Advanced Medical Practice Business and Marketing Ezine    Sep. 2014

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Are you losing your private medical practice because you can’t earn enough to keep it open? It’s because you were never told you needed a formal business education to reach your peak performance!
“They” taught you how to practice medicine, but not how to run a medical practice business, let alone a profitable one.

We are talking here about your need for implementing OFFENSIVE financial business weapons to earn what you want whenever you want.

 You learn these proven and effective business
 weapons and how to use them on this site!

Article #57 -  Sep. 2014

“The Fatal Form of Physician Attrition”

When Suicide accounts for over 400 physician deaths in the United States annually… at least those that are not attributed to drug use, attempted suicide, and mysterious fatal accidents that happen to physicians… it becomes a shocking statistic that essentially removes one medical school’s four-year
classes each year.

Why would you, a physician, care about what happens to other doctors? It’s their problem, not yours, right? You may be sad about your own patient that dies under your treatment, but
does your compassion extend to other doctors?

     The ramifications of these statistics in today’s world of rapidly increasing stress of medical practice predictably will become much higher soon.

     The problem is that the signs and symptoms are commonly camouflaged by physicians who don’t care to expose their deepest thoughts, hurts, rejections, anger, rage, and mistreatment by others in
the profession.
     The sometimes-vicious conflicts between groups of doctors practicing in the same community are far more extensive than the general public believes and that is ever discussed openly. Backbiting between doctors is widespread, but don’t tell medical students about that.

    Just the thought that seeking the help of a psychiatrist for the depression you are experiencing might drastically affect your practice, reputation, and your stability in handling patients.

     You could even get kicked out of medical school under such circumstances, especially at a time when you feel cornered between the intense desire to become a physician and getting the mental help you need at the time.
    Physicians have the highest suicide rate of all professionals, but about the same rate as in the general population. When medical students and physicians recognize… and many don’t… they have a mental problem they rarely share it with their peers for all of the same reasons.

     Instead doctors try to compensate for their mental problems in any way that they can. Many of you reading this may have already have gone through this battle or continue to fight the battle.

     Physicians are smart, learn the ways they can hide the obvious, and set up a habit pattern of managing their mental issues that may last for the rest of their medical careers… if they live that long.

     Continuously having to compensate for your symptoms that often reveal your mental weaknesses is the battle that few ever win.
    That’s because at every turn there are critical medical practice stresses that keep piling up on you and sooner or later you have to decide to do something to reduce
the pressure.

    You become unable to handle everything that stresses you. It pushes you into decision making… the ones that are apt to ruin your life in one way or another.

     Such timing of the decision-making process commonly happens as the result of some triggering event that becomes the last straw and they no longer have the mental clarity to get themselves out of the distress that normal minds could handle in a far more reasonable and transformational manner.

    The American Foundation for Suicide Prevention (AFSP) convened a workshop of 35 experts in 2002 under the leadership of Herbert Henden, MD, professor of psychiatry at New York Medical College. It included representatives from nearly all branches of the supportive organizations that work with and among physicians directly.

    The purpose was to uncover the key aspects of depression and suicide among physicians and medical students and the need to change the professional attitudes and institutional policies to encourage physicians to seek help when needed. The consensus statement was published (Center et al. JAMA. 2003; 289:3161-3166). 
    Tracy Hampton, PhD, published an article (JAMA, September 14, 2005—Vol. 294, No 10) uncovering aspects of Physicians’ Psychiatric Health that contributed to the dramatic elevation in the rate of suicide especially among female physicians.

     Dying by suicide is 70% higher for male physicians than for men in the general population. The suicide rate for female physicians is between 250 and 400% higher for female physicians than for non-physician females in the general population.

    Although the rate of depression among physicians is comparable to that of the general population, physicians’ risk of suicide is markedly higher.  Depression and other mood disorders may be under-recognized and inadequately treated in physicians because physicians might…

  • be reluctant to seek treatment

  • attempt to diagnose and treat themselves

  • seek and receive “VIP treatment” from other health care providers.

    No reasons have been found for the difference in suicide rates among male and female physicians. A heightened rate of suicide is found early as in medical school.

    The various stressor factors commonly associated with depression have been studied and no solid evidence of any of these factors have been found to precipitate
suicidal tendencies.

    The one issue that stands-out regarding suicides among physicians is that physicians are much more apt to succeed at it because of their medical knowledge… and are
good at it.
    A newer focus on diagnosis and treatment of depression and risk of suicide seems to be aimed at medical students. Medical students are intimately interactive with large numbers of physicians during their training and their mental state can be much more quickly recognizable by experienced physicians.

