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

Se tio Iv : Whe
IN P RACTICE: So Slow
My le st f o ite ll, the o e th t bsolutely iles me, is whe I he
p o i e st te, “Thi gs e e yslow ight ow; we ee to o somethi gto
i e se t .” The st questio I sk is why the p o i e belie es thi gs
h e slowe . The espo se ies f om “It usu lly gets slow this time of
ye ,” to “E o omi o itio s e wful,” o “The ompetitio h s e lly
e te w y t ou lie t/p tie t b se.”
If you w it u til thi gs get slow, I will tell you th t you e out of lu k;
you’ emisse thebo t. You timi gis poo , you h e l e ymisse the
oppo tu ity to e the p e of thi gs, be use by the time you e e
e t you e o ts llow pp op i te time fo the u ie e’s o si -
e tio eply, the y le will likely h e olle lo g to ew ph se.
I h p o i e get g y with me fo su h eply. She thought I w s
mo ki g he simply shi ki g the oppo tu ity to o e my expe tise. I -
ste , I efully e lu te the p ti e’s p o u ti ity y les, looki g fo
t e s p tte s. I i e ti e the likely use of the t e s p tte s
the set pl i motio so th t befo e slow- ow y le w s e y to
hit g i , me su es we e i pl e to heighte the p ti e’s isibility, oppo -
tu ity, t .
I wo ke with the p o i e to i e tify t gets i he m ket who woul
these poi ts i se so l y le tt ti e, we pl e t gete mes-
s ges to them. I suggeste th t the lie t usethis slowtime s oppo tu ity
to e lu te whe e the p ti e w s i te ms of hie i g its go ls, to pl -
o i gly, to e isit e e ope tio lissues. Shethought I w s ki -
i g. She eto te , “I o ’t h e time fo th t.”
a s busi ess you ee to m ke time to e lu te pl . How o you
k ow whe to pl ? You must look t you t . If you k ow some mo ths
e busie wh t p o e u es e mo e i em t e t i times of ye ,
you espo . If you k ow wh t times of ye e slow, these m y be the
i e l times to use you hum esou es fo pl i g. It is imp u e t to
o e exte you self i busy times to o this. Whe you h e time, use it
wisely to fo us o ll of the e o ts th t you w t to o ee to h e i pl e
th oughout the ye . a lthough you busi ess y le is p ob bly tie to you
t x y le, you e o ts o ot ll ee to be tie to this; you must simply e-
e llo te you pit l esou es o i gly.
Some time l te , the s me p o i e lle me to s y, “Thi gs e slow—”
Yet wh t I expe te to he i ot ome. r the , she s i , “But ot e ly
s slow s we usu lly woul be t this time, be use we pl e fo it. d o
you h e time to ome i e iewgo ls with me? I h e the time ow
e lly w t to m ke the most of it.”

c h pte 14: Whe d o You r espo to c y les?

1
To Every Sea son , Tu rn , Tu rn
d o ’t ssume the holi ys se so s e you o ly se so l y les. a y-
thi g th t h ges but omes b k full i le is se so l y le. It m y ot
o u u lly; it m y o u ily, mo thly, o i u e e but e u -
i g y le.
I itio to ommu i tio , se so l y les pply to ope tio l issues
too, su h s you hou s of ope tio . d o ot m ke the mist ke of e i g
hou s by you ow p efe e e. K ow you m ket its y les pl
you ope tio s to meet these o i gly. Fo i st e:
You will ot get ti e mom of you g hil e to tte
semi t 4: PM;he hil e e omi ghomef oms hool
t th t hou . Pl you e e ts o i gly.
d oes you physi i ssist t wo k while he ki s e i
s hool, oes this me th t ll the e p tie ts who see
he h e to miss s hool to be t e te ? You will h e p tie ts
who ot b e k w ytoe g geyou se i es u i gs hool
o busi ess hou s, so exte you s.
d o you s he ulesu ge y ysto llowp tie tsthe t ge
of lo g weeke to e o e ?
I the summe mo ths, oes e e yo e i you tow spe
the fte oo gol g o swimmi g to t ke t ge of the
w m we the , o e they hi i g f om the he t i ool qu -
te s o eei g o th?
Betwee c h istm s n ewYe ’s, isthewholetow o ski-
i g? O ewi te tio e s omi gto you e whomight
be looki gfo little self-imp o eme t u i gthei holi y?
a ll i bles eg i gse so l y les espe i to you p ti e lo tio ,
emog phi s, se i es, to you. O e of the be e ts of bei g p op i-
eto is th t you m ke the ules set the st . a lthough you w t
these to be to you pe so l t ge, theywill ot be t geous to the
su ess ofyou p ti e ifthey o ot t kei to o si e tio the y les
p efe e es of those you se e.

Se tio Iv : Whe
CLINICAL CYCLES
M yp o i e s eo e i gtheless-i si et e tme ts th t eg owi gex-
po e ti lly i em ; these equi e multiple t e tme t y les to hie e
esults o o goi g t e tme t y les to m i t i . If this is the se i you
p ti e, you’ best ept the f t th t keepi g li i l y les ti e—
k ow s ete tio —is impe ti eto you su ess likelyyou e siest e-
li ble me su e of p o u ti ity. c li i l y les e whe e ete tio shoul
th i e.
c li i l y les lso ge oss t e tme ts—le i g to exte sio of
se i es. Fo ex mple, i i i u l who h s u e go e i e tio of tissue
lle s to e u e w i kles will e e tu llybe likely i te fo mo e om-
p ehe si e t e tme t. This p tie t is mo e likely to be i te este i u t
li i l e su h s ski e o othe o i si e ti gi gthe pies. a
this p tie t will ee to etu fo epe t t e tme ts to m i t i the esults
of the o igi l i e tio .
Whe you e og izeth t ete tio exte sio ofse i es e loselytie
to li i l y les, you ee to i e tify how to use li i l y les to you -
t ge. c li i l y les equi e:
T ki g
M i t i i g ommu i tio out e h tokeep them ti e
a tt ti e ppe l to you t get
E sy ess se i e th t is e sy to subs ibe to
U less the se i es you p o i e e pu ely su gi l you o ot o e
o i si e se i es, pe so l se i es, o et il, you must ti ely wo k to
m ximize the o t ibutio of li i l y les to you su ess.
d o ot m ke the mist ke of belie i g th t the o ly t ge of li i l
y leis to ge e te epe t se i e. r epe t se i e equi es epe t t ,
s emo st te i ommu i tio , t smitti g you mess ges to u e t
p tie ts o e s you g e test oppo tu ity fo ept e of those se i es.

c h pte 14: Whe d o You r espo to c y les?


r epe t se i e t sl tes to ete tio , ete tio o s two t ges:
it ms th t you e oi gsomethi g ight bybuil i gloy lty mo gyou
p tie ts, it o s p e i t ble p o u ti ity e e ue st e ms. a
to this the exte e lue of loy lty f om p tie t with whom you h e
o goi g, t usti g el tio ship, you p ti e ow h s the t ge of
e sou es fo efe l futu et e tme t pote ti lf omsomeo ewho
is ti ely i te este i subs ibes to estheti me i i e.
r ese h shows th t p tie ts to y e seeki g thei st estheti t e t-
me ts t mu h you ge ge th t mo e th % of p tie ts who u -
e go t e tme ts woul o so g i . Thus the lue of ti ely u tu i g
li i l y les i you p ti e is le ly g e t t ge i out e h
ommu i tio . c li i l y les o e :
P e i t ble p o u ti ity e e ue
r epe t t isibility to you p ti e
I e l, t gete oppo tu ities fo h -to-h eli e y of
p ti e ommu i tio s
Loy lty o e e to suppo t e ou ge efe l
Loy lty o e etom i t i lifelo gp o i e -p tie t
el tio ship
Fo li i l y les to wo kto you t ge, you must i e tifythe se i es
p tie ts who subs ibe to them pl the timi gofthose se i es. If
you i e tly emi p tie t th t the time fo othe t e tme t is p-
p o hi g, the e is g e te likelihoo of booki g th t ppoi tme t. You
lso imme i tely t k lost epe t se i e i qui e why p -
tie t h s hose ot to o ti ue o m i t i t e tme t.
M i t i i g ti e ommu i tio s is these o equi eme t i usi g li -
i l y les to you t ge. You must m i t i ommu i tio , o ti ue
to t, eithe book the ppoi tme t o is o e why se i e will ot be
epe te owo i thefutu e. Th t is o e yis esse ti lto imp o i gqu l-
ity of e.

4

Se tio Iv : Whe
c o ti ui g to t be ompli te . Fi st, the st membe s oi g the
t ki g must e elop m ge ble systems spe i to you o e keep
those systems ti e. It lso equi es o ti u l mo ito i g so th t o y le
goes u oti e , yet you epe t o t ts o ot be ome bothe some to the
p tie t. Fi lly, it equi es epe ti g the y le o ti uously u til the y le
of t e tme t is omplete , o whe the p tie t hooses ot to e ew. E e
whe the y le of t e tme t is omplete , o ot o e look follow-up s
me s to me su e s tisf tio , to e e esults th ough u t t e tme t,
to m i t i isibility fo pote ti l efe l futu e se i es.
M ki g y les tt ti e e syto subs ibeto is wh t somem y llm -
keti g; I ll it ustome se i e. Whe someo e l e y w ts somethi g,
m ki g it mo e tt ti e th ough p i e, o e ie e, o i e ti e is us-
tome se i e. It is ot pl yi go o e’s emotio s to get thei i i u lto t
o somethi g he o she othe wise might ot i iti te.
P k ge p i es e le ly t ge i li i l y les. This pply to
y t e tme t th t equi es epe t y les to hie e o m i t i esults.
P k gi g wo ks well with pe so l se i es, su h s h i emo l o li i-
l ski e. You exibility metho s fo m ki g y les tt ti e must
be i iti g, o e ie t, must t the expe t tio s of you p tie ts
be o g ue t with you im ge, b , missio .
IN P RACTICE: In P ocket, at H an d
I helpi g you g p o i e est blish some ope tio l p mete s fo his
p ti e, I suggeste th t he p k ge e t i li i l se i es th t equi e
epe t isits. Se i es o e e to m i t i esults shoul be p k ge b se
o the umbe oft e tme ts o emight ee o e e e pe io , su h s
ye , o i e e umbe of t e tme ts. Those whi h equi e e e
umbe of t e tme ts to hie e esults shoul be p k ge by the optim l
umbe of t e tme ts.
He ob e te eheme tly, s yi g this w s m keti g t ti he woul
ot h e it i his p ti e. Fu the , he felt th t this woul equi e umbe -

c h pte 14: Whe d o You r espo to c y les?


