continued

Section II: What
to this practice, because they don’t respect my schedules. They are always
happy to recommend the latest, greatest, most expensive treatment, because
they know I have the means to buy anything I want. So I’m a little late, and
they expect that I’m going to wait?”
The physician told the sta member to bring Ms. Di cult to her o ce,
and to wait with her there. When she arrived, the physician handed her alet-
ter and told her rmly, “I am discharging you from my practice. We pride
ourselves on providing patients valuable treatment and experiences. It is
clear we can no longer ful llyour needs, nor can we meet your expectations.
Please let me show you out.”
SuddenlyMs. Di cult was silent, ashamed, and didn’t knowwhat to say.
She left without a word.
Later, I asked the physician if she wasn’t worried that her actions would
back re, that out of anger the woman would badmouth her to others. The
physician con dently replied, “Anyone who knows her and believes she is
right to be angry with me is no one I want in my practice. Case dismissed.”
IN P RACTICE: Case Dism issed —con t’d

What De nesRisk?
Life is never without risk.
To disregard the potential for risk in practicing
aesthetic medicine is to risk life.
CHAPTER 8
In medicine you can never fully predict or control what might happen. Mi-
nor complications simplymakethetreatment less than perfect. Thegreatest
risk is either loss of life or impairment that is more signi cant than the orig-
inalcondition for which treatment was sought. In aesthetic medicinethereis
an added risk—that of unful lled goals or dissatisfaction with outcomes,
which in turn can become a risk to your practice’s image and success.
Red ags are cautionary indicators that arise from the words or actions of a
patient alertingyou or your sta to matters that should concern you, or from
your own words or actions alertingaprospective or current patient, or even
acolleagueto apotentialproblem. Whether thesourcefor riskis the patient
or your practice, recognizing and minimizing unnecessary risk are the re-
sponsibility of the physician and the practice.
PATIENTS AT RISK
Health conditions can placepatients at risk. Unhappyor misguided patients
put your practiceat risk. Thekeyto avoidingriskypatients is to beselective
about accepting patients, thorough in patient education, and vigilant about
patient compliance to allthe obligations and instructions necessaryto avoid
complications.

Section II: What
In consultation, the provider learns about an individualand his or her goals
for improving appearance. The three essentials to discover during consul-
tation include:
. Thepatient’sdesireor intentionsfor aestheticmedicaltreat-
ment
. Hisor her expectationsfor thephysicaloutcomeofthetreat-
ment
. The patient’s expectations for the personal outcomes of the
treatment (howthephysicaloutcomewilla ect hisor her life)
Realistic goals involve much more than a physical state that can be reason-
ably and safely achieved. Determining these three factors is essential to
avoid thepatient’s havingunrealistic expectations or dissatisfaction with the
experience and outcome of a procedure. Although a patient coordinator or
nurse can ask the patient about these factors and should document the re-
sponses, it is you, thetreatingphysician, who must askand accept that apa-
tient’s answers are sincere, because inevitably you will assume responsibil-
ityfor thepatient, agreeto treat thepatient, and de neacourseoftreatment.
You must learn to read your patients, to recognize when they have underly-
ing personal or psychosocial in uences or potential mental health issues
that in uence their ability to accept reality. You must look for the warning
signs that indicatethat apatient is unableto let go of impossibleaspirations.
Question each patient to a rm comprehension and avoid misunderstand-
ings about goals and expectations.
REALISTIC GOALS
For the provider, the key to detecting unrealistic goals lies in understand-
ing what constitutes realistic goals. Fortunately, this is relatively simple:
Realistic goals are safely attainable.
Realistic goals do not produce extremes, or push extremes.
Realistic goals come solely from the patient and are not the
result of an outside in uence.

Chapter 8: What De nes Risk?


Realisticgoalsarenot based on an expectation for dramaticor
instantaneous life alteration.
Realisticgoalsarewhat emotionallyhealthyindividualswant
to achieve to improve their appearance.
The most egregious of errors occurs when a provider does not respond to
the patient’s unrealistic goals. As a provider in aesthetic medicine and as a
medicaldoctor, you areethicallybound to identifypatient goals that are not
attainable. Although you maydeclineto treat apatient who cannot grasp re-
ality, do not dismiss a patient with unrealistic goals. You must respond to
unrealistic goals, educatingyour patient and proposingachievableaesthetic
outcomes so that heor shecan determine in which realityhe or shechooses
to live. Be candid and honest and expect the same of your client. Negotiate
if you feel there is room to negotiate, but always qualify why. It is better to
have a client understand why you cannot or will not ful ll his or her goals
than for that individual to take those unrealistic goals to a less ethical pro-
vider. Although you may not convert a client to a patient, you will a rm
your credibility.
Anyimprovement in an individual’s appearance—newclothing, anewhair-
style, or an aesthetic medical treatment—can produce a short- or long-term
change in posture, con dence, and self-assurance. With clothing or hair,
the extreme is reversible. In aesthetic medical treatment, the extreme is not
so easilyreversible. Unlessyou want to beknown assomeonewho ful llspa-
tients’requestsfor extremealterations, you should not ful llthesegoals. You
will brand yourself as extreme. No signi cant other or parent should in u-
encethepatient to undergo aesthetic medicaltreatment. Theymay, and cer-
tainlyshould, support thegoals oftheindividual, but theyshould not bethe
compelling reason that someone seeks treatment. It bears repeating: aes-
thetic medicine ful lls personal desire.
When a battered woman, a child with a birth defect, or an individual with a
dis guring injury undergoes treatment to restore appearance, this is a per-
sonal goal. This can be life changing, and it certainly encompasses appro-
priate goals. But when patients state that they want to enhance their rela-
tivelynormalfeatures in thebeliefthat this willsigni cantlyalter or improve
their dailylives, you must search for the underlyingmessage. Willsoftening