    Help can be offered before students become fixed in their personal protective camouflage patterns hiding their mental state up to the time of their triggering event
for suicide.
    The belief and attitude that physicians can’t practice great medicine when they are depressed, under treatment, and followed by knowledgeable psychiatrists is unfounded.

    The test of your personal feelings about that can easily be determined by asking yourself, “Would you be comfortable with referring a patient of yours to that doctor under these circumstances?”
    You might be surprised about how many physicians around you are receiving psychiatric help and you will never know it. Depressed physicians rarely confide with their medical peers about their depression even when they recognize it is
affecting them.
    The professional obligation you have is to pay close attention to the common signs and symptoms of acute mental stress and depression in the physicians you associate with… then offer to help them somehow.

    One of the more recent and outstanding articles published by Robert Bright, MD and Lois Krahn, MD from the Mayo Clinic Psychology and Psychiatry departments in 2011 on the topic of physician depression deserves special attention (Current Psychiatry, Vol. 10, No 04, April 2011).

What are the predictors of depression in physicians?
    Symptoms of depression vary so much that we have to depend on the predictors of depression. Predictors are the things that are understood to be overly stressful to most people when they happen.

     Most of the predictors are present to some degree in every physician during their medical school and medical practice years.
    During the less stressful time between episodes of severe stress our mind has time to recover from the poison that comes with severe stress.

    When the severe stress is continuous, either because of the weakness of the doctor’s mental defense mechanisms to compensate for or because of the kind of stressors that rarely subside… like marriage conflicts, the depth of the
depression increases.

Think about how these predictors have affected you...

1. Difficult relationships with senior
    doctors, staff, and/or patients

2. Lack of sleep on a regular basis

3. Dealing with death of loved ones

4. Making mistakes either in
    treatments or surgical procedures

5. Loneliness, so common among
    introverted individuals

6. 24-hour responsibility… such as
    in obstetrics

7. Self-criticism… perfectionist as
    a personality trait

8. Peer-Pressure and criticism both
    overtly and covertly 

Better yet, manifestations of mental illness that goes beyond what a physician can hide or can find ways to compensate for...

        1. Severe ongoing irritability and
             anger, sudden bursts of rage
             resulting in interpersonal conflicts
             followed by remorse

  2. Marked vacillations in energy,
       creativity, enthusiasm,
       confidence, and productivity

  3. Erratic behavior at the office or
       hospital (such as... performing
       rounds at 3 am or not showing
       up until noon)

  4. Inappropriate boundaries with
       patients, staff, or peers

  5. Isolation and withdrawal

  6. Increased errors in or inattention
       to chart work and patient calls

  7. Personality change, mood swings

  8. Impulsivity or irrationality in
       decision-making or action

  9. Inappropriate dress, change in

10. Sexually inappropriate comments
       or behavior

11. Diminished or heightened need
       for sleep

12. Frequent changes in job focus
       and/or career moves

13. Inconsistency in performance,|

    As you know, many of these manifestations can result from causes other than depression and can be temporary in nature. Persistency is the tip-off to more serious conditions.

Be Aware : No one is immune to depression!

     Regardless of your level of intelligence, tolerance to stressors, and your power of your self-discipline every medical practice professional is susceptible to depression and the consequences of it.
    A longitudinal study of medical students and residents at the University of California, San Francisco revealed how much of an increase in the depression rate is caused while in medical training and education modes…

  • 15 to 30% higher than the rate in the general population.

  • First and second year medical students depression rate was about 25% above the general population. 

     A study of 123 pediatric residents at three U.S. children’s hospitals by
Fahrenkopf et al revealed that 20% of them were depressed. Follow-up was even more of a concern because these depressed residents made 6.2 times more medication errors than did their non-depressed peers.

Some personality traits can be your enemy...

     Lifetime prevalence of depression among physicians is 13% in men and 20% in women… which are comparable to the general population.
    Even though a Firth-Cozens study of primary care doctors revealed many factors that increase the risk of depression (see the lists above), a Vaillant et al study.

    It showed that they did not significantly increase suicide risk in physicians… at least not in those medical students who did not have underlying psychological difficulties when they entered medical school/college.

    The greatest personality trait predators known to stimulate depression are self-criticism and perfectionism. These two personality traits that most doctors have are silent avengers that work inside the minds
of doctors.
    From a distance, no signs can be seen of such violent turmoil of self-intimidation and guilt feelings, but when these progress into feelings of hopelessness and worthlessness you know that thoughts about suicide and deeper depression are not far behind.