some mi ist tio to t k th t it woul ppe th t he w s is ou t-
i g. It ust w s ot ight fo him.
Befo e I epte his positio , I sh e with him the followi g: Fi st, he
woul ot be is ou ti g. a i iti l isit equi es mo e time fo i fo me
o se t. Subseque t isits e sho te shoul be bille t lowe te.
He g ee . Se o , he woul be olle ti g fees i e fueli g pi-
t l esou es. To is ou t o ly llows the p tie t the t ge of e u e
fees fo up-f o t i l ommitme t f om whi h p o i e g e s the
sh t the outset to p y o you g-p o i e ebt. He g ee g i . Thi ,
he woul be m ki g it o e ie t fo lie ts ot o ly to ommit to se i e
i iti lly, but lso to ommit to m i te e ppoi tme ts, so the likelihoo
of s tisf tio woul be highe the p o i e woul be pp e i te fo
skille ob. a g ee g i .
I itio , the likelihoo of someo e etu i g fo somethi g he o she
h s l e y i este i is highe . Th ough e h isit th t i i i u l m kes
to theo e, thep o i e g i s mo e isibilityfo thep ti e h s op-
po tu ity to exte e u tio . E h time he se es th t p tie t, he fu the
fuels the p tie t’s ept e of him, thus ge e ti g efe l o e se -
i e. a g ee o e mo e.
Fi lly, peoplewho ommit to p k ges o subs iptio s e e ylikelyto
e ew without mu h fo ethought. This gi es the p o i e e y goo b sis
fo p e i ti g e e ue f om these p tie ts se i es i the ext ye
the e fte . He i ot g ee. He ske , “How I expe t th t ye o
mo e f om ow, the s me se i es will be tt ti e to the s me people,
th t they will w t to e ei e these se i es f om me?”
If you o ot h e the o e e to belie e th t fte ye p sses you
will em i tt ti e p o i e of se i es to you p tie ts, you h e big
p oblem. Tho oughly ex mi e you im ge, b , missio . If you e
ot o e t th t p tie ts will w t to epe t se i es to m i t i be e ts
o e time, o you e lly belie e i the lue of the se i es you p o i e?
Whe you e o e t of you self you se i es, you o ey this
othe s ept it. Whe you l k o e e you o ey th t, you
e o ts will ot ust f lte o e, but will o ti ue to sli e.
K owyou p tie ts m ket. K owthei expe t tio s. Meet thesewith
o e e, the t ge is you s. Mo eo e , if you e goi g to o e
“ o of the mo th” se i es, e lize th t you’ll lose out o somethi g e y
impo t t to buil i g su essful p ti e: o siste y.

Se tio Iv : Whe
INDIVIDUAL CYCLES
People go th ough ph ses i life: we g ow, ge, g u te, m y, h e hil-
e , gesomemo e, ou hil e g ow, we gesomemo e, weh eg -
hil e , we ge fu the . a l ge ompo e t of estheti me i i e is the
t e tme t of the isible sig s of gi g, so the i e it ble y le of gi g o e s
t ge to the su ess of p ti e i estheti me i i e. Howe e ,
the e e e ts:
O i i i u l le el, the y le must be o e tt he to
someo eyou e l e yf mili with, mely, loy lp tie t
to you p ti e.
O t gete le el to spe i popul tio g oups, i te est
i you se i es must be p o e o must be me su e .
The sig s of gi g e ot the o ly y les we go th ough s i i i u ls.
Wome gi e bi th; thei bo ies h ge. Me wome both h ge -
ee s, p t e s i life, o moti tio s. a lo gwith su h lte tio s, i i i u-
ls m y w t to imp o e thei ppe e, to m ke f esh st t i ew y-
le of thei li es. c y les of gi g equi e k owle ge bout the g oup i th t
y le, i i i u lp tie t’s y le equi es eful is o e y, pl i g,
thoughtful pp o h.
r e og izetoo th t i i i u l y les eli ke . a you gmothe who omes
to you fo b e st ugme t tio su e ly s th t he mothe esi es f i l
e u e tio , he spouse w ts to hisel his lo e h les, he siste
hopes to feelthe s mes tisf tio the p tie t felt s esult ofyou e. a
oles e t whose e is le e by you e s th t his mothe w ts
the s me h s to imp o e he e s s o th t lose f ie w ts he
e t e te . The you g wom who s ew f ee om whe he s le-
b g thighs h e bee esh pe h s siste who w ts he leg ei s t e te ,
mothe who wishes to h ehe e k e u e te , u t who esi es
tummy tu k.
So how o you use these li ke y les to you t ge? Th ough the
s me metho s you use to m ke e e y p i te oppo tu ity t geous.
P ti e with s mu h skill ex elle e s you put i to ommu i tio
omp ssio . M kee u tio essible, u iqueto you p ti eim ge,

c h pte 14: Whe d o You r espo to c y les?


Continued
b , missio . Exte e u tio t e e y possible oppo tu ity. Buil
p ti e el tio ships ot ust fo imme i te s tisf tio , but lso fo lo g-
te ms tisf tio t ust. Thesee o ts willt sl teto m ki gyou theo e
o ly hoi e fo m y li ks i i i i u l y les will b i g you the
t ge of t ust, ete tio , t th ough efe ls.
a lthough s e h e you isibility, you ot hie e su h esults
th ough e tisi g lo e. You ot g e su ess th ough me i el -
tio s lo e, lthough th t e h e you isibility e ibility. How-
e e , th ough out e h e o ts withi you o e with the i i i u ls
you t e t, you e e ti ely o eythesethi gs is o e someofyou
g e test oppo tu ities fo g owth.
IN P RACTICE: Exclu sively You rs
I k ow p o i e who ex els t tu i g i i i u l y les i to se i e. He
m y ot pe so lly i iti te the oppo tu ity, but he o t ibutes sig i tly.
His p ti e is ot ble fo its belief i u tu i g of lo g-te m el tio -
ships. P i e with his tte tio to i i i u lse i e, this pp o h o ti ues
to e h e his su ess.
He e e llows p tie t’s bi th yto go u oti e , se i gkeyp tie ts
mess ges i e te spe i lly to th t i i i u l’s st ge i the life y le. a t
ge , the bi th y mess ge i lu es gift e ti te fo pe so l se i e i
ski e. a t ge , it i lu es i e ti e fo o i si e e u e tio .
a t ge 4 , he se s well-lo e p tie ts book o gi g. a t ge , he se s
othe .
Whe you ge p tie ts exp thei f milies o ol e p tie ts be ome
g p e ts, he t kes ote. He i ites mom b by to ome i , he
pe so lly t kes g e t oy i the p ese e of hil e . This wo ks to his -
t ge, be usemothe s g mothe s e eli the tte tio heexte s
this ew little pe so . They lso t ke i the self-e h eme t mess ges th t
his o e e y st tegi lly ispl ys.
Whe pe so l y les p ese t, this p o i e ’s tio s e s u ique s the
m himself. Hemight ot k owle ge oppo tu itywhe it ppe s, but
withi few sho t ys, he ts i most ig i e i g w y: with
pe so l ote i e t e u tio th t esses the ee s ofthei i i u l.
He t kes e e y oppo tu ity to pe so lly o e t, whi h e ess ily i -
lu es his se i es s e so o be e t of the o e tio .

Se tio Iv : Whe
He lso shows e omp ssio beyo i i i u l y les of gi g
li ke y les. His p ti e is ot solely e i te to estheti me i i e; he
t e ts e p tie ts s well. We ll k ow th t e h e he e it y
li ks, i the se of ski e , beh io l/lifestyle li ks lso exist. He
t kes e e y oppo tu ity to ess his p tie ts’ i i i u l he lth y les s
well s those of thei f milies.
Fo some this pp o h m y seem ext eme, the e e e t i ly some
eli te issues oft t p i y. The e o ts ofthis p ti e m y ot be p-
p op i te fo you. Howe e , this p o i e ’s metho s illust te th t e e y
p ti e i hei whi h to se ethei te ests of its p tie ts t -
get u ie e i m e th t is wel ome .
These ex mples lso emo st te th t whe you e ful lli g the most
pe so l esi es of othe s, you h e the oppo tu ity to o mo e th ust
p o i e me i l t e tme t. You buil e u i g e y pe so l e-
l tio ship fou e o th t e. Pe so lt ust, esi e, e o seme t, e-
otio —it is ll tt i ble, esse ti l to you su ess.
c y les pe petu te, but o ot m ke the mist ke of letti g you wheels
spi . a lthough y les e e whe someoftheg e test t ges to the
su ess of p ti e exist, o e time they e ol e h ge. How you -
ess y les must meet th t e olutio ess h ge. Fu the , y les
eo lyo e ompo e t ofwhe t ge exists. Ifyou o ot pl fo
m ximize ll of you e o ts o e i g y les, you will ot m ximize the
lue of you bilities o you su ess.
SOCIAL CYCLES
So i l y les e the positi e eg ti e e e ts th t epe t themsel es,
sometimes p e i t bly, sometimes se so lly, sometimes u expe te ly,
ofte with g e t imp t o the w y we o busi ess. So i l y les
h e i ue e o you p ti e’s b l e sheet, if you let them. But if
you p ti e is t uly fo use o e of the i i i u l, you p ti e will
th i eo tt ti g e hi gthei i i u l, eg lessoftheso i l y le.
IN P RACTICE: Exclu sively You rs—con t’d

c h pte 14: Whe d o You r espo to c y les?


