Race & Empathy In Medical Centers

Can race (or any difference) affect the quality of care that a patient receives at any medical center?

from CNN

In the study, which appears in the journal Current Biology, people of Italian and African descent watched short film clips that showed needles pricking black- and white-skinned hands. As they watched, researchers measured the participants' empathy (i.e., their nervous-system activity) by monitoring sensors attached to the same spot on their hands. They also tracked the participants' heart rates and sweat-gland activity, a common measure of emotional response.

"White observers reacted more to the pain of white than black models, and black observers reacted more to the pain of black than white models," says the lead researcher, Alessio Avenanti, Ph.D., an assistant professor of psychology at the University of Bologna.

The researchers also showed clips of a needle pricking a hand painted bright purple. Both the Italian and African participants were more likely to empathize with this intentionally strange-looking hand than with the hand of another race, which implies that the earlier lack of empathy was due to skin color, not just difference. "This is quite important, because it suggests that humans tend to empathize by default unless prejudice is at play," says Avenanti...

..."A doctor with high racial bias may understand the pain of other-race patients in a more detached or disembodied manner and, in principle, this may contribute to the causes of racial disparities in health care," Avenanti says.

Previous research has shown that doctors tend to empathize more with a patient's pain -- and provide higher-quality care -- if they have a history of pain themselves, or if someone close to them has experienced chronic, debilitating pain, Dr. Green says.

"Now we are understanding that if you see someone as being more like you, you can empathize with their pain better," she says. "Race, age, gender, and class probably play a role in how we assess and treat patients with pain."

So does that mean that, say, an African American with low back pain should seek out only doctors who are African American?

Not necessarily. Green says it's more important to find a doctor who actively listens to you and asks questions.

"If you feel you are not heard, or that your pain complaints are not being taken seriously, you can and should see another doctor," she says.

Interesting article and worth keeping in mind around your medical center when you have a varied patient population.

The (Generally) Lame State Of Medical Center Press Releases

I use a number of pages that I've customized to receive information about cosmetic medical centers, technologies and companies.

There's always one or two totally lame press releases that come up from clinics who don't really have anything to say and are trying to use the PR listing services to bump up thier search engine rankings.

Here are a couple of examples just today:

  • AcuMedSpa Holdings, Inc. Appoints New Board Member
  • AcuMedSpa Holdings, Inc. Announces Corporate Updates
  • Lake Forest Plastic Surgery in Chicago Launches Redesigned Web Site

Now I don't mean to pick on AcuMedSpa or Lake Forest Plastic Surgery. They're just trying to increase their rankings and that's something that every medical center should be looking to do. But there are better ways than creating drivel that can never be consumed and were never designed to be read.

Press releases are a relic of the 80's and very nearly useless compared to what can now be done with content. Most businesses still release them but the benefit is negligible and is generally only read by the person that the release is about. Who the hell cares. It's a waste of time and money that could be better spent on actually getting in front of potential patients. The opportunity cost for this stuff far outweighs the benefit and is usually promoted by those who don't have any ideas of their own. Everybody else does it so we should too.

Ah, I rant. It's not all bad of course. There are some minor benefits but it's not the best way to get the rankings you actually want. (The very first thing that I'd suggest that you do is run a free report on your web site to see where you currently are.)

If you're sending out drivel and calling it newsworthy, please stop. It's killing me.

Medical Spa MD: New Partners & Services in 2010.

We've had some significant growth over the last while and that's enabled (and motiviated) us to look at how we can provide the most opportunity to our physician community.

We're currently buiding out relationships and adding additional offerings that include: strategic partnerships with other content providers, SEO +SEM, marketing & advertising outsourcing, training products, IPL & cosmetic laser classifieds, additional medspa MD guest post authors and more. The power behind this is the strength of our independant physician community aggregated in one place. Because we have so many physicians, we can harness the buying power of the entire group and businesses can provide pricing and services that they just can't afford when selling individually.