    When observing a colleague’s response to a severe and known traumatic stress situation they have recently gone through, most physicians who care about the welfare of their peers will notice such
behavioral changes.

    Symptoms such as quick temper, declining performance, lack of focus, intolerance of perceived incompetence, and conflicts in relationships, even turning to drug or alcohol use and isolation are a few.

What increases the risk of suicide?

     The relative risk of suicide in physicians compared with the general population is between 1.1 and 3.4 for men and 2.5 to 5.7 for women, according to a review of 14 studies about physician suicide.

    A survey of 4,500 women physicians found that female doctors are less likely to attempt suicide than the general female population. Their attempts, however, are more often lethal, logically because they have greater knowledge of toxicology, access to lethal drugs, and much better knowledge about how to accomplish it.
    Suicide-risk comparisons among the various medical specialties is unknown.

What is it that pushes a physician over the edge?

     General consensus agrees that nearly all physicians are candidates for suicide if the right circumstances exist. This hits home when a depressed physician finally comes to a mental decision for suicide based on lack of reality and reasonable thinking.

    The Silverman study created a profile of a physician at
high risk for suicide, including the following…

  • ·Workaholic white male age 50 or female age 45

  • ·Single, divorced, or currently experiencing marital problems and already depressed

  • ·Substance abuse and history of high-risking ventures

  • ·Chronic pain or illness

  • ·Significant changes in occupational or financial status

  • ·Increased work demands

  • ·Personal losses and diminished autonomy… disability

  • ·Access to lethal means (firearms, medications)

    Protective factors that lower the risk of actual suicide include effective treatment, social and family support, resilience and coping skills, religious faith, and restricted access to lethal means.

    Behavioral studies have demonstrated that decisions between suicide and murder have closely related emotional factors that come-up suddenly as a result of circumstances present at the time.
     It’s why there are laws that require a short period of incarceration for psychiatric evaluation when a lethal weapon is involved and the person is "talked-out" of suicide. This factor is validated by hundreds of murderers who kill people, followed shortly by suicide.

Barriers against getting help...

     Physicians fear exposing their mental weaknesses because of social stigma, trusting a local psychiatrist, confidentiality, and recrimination by colleagues and especially the licensing boards.

    The Givens and Tjia study showed that only 22% of medical students screened positive for depression sought help. And only 42% of medical students with thoughts about suicide tactics received treatment. Basically, medical students had similar fears to practicing physicians.

    With the subjective and often threatening actions of medical licensing boards, most physicians intentionally avoid any action that might lead to a medical board action
against them.

    This is especially true when a physician’s disturbing actions in the hospital forces “restriction” of hospital privileges and they are by law forced to report that action to the medical board… hence, “probation” time is substituted which is not reportable.

    So when you are assisting another surgeon and he or she suddenly blows-up into an unprofessional barrage of expletives not fit for human ears, you have a professional and ethical obligation to try and ease that physician’s pain that you know is underneath it all.

    And it will happen more frequently over time if nothing is said to that doctor and no help is offered.

    Remember to walk a mile in that physician’s shoes. Put yourself in his position as it can happen to you sometime. You may need a reciprocal helper to avoid bad results.

    As you probably know, avoiding any restrictive actions by the medical staff leaders keeps the entire situation away from medical boards and inside the hospital arena. Many physicians in such a circumstance that requires local action choose to accept a period of supervision to avoid privilege restrictions. It’s a smart move.

The lack of distinction between a psychiatric diagnosis and impairment stigmatizes physicians and impedes treatment.

Medical boards function like the crowd at bull fight...

     When the matador is gored by the bull the crowd cheers. When the bull is killed or defeated, the crowd cheers.

     Medical boards are not responsible to the physicians who come before the board for violations. They are responsible to the state Governor who appointed them to the medical board, in a high position of authority
and power.

    It’s true, no matter how many physicians are board members. Board members are satisfied with their actions whether you are punished or exonerated completely, like the crowds at a bull fighting event.

     Recently the
Americans with Disabilities Act (ADA) is forcing medical boards, credentialing bodies, clinics, and hospitals to make similar queries to pursue mental health histories of applicants for medical licensure.

     Among other credentialing bodies, the same investigations are being pushed to sort out physicians with mental disorders that might be dangerous to their patients.

     The Worley study reported a successful appeal to the Arkansas State Medical Board to revise its licensure questions related to psychiatric impairment following a cluster of medical student and physician suicides.
    When the questions asked by the board are too specific about one’s psychiatric history, and the applicant is denied licensure because of truth telling, it increases
suicide risk.

