wonder what percent of physicians would double or
triple their income if they knew and applied the
laws of influence, attraction, charisma, and
negotiation in their practice."
It seems to me........based
on the books on these topics that I read and learn
from one after the other that most physicians have
no idea how critical these behavior patterns are to
building a medical practice. I never knew they
existed, let alone what value they might of had in
my medical practice income and growth. It's just
another chink in our armor we never learned in
college or medical school.
I have a very clear understanding of these laws and
their power and the fact that we use all of these
factors throughout our daily lives to some degree
without even recognizing we are doing so, it is easy
to see that any success we find is directly
dependent on persuasion. Success is also dependent
on interacting and getting along with other people,
getting them to listen to you, do what you want them
to do for you, and getting them to agree with you or
of these influence factors are learned, practiced,
and used frequently, they enable you to become more
successful, earn a higher income, are trusted more,
and gain a much higher position in your job or
career. All these laws added together creates
charisma. People are drawn to you, trust you
automatically, want to associate with you, and are
eager to listen to what you say--that's charisma.
You've probably been in a group event when someone
walks in who immediately attracts others without
doing a single thing to make it happen.
all high level business people got there by using
the laws of persuasion one way or another.
Physicians can learn these principles of behavior
and use them to advantage in dealing with patients.
My article this month discusses all this in detail.
book about these things that I have found and
recommend you read is
by Kurt Mortensen. His other book,
Laws of Charisma
is just as valuable for any doctor to
read. You'll be surprised about how much you have
missed and could have used in your medical practice.
I've placed myself between a rock and a hard place.
I'm nearing the end of my article series about "Why
Doctors Fail" and I, as many writers often do, catch
a passing thought about one of the rules of
writing----Readers just don't like to read negative
creatives and topics slanted in a negative
direction. However, when most all descriptions about
important issues are painted in a positive stream,
it seems that readers walk away with a silly grin.
Probably that's because they are thinking they were
able to avoid any written
that the reader interprets as mirroring themselves.
recognize that all issues aren't as pretty and
positive as described. There's a downside to about
everything which often is a reminder that something
can be done to turn negatives into positives. If the
negativity points out the areas of thinking, action,
and responsibilities that need improvement. In
medical practice today there is a great need for
physicians and other healthcare professionals to
seek ways to combat the increasing pressures and
deterrents that threaten your medical careers.
Even the worst
punitive criticism about one's own potential
failures can be presented in a manner that is not
only constructive, but also profitable in nature.
This is what is behind my series of articles about
why and how doctors fail themselves in so many ways
that they don't recognize. My contention is that
someone has to point out these frailties to them and
inspire doctors to move up and ahead beyond what
they think they can handle.
The evidence easily
visible today tells us that the majority of
physicians are barely able to maintain a mediocre
medical practice for many reasons. This is exactly
the opposite of the circumstances of medical
practice 50 years ago. Because I watched my practice
disintegrate in front of my eyes as a result of
these changes, not knowing how to rescue it, I
understand the extreme frustration most doctors feel
And, because I had
to find out why I failed, and did. I now know and
understand most of the deficiencies that persist
today that continue to destroy doctors in private
My series of
articles about this issue of medical practice
failure, in my view, necessitates irritating doctors
who read what I write as a means to push them to
recognize their own shortfalls and what to do about
them. I don't write to ridicule, to distract from
the excellent work doctors are already doing
practicing medicine, to find fault, or to cast
suspicion on your capabilities.
Every physician is
capable of doing, improving, growing, learning, and
deciding that they can do considerably more in their
medical practice business part of
practice than they are doing today. The problem is
that the knowledge about how to do it is sorely
lacking. The cure for this problem for most
doctors is obtaining a sound business knowledge
which I have been trying to make them aware of over
the past 8 years.
One of the misleading
aspects of most programs available for improving and
streamlining medical practice business for better
efficiency and income is that upgrading office
business procedures, equipment, and software
sold to you will not resolve the real causative
factors that lead to medical practice financial
The resolution of the
practice failure problem is actually only a single
process, the critical thing. Until physicians
correct the gap in business
knowledge that is
absolutely necessary, medical practice financial
failure will continue indefinitely. I guarantee
Oddly enough, a similar
type issue of brick-walled efforts is now toppling
our own government.
is medical education headed?"
that the future of medical education today has to
require seriously planning for what is being
required of medical doctors in the very near future.