I'll be posting on these individually but here's an overview of some of the partnerships and additional services in the works.

Medical Spa MD Select Partners

We have a number of relationships with other cosmetic medical resources that we're working that include websites, magazines, and other vendors that meet our criteria for inclusion as a Medical Spa MD Partner. What's the criteria to be a Select Partner?

Medspa MDs Select Partners must offer significant value exclusivley to Medical Spa MD Members as a group and provide fantastic service and responsiveness to Members.

If you're a business you can apply to become a Medical Spa Select Partner here.

A New Site For Medical Marketing & Outsourcing

This new site will be all about outsourcing for cosmetic medical practices. Outsource your marketing, your advertising, your SEM (Search Engine Marketing), article writing, direct mail and postcards... all that stuff.

  • Outsourcing
  • SEO & SEM: Directoy submissions, local search, backlinking.
  • Marketing & Advertising
  • Article Writing & Submission
  • Direct Mail: Postcards & Mailers

You'll be able to get whatever you need oursourced at a fraction of the time and expense that you'd be expending to source and and manage it. We'll probably start out fairly small and focus on a couple of services that we can already deliver exceptionally well and use ourselves.

Medical Spa Writers + Guest Posts

One of the easiest ways for you to get some exposure for your practice or company is simply to write a guest post here on Medspa MD. We're actively looking for physicians and providers who can offer real value to our community. You'll recieve a valuable link to your practice or business and some welcom traffic.

Submit a guest post onMedical Spa MD.

Medical Spa Products

The Advanced IPL & Laser Training Manual and Advanced Medical Spa Aesthetics Training Manual & Study Course are fantastic resources to train and educate your existing staff, and new hires. Paula's done an absolutely amazing job of getting everything your staff needs in one place. I only wish I had this way back when. If you'r training process consists of having new hires follow you around... your life just got a lot easier.

Used IPL & Laser Classified Ads

Looking to sell your cosmetic laser or IPL? Looking to get a killer deal on one? Medical Spa MDs classified listings are where you'll want to start. (It's anticdotal but I think we've passed the $1m mark.)

Teeth Whitening

We were approched by a company providing custom teeth whitening services for companies and organizations as fund-raisers and asked if we'd allow them to sell whosale teeth whitening kits, pens and services to our Members. We've tentatively said yes and are trying out their services ourselves to see what we think.

These are exacly the same services that dentists offer and include taking impressions, making custom whitening trays and delivering them back to the clinic. Clinics would buy these wholesale. The markup would be in the 100%-300% range I'm guessing.

This could be a fantasic add-on since the #1 cosmetic service that people want is actually teeth whitening.

Laser Repair, Parts, & Service

Another interesting deal that I'm not at liberty to discuss quite yet but we're looking to take on some reilable partners to provide IPL & laser repair services for Members. If you've every had an IPL hand peice rebuilt by the manufacturer you'll know what I mean here. (Of course we'd love to have good technology providers as a partner too.)

Anyway, that's just a few of the directions we're moving in. I'll update this post as we get some of these services up and running. If you want to make sure you're aware of your options and our Partners offerings, make sure you're a Medical Spa MD Member.

Nu U Medical Spas Sued By Illinois State Attorney General

Attorney General Lisa Madigan has filed a lawsuit against the Chicago-area medical spas, Nu U Med Spas, for performing unapproved procedures without a physician's supervision and luring patients through deceptive marketing.

This looks like it started with an expose by local Chicago television news.

The seven NuU Medspas in the Chicago area aggressively promote Lipodissolve, a series of injections that supposedly will melt your fat away.

The ads talk about reduced inches with no knives, no tubes, and no pain -- a deceptive ad, patients say.

NuU does not tell clients that Lipodissolve is not approved by the Food and Drug Administration.

"There is no study out there that shows clearly whether it works and what specifically are the risks of it," said Northwestern Memorial Hospital's Dr. Michael Lee.