     So they loosened up the questioning enough that applicants don’t need to lie about their psychiatric history.

     Remember that medical board decisions are made by assigned board members that are not all physicians. Consider that board decisions are made subjectively by all members. Their voting is influenced by their moods, attitudes, and opinions at that time.
     I witnessed a complete change in a medical boards favorable decision to that of a unfavorable decision when only one physician board member who disagreed, stood up and proceeded to attack the defending physician with biased opinions, personal insinuations, and remote possibilities of problems stemming from the background of the defendant physician.

     The rant completely changed the favorable vote of every other member of that board to an opposing vote in 3 minutes.

     The "set-up" for that to happen, is something every practicing physician should know about. Board members are from all different medical specialties.

     When, for example, an OBG board member doctor brutally whiplashes the defending OBG physician, the other members of the board hearing the rant have no credible knowledge in OBG to refute the other board member's opinion, insinuations, and personal biases.

     That causes all members of the board being forced ethically and morally to go along with the "bitchin" OBG physician's
derogatory comments.

     The common sense and fair option in regard to this situation is for the board president to delay the board's decision, order a personal OBG doctor interview and review of the defendant physician's situation.

     The board president has the power to do this, however, in the uncomfortable and conflicting circumstances present they rarely think to do this process. A personal attorney for the defendant doctor would see that this is done and save the physician a good deal
of grief.

     It makes one wonder how many other medical board decisions like this occurs in the U.S. annually. No wonder practicing physicians have great fear of being in front
of their state medical board, especially those with treatable psychiatric problems.

     The unchained power of a board member to destroy a doctor's career and life forever continues to be an egregious element of every medical board's vulnerability... and no doubt continues to be a credibility issue of all medical boards.

     Is it any wonder that physicians fear medical boards and their unpredictable decisions and outcomes? I have advised any doctor who has been summoned before the medical board for any simple or complex infraction to always have an attorney
with them!

    Acknowledgement of the psychiatric history and treatment by the applicant does require a deeper investigation of the problem… probably requiring psychological and psychiatric consultations. At least that is a much more realistic means to weed out the
bad actors.

    Changing psychiatric diagnostic terms and definitions creates more confusion. The difference between a diagnosis of depression and bipolar II diagnoses is the difference to an applicant of being board-reportable and non-reportable.

The thrust of it is to persuade medical boards to use screening questions to ensure that they are seeking information about degree of impairment, not simply the presence of a medical disorder.

The problem with physicians treating physicians...

     It’s called the “VIP” treatment which can end up being a friendship courtesy action taken rather than a clinical relationship action. The treating psychiatrist or psychologist has a strong tendency towards under-diagnosing the seriousness of the problem to avoid hospitalization of the doctor and the stigma attached to it.

     In doing so, there’s an increased risk of suicide in a patient
who faces an imminent risk of self-harm and should have been hospitalized for treatment instead. The suicidal ideation can easily be covered up by a physician-patient by saying the right things to throw off the questioner.

What do we physicians do when we recognize that other doctors are depressed?

And what has this article to do with the topic of medical practice business and marketing?

     Are there any more good Samaritans left in our profession? Since state laws having to do with being a good Samaritan and the increased risk of lawsuits against doctors who stop at auto accidents to help the injured have changed the face of physician samaritanism, do you continue to stop to help the injured at auto accidents? It is a risk for medical malpractice litigation.

    Just keeping up with each state’s Samaritan laws is a difficult process in itself. They are all different. Violations of the law are so variable from state to state it requires that you have a printed out copy of the state laws in your car as you travel across those states on your vacation trip.

    I discovered that the risk of a lawsuit for doctors who stop at accidents to assist is more of a risk than I’m willing to take.
    I say that because of my experience as a flight surgeon and flew on over 80 medevac missions in Vietnam where medical supplies and drugs were severely limited.

    Discovery that a Navy Corpsman trained for six months could do everything that I was able to do on a helicopter medevac mission meant that the same circumstances are present at roadside accidents where most people are smart enough to do all that a physician can do to help, until the ambulance and EMT team arrives at the scene.

     I connect these issues with the fact that most physicians who experience or witness an obvious unprofessional happening by another doctor do not want to get involved, walk away, keep silent, and figure he or she will do it again in front of others and one of them will say and do something about it.

    One day I happened to become one of those irate physicians during a difficult abdominal surgery case. It shouldn’t have happened but at the time I felt there was no other choice.