I'm referring here to the rapidly increasing
percentages of graduating medical students who
because of their overwhelming educational debt or
because of the new generation of medical students
who don't want or need to work hard for much of
anything, are choosing to become employed
physicians. The AMA Survey recently reported that at
least 50% of students are choosing that route to
If private practice,
as predicted, disappears in the next few years, then
all medical students will of necessity have to be
taught and trained how to survive as an employed
doctor. Should that be the case, it's logical that
medical schools will become easier and less
stressful for students since all medical students
will be doing the same thing in practice--having
limited practice and independence as an employee.
education will follow the highly promoted concept
today of "Team Health Care" in the future. That's
where patient treatment becomes a matter of
committee decisions exactly as corrupt as we see
daily in our government decisions. It reminds me of
the description of a "committee." ..... where a
committee project is to create a horse, which in the
end results in a camel. Committees have a hard time
agreeing on anything.
Up to now, private
doctors have had the advantage of using every
element of medical education, training, experience
and expertise to give their own patients the best
form of treatment they know to give a patient. When
that means of treating patients converts to a
"team/committee" decision process (where each member
always seems to have a better idea or different way
to treat the medical problem), the medical treatment
options widen, but are not any more reliable than
the patient's doctor would have done anyway.
The supposition that team efforts are better for a
patient than what the patient's own doctor would
have done, has not been proven to be better by
double blind or other studies.
"instant education" by the committee process fills
in all the essential gaps in the medical knowledge
that's necessary to provide the patient with even
better healthcare or treatment, may be a myth.
Of course, in
healthcare you can't possibly know everything so
there is a concept that using a committee to decide
the best care incorporates the knowledge of many
members in order to reach a better treatment than
you can do yourself. And, if that's true and
reliable, then why not put every patient treatment
decision in front of all the medical staff members
where a more complete knowledge base exists, and
therefore much better treatment results?
Then there's the
fact that many members of that committee won't even
be medical doctors, but yet can influence the
decision making without having all that medical
experience and knowledge. The most efficient and
reliable form of control is a dictatorship. So, who
is the head of the committee and does that person
make the final decision?
How does a medical
school curriculum teach a student to handle the peer
pressure, intimidation and coercion present during
any committee decision making process. As an
employee, a physician must be adaptable to what the
decision makers want them to do. That factor means
that the student or young doctor doesn't have to be
medically smart, just learn the easy and common
medical stuff and the rest will be decided by the
"team". I call that "welfare
practice"............treatment is derived from the
entitlements of the team.
Our society and
culture has been educating all of us to get a job.
Meaning that we are all being educated to be
employees, not independent thinkers or
Medical education will have
to shift their curriculums to teach doctors how to
handle medical employment and how to handle being
restricted from using all their medical knowledge.
So, they would not need to be taught a lot of
medical stuff they will never use during their
employment. Maybe that would reduce medical school
to less than 4 years as well.
Somehow all this seems to
be point towards college educational systems that
have succeeded over the years in convincing premed
students that the "getting a job" goal is of primary
importance to them. It follows that these students
enter medical school already mentally predetermined
to seek employment as a physician rather than
private practice. It drives the herd to follow the
leader until all doctors seek the same employment
attraction. Couple that with the new generation of
doctors who also prefer an easier way to practice
medicine, to practice part time, or to consider
medical practice a hobby to do now and then.
Add to those factors the
fact that 50% of female doctors that occupy 50% of
each med school class practice medicine only part
time. Part time practice usually requires being
employed in one fashion or another.
Do you think that medical
education must conform to whatever kind of medical
practice is available to graduating medical
students, such as being employees only?
Or, do you believe that
medical education will not change, regardless of who
controls the practice of medicine and methods of
healthcare in the future?
thoughts that run through my mind often.