That's not a problem, said NuU district supervisor Laura Rowsey, formerly a modeling school sales manager.

"This is a soy-based mineral with amino acids," Rowsey said. "Bruising and swelling is like your worst case scenario with this treatment."

But doctors have seen a number of Lipodissolve complications.

Cynthia Sacramento, who went to the Lincoln Park spa, suffered painful scar tissue buildup around her injection site that will require surgery.

Dr. David Song of University of Chicago Hospital said the entire injection area will have to be excised.

Sacramento said she's devastated.

Even proponents say Lipodissolve is for treating pockets of fat, not for bigger weight problems.

NuU in Lincoln Park signed another former client, who preferred to remain anonymous, up for $2,400 in treatments on his belly.

"I think it's a big scam, a waste of money," he said. "The only thing that got thin on me was my wallet."

NuU sales people are pressured to meet sales goals and arrange for many clients to finance their treatments. The money is collected up front and NuU claims it's not refundable.

"Our goal was to get $15,000 a day," said former NuU spa manager Patti Feinstein.

Feinstein recalled how Rowsey scolded her for turning away a skin cancer patient saying, "You are not going to make quota if you don't sell," Feinstein said.

Records show her spa sold made more than $200,000 a month.

Ouch. You have to love how a reporter makes a point of stating that the Nu U spokesperson was fromerly a sales manager for a modeling school. Looks like another slap-down for Nu U Medspas. Madigan's complaint claims that Nu U Med Spas try to lure customers into buying "Lipodissolve, which is an injected therapy used to dissolve fat cells." Here's the full press release:


Attorney General Alleges Nu U Performed Unapproved Procedures Without Physician Supervision And Used Deceptive Marketing to Lure Patients

Chicago — Attorney General Lisa Madigan today filed a lawsuit in Cook County Circuit Court against Nu U Med Spas for deceptively marketing and performing unapproved, unsupervised cosmetic treatments that caused some patients to experience extreme pain and lasting injuries.

“These procedures have yet to be thoroughly researched and sanctioned by the proper medical authorities,” Madigan said. “Despite lacking concrete scientific evidence, Nu U purposefully misleads consumers into believing that their medical spa treatments are safe and effective. I’m very concerned that the health and safety of Illinois consumers who visit Nu U Med Spas are at risk.”

The Chicago-based medical spa chain allegedly uses high-pressure sales tactics based on deceptive marketing claims to induce consumers into purchasing a series of medical and beauty treatments, including Lipodissolve, which is an injected therapy used to dissolve fat cells, according to Madigan’s complaint. Nu U allegedly claims its treatments will “liquefy fat quicker” and can “rid your system of that life long battle of the bulge,” but Nu U fails to inform consumers that its treatments haven’t been approved by the U.S. Food and Drug Administration (FDA) as safe and effective treatments. Both the American Society for Aesthetic Plastic Surgery and the American Society of Plastic Surgeons do not recommend using Lipodissolve for fat reduction due to the lack of research that shows its effectiveness.

Further, because Lipodissolve is an injected treatment, it requires a physician’s order, but Nu U allegedly administers the fat-reducing treatment without a doctor’s order. In fact, despite its outward claims, Nu U allegedly fails altogether to monitor and evaluate patients by licensed physicians at all seven of its Chicago area locations.

Madigan’s complaint further alleges that the Nu U personnel rush consumers into signing contracts, medical consent forms and financing documentation for treatments but fail to review the documents with consumers. The defendants allegedly pressure consumers to sign up for health care financing but fail to inform consumers that by signing the financial documentation they are authorizing an automatic credit card charge. Nu U allegedly refuses to provide refunds when requested, even in the event that a consumer has not received all of the contracted treatments.