    My surgical assistant was a credentialed surgical assistant male nurse that I had operated with many other times previously. And I had been repeatedly irritated by his previous inattention to the surgical procedure while continuously talking, primarily to the anesthesiologist.
    This patient had extensive adhesions which were attached to the iliac vein and artery. Retractors and their placement were critical to visualizing the dissection.

    I purposely voiced my difficulty doing the process on several occasions, thinking that the assistant would respond appropriately by holding the retractors exactly where I placed them to see what I was doing.

    I even waited for the anesthesiologist to sense my distress and stop communicating with the surgical assistant, egging him on.

    I would place the retractor in the perfect spot and within about one minute the assistant let it slip out of place and occlude my vision and dissection. After the fourth time, I blew up at the assistant and proceeded to dress him down verbally for his poor assisting activities.

    His inattention to a difficult surgery situation was intolerable and later I refused to have him assist me in the future.
    Of course, his arrogance pushed him to deny everything I accused him of. Since I had never done anything like this previously, it shocked everybody in the operating room, silence followed.

    They saw a side of my personality they hadn’t seen before, and it must have scared them all. I was near the end of the procedure so I elected not to demand a new assistant. The assistant continued to talk, but only intermittently after that until I closed
the incision.

    It’s obvious that this assistant irritated other surgeons because of his antics, but nothing was ever done about it.

     I need to connect all the above issues now to describe what may often result from a physician’s behavior patterns, good and bad.

    It’s about how much your behavior influences your medical practice business income and your reputation among your colleagues… and your whole medical career. It all fits into the categories of marketing called public relations, promotion, and customer services.

First, the positive effects of your actions...

1.Your reaction to a peer’s mental problems or suicidal thoughts…

     Perhaps your experiences in the medical profession may be quite different than mine. After my medical practice experiences in the military for 5 years, HMO Kaiser Permanente for 3 years, hospitalist for 5 years, and private medical practice in OBG for almost 20 years, I write about what I have seen throughout my practice of medicine.

    If you are aware of another doctor’s mental problems and make no effort to help them at a time when their deviations from normal behavior become obvious, you will place yourself with the 95% of physicians who do the same.

    If you try to help that doctor when their problems are recognizable, you confirm the great compassion and empathy you have
for others.

    The doctor you helped, even if it was simply to point out to them their own symptoms that they may not recognize as abnormal were abnormal, will always be remembered by that distressed doctor.

    This is especially true when they have not asked you for help them self. When they get better, they will repay you somehow due to a law of attraction called “reciprocity”.

    Other people who know about the help you gave puts you in a position of being in “more demand” and more highly respected in the medical community.

    It also demonstrates that you also have the same compassion for your patients… another valuable attribute that draws
more referrals.

    Saving the life of another physician is no different from saving the life of a patient. It certainly is a badge of honor to be responsible for such an action. Sometimes we do far more for others that no one knows about, but you know the pleasure you feel from it.

    The ongoing debate about how to prevent physician suicide continues with no answers.

    One thing is true; physicians who are trained to recognize the early and common  behavior of those who are most susceptible to suicide are the ones that will have the best opportunity to make the greatest impact on prevention of the suicide.

    A word or sentence of support and comfort spoken at the right time can create miracles to happen.
    You aren’t obligated to perform ongoing psychological counseling. But a few gentle words expressing concern about for their welfare is key to moving them on to the professional counseling level.

The importance of lessons we learn from experience…

If you weren’t reminded about the behaviors of physicians heading for career or life mental problems, how would you know what to look for in your own patients as well?

    Suicide results from a graduated sequence of increasingly strong emotions and feelings. First, we are irritated by something that is usually forgotten soon after. The persistence of the same irritation moves you to anger about it.
    We as physicians often repress our anger, we’re professionals! Ongoing repressed anger over time moves on to significant frustration, as you know.

    Persistent frustration that is not dissipated by some form of release or distraction moves on to depression, usually because of the belief that nothing will change, help is not possible, self-worth declines.

    Bipolar depression is the early and treatable mental problem. Doctors tend to do anything to avoid this problem and to avoid the stigma and effects of being considered impaired, losing referrals, assumed to be unreliable and unpredictable. 

Severe depression pushes the physician to react to their intolerable behavior, otherwise they may have to quit medical practice or be forced to stop practice. When forced to make decisions while under distress, the decisions are made emotionally, not from
reasonable thought.

    Emotional decisions are made without consideration of future consequences. Suicide decisions are commonly made instantly and at an instant when all hope of recuperation seems impossible.
    The decision is often forced on them by a single triggering occurrence that pushes them over the edge, is all they can tolerate. They feel that they have to get rid of the “pain” at any cost right then. Nothing else matters to them.