It bothers me because I will
soon be the recipient of future healthcare and I
dread the thought that my care or my family's care
will be managed by part time doctors, lazy 9 to 5
physicians, or by team decisions that I consider
unreliable and infected with mixed biases and
Problem of Taking Time To Think"
"Thinking is the hardest
work there is, which is
probably the reason so few engage in it." ---Henry
took me a lot of years to learn how to think, today
at 75 I believe I'm possibly the best thinker this
side of the Mississippi......or not. At least I
practice the process a lot more now than I used to.
I remember Mr. Rose
and his son that I hired as carpenters to build
another room on to our house. He was referred to me
by a friend along with very credible credentials. As
he worked on the foundation and wall construction, I
noticed I would find him
sitting on a
pile of 2x4s quietly pondering something. He wasn't
on an hourly pay setup where I might have believed
he was wasting my time and money, but I was in a
hurry to see the job finished.
So one evening he
was still working when I got home, the perfect
opportunity to ask him why he spent a good deal of
time sitting by himself quietly. I knew it wasn't a
health problem by his sturdiness and carefulness he
used in his work. His answer was probably the first
time in my life that anyone had made me so
enlightened about thinking. He told me that everyone
in life should take quiet time to do thinking about
His explanation to
me indicated that he used thinking to make decisions
about my room construction, organize what should be
done first, or next, and the reasons for it so that
time would not be wasted doing over all the mistakes
that one fairly often made in construction. It also
avoided having to throw away a lot of good lumber
and materials wasted in those blunders---let alone
the increased cost of materials that resulted from
I realized he was
trying to carefully get the job done faster and with
less cost to me, thinking of me and not himself I
suspect. The idea has remained in my mind for all
these years. It brings to mind how much time
physicians waste by not spending time thinking. I
remember all the times I had to wait in the surgery
doctor's lounge for my case to begin because of
delays by the cases ahead of me on the schedule.
Actually, I never saw a doctor reading a medical
book or journal, or managing practice problems on
while waiting, including myself. Waiting sometimes
was far more than an hour.
The same was the
case as I waited on a labor patient to progress
along. That wait time often went for hours and
hours, which some doctors used to go back to their
offices to do work there. But, there are more
important issues here. In such a busy and rapidly
advancing world we take even less time for thinking
through issues and problems, and therefore make more
mistakes in our practices.
If you had asked me
what was happening in the outside world in those
years in practice, I doubt I would have known. In
the early 1970's I didn't see what was happening in
medical practice like the fact that managed care
had been approved by congress and was in full swing.
When I saw my good patients disappearing to the
HMOs, my income dropping, and having to sign
hundreds of participation contracts with the HMOs,
at lower fees, to keep at least some of my patients,
I finally got serious about thinking where I was
going and what I could do---late---but did it.
If I had taken time
to think, and kept in touch with the happenings and
news, I would have saved myself a lot of grief. But,
I was so busy seeing patients, the thought never
entered my mind--a complete distraction by my
solitude the mind gains strength and learns to lean
upon itself."---Laurence Sterne
The same thing
happened to me when suddenly all the medical
malpractice insurance companies left California. If
I had been thinking and watching, I would have seen
this coming down the road. Instead, I went "bare"
for two years until the doctors finally started
their own medical malpractice insurance
organizations and got on board. I even thought of
quitting OB at the time because of the inherent risk
of the specialty.
Lesson: Any medical
doctor that doesn't take quiet time thinking
about the eventual effects things that can and will
demand changes in how they practice, is likely to
always be reacting to their environment instead of
being proactive. Unfortunately, their destiny will
be determined by circumstances and events, not by
personal choice and control.
It's always interesting to me how we travel
through premed, medical school, internship and
residency with the power of our discernment,
diligence, and decision making, yet suddenly stop
using those attributes during private medical
practice. Your life as an employee means you will
always be working for the rich, and all the rest is
done for you by someone else, usually by someone who
is not a physician and doesn't think like a
And that, doctor, is an absolute medical career
tragedy that keeps trimming down our professional
potential and capabilities, crippling our freedom to
practice medicine the way we see that best
accommodates our personal desires, satisfaction,
fulfillment, and happiness in our lives.
Games Are Over, Lick Your Wounds, Protect Your
are so consumed by the agenda of the
Liberals/Progressives that I believe in 5 years our
nation will be in shambles, enough so that the
medical profession as we know it will be a memory.