Madigan’s lawsuit charges Nu U with violating the Illinois Food, Drug and Cosmetic Act, the Illinois Medical Practice Act and the Illinois Consumer Fraud and Deceptive Business Practices Act. It asks the court to permanently enjoin the defendants from owning or operating medical or beauty clinics in Illinois and to order the company to pay civil penalties of $50,000, an additional $50,000 penalty for each violation committed with the intent to defraud, an additional $10,000 penalty for each violation committed against a senior citizen 65 years of age or older, and the costs associated with the investigation and prosecution of the lawsuit.

To be honest, this looks like some grandstanding on the part of the Attorney General. Lipodissolve is used in perhaps thousands of medical spas and cosmetic practices around the country without 'painfull scar tissue build up' and complications.

And what does it actually mean when. "Dr. David Song of University of Chicago Hospital said the entire injection area will have to be excised."? An entire treatment area excised from needle sticks? Seems fishy to me. Might well be something of a hatchet-job.

Anyone have thoughts on this?

Discount Medspa Do-it-yourself-Botox website shut down.

When we first discovered the videos promoting do-it-yourself Botox and filler injections being promoted on Youtube, I posted this article on Fake Botox or not, Discount Medspa is going to jail. Since then the websites have been shut down and the womant in the video's been charged with illegally offering prescription drugs without a license.

Via the Examiner

Even before a December 2009 ABC 20/20 report on self-injectable facial drugs including Botox, Restylin and Dysport, the company Discount Medspa had been shut down for selling these types of products to consumers without prescriptions for them.

Texas Attorney General Greg Abbott charged Laurie D’Alleva of Tarrant County, TX of illegally offering prescription drugs without a license on November 24, 2009 and gained a temporary restraining order barring her company from continuing to sell the drugs online. She is also charged with fraudulently claiming membership in Texas Medical Council, which doesn't even exist, and using this claim as a basis to say she can legitimately sell these products online.

The real surprise is not that this was shut down, it was the number of coments (98) from individuals proporting to be Discount Medspa patients who were defending the site and Ms D'Alleva. Shocking in some cases. Here are some of the comments.

"If smoking dope is okay with the moron than leave our botox self injection alone, no one is having a problem with it except the money grubbing doctors and pharmacys that sell the stuff. Bug off!"

"Funny we can inject ourselves with insulin and yet because of the greed of physicians, someone like Laurie is put out of business because why? She put the choices into the hands of the people."

"The FDA does not regulate how doctors use it. They go through a 3 hours class to inject it. What is the best way to learn?(DO IT YOURSELF)"

"I did purchase from Discount MedSpa and injected myself with Freeze (crows feet and forehead). I am extremely happy with the results. I will definatley do it again. I also have a college education and run my own business, so don't call me stupid."

"I have used the Freeze product from Discount Medspa with great results. The over priced Doc I received injections from did not do any better job than I did myself. It took 10 minutes and study on facial muscles. If the product is pure I see no problem with being able to inject at home."

"If I want to Freeze my face then let me and stay out of my business. It's not like I am harming anyone else. It's not like I am unfamiliar of the risks. It's not like I am jumping off a bridge and acting irritational, it's Cosmetic!"

"all these other money hungry Doctors thinks $320 every 4 to 6 months is reasonable thats crazy!!! I was purchasing 100 units of Freeze for $149.00 and was doing it myself do you think I am going to spend $320.00 for 40 units and have someone else do it,"

"Once I did the injections I realized how much of the "you will hurt yourself" is hype. This is the mantra that will brainwash us into being dependent and financially strapped to our medical treatments,"

"Yes, it is crazy...I have done it myself, I had great results with the fillers but always wondered what was really in them, what was I injecting into my face?"

You can read the entire thread here.

Are the best medical spas making the most money?

Is you're medical spa providing the best medical care or just making the most money? Are they mutually exclusive?

