Retail Medicine: Don't nickle & dime your patients.

Little added fees = pissed off patients.

If you're adding small fees to your service to cover your costs, you're pissing off your patients. If you didn't guess, pissed patients don't speak kindly of you. Actually, I'm a proponent of the flat fee. I hate the little charges.

From Ronda Abrams 

When I went into business, I sat down with a lawyer to review my legal and tax responsibilities. When we finished, he gave me some wise advice.

"Rhonda," he said, "don't nickel-and-dime your clients. Clients willingly pay thousands of dollars in hourly fees without complaint, but if I bill them $2 in long-distance calls, they'll get upset. It's small items that alienate clients."

We all react negatively to what we see as petty little fees that should be part of what we've paid for. A patient might be willing to spend $3000 for liposuction but she doesn't want to be charged for the laundry service or the support hose. The tiny fees at the end mark you as a cheapskate. It's better to charge an extra $100 for the service and give the hose away for free.

Make the most of the fact that you're not charging for these extra services. After all, you're a physician angel and friend to all your patients, right? Have your front desk go through the bill detailing the little suff as "Complimentary" or "Fee Waived." That lets the patient know you could charge them but haven't, increasing customer loyalty. Make the last interaction the most pleasant; go ahead and give the wheelchair ride for free.

Resources: Physician info sites from a psychiatrist

From Corpus Callosum: Yeah he's a psychiatrist, but what the hell...

Merck Medicus is a great site.  I had to provide some medical license information, so I don't think it is available to everyone.  That is annoying, but I understand why they do that. The site provides free access to resources such as Harrison's Online, Mosby's Drug Consult, etc.  I assume the pay for that access, and I also assume that they would have to pay a lot more if they opened it up to everyone.


Biomed Central is a publisher of open-access biomedical journals.  Some seem rather obscure to me, such as  Cerebrospinal Fluid Research, but others have a wider appeal.  I occasionally browse these journals just to keep myself updated, or to find things to blog about.


The Doctor's Guide to the Internet is a news aggregator that pulls in articles from a variety of sources, plus some CME programs.  You can register, then customize you own page with the feeds that are of greatest interest to you.  Sometimes the robots pick incorrectly, such as when it included Unexpected hemodynamic depression after induction of anaesthesia - (Anasthesiol Intensivmed Notfallmed Schmerzther) in the channel for Depression.  The robots pick up a lot of case reports, which are a good way to refresh your knowledge base and exercise your clinical thinking skills.  

PhRMA Medicines in Development is on online database of pharmaceuticals currently in some stage of development.  I like to browse through it from time to time, in order to keep up on what is in the pipeline. 

Customer Service Obsession: Love your patients the Amazon way.

 Is obsessive customer service part of your medical practice?

Amazon is taking a page from Nordstrom's 'heroic customer service' book. Why? Because it's good business. I posted on the oft-induldged stupidity of price wars. One of the differentiators that drives business is customer service. Notice I did not say 'patient care'. Customer service is outside of the medical care you're providing. Customer service is the touchy-feely warm and cozy perceptions that your patients have or don't have.

From my friend Shmula's blog on Amazon's customer obsession:
pushing 300,000 - 600,000 units of product per day through a fulfillment center is no easy task. gratefully, Amazon’s home-grown software and efficient processes help to deal with the immense volume. sometimes, if there are inventory gliches or poor product flow, an activity known in warehousing as “product chasing” occurs. “chasing” is when a product is ordered, but it is nowhere to be found in the (1MMft^2) facility. in reality, it is somewhere, but according to the inventory software the product is supposed to be in its assigned bin, but it has been moved somehow, drifted to another bin, or stolen. this defect is called Inventory Record Defect Rate and is one of the most important metrics at Amazon, and is highly scrutinized and reviewed by Bezos and his senior team.

Why is it important? because when the front-end Amazon store allows you to order something, the precondition is that the product and the quantity desired is currently in an Amazon facility: the software follows a very complicated algorithm based on network optimization, shortest path techniques, and traveling salesman routing; a check is made against the inventory database — in real time — how many are available, which facility, and how many have been committed already. when the order drops into the assigned facility, the picker goes to the bin where the product is supposed to be, but because IRDR is poor, the item is not there. this situation leads to two following options: (1) go to a local store and buy the item and ship it to the customer or (2) do a “network flip”, where the assigned facility “flips” the order to another facility that has that product. option (2) is ideal, but during the holiday season, it is very difficult to do. during the holidays, option (1) is common.

doing option (1) is heroic and is a true example of customer obsession at work: it’s not about serving all customers as an aggregate, but it’s about serving one really well, several million times. at Amazon, they really believe this and live this.