Bu sin ess a n d Econ om ics
The sto k m ket, i te est tes, o sume p i e i ex, the p i e of gol ,
g soli e, e e g o e ies e ofte use s i i to s of y les of p os-
pe ity, g owth, e essio , ep essio , e o e y. Busi ess e o om-
i s i ue e you p ti e ot th ough the ee to ust p i es to meet
st , but th ough the ee to ust you expe t tio s, ex ee the ex-
pe t tio s ofthosewilli gto i est i you se i es, to e lizeth t t o
time is ex ess pessimism o g ee pp op i te.
P olitics
r ight o left, libe lo o se ti e, o se tio ist o o sumptio ist, p-
it list o so i list, ust s politi l iews h ge, so too o the y les th t -
omp y them. You o ’t ee to h ge you iews o you politi l p ef-
e e es, but e lize th t these y les will i ue e you p ti e.
En terta in m en t
a t ess a geli jolieis popul , so wome p tie ts ofte equest th t thei
lips be sh pe like he s. a to Hugh j km is see o the big s ee
shi tless, exi ghis mus les, the efo eme w t thei pe to lmus les
to esemble his. Whe “B yw t h” i e weekly o tele isio , e e yo e
w te h bo y; to y’s “Wh t n ot to We ” f s e mo e wo ie
bout lothi g th wh t is u e e th. E te t i me t h s y les. Holly-
woo the me i go th ough lte ti g pe io s of tte tio to ski ,
f es, b e sts, bo ies, y les of emph sis o twig-thi sh pes fol-
lowe by ye s i whi h oluptuous ess is extolle . c eleb ities e p-
pl u e fo the thi gs they o to look f bulous t gi e ge, while othe s
ou e thei i te tio to ge se sibly g efully.
The y les of wh t is i ogue e i ult to p e i t m y h ge
o e ight. It is best to oi bei g sso i te with the t e of the mome t
simply fo us o the ee s of the i i i u l. Be use tomo ow, it m y
be Miley’s lips i ste of a geli ’s.

4

Se tio Iv : Whe
RELATIVE WISDOM: Th e Cycle of H istory
Histo i e e ts m y ot el te i e tly to you p ti e, but they i u-
e e existi g y les e t i ly hi e o e te oppo tu ity.
I w s ot bo whe P esi e t Ke e y w s shot, but those who we e
li e emembe the y well. My st memo y of y histo i e e t is of see-
i gP esi e t n ixo get o heli opte m ki ghis f me sig of i to y
my f the t yi g to expl i to -ye -ol wh t h t spi e . The y the
Be li W ll me ow w s the o lytimeI e e s wmyg f the y s he
w t he i isbelief elief th t the wo l he f om to s e his f mily
his life w s o e g i u ite wo l . Septembe 11, 1, w s my el-
est so n i hol s’s st y of p es hool, lthough I shoul e ll th t
yfo the y lei myso ’s life, I will e e fo get the y leit beg fo -
tio fo ou wo l .
The y I spoke i c hi go befo e the pl sti su ge y ssist ts g oup
w s ele tio y . The ity w s buzz, p ep i g fo B k Ob m ’s
ele tio ight llyth t woul be ome his i to y eleb tio . a s I w ite this
book, the ou t y the wo l teete o e o omy built o pill s of s lt
pill s of s .
Thesee e tsi histo y ememo ble, but they lso i ue eso iety,
the e o omy, the i te ests of i i i u ls, e t i ly you p ti e. Wh t
is sig i t i these y les is th t s p o i e you must be le t to the w y
theyi ue eyou p tie ts. a s p op ieto you must m ke e t i these y-
les o ot e sely i ue e you p ti e ope tio s. I f t, some
m y p ese t oppo tu ity, but be eful of how you spi th t oppo tu ity.
E lie i this book I efe e to fo estheti me i l se i es th t
toute is ou ts o se i e to stimul te the e o omy. a poo pp o h, but
ot i theo y. c e t i ly e o omi theo y implies th t if o e se to gets mo -
i g, othe s will begi to ebou s spe i g stimul tes spe i g. But o
you is ou t me i l se i e to get e o omy mo i g?
You might use the oppo tu ity to e ou ge you u ie e to i est i
themsel es whe othe i estme ts o e little etu . You woul ot i e tly
ommu i te this i you mess ge, o you oul be pe ei e s oppo -
tu ist by you t get u ie e, but su h mess ges thei w y to help
fuel i te est th t l e y exists.

c h pte 14: Whe d o You r espo to c y les?

41
a fte /11, the o ept of o oo i gbe me omfo ti gi e . We ll e-
t e te i to the s fety p i y of ou homes; home f mily be me
so iet lfo us. The e e theo ies th t those who we e hil e t the time of
this e e t will use thei expe ie e s b sis fo e i g thei ge e tio s
o e th t is e y p i te i i i u l.
d i you, you p ti e, o you p tie ts use this expe ie e, o y othe
expe ie e, to sh pe the e o ts i e tio of you el tio ships? Shoul
thesetypesofe e tsi ue eyou p ti e? d o you ee to e og izewhe
theyh e the pote ti lto whe they tu lly o i ue e you p tie ts?
Whe histo yi ue es i i i u lbeh io , you p ti eis e ote
to se i g i i i u ls’ most pe so l esi es, you be e t i th t histo y
will i ue e you. Howe e , usi g this to isibly pl y o p ey o how his-
to y h s i ue e othe s is simply w o g. You ot p ete histo y h s
ot i ue e i umst es, but you shoul o ly ess those i -
umst es i i i u lly. d o ot spe i lly ess the y le i histo y, be-
use whe you look t y histo i l e e t th t t uly h ges people, it
p ob bly ies some eg ti ity. a eg ti ity oes ot belo g ywhe e
i the p ti e of estheti s.
Theg e test ex mpleofthis s it pplies to estheti me i i eis y lei
the l te 1 s e ly 1 s: the sili o e-gel b e st impl t isis. Me i
ou so iety, e e me i l so ieties, lle it th t— isis. a ll-
i g it th t m e it th t.
It e te l m whe e l m w s ot ee e . It ise publi out y th t
oul h e ui e i ust y, but whe p o i e s, me i l so ieties,
the impl t m uf tu e s took the st e ly o to ess this, they i
bsolutely the ight thi g. They oi e the eg ti ity of this histo i mo-
me t i he lth e. They fo use o the esi es of the i i i u l, they
eme ge to themsel es i e i whi h the o e of thei p ti e, es-
theti me i i e, is hel i highe eg , is mo e epte , its se i es
e g owi g i em so pi ly th t this m y soo ex ee the spe i lty’s
bility to se e it. n ow, o e e e l te , sili o e b e st impl ts e o
lo ge ews; they e hoi e fo wome i pe so l y les of m keo e s o
b e st e e o st u tio , o i li i l y les i whi h p io impl ts
ee to be epl e .

(Trang không có chữ)

When DoYouPractice
Privacy?
Show me someone who never gossips,
and I will show you someone who is not interested in people.
— BAr BAr A WAl Ter s
CHAPTER 15
Human hav a n d fo p ivacy that i phy ica a w a motiona . W
n d p ivat pac , ou own motion , and i u and ag nda that a ou
a on . A phy ician mu t cogniz , p ct, nu tu , and mo t of a , p ac-
tic p ivacy. D pit M . Wa t ’amu ingquip abov , aphy ician i in th
bu in of fu ing p op ’ p ona goa , and a though you hou d b
d p y int t d in you pati nt , you mu t never go ip.
Wh n do you p actic p ivacy? A of th tim . Why? B cau you a in a
p cia ty d vot d to ving th individua and hi o h p ona d i .
That in it f i a v y p ivat matt .
W a qui p ivacy: w p ot ct th pac a ound u , into which w a ow
on y tho w t u t. Th d i fo p ivacy inc ud th n d to om tim
gua d ou t u f ing f om oth . W a hav c t that w k p about
ou v o on anoth —not thing w a a ham d of, ju t matt w
choo not to ha .
A though w ch i h p ivacy, w iv in an info mation ag wh gath ing
p ivat info mation about oth i a y to do. P ot cting p ivacy i mo
di cu t today than v b fo ; th fo it va u i v n g at .

s ction IV: Wh n
Th U.s. H a th In u anc Po tabi ity and Accountabi ity Act of 1996
(HIPAA) impo d th P ivacy P oc du a enfo c m nt r u , which took
ct on Ap i 15, 200 . Thi u ft m dica p actic c amb ing to n-
fo c n w p oc du and p oc pap wo k d ign d to p ot ct pati nt
p ivacy in a p ovid ’ o c and gov n th u and t an f of info mation
in pati nt co d .
A though you may p actic on y nonpayo vic and do not d a with
any h a th ca in u anc , you a ti bound by HIPAA gu ation . Fo
xamp :
You p c ib ap op ativ o po top ativ m dication that
i na cotic. Wh n th p c iption i d at you pati nt’
pha macy, th t an action i automatica y po t d to hi in-
u ba d on a p c iption d ug p an. Th in u at
contact you to nd out why th d ug wa p c ib d.
You qui p op ativ HIVt tingthat cou d u t in you
ob igation to po t nding to h a th vic ag nci .
A pati nt ha comp ication that u t in th n d fo m -
g ncy ca .
Th a a xamp of ca in which th HIPAA u app y and why,
a though you may not acc pt o p ovid payo vic , you ti mu t -
p ct and p actic p ivacy a it at to h a th ca info mation.
In a th tic m dicin , how v , p ot cting a pati nt’ p ivacy ncompa
mo than HIPAA gu ation . r cognizing, p cting, and nu tu ing p i-
vacy i ntia to you ucc and to you xi t nc a a p ovid of m d-
ica t atm nt. Wh th ap oc du i imp and noninva iv o i u gica
and intimat in natu , you and you ta mu t fo t an awa n and -
p ct fo pati nt p ivacy, p ci ca y with ga d to:
Di ct ncount
Con u tation
T atm nt
Communication