There's a New Yorker article detailing the commencement address Atul Gawande Atul Gawande delivered this commencement address, titled “Money,” to the graduates of the University of Chicago Pritzker School of Medicine. It expands on the themes he touched on in his recent article about health-care costs in McAllen, Texas, which figured in President Obama’s speech on health care.

The text of this speech is available in this article in the New Yorker:

No one talks to you about money in medical school, or how decisions are really made. That may be because we’ve not thought carefully about what we really believe about money and how decisions should be made. But as you look across the spectrum of health care in the United States—across the almost threefold difference in the costs of care—you come to realize that we are witnessing a battle for the soul of American medicine. And as you become doctors today, I want you to know that you are our hope for how this battle will play out.

Kevin MD has this on: Can doctors resist the lure of money?

That’s a tall order for many American physicians.

In his speech, which is an extension of his celebrated New Yorker piece, he looks at so-called “positive deviants,” or doctors who practice higher value, higher quality care, than everyone else.

What makes these doctors so special? In essence, they have to “resist the tendency built into every financial incentive in our system to see patients as a revenue stream.”

Indeed, “These are not the doctors who instruct their secretary to have patients calling with follow-up questions schedule an office visit because insurers don’t pay for phone calls. These are not the doctors who direct patients to their side-business doing Botox injections for cash or to the imaging center that they own. They do not focus, the way business people do, on maximizing their high-margin work and minimizing their low-margin work.”

Unfortunately, most American doctors fail to resist the allure of money. In some cases, it’s greed. But in many others, patients and business have to be intertwined simply to keep the doors open. Doctors cannot practice quality medicine while bankrupt.

Changing physician behavior needs to be accompanied by fundamentally modifying the incentives that influence doctors. Without radical physician payment reform, Dr. Gawande can implore future doctors to fight the financial incentives all he wants, but most will realize that resistance alone will be futile.

So where does that leave us? Are plastic surgeons and medical spas practicing medicine first, or business? How, if ever, does cosmetic medicine differ from 'real' medicine? Is there any ethical guideline that applies or is cosmetic medicine fundimentally different?

Do it yourself Botox, Restylane, & Juvederm Disasters.

So while there are still a number of people posting on how much the love Laurie D'Alleva and her videos touting the benefits of do it yourself Botox, there are a growing number of people who still have a non-paralyzed thought or two that are coming forward to talk about the problems you might have pumping fillers into your face. Perhaps the do it yourself Botox crew are also attracted to Trepanation.

Here's a story from ABC News: Watch the video on "20/20"here.

Some consumers are ordering prescription-only cosmetic products online and injecting themselves at home. One woman who self-injected her face with filler said it caused bags and lumps under her eyes, and a hard, infected pustule on her cheek.

For millions of Americans, the solution to crow's feet, thin lips, and frown lines is at the end of a syringe, or in a bottle. A quick trip to a medical spa, dermatologist or plastic surgeon for a Botox injection, lip augmentation or chemical peel offers the promise of a youthful look.

But these cosmetic procedures -- and the medical expertise that comes with them -- don't come cheap. For a single treatment of Botox, doctors charge about $380; for lip-plumping injections, over $500; and for a chemical peel, a whopping $700.

These high prices are enough for some consumers to take their business away from medical professionals, and go instead to the Web. They are "doing it themselves," ordering prescription-only products online, and injecting themselves at home.

Laurie D'Alleva, of Mansfield, Texas, is a big fan of "DIY" beauty injections and treatments. She is the face of a DiscountMedSpa.com, a website stocked with what she claims are pharmaceutical-grade cosmetics, similar to Botox, Restylane, and Retin-A. 

Self-injecting botulinum toxin might sound dangerous, but D'Alleva, 39, tries to put her customers at ease with informational videos, complete with tips and pointers on how, and where, to inject. "It doesn't hurt... It's easy," D'Alleva claims in one video, as she stands in front of a mirror and injects her face repeatedly.