This kind of take-no-prisoners approach to customer service is absent in most clinics I see. You're asking your patients to spend their money inside of your business. Great customer service is your obligation.

Group visits for cosmetic patients?

Via Kevin, M.D.

The Doctor will see you,alll, now: Group Appointments Give Patients More Time To Talk

Chang's office began offering such group visits only for patients with diabetes, and then for people with asthma. Instead of spending 10 or 15 minutes each with 10 patients — many of whom need to hear the same thing — she might spend 90 minutes with 18 patients. Each patient learns from others' questions and symptoms, and the doctor covers much more.

Group visits

Studies have found that patients attending group visits had fewer emergency room and specialist visits (and thus lower monthly costs), stayed healthier and were more satisfied with their care. Three models exist.
Cooperative health care clinic, created by Dr. John Scott in Wheat Ridge, Colo., in 1991, is an alternative to individual doctor visits. The same group of patients usually sees the doctor together monthly.
Specialty group visits, which Scott developed in 1995, are similar, but patients have the same diagnosis, such as pregnancy, diabetes, hypertension, arthritis or fibromyalgia.
Drop-in group medical appointments, developed in 1996 by clinical psychologist Edward Noffsinger in San Jose, Calif., typically have different patients at each session.

I wonder if you could do this in a cosmetic setting. Has anyone tried something like this? 

Medspas Online: Search by Tag

Keep Your Medical Spa Updated - Large File Transfer

Multi-location Medspas use online tools for large file transfer.

Multi-location medspas often use these types of tools to update multiple locations all at once. They keep the most current copy of the file on a site and each location then downloads the files, ensuring that all the locations are updated with the same information at once. Having used a number of these tools, we've found that www.dropload.com works simply and effectively.

The one caveat is that the file is only available for seven days. The benefit is that it's free.

Click here to go to www.dropload.com 

 Other possible solutions are:

Steamload - www.steamload.com - Has a free introductory membership but you'll have to pay to use the usefull features.

 Send Your Files - www.sendyourfiles.com - Similar to Steamload but can handle multiple GB files and costs just $29 a year.

Medical Spa Equipment Auctions On Ebay

We have posted a list of current Ebay auctions for IPLs, Lasers, and cosmetic medical devices. Here's the current list of non-medical aesthetic equipment auctions that are previlent in medical spas.

How Doctors Use Google

Patients trust Google almost as much as their physician. (article) Not surprisingly, doctors too find the search giant results very useful.

Clinical Images
Google Image Search is very helpful when reading  "dry" subject from a book without illustrations. Check out the web page that Google shows below the image (when you click on it). Sometimes this can lead you to very interesting websites which are otherwise hidden on page 20-30 from the regular search results. We are all visual creatures and clinical images are definitely helpful.

Scholar Search
Google Scholar employs the same page rank algorithm used by Google to weigh the significance of a particular article. The problem with the Scholar is that it lags behind PubMed in updates. For example, if you search for a topic and the article was published several months ago, it will not appear in Scholar but it will show up in PubMed. Anyway, search for "scholar" and Google Scholar will be the first hit on both Yahoo and Google.

Use Medical Terms in the Search Query
Using "differential" or other medical terms to sort out the commercial websites is very useful. The other option is to go by the source, like "search term" + "NEJM", "AFP", "Merck manual", "eMedicine", etc., just like Kevin mentions it in his post. Google aslo offers personalized search that you can use to shift the slider to "Max" to leave the commercial websites out.

References:
More people consult Google over health - Times Online
How do I use Google? - Kevin MD
Some Great Google Tips - California Medicine Man
Clinical Cases & Images Blog

Malpractice, State By State

The Coalition for Affordable and Reliable Health Care, an advocacy group supporting medical liability reform, has a clickable map of the U.S. on which you can click your state, or any other one, and get a pop-up with real-life stories, statistics, etc. from that state illustrating the problems of the liability system. Also on its site: texts of current malpractice reform bills in Congress, information on California's MICRA law, and much more.