A though v y pati nt ha a di nt n d fo o xp ctation of p ivacy, it
wou d b a g av o to tak any a p ct of p ivacy fo g ant d. Fu th ,
p ivacy do not app y o y to th individua you a t ating at th mo-
m nt. P ivacy mu t app y to any individua you p actic ha v d o n-
count d in any way.
DIRECT ENCOUNTERS
Wh n two o mo individua conn ct in om mann —vi ua y, v ba y,
o phy ica y—th ncount i di ct. Di ct ncount mayoccu in you
o c o in pub ic p ac . Th y may occu b tw n you and p o p ctiv o
xi ting c i nt o pati nt , b tw n you and you ta , b tw n ta and
c i nt o pati nt , and b tw n c i nt and pati nt th m v .
Anydi ct ncount , pa ticu a yin you o c , mu t fo t p ivacy. Wa k-
ing in th doo , ch cking in with th c ptioni t, and v n b ing at d in
th waitinga a hou d a owan individua to main anonymou to anyon
oth than you ta . Of cou , you cannot p ot ct th p ivacy of you pa-
ti nt if you ch du th m o that mu tip pati nt a waiting at th am
tim ; th fo adju t you ch du ingp actic o hav pati nt co t d to
a p ivat oom on a iva . Thi hou d p ovid individua with a comfo t-
ab pac to di tanc th m v f om oth and a p ivat mom nt in
which to comp t o vi w docum nt . In om ca you may v n n d
to p ovid individua with a di c t, p ivat nt anc to you o c . l ik -
wi , aving you o c hou d a o d th am p ct fo p ivacy.
Out id th o c , you may ncount a pa t o cu nt c i nt o pati nt, a
might m mb of you ta . shou d you acknow dg th individua ? To
igno th ncount i ud ; to acknow dg it might vio at p ivacy. A
ubt mi and a nod of th h ad i om thing w di ct v n to t ang
w pa . In doingthi , you a not vio atingp ivacy, no a you b ing ud .
You a tting th c i nt o pati nt choo how to pond.
How do you p v p ivacy in di ct ncount wh n th y p og to
conv ation ? Again, by tting th oth pa ty tak th ad. It i a on-
ab to tu n ag tingo a khowth oth p on i , but do not go b yond
that with anything oth than ma ta k, v n if th c i nt o pati nt ad
Chapt 15: Wh n Do You P actic P ivacy?

5

6

s ction IV: Wh n
you th , b cau oth a ound you may b i t ning. Do you want th m
to thinkthat th di cu ion you a havinga a u t ofadi ct ncount in
a pub ic p ac i acc ptab and common in you tanda d of p ivacy?
RELATIVE WISDOM: An En th u siastic Crow d
Ap ovid ofa th tic m dicin b ong to th am tn c ub I do. som
of hi pati nt wo k th , and wo k out th a w . How v , many of
tho who wo k and wo k out th wou d n v b hi pati nt .
Why? B cau v ytim tho pati nt who ado him(and th y hou d;
h fu d th i p ona d i ) top to ayh o, th conv ation ad to
p ivat d tai about that p on’ ca o cu nt pha in if . H i v y o-
cia and i comp im nta y to th p op . H ov th att ntion, and o do
th y, but hi vo ubi ity mak many p op qu tion hi tanda d of p ivacy.
Th i anoth p ovid of a th tic m dicin at th am c ub. H i a
mod of di c tion. H nod and ay h o co dia y to many p op , go
about hi bu in in a v y po it but p ivat mann , and no on cou d
gu who among th c owd a hi pati nt and what h ha don to im-
p ov th i app a anc . I oft n wond d what wou d happ n if om on ap-
p oach d him to ngag in a conv ation about hi p of ion, but I n v
aw thi happ n. so on day, a w w both wa king out th doo , I d -
cid d to a k.
Hi p ywa an indicato ofwhyh i ucc fu : “I k p myp ivat and
p of iona iv pa at , and wh n I am in pub ic, I mind my own bu i-
n ,” h aid. “My pati nt know and p ct that.” Thi i a man who i
v y c a about hi imag , b and, and mi ion a it at to p ivacy.
r ativ wi dom: Whi a pub ic p ona i impo tant to t oth know
who you a , p ot cting th p ivacy of tho you t at i an v n mo im-
po tant m ag .
P RIVACY IN CONSULTATION
A though a con u tation tak p ac in a c o d, p ivat oom, v y igni -
cant p ivacy con id ation a invo v d. F om th mom nt an individua
nt that oom, h o h wi b ha ing with you and you ta d tai of

Chapt 15: Wh n Do You P actic P ivacy?


ap ona d i to nhanc app a anc . Th nti ncount hou d up-
po t th p ivacy th p on ha a ight to xp ct in nt u ting v y p ona
info mation to you.
Con u tation inc ud th p ci c p ivacycon id ation : tho fo th in-
dividua , th xamination, and photog aph . Th ya o qui that you n-
u p ivacy fo th individua phy ica y, motiona y, and with ga d to
any info mation that p on ha with you o that you di cov .
Th fact that m dica info mation mu t main p ivat xc pt wh n th pa-
ti nt ign a p ci c a i an indu t y tanda d, but oth info mation
mayb di cov d du ingcon u tation, uch a th individua ’ motivation,
xp ctation , outcom , p ona i u , ag nda , and in ight . Thi info -
mation qui v n g at p ct fo p ivacy, b cau it i ativ on yto
you and th pati nt. r a y do uch info mation n d to b conv y d to
anyon , xc pt p hap a f ing phy ician.
Th motion pati nt attach to th d i fo which th yhav ngag d you
a w a th motion attach d to th con u tation it fn d to main p i-
vat . I do not know how many tim I hav h a d p actition di cu th
motion of th i pati nt , a though th y do not m ntion nam . A con u -
tation i d ign d to focu on th d i of th individua ; th fo you
hou d focu on that individua ’ motion and n d . A though you may
nd that xamp f om imi a ca a b n cia to ha , it i inapp o-
p iat to ha an cdot about oth pati nt ’ motion . F ing a high y
p ona ; no p on’ xp i nc hou d v b ha d with anoth .
Phy ica xamination qui that you nt om on ’ p ona pac . You
mu t touch th individua , and thi i an intimat and intimidating xp i-
nc fo om p op . examining a woman’ b a t o a man’ ov hand
may b outin fo you, but h o h might nd th xp i nc v y un-
comfo tab . To n u p ivacy in xamination, you mu t:
A ow pati nt to d o und in p ivat ; th y hou d b
und d on y du ing th xamination po tion of th con-
u tation.

s ction IV: Wh n
exhibit good mann . Knock on th doo b fo nt ing,
a kpati nt ifyou maytouch th mto xamin th m, and ook
at th m wh n you p ak. K p a chap on in th oom to
tak not , to ho d a hand, o to imp y b th to a i t if
th phy ician qui it.
s t an app op iat ton . Do not u th xamination fo any-
thing oth than that—a di cov y of th phy ica condition
p nt. Do not di cu anythingoth than what you nd on
xamination; wait to di cu a comm nd d cou oft at-
m nt aft th xamination. Do not t y to u ma ta k to
mak an awkwa d ituation a itt t n .
Taking photog aph a pa t of th con u tation invad th pati nt’ p i-
vacy, y t it i n c a y. so how do you nu tu p ivacy wh n photog aphy
qui intimat docum ntation? Fi t, xp ain why th photog aph a
n c a y: th y aid th pati nt to und tand th goa of u g y and p o-
vid a ba in again t which po top ativ u t can b n. Th y b n -
t th p ovid by t acking t atm nt that qui mu tip cyc o func-
tion a a f nc du ing a u gica p oc du . s cond, b v y p ci c
about photog aphic a , a owing th pati nt to d t min wh th
photog aph can b u d fo p ci c and c a yd n d a on oth than
fo pati nt b n t and p ovid f nc . Thi d, u xi ting pati nt pho-
to to d mon t at outcom with cando , p ct, and in a po itiv man-
n . Do not u pati nt photo to point out what i w ong; u th m to i -
u t at imp ov m nt and po itiv outcom . r p ct th p ivacy of th
individua who do a ow you to u th i photog aph fo pati nt duca-
tion. In doing o, you wi d mon t at you tanda d , and oth wi not
h itat to a ow you to u th i photog aph fo pati nt ducation.
Todayimagingand vid o a b ingint oduc d to uppo t th con u tation.
Vid o in pa ticu a a ow a 60-d g vi wofth individua p op ativ y
and po top ativ y. Imaging mu t b c a y d n d a a communication
too , not a an app oximation of u t . Vid o mu t b d n d a am an of
docum ntation. Th am tanda d ofp ivacymu t b n u d a with ti
photog aphy, and quiva nt con nt mu t b docum nt d. Ifth pati nt’

Chapt 15: Wh n Do You P actic P ivacy?

9
p op ativ photo a u d to p oduc comput imu ation to d mon-
t at th p ann d chang a a pa t of th con u tation, it mu t b c a y
tat d that th imag do not p nt an app oximation of u t .
What v imagingm thod i mp oy d, a iz howvu n ab pati nt f
in thi ci cum tanc ; do not a k th m to wa k th m down th ha in a tat
of mid to a oom with g a ing photog aph ’ ight and unn ving
a h . Ifth pati nt mu t b photog aph d with intimat pa t ofth body
xpo d, xp ain th a on fo uch photo . Do not phy ica y touch pa-
ti nt to mov th mwh you n d th m; in t uct th mg nt ya to th ap-
p op iat po itioning. If you know th ight wi a h and th docum nta-
tion do not qui ing th pati nt’ y , ugg t that h o h c o
th y . Ifyou mu t photog aph th individua in pap panti , k p th
on fo th ho t t p iod of tim —not fo xamination, not fo any a on
oth than fo taking th photog aph .
IN P RACTICE: Mean Old La d y
I had a c i nt who attach d d c ipto to om of hi pati nt ’ photo . H
ab d on p op ativ photo in pa ticu a a a“m an o d ady.” ev ytim
h aid thi , I c ing d. What w tho h wa p aking to thinking?
Wh n I app oach d him about thi , h t aid that no on m d of-
f nd d by hi action and that th woman h f ab d h app a anc a
“m an” in th p op ativ imag . A w di cu d it fu th , though, h
a iz d my a a m wa w found d.
A though oth might not imm diat y xp an obj ction to uch a-
b , at om point th y wou d think it. That mom nt wou d ik y b wh n
th y w about to ign a photo a fo m and w pond ing how thi
p ovid wou d ab th i photog aph . Nam -ca ing i immatu at b t.
What i mo t impo tant, th ough hi wo d thi p ovid wa vio ating om -
thing ntia to fu ing hi vocation in a th tic m dicin : h wa b ing
n gativ .
Thi woman a ow d th phy ician to inc ud tho photog aph a a pa-
ti nt ducation too , y t th p ovid ’ wo d ack d v n a modicum of -
p ct fo that woman’ p ivacy. You a th gua dian of you pati nt’ p i-
vacy, v n in th u of photog aph .