Section II: What
ethnic features reduce the bias and discrimination the patient may have
encountered? Will an improved gure restore a failing marriage? Will a
younger appearance lead to career advancement? The provider’s sound
judgment is essential when the patient’s expressed goals include a life-
changing experience. The likely reality of that change is a part of qualifying
risk.
Determining that a prospective patient is emotionally healthy is as much a
matter of observation as of judgment. Although the provider expects that
the patient will honestly answer questions about medical conditions, in-
cluding emotional health, an emotionally unstable individual probably can-
not provide objective self-evaluation. This person can represent a signi -
cant source of risk to your practice. The more you and others in your
practiceobserve apatient whoseemotionalhealth is questionable, the more
likely you will arrive at a con dent decision regarding whether to treat this
patient.
REALISTIC EXP ECTATIONS
Realistic goals are what a client wants to accomplish by undergoing aes-
thetic medical treatment; realistic expectations involve the ful llment of
goals as well as satisfaction with and acceptance of the process. Although
you may have a patient whose goals are ful lled, he or she may still be dis-
satis ed becauseoftheexperienceor theprocess necessaryto achievethose
goals. After you have determined that a client’s goals are sincere and attain-
able, ensuring that risk remains low requires that you fully explain the pro-
cess necessary to achieve those goals. This includes:
Pretreatment or preoperative expectations and patient obli-
gations
The discomfort, anxiety, and pain involved
The time commitment, including recovery, down time, and
the period necessary for results to be attained

Chapter 8: What De nes Risk?


Posttreatment or postoperative expectations and patient ob-
ligations
The potential for unful lled goals and possible undesirable
results
The potential for and de nition of adverse events
The patient’s nancial obligation
To make certain that no aspect of the process is overlooked, a consultation
agenda form should be created that assigns responsibility for each segment
of the process. Use this agenda as a checklist to ensure that nothing is over-
looked duringconsultation, that thepatient completelyunderstands and ac-
cepts every element of the process, and that the patient has been given all
appropriateforms and instructions. Followingachecklist reduces theriskof
failingto fullydisclosetheprocess or to provideessentialdocuments. Ques-
tion your patient’s comprehension of all that is communicated; don’t as-
sume that your message has been thoroughly understood.
Realistic expectations also requirethat thepatient grasp thepotentialfor ad-
verse outcomes or less than ideal results. Physical risk should be minimal if
you have carefullyquali ed the patient as agood candidate. But if heor she
does not comply with preoperative and postoperative instructions, the re-
sults may be less than optimal, and you could be held responsible. If you
fear your patient won’t quit smoking before a procedure, won’t stay out of
the sun, or will misuse pain medication, don’t take chances. As part of in-
formed consent, havethepatient sign an acknowledgment that he or she ac-
cepts the practice’s policies and procedures de ning the patient’s respon-
sibilities, and the nancial or physical consequences of noncompliance.
Providevalid dataabout what can happen iftheprinted instructions are dis-
regarded. Emphasizethat thesearenot scare tactics, but arefor thepatient’s
own safety and well-being for which you ultimately take responsibility, and
that you can and will deny treatment if the patient is noncompliant.

8

Section II: What
RELATIVE WISDOM: Blu ep rin ts
It’s common knowledge—no remodeling plan goes without alterations. The
problem, according to most home remodeling contractors, is that clients de-
cide to make alterations to their plans but don’t comprehend the cost or the
timeconsiderationsthat changes generate. However, accordingto thoseofus
who embark on remodeling projects, sometimes you just really want things
to be perfect. Where the two meet is the place called “timing is everything.”
We decided to remodel our master bath after what began as a discussion
about new towels and a coat of paint evolved into a plan for new cabinetry
and tileand resulted in aroomstripped backto thestuds. When I had nally
selected the right marble, granite, mosaic, and wood, we realized that the ex-
isting spa tub simply would not complement the new layout. The new spa
tub was a di erent dimension than the old, which would allow for a larger
shower. Thelarger shower featured steamand rain, which required morehot
water, and thus the need for new plumbing. The need for new plumbing re-
quired running some pipes into the ceiling, and thus provided the opportu-
nityto raise adome above the tub. The raised dome allowed for achandelier
above thetub, and hencetheneed for newwiring. Therewereno circuits left
on the board, so now a new panel had to be pulled into the house.
In every family there is a familiar story of remodeling and a project that
never seems to end, and when it does, the nal bill is astounding to the
homeowner and no surprise for the contractors.
Relative wisdom: The desire for an aesthetic procedure often begins with
a patient’s straightforward wish for little changes—they are easier to accept,
and it’s more likely that the goals are realistic and the experience will be fa-
vorable. As a result of a favorable outcome, the patient may de ne new goals
and desire new services.
For your patients to remain happy on their journey of self-remodeling,
you must remain meticulous. Don’t overlook the discussion of goals and ex-
pectations with each newtreatment simplybecause you are familiar with this
good candidate. Don’t mistake new goals as realistic because the patient has
proved realistic in thepast, or assumemotivations aresincerebecausethepa-
tient is known to be straightforward. Always follow your blueprint for mini-
mizing risk and you will not only avoid risk, you will retain happy patients.