2. Second, the negative business effects resulting from a doctor's pre-suicidal actions and behavior…

1.    You lose patients when you fail to treat them well. There goes money down the tubes. Temper, bad moods, and lashing out will also cause office staff problems.

2.    The dominant reason that patients quit a medical practice is because of the bad way they are treated.

  3. When your reputation includes a
      confrontational attitude you will
      lose all referrals.

  4. Because patients are your single
      complete source of income in
      most cases, any personal issues
      you have that bothers your
      patients will come home to roost.
      Your demeanor, dress, and words
      can cause far more harm to your
      medical practice business than
      minor mistakes you make in
      treatment of patients.


     Most physicians will look at this article and wonder why I wrote it. Suicide among physicians is not a well tolerated topic of conversation anywhere. But, you have to admit that when it happens it is always a tragedy for everyone around that doctor.

     If this conversation stirs up at least one physician to save another from suicide, it’s worth the time it took to write it. I had no idea about how many physicians commit suicide annually, my guess would have been maybe 50… not 400.

     That amounts to a whole medical school full of medical students and doctors. Considering that about 19,000 medical students graduate medical school each year, we lose 4,000 doctors each decade in our country that could be prevented.

     Further, figuring that each medical doctor averages about 5,000 patients in their practice over time, then the 400 doctors lost to the profession would never get to treat about 2 million patients in their careers that other doctors will have to treat.

     No matter how you look at this issue, suicide of physicians is a huge tragedy that affects many more people than just relatives, family, and friends.

handwritten signature Dr. Graham


"Professional Probe"

 photo of forklift fallen off platform 
							with large bomb on the forks Some dangers we face are more dangerous than others. The most dangerous ones are the ones that are unexpected and life threatening.

Suicide is one of those. The suddenness at which it happens and the symptoms that expose it's probability are rarely recognized or predictable.
Being alert to symptoms leading towards suicide can save lives of patients and doctors if help is offered
right then.

The path to suicide is paved with cyclic depression and mood changes. There is a pivotal trigger soon before action is taken, that, if recognized, can be defused by compassion. A trigger will occur again unless mental treatment is provided.

I often think that being in front of a medical board is similar to attempting to defuse a bomb about the size of the one in this photo.

 Article #65-A

Photo of Dan S. Kennedy, 
						marketing expert "Get Your Marketing Ready For Those Most Likely To Vote YES"

By:  Dave Dee
Last week I read a funny cartoon
about the election …

“The Brilliant Mind of Edison Lee” cartoon shows Orville Edison running for the White House.

An assistant tells him he has a call from Mr. Jones from the industrial polluters association. Edison
takes the call and says, “Bob, for a small campaign contribution we’ll see to it that the EPA leaves polluters alone when we take office.”

Edison hangs up the phone and his assistant says, “Oops… sorry. Mister Jones is on line two. That was the Sierra Club.”

Oops is right. That’s a costly mistake—and
while the cartoon is funny, businesses often make a similar mistake when creating lead generation campaigns.

At GKIC, we teach the marketing triangle. This
system is based on the three components of marketing—market, media, and message—for anything, anywhere, and at any time, at any price, under any conditions. (More about this in Dan Kennedy’s  The Ultimate Marketing Plan and in your Income Explosion Guide that comes with your   Most Incredible Free Gift Ever package.)

Matching the right message with the right market
is powerful and can elicit a much stronger response when you get the “who” right.  And while my Orville Edison cartoon example seems so obvious, somehow, sadly when it comes to lead generation, businesses often get the “who” wrong – and it can be
extremely costly.

It’s what Dan Kennedy calls “Blind Archery.”
It’s when you simply shoot your message out
to a lot of people and hope it will reach
enough of your ideal customers to make
it worthwhile.

Here are five steps you can do to get your
marketing ready so that more prospects say “yes”
to what you have to offer while avoiding this costly mistake. 

1)       Identify your WHO.  In our cartoon
example, Orville failed to accurately identify who
he was talking to. Don’t make the same error.
Before you write a word of copy or pick out your media, take time answer the following questions:

  • Who do you want to respond to your message?
  • Who is your ideal customer?
  • Who is your current customer? (If you can’t answer who your current customer is, then do some research to find out.)

The more accurate you are at identifying your ideal prospect, the more impact your marketing will have. 

2)       Find out what’s important to your reader.  When Orville answered the phone, he was thinking about his priorities—to raise money for his campaign and get votes—not his constituents.