50

s ction IV: Wh n
P RIVACY IN TREATMENT
You pati nt a mo t intimat y xpo d and vu n ab wh n you a di-
ct y t ating th m, wh th th t atm nt i inva iv o not. Du ing th
cou of t atm nt, th pati nt i n v in an att activ tat o po ition.
Obviou y, app a anc i om thingthat i ofva u to that individua , o h
o h wou d not hav com to you fo app a anc nhanc m nt. How do
you mak you pati nt comfo tab , anxiou , and h p th m f
xpo d? By n u ing p ivacy.
P ivacy in t atm nt qui a g at o t and a mo n itiv p p c-
tiv than p ivacy in con u tation, b cau any cou of t atm nt i mo
intimat and intimidating than con u tation a on . Fi t, by acc pting t at-
m nt th individua ha acknow dg d p ona di ati faction with om
a p ct of hi o h app a anc , and that can w ak n f-con d nc . s c-
ond, byacc ptingt atm nt th individua i mpow ingyou to a t o im-
p ov app a anc in om way. Th p on i i kingmo than a bad hai -
cut that wi g ow out o a poo fa hion choic that can b tu n d o
di ca d d; th u t ofan a th tic p oc du can b p man nt, and out-
com a n v fu y p dictab . ev n if you hav don an xc nt job of
ducating th pati nt o that h o h con d nt y acc pt t atm nt, th
i ti a bit of unc tainty that can mak th pati nt f v n mo vu n a-
b . Thi d, in many ca th wi b p op p nt du ing th t atm nt
oth than you, th t u t d phy ician with whom th pati nt ha bui t a -
ation hip. To p ot ct p ivacy and uppo t th conn ction you’v mad
with pati nt , a ofth individua hou d b int oduc d to th pati nt b -
fo t atm nt, and ach of th individua n d to p ct and nu tu
you pati nt’ n d fo p ivacy and comfo t.
Inva sive Trea tm en t
In ca in which an th ia i invo v d, a pati nt wi ik y not know th
p oc that occu du ingt atm nt. N v th , you hou d p ct thi
individua ’ p ivacy, v n though h o h cannot h a you and i not
awa of you action . You ta can h a and you, and you mu t t an
xamp by xhibiting th am tanda d of p ct and p ivacy in thi ci -
cum tanc .

Chapt 15: Wh n Do You P actic P ivacy?

51
Apati nt hou d not awak n to nd au ina ycath t in p ac that h o h
wa not to d about in th p op ativ p pa ation . Pati nt hou d not b
d d o und d o hav to wait, awak n, o cov in common a a o
b in vi ua o audito yp oximityto oth pati nt . B fo , du ing, and aft
t atm nt, and if n c a y, on th way out th doo , th pati nt hou d b
i o at d f omanyon o anythingnot di ct yconn ct d with that t atm nt.
Non inva sive Trea tm en t
ev n wh n at atm nt i noninva iv and th pati nt i fu yambu ato yb -
fo , du ing, and aft t atm nt, you mu t ti p ot ct p ivacy. A ow th
individua a qui t mom nt o two b fo t atm nt to co ct hi o h
thought . Whi p pa ing fo t atm nt, di cu with th pati nt what you
a doing. Whi admini t ing t atm nt and a you di cu th cou of
t atm nt with you c inica ta , do o in a mann that th pati nt can un-
d tand. Fina y, wh n t atm nt i comp t d, a ow th pati nt a f w p i-
vat mom nt to d , g oom, o app y mak up. A ow th pati nt to xit a
t atm nt oom wh n h o h i p pa d to av , not imp y wh n you
job i don . With any fo m of t atm nt, inva iv o noninva iv , a g nt
but m touch of th hand, kind and ncou aging wo d f om you and th
ta , and a di ct focu on th ca at hand wi d mon t at you commit-
m nt to th individua and p ivacy.
EXP ERIENCE MATTERS
Did you v wond what pati nt a thinkinga th yp pa fo t atm nt
and what cu th y pick up f om th nvi onm nt?
Do th fa t mov m nt of ta , th di conn ct d conv ation , th c ink-
ing and c anging of in t um nt , th unfami ia m , and th cho of
t atm nt oom mb an automotiv pai hop?
A in t um nt aid out— hiny, ha p, intimidating m ta obj ct , in-
c uding n d — ight b fo you pati nt, with no xp anation of what th
in t um nt a fo , and no notic to an awak pati nt b fo you u th m?
Do you ma k you pati nt p op ativ y without t ing th m why o
what you a ma king? Do you d c ib th ma king a you do th m, but
Continued

52

s ction IV: Wh n
add on yc inica ta , a ifth pati nt w not th ? Do you ma kth m
wh n th ya dat d o that wh n th yawak , th ywond what a th ink
i fo ?
Do you dat pati nt and th n t ap th mto th tab ? Do you cath t -
iz th m but fai to t th m b fo hand? A th y mid ap d and chi y
wh n th y awak n?
Do you mak c tain that waiting ov d on a updat d a t atm nt
p og , v n ifth p oc du i goingw and i on t ack? Do you p ak
to th i fami y m mb a oon a th t atm nt i comp t d and you pa-
ti nt i mov d to a cov y a a?
A you th a t p on you pati nt b fo h o h av th faci -
ity? Do you info c a of th i pon ibi iti that a ntia to good
outcom and af cov y?
Th b t way to judg ju t wh you ucc d and wh you fai in p -
ving p ivacy and upho ding individua pati nt p ct and comfo t i to
m a u pati nt ati faction in a th a a , to ncou ag di ct f dback
on th i xp i nc , and to u thi info mation ctiv y. How can you
imp ov without f dback f om tho you v ? Th b t m an to contin-
ua yimp ov you p actic i to a kpati nt wh th th i xp ctation w
m t o xc d d—o if and how you fai d.
P RIVACY IN COMMUNICATION
Wh n you communicat with you pati nt on -on-on b hind c o d
doo , you may uppo that p ivacyi not an i u . Mayb , mayb not. A k
a ta m mb to it in an mpty oom adjac nt to th oom in which you
might typica y conduct con u tation o xamination . Can h o h h a
what i t an pi ingin th n xt oom, o th oomdi ct yb hind that oom?
M dica p actic xamination oom noto iou y cho. Foot t p and
voic in th ha ca y. Might th hav a igni cant impact on you p ac-
tic ? P obab ynot, but th ywi b om thingpati nt m mb and ca y
with th m, and it may inhibit th m f om f y xp ing th i d i , ob-
j ctiv , and motivation.
EXP ERIENCE MATTERS—con t’d

Chapt 15: Wh n Do You P actic P ivacy?

5
Wh n i it app op iat to ca fu y va uat th n d fo and in u nc ofp i-
vacy in you communication?
Wh n communication i p ci c to th individua and xi t
anywh oth than b hind c o d doo
Wh n communication i p ci c to a ca and i di ct d to-
wa d anyon inc uding th ubj ct of that ca
Wh n communication i di ct d to an audi nc with whom
you do o do not hav an tab i h d ation hip
P a tien t-Sp eci c P riva cy
r p cting and upho ding p ivacy in communication with an individua b -
gin th mom nt h o h ngag you p actic . A oon a th p on in-
t oduc him fo h f, it i you pon ibi ityto imm diat yobtain thi
individua ’ contact info mation and th m thod and mann in which that
pati nt p f you to communicat with him o h , uch a th b t phon
numb to ach th pati nt, wh m ag can b ft, and with whomand
at what tim it i b t to ca . Thi i a ntia a knowing that individua ’
nam and how h o h p f to b add d (Ma y? M . smith? M .
Jon ?). Thi info mation i a ntia to p ot ctingp ivacya it i to max-
imizing th va u of you communication o t with thi p on.
How v , gath ing info mation, co ding it, and u ing it ctiv y a
th di nt i u . In many p actic , pati nt info mation i co ct d,
th n p ac d in a hanging . If th info mation i not co d d ct oni-
ca y, it ha no va u fo u in bui ding a databa .
If t ntion i ntia to you ucc in continu d o add d vic and
in f a , and th co of thi i vi ibi ity th ough ongoing communication
with tho who know and t u t you, how wi you ucc d if you do not
communicat with xi ting c i nt and pati nt in th mann th y p f ,
uch a mai , t phon , o di ct mai , o o icitation p f nc . Th
communication o t you p an wi fai if th y do not m t th audi nc ’
communication p f nc , inc uding th i d i fo p ivacy.

5

s ction IV: Wh n
Ca se-Sp eci c P rivacy
Communication p ci c to a ca xi t b tw n th p ovid and pati nt,
b tw n th p ovid and ta , b tw n th p ovid and a f a ou c
wh n it i anoth phy ician, and b tw n th p ovid and pati nt oth
than th individua you a t ating.
To ducat oth pati nt , you n d to communicat info mation about p -
ci c ca to th m about oth pati nt ’ ca . sp aking in g n a iti and
p ntingan ov vi wofap oc du i impo tant, but di ct xamp , in-
c uding pati nt photo , a th mo t ctiv m an of i u t ating you
ki and d mon t ating th o y and pot ntia outcom .
r p cting and n u ing p ivacy in th ituation qui that you focu
t ict y on th vant c inica fact a th y app y to th individua in con-
u tation o th ca you a i u t ating. educationa too uch a pati nt
photo mu t b di p ay d in a mann that do not v a th pati nt’
id ntity. Fo th u of uch t aching aid a photo , you mu t hav ign d
a on , b cau photo and ca hi to i mu t b comp t y
anonymou .
Upho dingp ivacya o qui that you t an mit on y ntia know dg
about th ca to ta m mb , oth p ovid , and pati nt you a du-
cating. Do not dito ia iz o o an opinion un that opinion i a p o-
f iona y comm nd d cou of t atm nt. Do not cha act iz th ca
und di cu ion by u ing ab uch a “c a y ov bak d” ga ding
om on ’ un xpo u , o “nic g andma” to f to a woman in h -
nio y a . som tim w ca ua yu ab to cat go iz thing in ou own
t m of judgm nt o fami ia ity, but u ing uch ab in you p actic i a
b ach of p ivacy—and good ta t .
Au d ien ce-Sp eci c P riva cy
You and you ta hou d not nd m ag that a high yp ona to p o-
p you do not know. You do not want you p actic o you communica-
tion to b unw com o to app a mi guid d. Mak c tain you p ct you

Chapt 15: Wh n Do You P actic P ivacy?