Our nation is unrecoverable at this stage. By the
time Obama has completed his massacre of capitalism
over the next several years, every doctor will be
forced into the existent Obamacare system of
healthcare, and no such thing as private practice in
any form will be permitted.
The democrats have
locked up the control of our country, economy,
judicial system, and government so tightly today
that only riots and anarchy will be able to change
the downward fall. I say that so emphatically
because I have been diligent in my reading,
research, and reasoning to the point of confirming
in my mind we are in that much trouble.
deadlocked and can't be changed. The increasing
entitlements will guarantee that because of the
voting influence of the recipients of government
handouts who will
vote into office those who will continue the
handouts that they have not earned. It won't be long
before doctors are forced to accept all
entitlement patients whether you want to or not.
Physicians income, salaries, and lifestyle will be
driven downwards like never before---and the silly
part is that it already is happening.
attitudes and optimistic jabberings are a
smokescreen covering up the true political agenda
now visible to anyone who seeks the truth. People
like the generic economist who writes for the New
York Times, Paul Krugman, are saturating the media
with demagoguery in an effort to convince everyone
that socialism is good for everyone. And, that
inflation, printing up more paper money while
decreasing the value of real paper money, is the
means to diversify the wealth---take from the rich
and give to the poor.
It seems clear that
this battle between socialism and capitalism has
been going on for centuries. Three hundred years ago
Emanuel Swedenborg wrote, "It is no proof of man's
understanding to be able to affirm whatever he
pleases; but to be able to discern that what is true
is true, and that what is false is false---this is
the mark and character
of intelligence." Democracy will cease to exist when
you take away from those who are willing to work and
give to those who would not (Thomas Jefferson).
leader, Norman Thomas, said, "The American people
will never knowingly adopt socialism, but under the
name of liberalism, they will adopt every fragment
of the socialist program until one day America will
be a socialist nation without ever knowing
how it happened."
such as Ludwig von Mises (1881-1973), Hans Sennholz,
Kurt Richebacher, Irving Fisher, as well as
financial geniuses such as Robert Ardrey, Peter
Drucker, Leonard Read, Graham Summers, Andrew
Dickson White, Brescioni-Turrroni, Henry Hazlitt,
among others have witnessed and written about the
tragic results of the publication written by John
"General Theory of Employment, Interest and Money."
Keynes provided the rationalizations
necessary for politicians and government to spend
and inflate money endlessly. Our collapse is a
Cuba is a good example of the philosophy of
Keynes. Socialism masquerades as social justice by
rewarding people for reasons other than hard work
and diligence. The problem in our own nation is the
same. Author Richard Mills writes about the recent,
and very first, audit of the Federal Reserve Bank
that dictates our economy today. He writes, "Between
December 2007 and June 2010 the Federal Reserve
secretly bailed out many world banks, corporations,
and governments to the tune of giving away U.S. $16
Trillion dollars, most went outside our own country.
Doctors, if you are looking towards a bright
wealthy future in medicine, you should do everything
in your power to protect what you already
have---after all, in a few years from now you may
very well be carrying weapons that politicians are
now trying to restrict access to--likely already
knowing what will really happen in a few short years
to buy a
a bit on
to me in
in a big
in a few
Ganey--If you don't know what
that is, you'd
better learn fast"
It seems to me......that the oppression,
control, deliberate and intentional destructive
process pointed straight at the medical profession
is now reaching a level of nightmarish height that
hospitals and physicians will be spending more time
trying to protect their asses than to do what we are
taught to do--practice medicine and actually enjoy
This spiral is moving upward so fast that
physicians will not be able in the future to
practice what they were taught, live with the
integrity the profession once had, and retain the
independence of thought and action so important to
the business of and practice of medicine. This
description of present and future medical life is
best exemplified by
Press Ganey is a little-recognized company,
founded in 1985 by an anthropologist and sociologist
from Notre Dame, to comply with the federal
compulsory mandate required of hospitals. The
federal mandate required
all hospitals to do patient surveys about how happy
patients were with their medical care.