Too often businesses have this same failing. Ask yourself, if you were in your prospect’s shoes, what would make you buy, give money, sign up, respond to, etc. whatever it is you are offering.

If you do not fit your customer profile in your niche, you will need to do some work to understand your prospect and customer’s desires, fears, and motivations. You can do this by doing things such
as reading industry publications and visiting forums. (For a full list of how to get inside the mind of your customer when you are an outsider, take a look at page 19-20 in   The Ultimate Sales Letter.) 

3)      Ask your list broker for the data card.  If
you are renting mailing lists from a list broker, you can ask to see the data card. This will provide you with information about your prospect’s age, gender and types of products they’ve purchased in the past.

For example, if you are selling financial services
you might ask for a list of people who have
previously bought financial programs, magazines,
or newsletters or other financial services through
the mail. 

4)      Use your product or service as a consumer would.   Take your product or service and use it exactly as a consumer would. Open your packaging, read the instructions and labels. Use it as
instructed. Test it. Take it apart and put it back together. If you provide services and it’s difficult to use your own service, consider hiring a secret
shopper to give you feed back.

5)      Examine what has “sold” in the past.  Do
you have a promotion that was particularly
successful or is there something you say in face-to-face sales that works well and has a good closing ratio? Studying what has worked well in actual
selling situations will help you avoid making
incorrect assumptions about your WHO.

Unlike Orville Edison who had the advantage of knowing exactly who he was talking to—had he asked—when you are sending direct mail out, you can’t speak with your prospect to get direct
feedback from him or her.

However, when you take the time to use these five steps to get to know WHO your customer is, you’ll
not only create a more successful campaign that connects with your prospects giving you better results, but you’ll make prospects want to be your customer—and a loyal customer at that.

Want more insider information on how to leverage marketing and sales to improve your business?  Click  here to claim your special free bonus of $633.91 worth of marketing materials.
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Dave Dee  is one of Dan Kennedy's most successful students. Dave saw Dan speak over 16 years ago at one of the Peter Lowe Success Events when he was a struggling magician. He bought Magnetic Marketing and as you will hear when he tells you his story, his life changed in less than 90 days. Dave became a very serious student of Dan's by attending my seminars, joining his coaching group and most of all from implementing what he learned. Dave has become a top flight mentor and expert and is the GKIC Chief Marketing Officer. For more money-making marketing tips, tactics and strategies, go to
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In Every Issue...

My desire is to always offer you the business and marketing strategies that you will need if you ever wish to reach your maximum potential in the practice of medicine whether you are employed or in private practice.

My New  Book

"The Wounded Physician Project"

photo of the cover graphic for the wounded physician project
 Click on the image... for details

Do you really know
the core cause of the medical profession crisis we
are in today?

No, it's not the government. 

 What are you willing to
do to save your private
medical practice?

The average medical doctor in the US practices medicine for 12,617 days and leaves a million dollars on the table during that time.

They never are able recognize that it was available to them during all those years because they lack a business education.

This book is unique because no other author has ever written about the primary cause and solution to today's increasing attrition of physicians and the demise of private medical practice.

Once the reader becomes exposed to the extreme and relentless series of strategic moves organized and implemented by our government to control healthcare, the reader will understand why all physicians must be provided with an academic
business education.

Secondly, the reader will discover the critical importance and practical value of a business education for practicing physicians. Today, most physicians struggle financially while running their medical practice business because of their reliability on their own
business ignorance.

The contents discuss all the benefits and advantages of business knowledge, how to get  it and use it, and quickly reverse the money crunch you are experiencing today.

You probably won't get much benefit from an MBA degree because it's not oriented to medical practice business that demands special knowledge, implementation, and decisions.
     The success principles of all businesses are the same, but the management of those business strategies have to match the passions, objectives, and diligence capabilities of each  physician.

The content is meant not only to inspire physicians to gain business knowledge, but also to get a very clear understanding about how fragile their medical career is to present day economic, political, and social threats.

The ultimate goal of all medical doctors should be to use their business knowledge as a offensive weapon against predators, both economic and governmental, to survive and grow using the business tools I continue to throw at you. It's the only offensive force that physicians have to use to remain in private practice.

I truly believe this is the one and
only solution
for maintaining solo medical practice. This is especially critical to the most popular option---cash only practice---for practicing medicine outside the government healthcare system.

  Order the book 

Available through your local bookstore's order desk or at these online bookstores:

Amazon .com
or by phone
1-888-795-4274 x 7879

I guarantee that the content will stick to your mind for as long as you practice medicine.