Disaster isn't what "Alex," a paramedic, had in mind when she visited DiscountMedSpa.com a few months ago. In her 40s and dating, she just wanted to improve her look, and save some money. She asked ABC News not to disclose her identity.

After viewing "every one" of the instructional self-injection videos on D'Alleva's site, Alex was convinced she could do it herself, since using needles was part of her job.

"Why should I pay somebody else that got a few hours of training to do something I think I can do pretty easily?" she said she thought at the time.

Alex paid $450 for a DiscountMedSpa.com products including an injectable facial filler. She says she injected the products under her eyes and alongside her mouth.

But "the next morning, I woke up horrified by what I saw," she said. "Literally, my heart started pounding, and I thought, 'What have I done, what am I going to do?'"

The Medical Spa Aesthics Training Course & Study Guide for medspas & laser clinics.

The Medical Spa Aesthetics Training Course & Study Guide for Medspas, Laser Clinics & Cosmetic Medical Practices.


Written by Paula D. Young, RN, the Advanced Medical Spa Esthetics Training Course & Study Guide is a two part learning cirriculum for non-physicians. The course is delivered in two parts that include a text book and a study guide.

This is an invaluable tool for any Laser Center, Med Spa, Plastic Surgery or Cosmetic Dermatology practice to train every new medical spa staff member on what cosmetic proceedures you offer, how they work, and what alternatives there are.

This study course is being used in medical esthetic schools and leading medical spas and laser clinics to provide every new esthetician and laser tech with a study course, and test their knowledge before they're hired.

For the first time, your laser clinic or medspa staff has the latest information on the newest nonsurgical medical treatments, from Botox, Restylane, and the newest filler injections, to fractional CO2 laser resurfacing and IPL treatments.

Your medical spa staffs knowledge and expertise is a critical componant to your success. Now you can be confident that your front desk, estheticians and laser technicians have the information that they need, and can answer patient questions with confidence.

Memberswill only be available to existing Medical Spa MD Members so be sure that you've signed up for your free membership.

Medical Spa MDs: What's your problem?

OK,  since 90% of poll takers responded that they'd like something enough to pay at least something, it looks like I'll write something on medical spas. Of course if Dermacare starts voting that number might drop.

questionmark.gifSo I thought I'd ask for input as to what, if any, information the 10k monthly readers of this site would like to know more about (yes... increasing new patient flow will be in there automatically) 

Operations? Hiring? Technology? Finaincing? Where to buy a whetstone to sharpen your Botox needles so you can resue them? How to compensate your minions? How to keep get out of a medical spa franchise? Non-compete agreements?.... whatever. 

I'd just like some imput and interaction that can help provide some guidence about what you'd like to know the most so I don't waste as much time as I might.

Just leave a comment or send me an email.

Dartmouth Medicine Online Magazine

spring05.jpgDartmouth Medicine

An online magazine for alumni and friends of Dartmouth Medical School and Dartmouth-Hitchcock Medical Center.

Dartmouth Medicine's print edition has a circulation of about 28,000. About 60% of its readers are involved in some way in medicine—as physicians, biomedical scientists, medical students, nurses, etc.—and about 40% are lay—patients, donors, parents, residents of the region, etc

Wall Stree Journal Article on Medical Spa Franchises: Medspa boom is a bust for some

The following article on problems with medical spa franchises ran in the Wall Stree Journal. It's a telling article that points the finger at the current crop of medical spa franchises. I signed up and read it after Ron posted his comments on being an unhappy Sona owner.

Medspa Boom Has Become a Bust for Some

a.medspalogos2.gifBy RHONDA L. RUNDLE: November 21, 2006

Jeff Nebot thought he had struck gold. Two years after opening a laser hair-removal franchise in St. Louis, annual revenue hit $3 million. And over time, the lavish salon added other cosmetic services as Mr. Nebot joined the rush of entrepreneurs into the emerging business of medical spas. Medspas (also called medispas) offer such medical treatments as Botox injections and laser hair removal in a luxurious environment rather than a doctor's office. The field has been rapidly expanding in recent years as entrepreneurs and doctors alike have sought to profit from the dual quests of many affluent consumers: prettification and pampering. For an increasing number of those who entered the business, the boom is proving a bust.

