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Medical Practice Insights 2013

 
 July 2013

Topic: "I 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.

Now that 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 your ideas.

When all 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.

Nearly 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.

The best book about these things that I have found and recommend you read is
MAXIMUM INFLUENCE,
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.

 

 June 2013

Topic: "Tell Me I'm Nuts!"

It seems to me..........that 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 implications that the reader interprets as mirroring themselves.

Most readers 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 today.

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 medical practice.

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 failure.

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 that.

Oddly enough, a similar type issue of brick-walled efforts is now toppling our own government.

 

 May 2013

Topic: "Where is medical education headed?"

It seems to me.......... 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 practice medicine.

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.

Probably, medical 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.

Supposedly, that "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 entrepreneurs.

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?

These are 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 opinions.

 

 Apr. 2013

Topic: "The Problem of Taking Time To Think"

"Thinking is the hardest work there is, which is
probably the reason so few engage in it." ---Henry Ford

It seems to me.......... that it 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 fairly often 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 most anything.

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 that.

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 the phones
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 "busyness."

"In 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 physician.

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.

 

 Mar. 2013

Topic: "The Games Are Over, Lick Your Wounds, Protect Your Family"

It seems to me..........we 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.

Congress is 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 overwhelmingly 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.

The complacent 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).

The socialist 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."

Great economists 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 Maynard Keynes', "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 certainty.

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 from now.

bold handwritten signature of Dr. Graham

 

 Feb. 2013

Topic: "Why Permit Yourself To Destroy Your Own Medical Practice?"

It seems to me..........that any doctor who has dedicated so many years of their lives to get a medical education, without even mentioning the cost of it all, would never permit their medical practice business to destroy all that bloody effort and cost. Yes, you can make a good income practicing medicine in private practice by long hours of effort, increased frustration, and a significant amount of neglect of your family and lifestyle.

All that does is lead to practice burnout, stagnation, and eventual drop of income to an uneducated person's level. It truly also takes the joy out of practicing when you are pushing huge numbers of patients through your office daily just to stay even financially. If you don't believe it, look around at the doctors who are doing this, talk to them, find out why they are doing it--money? compulsion? mindset?

All successful businesses require good management. You can earn high income for a short while, but you learn to keep it, use it, and perpetuate it only by having a sound business that's well managed. If you start a medical practice, you automatically have a small business going. When you intentionally start a medical practice, you have an obligation to yourself to do anything necessary to make the business side of practice function efficiently and profitably---am I wrong?

After all, this business becomes your livelihood, the source of all your income, the goal you have worked for over a decade, and the most important asset that allows you freedom to enjoy your life. So, why do over 95% of medical doctors neglect to do all they should do to polish that machine to perfection? I know, they're too busy curing patients to learn how to run the business for maximum productivity. Maybe, these doctors really don't give a damn anymore about their medical career goals or the income they receive.

I believe the cause of that attitude is "passion burnout" more than anything else. That passion to achieve has been burning in your mind for so many years, you have no energy left for perpetuating it any further. That usually happens once your medical education and training has been completed. It's just a relief to be able to call yourself a "doctor." You can't stop to lick your wounds, the battle isn't over. The same thing happens often in life when you think about it. You wait a period of time to buy a special item or do a special thing and finally do it. You lug it home, unwrap it, try it out to see how it runs, use it once or twice, and they put it away in the closet and forget about it. You're on to the next new passion.

Isn't there something inside yourself telling you that you have a mountain of new stuff to do and you're just getting started? Maybe you do, but you're thinking maybe about procrastinating a bit on that effort? Then it never gets done. The best time to polish your well oiled money making business machine is when you start your medical practice and have the time to establish a business system for your practice. You'll be too busy to do anything like that later on. For most doctors, it's already well beyond
that checkpoint.

You see, the same stuff has happened to me in my practice. Maintaining your passion to make your medical practice top notch is a lot more involved than seeing patients. You create that passion by establishing new goals--ones you likely can reach. Although you hate to do management of your office, it has to be done somehow. You need to educate yourself how to run a business profitably and productively. Medical schools don't teach that and never will. You certainly can learn all the basics of business by reading all my articles on this website, including the books I recommend.

"It's not enough that we do our best;
sometimes we have to do what's required."
                          ---Winston Churchill

Common understanding tells you that no one is forcing you to learn about running a business well enough to bypass your competition, to reach your maximum potential as a physician, or to make yourself wealthy, but it has it's advantages.

No one really cares whether you succeed or not, except for your immediate family who depend on you for survival. After medical school no one is patting you on the back for working hard, doing a good job, or being a great doctor. After 40 or so years of medical practice, there are no parades for you, no standing ovations, no mention in the medical school alumni news except for your obituary, and no one asking you how your practice years went. You get all that stuff from inside, your confidence in yourself, your self-esteem, your patient's feedback, and your personal belief that you are doing a fantastic job despite what others think.  

If you need accolades and recognition, you need an academic medical practice in a big university medical school and hospital where medical research, high status, and your publications worldwide can do that for you.

At the end of the day, your satisfaction can only be fulfilled when you have proven to yourself who you are. Thomas Edison puts it in a few words........

"If we did all the things in life we are capable of doing,
we would literally astound ourselves."
                                          ---Thomas Edison

bold handwritten signature of Dr. Graham

 

  Jan. 2013

Topic: "Press 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 it.

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.

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, "BAD MEDICINE."

  • 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 mandated surveys.
     
  • 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" survey scores.
     
  • 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 reimbursement for 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 surveys.

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 feeders.

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 cure darkness.

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 cost saving.

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.

"When people are least sure, they are often most dogmatic."
                                          ---John Kenneth Galbraith

bold handwritten signature of Dr.Graham

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