55
audi nc ’ communication p f nc and p ivacy. Fo xamp , if you
nd a pati nt in a c tain t atm nt cat go y a vant c inica updat ,
mak c tain th info mation i co ct a to ta g t and ub tanc . Bui d a
databa on individua pati nt ’communication p f nc and app yth
wh n you ta g t pati nt a a g oup.
IN P RACTICE: Messy Matters
Th ation hip a pati nt d v op with you i p ona and ba d on t u t;
th foundation on which you p ovid ca i bui t on that individua ’ p -
ona d i and th t u t h o h ha in you to fu that d i . Th a
tim wh n that t u t t an c nd th imm diat cou oft atm nt, and a a
ca ing p ovid , you might nd you f caught in th midd .
A young woman and h much o d ancé a iv d in a p ovid ’ o c .
Th woman wa king a p ci c t atm nt. Both w candid by a ap-
p a anc : h in h d i fo t atm nt and h in hi uppo t of h p -
ona d i .
Aft th con u tation, h ag d to t atm nt. s v a day at , h
ca d th o c wanting to p ak to th p ovid . sh wa having cond
thought . sh ft am ag with h c phon numb fo th docto to ca
h back.
Th p ovid ca d h back on h hom phon a i t d in h cha t,
ath than on th c phon . H ancé an w d. Th p ovid a k d to
p ak to th woman, but h wa unavai ab . Th ancé a k d th a on
fo th ca and ifh cou d tak am ag . Th p ovid not d that h wa -
tu ning h ca . A a cautiou and ca ing p ovid , h want d to di cu h
conc n with h .
Two w k at , th p ovid wa app d with a aw uit. Th woman’
conc n w that h wa not c tain ifth p oc du wa ight fo h , and
h wa b ing pu h d by an adamant pa tn ’ d i , not h own. By
p aking with th ancé, a b it b i y, th p ovid unknowing y cam b -
tw n th pati nt and h ancé and vio at d th woman’ p ivacy.
Th on h i on I know you cogniz ight away. N v di cu a
pati nt’ ca with anyon but th pati nt. Th p ovid h thought hi ac-
tion w innocuou . Th coup m d to b a happy and mutua y up-
po tiv coup . Th i initia vi it p nt d no hint of th woman’ t u f -
ing . r ga d , th damag wa don .

(Trang không có chữ)

Why
First, have a de nite, clear, practical ideal; a goal,
an objective. Second, have the necessary means to achieve
your ends; wisdom, money, materials, and methods.
Third, adjust all your means to that end.
— Ar ist o t l e
SECTION V
16 Why Do You Practice? Your Business, Your Goals
17 Client and Patient Goals
18 Safety: The Ultimate Goal

(Trang không có chữ)

WhyDoYouPractice?
YourBusiness,YourGoals
I want to be remembered as the guy
who gave his all on the eld.
— WAl t er PAYt o n ,
n Fl HAl l o F FAMe r u n n in G bAc k
CHAPTER 16
Y p a y v a ; a a , a d a g a
y f y f y a ag . Y f d h m y pay f y d a-
, a d y d a a d p f d y , a d ga h d h
wh w ha p y p a . t h ma a a d m h d y
da y a a , d a , a d a y pa a v y a m d a a
g g a . Y g a may d p a a d p f a f m ,
m y, y, v va , mm m y v a , h a fa
y v g h happ f h y a . t h a m wh
y m adj y g a a f m d , m d -
, a a y f p a .
G a a a a d f g v d a d a h-
ma aga wh h m a am a d a mp hm . t
a g a g a a fa . t d a , a a a g a
y m a d d, j v , a d p agma .
i a h m d , a h g a a h v d h gh a , v , -
, a d v y . M a g y p g
wa d a h v g y g a f va f y d f h
g a f a h m d : f g h d f d v d a mp v
h app a a a d ha h f .

0

s V: Why
Y ad g a y a a v , a v p a . H wy
d “a v ” j v , a d h am f m y w h a d
d w . W mpa h m y p d p v d g a a d
v a w a adm a v a d v f . i h a
mm m f m a d a y a w g ma y p a .
Y may h ha h g a y a a , v , a d
, a yy m d y ma g a : wha y xp -
a a f y p a a awh . Y maym a h v ,
p d v y. G a maya d d yg w h, pa , p a f -
m , a h, a d va , p hap v a a f m m a g
m f m a v p a a w y p h g a .
IN P RACTICE: A Differen t Gam e
Wh i wa , i m a ma wh w d day p v d a va d
myp f a f . H ga h a a am d a p a h 1 70 ,
wh a h m d wa a v y. H a d h p a hav ma d
a d v v d, p g pa w h h gy, va , a d pa d -
ma d . i w g h , i a d h m h w h d v p d a p v d
a a m p y a h p a . Wha w h g a , a d wha d d h
va m ?
H gh-p d a , h gh-p a , a d h gh v y w pa
f h mag , h d m . t h y w a . H gh v wa h
ma g a . r v m w h mm m a d .
i w d d, wha h wa h ma g a ? H d m wa h m
f v y pa wh f h had ha d h gh h a d a .
Wh h d d g a m f v a d p d v y, h d d
h p m . H mm m h j y a d a fa f h p g
h f h g a wa a h d d f h p a . H gam wa
w y m , y m .
Wha i a d f m h ma m h g p a f a h
m d h d v a w wa . F , y g a m q yy .
A h gh p a mm yd d v a d p a -
w a h, v y va h g a m a y. M v , wh a
h ma g a f y p a may a m a f p a y
ad d m fp d h d, y m v gh
f h a y h m a p v d f a h m d : -
ha h v f h y hav h v y f g h p a
g a .

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

1
BENCH MARKING
t h p f mpa g h v m , , a , f p a -
, p v d , p d aga m a benchmarking. A m-
f hma g d x , a d ma y d h a
hma , va a , h w w h p a p f m g aga h .
b hma g ha g a va wh d m a v a m f
h p a , h a adv v , g d m , p a p d ,
v f p d p d v a h .
H w v , hma g a p d v f ad y f
ha ad q a a d d y pp d y d p f m g— m g
a g h mp y m a a y m ha ha d -
a g d m a d pa a fa . b hma g ha
d mpa v h ad, a a , v , a a , , a d
m . A h gh h a p v d f mpa a v da a, wh fa
h v y a p g h f d pa y. if y d ’
da a p a y a y w p a , y may v a d -
a ha y d ’ m a p y m g a da d, ha w ’
g v y h a , h p y h p m.
TRAF F IC
Tra c f a y wh m a w h y a d y p a . i
a d a d h g a d ; y mag m -
v y a . A ha a d, h g a pp y d
a a h p a f a . r f a a m f m p a d
p a d xp , f m a d , a d f m y ,
pa , a mpa y g f d a v , a , a p , v p ,
a d gh . t h p p w a y a mag f y a d y p a
ha m g w h y m p v d g a . ev y
y p a m a a a a ma w h y mag
a d m .

s V: Why
Mea su rin g Tra f c
Y g a m a f a f d v d a wh hav xp d a d -
y p a v . t h a m a d , q a -
a v y:
H w ma y a f a v d da y, w y, a d
m h y?
H w ma y a a h d d da y, w y, a d
m h y?
H w ma y a a h d da y, w y, a d
m h y?
H w ma y a a a d, da y, w y, a d
m h y?
H w ma y a x g pa , h w ma y a w m ?
t h p v d a q a a v a m . t day’ ph a d h d g
f wa a d m a a d p v d p a . s a
m m h d hav a a da d p d f ga h g f ma
a q y p a da a f wa m a g ma
a q a v .
if h m f a f d p p a y h gh mpa d w h
h m f a a v , y hav d d a
p m. t h p m may d a y m f a a : a -
p , h d g, p g, m f ma . t h a a y
x v . F d h a f h p ma d . l w ,
h m f a a v h d d mpa d w h
h m f app m p h d a v y . A h gh
m f a a q v ga a h a y a
h p m.
Da y, w y, a d m h y a a a a d m d a d
m a p f ma . M h y d a mp d a a y

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


a ad d . i a d a may hav a h d pa
f m y a y a . Add g h pa h gh mm a w h
a g p p a a d w h x g a d pa a f h ha
h v f a a d v a p a m a d d d g -
p a m h gh a g d mm a .
M gq a a v a d m a d m gwha
x a mm a a d a h y p p v pa h -
d gh ; m a g p f ma m a a g
a mm a a d p a . o a da y a , m a g a
p v d va a f ma a :
t h p f ma f y a mp y , h a p-
. t h a d fy h g h a d w a -
f h wh p v d h mp f y
p a . F xamp , f y ha a h M day a d
W d day y h d m app m ha a y
h day, d h a h p a w g h -
ph h day ?
t h f a y x a mm a , h a h
p ’ p adv g, m d a v ag , h -
a h . ify m a M daya d W d -
day, a y ad s day a d t day?
s h d g p f a d . k w g wh y
a xp y ava a a a mp f
p d v y. if M day af v a d a-
h d a v f , h d h d v d
a p d v y.
t h v f -p m . if h p a ha m
ha v d f f a a d w h
wh m h -p m , y m d fy wh h f
h a h p ha h g a va . if y
d v yp p a v pa ag f a f a h -
a v a , h w ma y a g , a d f ,
why ?

s V: Why
t h a mp xamp f q a fy g a , h y d m a a
m a m a h p f ma f y a a w a y
w h p p v pa a d pa . Wh d -
j w h a q a a v a a y f a , h m a m a a
pp mp v p f ma a d p d v y.
o d v d a xp gad y p a a q a d,
h y m q a d.
Wha p mp d h a y ?
Wha p v d d h a g d
f ma y ?
t h da a a f f a g h f y p a .
o h pa , h p v d , adv g, a h, a d pa a
a h m y . Q a a v da a a g v y a f
wha y a a y ( h a w , f a
v , a d d ). r a y y v v d g
a p p v pa y ; v f m v a g w g m-
m da a y f m a a d pa a h phy a , ha
a ha d v d a w a h y h i , a d y f
y a f ma , a a m d a y ad ha f a d y ,
p a a h pa a y .
Q a fy g h f a y w wh h y a -
d g. Y a h d h p v d g h g a a a d
va a ha d p v d a . i a v a ha
y h w y app a d v d a f f a y h pa-
a d phy a .
Pa fa h v gy g a q gda a d m m :
H w m h h d y p a g a ?
H w m h f ha h d a —a
a v ?