"Several Sona franchisees, though not Mr. Nebot, are in private arbitration over problems that include misrepresenting a complicated business as a turnkey operation and failing to provide needed support. Sona officials declined to comment.

Several franchisees of Radiance MedSpa Franchise Group PLLC, a franchiser in Scottsdale, Ariz., say the company's financial projections overestimated revenue and underestimated initial start-up costs, including working capital.

The president of Radiance, Charles L. Engelmann, recently said: "There are currently 32 open stores and we will have 47 or 49 open by the end of the year. None of the stores have closed." He also acknowledged that some franchisees are attempting to get their money back.

"I can't be my own medical director any more, which is an added expense I can't afford," says one Florida physician who is not a dermatologist. He says he is "facing personal bankruptcy and trying my best to get out while there is something left for my family" after miscalculating what it would take to market, advertise and build his business. Indeed, many medspa owners are doctors who hope to make easy cash at a time when income is shrinking from their traditional medical practices.

You can read the entire article on the Wall Street Journal site here. It does require a subscription. 

You might be a Medical Spa Entrepreneur if...

check.jpgA lot of physicians think that they have entrepreneurial experience. After all, they started or ran a medical practice, and isn't that what a physician entrepreneur does? Maybe, depending on your own definition. Well, here's mine. These are not all necessarily descriptive of the current situation, and they are not all things I'm proud of or would recommend. Most of them certainly were not intentional, but they are all taken from my personal experiences. Some are humorous, some are not.

These days I'm happy to say that the vast majority of these things are behind me. Much of what is detailed below was brought about by the speed with which we are/were growing. Nowdays I'm usually home at night,Surface clinics have excellent staffs that I adore and count as friends, and I'm starting to have some free time again to devote to other persuits. Life is good.

And now, without further ado...

You might own a Medical Spa if...

You've 80k in credit card debt from cards you never knew you had.

You've averaged 60-80 hours per week of work for the past seven years.

You can personally have the most advanced medical treatments available but receive the poorest quality care.

You've found yourself at 2am painting treatment rooms in your underwear.

You spend two days without sleep because you know you're going to have to fire someone even though you're firing them for stealing from you.

You're accountant calls while you're leaving for vacation to tell you that your newest location is 25k in the hole so far this month and checks are bouncing.

You have employees that make five times what you do.

You eat all of your meals off of paper plates using plastic utensils. 

Without trying you've succeeded in convincing all your employees to never try to start their own business.

When someone asks you what you're doing this weekend you say "Working, of course, just like any other day."

You go to the gym once every six months and kid yourself that it makes a difference. 

Every six months you see the same guy at the gym who's obviously in shape and think "How in the world does anyone have time for that?"

6pm feels like 1pm.

Your staff clocks out while you're having lunch.

You drive home in the dark every night of the year.

You drive 60k miles between clinic each year.

You're ear aches at the end of the day from having a cell phone pressed against it for hours.

When people ask what you do you answer," I answer questions all day".

You have a bet with yourself on how long after meeting a woman and telling her what you do she asks, "What do you think I should have done?"

You learn never to answer the above question.

You have the most overwhelming sense of Deja Vu every time a physician with any type of rinky-dink cosmetic practice tells you that he's thinking about franchising his business.

Your wife is reduced to tears at a fourth of July parade when a patient accosts her demanding to know why your physician, Dr.Y, has ruined her life.

The physicians complain that the front desk is booking too much time for something and changes the default in the schedule. The front desk complains that the physicians take that much time and change it back.

You've closed, locked the doors and gone home leaving a patient still sitting in a treatment room.