Show the world what you are capabable of doing... not what you were expected to do.


Words of Conscience

"Walk worthy of the vocation wherewith ye are called."
---Ephesians 4:1

"A feast is made for laughter and wine maketh merry, but money answereth all things"
---Eccl. 10:19

Borderless Humor

"Sometimes, when I look at my children, I say to myself, "Lillian, you should
have remained
a virgin."

---Lillian Carter
(mother of Jimmy Carter)

Inspiration Time

"The best way to predict the future is to create it"

---Abraham Lincoln

Views I Only Share With My Friends--

What my medical career
taught me...

Click Here... and how it can help you manage your medical practice business at the highest level of expertise.

 Facts And Stats

1. Thinking of getting an MBA??
Articles and Reports about the quality of business schools are seen more frequently today. It seems that a few business schools have closed for lack of funds (no federal money) like the Moxie Center at UCSD.

An article in the WSJ Aug. 2015, by Ken Kuang states that "Moxie failed to teach the two basic survival skills for startups: understanding the concept of 'win-win' and how to forecast profits and losses." Many U.S. business school graduates can't create a realistic profit and loss statement.

This is why I have been repeatedly stated that physicians do not need and MBA, it won't help a physician in private medical practice because the MBA teaches about general business issues unrelated to the medical profession.

2. Business schools responses...
After finding weaknesses in business education programs several schools have begun...

A. Implementing business prog. with enterpreneurship programs

B. Providing undergraduate courses and concepts about business principles and mgmt

C. Creating of two different business ed. programs... regular MBA and Professional MBA

D. Summer business schools prior to the MBA programs

E. More about startup methodology because of the studies showing that prior to 1990 about 25% of MBA grads ended up in self-employed jobs and by 2010 only 5% choose self-employment.

P.S. Physicians have at least one big advantage. They work continuously in an entrepreneurial environment as a necessity for medical practice.

The big disadvantage physician's have is insufficient business education.

 Important Notices

Protect your private medical practice income using the strategies in this eBook, which  contains the keys to your medical practice survival.

  Click on the image below for more details

B uy yourself the most extraordinary experience of your medical career.

eBook,How to propel your medical practice income, cover graphic
"How To Rapidly Propel Your Medical Practice Income To Unlimited Levels In 6 Months"
Click Here When you need expert help and advice, and when...

red arrow pointing to rightyou just don't know where to turn to get honest and reliable help with your battle to fight the external forces that compromise your practice revenue and growth.

red arrow pointing to rightyou want to improve your medical practice income dramatically in a short period of time.

red arrow pointing to rightyou prefer to find the means to reach your highest level of practice income
and productivity.

red arrow pointing to rightyou demand effective and reliable means for preventing the financial collapse of your
medical practice.

red arrow pointing to rightyou are determined to find ways to combat govt. fee restrictions that continue to increase.

red arrow pointing to rightyou recognize that what you are missing in your medical business are implementation of business principles and marketing strategies.

red arrow pointing to rightyou want to do it yourself and save a bunch of money.

red arrow pointing to rightyou are sick and tired of putting up with what you are being forced into doing with your practice to stay afloat.

red arrow pointing to rightyou are aware that no other physician author is making any effort to tell you what to do and how to do it effectively to reach your expectations you had for your medical career when you started.

red arrow pointing to rightyou understand the severity of being in a business without ever being taught the business knowledge to run it profitably.

red arrow pointing to rightyou insist on having a blueprint for your medical practice business that provides every key to your practice success at the
highest level. 

References For Maximizing Your Practice Income

 Read every article published on my website (over 75 medical business articles)
blue arrow pointing down

/article archives

My Other Medical Websites


Paraprosdokian Ideas

"They begin the evening news
with 'Good Evening," then
proceed to tell you why it isn't."


bird on its back feet up in the 
			air--I give up




 Thank you for 
and reading.





 photo of Dr. Graham and his two corpsmen in Vietnam 1965    photo of Dr. Graham early in medical practice    photo of Dr. Graham and his wife Linda    photo of Dr. Graham later in medical practice  photo of Dr. Graham with his medical practice associates

Marine Flight Surgeon Vietnam

1973 Private Practice

 Wife Linda 1985

1994 My office

My Medical Practice Group
Graham, Mayo, Kaplan, Seibert,
DelValle, Chuba

masonic symbolAmerican flag Curt Graham, M.D.
2404 Mason Ave.  Las Vegas, NV 89102
E-mail = cgmdrx(at)
 © 2004-2015  Curtis Graham, M.D.,  All Rights Reserved.