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


H w m h h d f a g a ?
H w m h h d pa d g a ?
D m ga w h q w h p y m d h mm -
a v h , m h d , a d m ag y p a g a
a ; h a w w a h p a h mm a g a a d
max m z y . Y w a wh m a d m y a p a y
p y .
M a g a q m ha j d m gwha w . W h
a m a f a , y d hav a a f ga g g v -
, ad g a a a f v a d p d v y a d y -
ma g a . r a h g y ma g a q a -
m f m p p a g a , g g w h a g a .
YOUR TRAF F IC E QUATION
n a q a , a d p a g a , h d m f ma d , p -
d d a da d. sp hma d y a a d a -
a , h y h a f y p a , ma , a d g a ,
a a , a d p d v y a w .
i d ’ w why a m a g mp g a f w h p v h
g a h d p d ha f f h p d v m h p a g m.
i a d ha q a a y m d a , y i m d a f
a da d z d q a a d g a h ha m d a p f a
a a g p a d gg a mp h. J a y a d y p a a
a q m d , h d y q a a d g a d d y y
d v d a y.
F , a a m d a p v d , y a q d a a d a d x-
p p a d v pm a d ma ag m . H w v , a ap v d a d
p p , y d avvy gh h h gh p p h p y
d y . t h h y: y w m d f p d v y,
v , a d — a a a y a da d.

s V: Why
n x y d d a d ha y ma g a w a h v d
h gh mp d g g a f:
t a
c v a d
P d v y
r v
A h gh h g a a a h v d h d , h y a d m d -
v d .
Y a q a , q a y, wh h w d m d a y
p a , mp y h am f y p a m g a
a —a a a v — ha w ad
v f a pa . Y m hav a a g a . t h f wh
a d wh y g a q a y a a . i h m mp y a d
q a , y ha a mp x f va a a d pp ha -
a a m .
Tra ckin g
i am f a d a f wa y m f a g a , v ,
a d . t h m ph a d f wa y m a m a g -
h y a p g amm d a d d y a d app d y, a d
a a y f h da a a .
Max m z g h f f y g f wa w y d va a da a
a y p a . A v , d g pay v , m hav a
m g d , a d m a , m p d . F xamp , a -
m ha q m p y ma a a hav d m d -
d a wha h a (xxx.1), d (xxx. ), q
a m , a d . A a v ha q g y
ma a aga ha w d a d m d f h a d -
q v .

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

7
r p g a d y g g d w h h m d w d a
wh h pa hav m f a a m a d hav d. t h w
p p a y w a y pa mm a y -
m . Da a x a d f m p a w y p a a m y a d
h av ag m f a m pa d g . Y a a p a f
p d v y a d dg f p ha g pha ma a a d pp .
A y a g y m m a d mpa av d d p a-
f a a d da a . A a m m h d d a d a d
y a g d v a d p d a d p da a .
IN P RACTICE: Traf c Lost an d F ou n d
i happ a h m . s m a h a g f a p p -
d a m , a d h p wh a w h ph ay , “n , w
d ’ d ha .” i wa v g a a d a d g a h ph wh a
a m m g f h a , a d f h d ay “G d y ” af-
ay g “n ,” i a h d h ph f m h ha d a d mp d h
a . t h a wa a g f a d ma ha wa ava a h
u d s a . t h a m m a w g h ph had h a d f h
a d a d “n ,” a wa h f h d f h p a .
i a d h a wh h had h a d f h , “i ad a -
.”
i a d, “Wha d d y wa h a h v f y ? t h a v-
a g a p ha a af , app v d, a d ha D g a y , f
wh h w hav ma y happy pa .”
“i wa hap my ; ’ a a d ma my h gh g.”
i p d d, “Y a z ha d ma j h a
y, hav d f ha p p , a d a fa d h p f
wha app p a af f h j ; fa , h y may da -
g . D p f hap w h y w fa , a p
a d fa g af g; h a fa m a a .”
“i’m v y h ; i d ’ hav a f fa ,” h p d d.
i d h , “t h a j d d g v y a y a a -
. by h way, h w d d y m a ?”
“My m m ha h p d y D .”
t h d hav a . i d d p g a f d, a
h h y g w ma wh wa d h a a y am a
Continued

s V: Why
h y g pa wh had h h gh p d g a m
d a d a a h h w ma d a d h pp dy.
Y a h d a gh p m z a h a a d pp y. t h
a m p d d m h g h a d f, m h g y ’d
a h h a a , m h g y mp y d ’ v . b f h
p wh a d y h m y a d a f y p f m
a p p d , d ’ h h hav a m va y ha
mp y p d w h a a “n ”? t a g a f w m m xp h p -
’ a f a g h p a y p j y h
d v d a a a ad v a a d pa .
Wh y v a a q ga ap d a m ,
h p a w g h ph h d p d a f w :
n v ay “n ” f y d ’ a p p d hav
v h a d f ; ad, a a h a ’ g a d .
n v ay“n ,” v f h p d m h g a d h a d
f h p f y p a ; a h w h p a d f
y p a .
A way q a wh h p h a d f h a m a d
wha h h h p a mp h; h d m f ma-
a y p a h p d ha y a .
A way a wh h p a gh a d a y p a a d
wha m va d h m h w h y p a .
A way p , pa , a d ady d a , v f h a
h a g y hav d.
i w, a a a g. i’v h wh a a v a a d
a fy w p f m a ha m va h dy. i’v h
wh m a f h 1 -y a - d y gf p a gm a . i’v
h wh h a m a g fy a y“ h a dy mp a ”
h a ha h . n ma h w za h a h a , d
why h h a d y . t h , w h h pa a h ,
a d w h j dgm , hav y a gh . t a a a f d,
j ma a y wh a gh g y mp d w h
wh h m a d ay m ha “n .”
IN P RACTICE: Traf c Lost an d F ou n d —con t’d

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


CONVERSION
c v wh a a p y v a d ag d g
a h a m w h y p a . c v q a d wh m -
v pa a — h d v d a ag y mm d d
f a m a d p . H w v , v d m d a
h m f f m d a a a m — v a h
m f a p a . Why? b a wh y q a fy v a h
m f a m , y v h d v d a wh hav a p d y
v f m a d d f w h gh. t a g h -
d v d a a m ha y v a d m h-
d a v . if y xp m ha a f w a f -
v ( a wh a d v d a a p a d a d y -
v ), y m f h a a h a a d h mm a yam g
h m.
c v m a q a a v ym a d; h h m f v -
d g a m a f a y v y p a . Q a a v m a m
f v v v ga g g pa a fa . i h d v d a -
ha m a v y hap a xp . i q a d a g, a d
y q ha q a a v m a f v p v ,
v wh a m may mp y f a pa ’ g a .
Wha g d v a pa , y hav ha v
f a m fa h pa xp a ? n a outcomes, ex-
pectations of care. t h h g a fa ha a hav a mpa y
m q ha y ym p v , q a a v m a
f v :
1. Patient satisfaction: A happy pa may v a m
a y ha a happy pa
. Opportunityfor referral: Apa wh f y a d w h
h m a d xp ha a g a p a f
y ha wh j happy w h h m
. Opportunity for retention: A pa wh f y a d
w h h m a d xp m y
y ha wh j happy w h h m

70

s V: Why
i a p a d gh: f a h g a f d g
y p a . if h f y - -pa v m a d
a a p v v , m a g y pa xp f m y -
d g g a m a y pa , y hav y w y f a p v
f a . if h fy - -pa v m a d
a a y h g a p v q a y v , h pa w p a y
mm d y h . o y h m a d a d pa w
f h y , a d p a f a y m wh ha had ap v
xp y p a ha a y h f
d g y .
You r Conversion Eq u a tion
id a y, y v q a 1:1, m a g ha v y d v d a wh
m y a d a app p a a d da a p a m a d v
pa a . H w v , a h d a ha m m f a -
h m d m ha p v d f ma g a d ;
h f p j g a 1:1 v f y p a h gh y p m .
Y v q a h d d a g a ha mp d a
h gh p d v y a h ha mp y v a a a f d v d a
y h d v g pa . t h d v d a f y a am
hav va y g a d p a g a . t h m mp h v y
p a g a a , h g a h h d ha h m y v h
v p , a w a h m y p d p v d g v , w
g a , h g a g v .
t h m q d d a a d v a d v d a pa a
d p p h am f m h a a p d q a d
h am f m a d v d a w v ma a d . F p -
d ha a va v , q a m m , a d a h -
v y p d, y m v m v pa m d, h
h d ha h p w g h d h gh . F w w -
v a a g am f m a w h m p p v d f m
m d p d . i add , ma ywh q - va v p d
a g a g a a .