Naturally, guess who hospitals turned to at
the time in order to comply--a small company waiting
on the sidelines to do the surveys for them--called
Press Ganey? Oh yes, the company was sold in 2003 to
American Securities, a New York private equity firm
for a reported $100 million.
Let me point out to you a few of the
consequences of this survey mandate that now is
terrorizing hospitals and physicians. I suggest you
read an excellent summary article about this in
FORBES--January 21, 2013--by Kai Falkenberg--titled,
- The theory under
Obamacare: Betting that increased
customer satisfaction will improve the quality
of medical care and reduce costs.
- The teeth that
create compliance: $850 million reduction
of Medicare reimbursement fees for hospitals
with the worst "satisfaction scores" in these
- The dominant force
behind the mandate: Giving patients
everything they want and need to be satisfied
with their healthcare, forces hospitals and
physicians to deviate from what they know is the
right medical care and treatment of patients in
order to comply with the survey scores and
mandate or be punished severely.
- Judgment relies
totally on the patient satisfaction survey
scores: In essence, medical reimbursement
systems, medical liability environment, and
clinical performance score-keepers ensure that
hospitals and physicians will be rewarded for
excess and penalized for not doing enough in
medical care of patients.
- Money drives
medical professional behavior: Employed
physician's compensation is increasingly tied to
their personal "patient satisfaction" scores,
leading to increased over treatment and over
testing of patient's. Hospital fee reimbursement
is directly tied to their "patient satisfaction"
- Employed physicians
salaries rise and fall depending on their
personal "patient satisfaction" scores:
This blackmails hospitals or other healthcare
delivery organizations, who pay the physicians,
to kowtow to the
"scores" mandate to maintain their highest fee
medical services to
patients by paying
employed physicians as much as $10,000 per year
less if their "scores" are low.
- The 2002 CMS
(Centers for Medicare and Medicaid Services)
created a national compulsory patient survey
program for patient surveys and required public
reporting of the survey results: Survey
programs processed 70 million patient surveys in
2011-2012 from 10,000 plus health care
organizations and half of all U.S. hospitals.
Patrick Ryan, CEO of Press Ganey, already has
predicted the next step---surveys of medical
clinics and doctors offices.
- Results of this
mandated patient survey system: Cost of
medical care has increased billions of dollars
just from this one mandate that has no proof
that it will reduce our healthcare costs and
has, instead, added billions of dollars to
health care costs. The Cleveland Clinic now
spends $500,000 a year on government-dictated
Did I just hear a thunderous roar of outrage
shaking my computer off the table? I thought so.
Doctors love to be measured, rated, categorized, and
investigated for their professional clinical care
and backgrounds.......don't they? When I think about
the numbers of sites now "scoring" doctors on public
media such as Kudzu.com,
beenverified.com, healthgrades.com, and others, I
see and understand why the number of doctors is
decreasing at a rapid pace.
You can't hide with your head in the sand
expecting to achieve true success. It would be
foolish to simply roll over and play dead without at
least making use of your creative muscle to avoid
being brought into deeper bondage by the bottom
Fear dependency keeps you searching for a
chink in the armor of increased control of
healthcare, while you should be planning for,
investigating, and finding ways to bypass the issue
of increased restrictions on medical care by
physicians. Instead, be creative enough to discover
one of many ways to do much more with much fewer
options. It's better to light a candle than try to
The ultimate indignation felt by every
physician is evidenced by the government using an
intellectually disgraceful criteria as the basis for
improving health care which is unsupported by any
acceptable measure of scientific study other than,
"It seems like a good idea." Secondly, the surveys
are flawed in multiple ways that begs repair.
Thirdly, the simplest cost estimates to the
government, actually to taxpayers, indicates that
the cost of healthcare is increased by billions of
dollars expecting the results to be beneficial and
The most regrettable aspect of it all is that
physicians and all healthcare professionals are
being involuntarily forced into compliance to a
system that requires compromises in professional
integrity, ethics, and honesty beyond any tolerance.
The insanity of those making the rules goes
beyond comprehension. Unfortunately, the facts won't
be made available to the general public and the
common person will continue to be led to believe
that the government knows best and doctors are too
dumb to realize it.
people are least sure, they are often most
---John Kenneth Galbraith