You walk into the clinic kitchen while the staff is discussing horror stories of performing Brazilian hair removal in graphic detail.

You wonder if the computers ever actually work when you're not there.

You have to chase down a woman who's attending a free seminar and trying to make off with $600 in product samples. 

You feel almost euphoric just thinking about what it would be like to not owe anyone any money.

You develop a deep and abiding hate of yellow page salesmen.

You wonder why, when every salesperson on earth is deeply committed to helping you 'grow your business', they're never around when you're signing payroll checks. 

You've told someone not to start a new medical spa on their own because you sincerely can't bear the thought of someone going through what you've been through.

Just closing the doors and moving to South America seems like a perfectly viable option.

You've worked multiple Christmas days.

A physician you've trusted and put in a position of power starts having patients pay him directly inside the treatment room and sets up a secret merchant account so that he can swipe a card and have the money deposited directly into his personal account.

After you fire the above physician, he breaks into the clinic and steals equipment. While you're on the phone the next morning with the police, his wife calls and leaves a hysterical message asking 'How you could do this to us?" and threatening to sue you.

A patient asks "Why is ________ at the front desk insisting that she deliver deliver products and take payment at my house?" 

You've paid the federal government more in business taxes than you've paid yourself.

A physician calls you and asks for your help since American Laser Clinics has an armed guard in his waiting room to prevent him from seeing his own patients while at the same time their performing treatments using him as their medical director.

The same physician tells you that he's been doing this for thirty years and know how to run a clinic better than anyone while dismissing reports showing his declining performance as a 'computer problem' and asking you for money so that his kids can continue to go to private school and he doesn't have to sell his airplane.

The same physician thinks that all his new patients are coming through excellent word of mouth and his superior charisma while dismissing the $16,000 you spent last month advertising his services.

You have to deal with this physicians office manager who's decided to get even with you for not hiring her so she takes every opportunity to sabotage you.

You find yourself expanding to a physician why you can't advertise in a fashion magazine using before & after images of extremely unattractive sagging bellies and thighs from 80 year old morbidly obese patients even though 'the results are good'.

You don't worry about filing taxes late because you know you're not in a situation where you could possibly owe the government any more money.

You've felt a sense of relief when an employee has quit because now you don't have to lay them off.

You're an expert on what does and doesn't count as a business expense.

You've slept on the floor of your office or on the couch in a waiting area more than once.

You've seriously considered buying a cot for your office.

You wonder where the last five years went.

You realize your wife must be a very special person because what other woman would put up with all this and still like you?

You have 6 horses you never ride, a gym membership you never use, children you hardly see, and family vacations you don't go on. 

You look at every medical spa you drive by in your car thinking, "I bet the guy running that medspa is making a lot more money than I am."

You have a surge of bile when you're at a medical convention and a consultant says to a packed room of physicians, "Of course you can make $250,000 per treatment room right now," and then proceed to tell everyone that the key is to 'not let any patient leave until they've bought product and booked another appointment.

You wonder how the above consultant got anyone to listen to her, ever. 

You're able to write a list like this in a half hour right off the top of your head.

This just a partial list of course. I may add to it. And of course these are all in the past.

Book: Marketing To Women

Marketing To Women: How to Understand, Reach, and Increase Your Share of the World's Largest Market Segment

Link to Marketing to Women on Amazon.com

Marketing To Women is the business marketing book that I give to physicians. It's really that good and since our client base is 90% women, that's the market I'm after.

While most docs think they know everything there is to know about patient interaction and consultations, my experience is that they don't. Drink the Cool Aid and read this boot. The book offers some useful insights as to why women make the decisions they do. Understanding why women make choices, it's easier to address the hurdles and obstacles that prevent women from purchasing.

Key truisms:

  • Women are much more loyal than men.
  • Where men are searching for the best solution, women are searching for the perfect solution.
  • Women are much harder to please than men because their list of requirements is longer.
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