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

71
F p d ha a va v a d q a g a /pa v -
m fd mf , v y, a d m y, y m v pa w
g a , a d h h d w g w . M d v d a
h a g y w v a m h m a a y f mp y a -
d ha h p v d a d p d a gh f h m. t h f y
v q a g y d g h f w g:
1. t h m f d v d a wh y p a f
va v , m d p d a h m f
d v d a wh g h p d w h y p a -
. t h q a :
l Pc : l PP
[ m d p d : m d p d pa ]
c v h a a p ag y d v d g y l PP y
y l Pc g a m d p d p ag , l P%, f
v . D h y p d , y p v d , a d y p -
d /p v d , a d y may a wh ha g h a d
w a a d wha a a .
. t h m f d v d a wh y p a f
mp h v , va v p d a h m-
f d v d a wh g h p d w h y
p a . t h q a :
iPc : iPP
[ va v p d : va v p d pa ]
c v h a p ag y d v d g y iPP y y
iPc g a va v p d p ag , iP%, f -
v . D h yp d , yp v d , a d y m-
m a f y hav m ha pa d a
v v d h d a fpa . i mp a w
h a m d d v ; h w v w a -
y p , d a , a y h va a
ha d ma g a v .

7

s V: Why
n w w gh h p ag aga h a v va a h ha y
p a m x. F xamp , f y m x 0% m d p d a d 0%
va v p d , y a p ag f v w mp y a
av ag :
l P% iP%
if y m x 0% m d a d 70% va v , y a p ag f -
v w :
(l P%) 7 (iP%) 10
Wha h a m y h w p d v y d a a
a v a :
if h m 0%, h ha f f h y a
v pa a .
if h m 0%, h f f v y v y -
a v pa a .
if h m 0%, h f v y v y -
a v pa a .
i h a m a f wha h v p ag h d ? Y . i ,
j a y mp f h a h m d a p a p a , a d v d -
a z d m ha a a :
t h yp f p a
t h ma y/ p a f h p a
t h p a ’ ma a
t h p a ’ d m g aph a g
t h p a ’ mp
t h p v d ’ j v
Ma y
t a a f h fa a wh a a yz g y v p -
ag . Y m a y f: D my v a av m a p -

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

7
d v a i f i a ? if d , h y d d m wh
h p m x :
i a w g a gh f v ?
i v w— g a g gh pa ?
i v v a —pa f w g h gh
a m ?
t h mag q a f v , a d a h gh y g a f -
v q a a v , h y f ha m va a d m-
pa y w a xp a ha ha va a h ha h
m f. n m a a w ; h y p v d wha may
gh gh , a d wha d a d a d mp v d. if y
d aw h a m a g m v w h d g a
wha p h wa a d f wha a h p h
v , y ’ m a pp y va a y app a h. Y m-
p y a m f y d ’ w why y a wh y
h d , a d y a app a m g y g a f y d ’ -
g z h w y a v d.
RETENTION
r a mp a a f a . ifap v v y g -
a f a , w a y f v h pa . c -
d h fa f m a h ha va da h mp a f -
y :
t h maj y f d v d a wh hav had a h p -
d w y d g f a h p d f h
am a d a .
o v a , h p p a f d v d a d g g a h
a m g w g a g , pa a y am g y g
p p a .
n va v a m a ap d y g w g d ma d a d
m f q p a d a m max m z ma -
a .

7

s V: Why
A pa wh q a y f v wa p v w ma w h
y . n pa w w g y pay f a d d g v p d w h
y a d m f h xp h m a wa d g ;
h y w y y mp .
if pa a y g, h y w p p a f a h
m d wh p v d h q a y v h y , a d h y w y
ma w h ha p v d wha d a 0-y a y a a m f
a h m d . M v , f a m va v w h a p a g
y , wha h d h ha a pa w f f a m
f h xp f h gh q a y? r w h va v p d
hav m d va a h ha d f d p a . t h f
the quality of the overall experience ha w d wh h y a a pa-
.
M a g h q a y f v w y f a d wh y fa h
f p v d g a p v xp , v wh a m a fav -
a . t h m a y g a d a f mp v m a d y
g a d a f f a a d .
You r Reten tion Eq u a tion
t h q a mp m a a d a y
mp mp , a h a f a g f :
1. c mp d v fm p - y a m : a m
ha q m p p d v m a h a a

. o g g v f p ma a m : a m
ha m p a d v p va ma a

. n w add a v mm d d pa wh hav
mp d a a d f a m w h y p a
. n w v pa wh hav mp d a a d
f a m w h y p a

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

7
t h g a 100% h w a g . if
mp , y d d h a :
i d a , h a a pa a g m g ?
i p d a d— gf map m
xp a ?
i p a a d? Ha a v fa d, a d wha
p a y ha fa ? (F xamp , d
a app m a a m ha adva ag f h pa ?)
o y d fy h a f , y m a . Wh -
d a , d h w y a h p, h a y f g h d v d a a
ag h w ma y xp g y f y pa-
’ v a h a h. Y a a way aphy a ; d p y p a y,
y p ma y h d v d a ’ h a h. if h p -
d a , v w h a a d wha y a . Wh p a -
a d, d h , va a h mpa mayhav y p a v -
a , a d m d fy p y add h .
t h h d a g y, w add a mm d d v pa
wh hav mp d a a d f a m , h d a y d 100%
v . H w v , h h d h a g a . Why? b a -
mm d d add d v a m m p v d ypa a a -
ma h p a am d mp v p a m m . A ay-
g h p p q mm d g a y add d v a h m
f a a a a mp f a m , af a m ha
d a a adj . Ma pa f y a - a ag da
d p a m a d add d v ha may a y f -
w g a m f y a h v h pa ’ g a ; h a a gg
ga d g add a v w m a a p d g p a -
m va a .
t h f h a g y f , w v pa wh hav m-
p d a a d f a m , h d a 100%. H w v ,
h a g y v y d m a y ma a a g g -
a h p w h pa af h f a m mp . A -
g g a h p a h v d h gh mm a , p a -
v , a d a mp m .

7

s V: Why
ev w h a g g a h p, a a f d m y
a f h a g y. r a h ha xha g f wha
may a v y ma ma g , y ma a a a h p
w h y pa h gh h y a p a pa a d p a
f f a .
IN P RACTICE: Last-Min u te Jitters
ev y p a f a h m d ha h a d h , wh happ
y , y may d .
A f y a pa a d m . H p a wa d g w ha h had
h d a d pa d a a d wa g g a w g
h p h m ma ag h pa ad. H w v , wha wa a m g pa
ad am a f v ; m w w wha h p a -
had xp d v h gh f m .
My h gh wa a a a d v d . r a
wa h gh, a wa v . H w v , p d v y a d v d d
a . c a a w a y h gh.
t h a a had mm a y: h y w a a w h
h w p v d a d h pa d a . i a d h ma ag
p d m m ma g a f w a d m a h a a d
h xp w h h p a . “Why?” h a d. “t h y a a ady
.”
F , i a d, h ym gh . s d, v f h ya , y d
d why. s m h g had happ m ha a d m
a a .
i y h ph a a d h a d d d d v
ha a h pa wh a d xp d h xa am h g: a x y.
t h pa d a wa g ha h wp v d wa q y
ga g p p a y a d h g w g g q y. t h gh
h a m , d v d a f p d g q y, wh h g -
a y f w h g :
s h pa , wh w d wh h h h ha a d
q y
D a fa am g pa wh d d a ( w p -
d a ) h m f y d a d a p a p
m

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

77
Had h p a m a d v a h m f a m a h
ha a p a , h a a w d hav v d. t h -
g w v a w d y hav a d p d a-
, p . W h q a a v y v w g h v ,
h f p p f ma w d hav d d, a d h
h d f w d hav h a d y p , d d.
t h h : c v m a g a ha mp d p -
d v y. t h y h d m a d a h m fa p a , a h m
f a m . Q a a v m a f v a g a d a f
mp v m ha m a .
WH AT YOU KEEP
i wa a a wh ma a , “W a h m a d ywha y
a , a h ywha y p.” o f h f g m y, i
app y h p y h p a f a h m d day, a d i v
ha h pa y p a fa m a v y p a ha h
m y y ma , h xp y a a a .
i a a f va v p d q g h m p a m
a h v p ma a m ma a , -
a mm yp a a d h gh y v d mp . A a
v f w d y j f ha m w h a j a
q a , va a , f m d , a d a m .
c d h f f a a m a v h p d v y a d m
v m q d f h p v d a d a . n w d h p a v
a d h p d v y a d m v m q d f h p v d a d a
h a d a h q v . Add h h va f m wh ha
mad h mm m a y v a a g g p v d f a -
h v a d h a p a f f a a d add d v .
n w d h va f h pa y mp yga v h va f h
pa y p.
r ha m va . t a , m a , a d d . Ma
a y f y pa y m d g h m ma a a m .
Ma y gapp p a a d d v d a a h pa , p v d g a -
m , pa ag a m , a d a y- -f w p f y p a . A -
way m a a fa w h v ypha f a m . if a fa wa ,
w a d h f wha y p.

7

s V: Why
The person who starts out simply with the idea of getting rich
won’t succeed; one must have a larger ambition.
— Jo Hn D. r o c keFel l er , Fo u n Der o F s t An DAr D o il
P RODUCTIVITY AND REVENUE
A y m p d g d v g a v . o
g a y f a ; y xp paym f y p d v y
v d d. i a a h p a , p d v y mm yp -
z d a d m a d h a g :
t a m g y
c a a d v
P a m f w- p a
Adm a
o a h
P v d a d a m hav d v d a g a f p d v y; h
v - a g a a f p d v y f a h p v d f v a d f
a a ha mp d d p a v g a .
i h va g a h p d v y g a q a a v y a d q a -
a v y? A y. A h gh p d v ya d v a h yd -
d y a q a a v m a , w h q a y m a f p d -
v y, m gh a a d d q a y g a f p d v y. A ,
w h q a y v w f h fa ha d m h g a d v ,
y w a a y g a f v .
G a f p v d p d v y h d . t h m va a m
y hav a a p v d p d v y ha d y g a v . Y
g a p d v y m v m p v d g a m g y.
t h , h w v , w d p w h v g m a-
a d v . t h m a y d a , v h m
pa , a d a y ma ag h d v d a a h gh a m