Retail Products Expiring on The Shelf?


Make sure you're not losing money or damaging your patient experience with expiring products.

Have some products edging up to their expiration date? You're not alone.  If you are not sure what to do with them or how to recover the expense keep reading.  We have all at one time or another dealt with slower than expected retail sales and the subsequent back stock of expired products in our storage rooms.  But there are simple solutions to get you back in the black.

Expired products cannot be sold to patients, nor should be housed in exam rooms, lobbies, or common areas.  Do not throw those products away, you have options.  Reach out to your assigned sales representative, they want to keep your business and a good sales rep will do everything to keep you happy.  Depending on the skin care company, sales reps are given car stock to engage new customers.  Many reps will be able to sub out some of their car stock for your expired products.  They can also reach out to their regional managers for additional support, or worst case the company as a whole may buy back the products with a restocking fee.  Another option for expired products is to offer them at deep discounts to your staff or create simple staff contests awarding them with product.

If your products have not yet expired but are getting close you have more options in offloading the overstock.  Cleansers, sunscreens, and moisturizers can all be placed in your backbar for facials, peels, microdermabrasion or microneedling.  Use them in treatments that are bringing in revenue.  If you have 3 months or greater before they expire, promote a simple “Gift with Purchase” to your existing customers.  Purchase an IPL package and receive a free sunscreen or free retinol with chemical peel series.  Finally, if you find your practice is not happy with a skin care line and are looking to bring in a new line.  Many skin care companies will offer competitor buy backs with your opening order.  Just remember keep your opening orders as small as possible with as few SKU’s as possible.

Now that you have options for those products, here are a few tips to avoid repeating the past. When you get a new shipment of products in, have your staff check expiration dates on arrival. If you have less than 18 months to expiration, send the products back.  Most sunscreens and anti-aging products have a 2 year shelf life.  Make sure your practice gets full advantage of those 24 months.  Check your sales history before ordering and order as small a quantity as possible, no need to keep a stockroom full of products.  Well, unless it’s Aquaphor, that stuff lasts forever.

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Nancy Miller, RN MBA

Experienced Executive Director Of Operations with a demonstrated history of working in the health wellness and fitness industry. Skilled in Healthcare Information Technology (HIT), Electronic Medical Record (EMR), Health Insurance, Nursing, and Clinical Research. Strong operations professional with a Master of Business Administration (M.B.A.) focused in Health/Health Care Administration/Management.

Reduce Complications after Laser Treatments with This Simple Assessment

Skin Hydration, a simple but often overlooked assessment in preventing complications after laser treatments. We are all accustom to screening for sun exposure, use of topical agents, and medication history prior to administering a laser treatment.  But we often overlook assessing for skin hydration. Lasers target specific cromophores (Melanin, Hemoglobin, and water) and deposit heat energy. Dehydrated skin will respond very differently to a set energy level than hydrated skin.  As skin tolerance is reduced likelihood of prolonged redness, small burns, and infection increase.

Conduct a simple physical assessment focused on temperature turgor and moisture level; take a quick patient history of hydration status including level of alcohol and caffeine intake. And finally, if you have a Wood’s lamp handy a quick view will provide a confirmation of your assessment.

If you find the patient is dehydrated be conservative with your energy settings. Dehydrated skin will be more sensitive and healing time will increase. Pay special attention to ablative lasers that primarily target water, you may even consider postponing their treatment until their skin hydration improves.
Educate your patient on hydration health, products to improve transepidermal water loss (TEWL), use of humidifiers in the home, etc.  Their skin will thank you as and their outcomes will be more predictable and effective.


Nancy Miller, RN MBA

Experienced Executive Director Of Operations with a demonstrated history of working in the health wellness and fitness industry. Skilled in Healthcare Information Technology (HIT), Electronic Medical Record (EMR), Health Insurance, Nursing, and Clinical Research. Strong operations professional with a Master of Business Administration (M.B.A.) focused in Health/Health Care Administration/Management.

Picosecond Lasers – Do I need one, and which one to buy?

picosecond lasers

Guest post by Dr. Steven Ang

This article is a personal review of some of the Picosecond lasers currently available in the market. The relevant distributors in Singapore had provided information on these lasers, when the machines were tested in November and December 2016.

The first commercially available Picosecond laser was the Picosure, introduced by Cynosure Inc about four years ago. Since then, more of such lasers have entered the market. When launched, the Picosure was a 755 nm Alexandrite laser, but Cynosure has since taken measures to introduce two other wavelengths, 1064 nm and 532 nm. All the other companies primarily used the 1064 nm and 532 nm wavelengths, in addition to other wavelengths. These wavelengths are usually introduced to tackle the problem of removing stubborn green and blue inks in tattoos.

For anyone contemplating to purchase a Picosecond laser, the first question that naturally comes to mind is: Is there a need? Is the Picosecond laser really superior to the more commonly available and much less expensive Nanosecond Laser?

According to a systematic review article in the journal, Lasers in Medical Science, in September 2016, the Picosecond laser had not proven its superiority over the Nanosecond laser in the removal of blue and black tattoos. However, in the same journal in February 2017, Forbat, Ali and Al-Niaimi posited in a letter that the applications of the Picosecond laser could extend beyond tattoos to pigmentation reduction and tissue remodeling.

On deeper analysis, the Picosecond technology is rather persuasive. The idea seems logical that when the pulse width is narrowed, laser energy can be more efficiently converted into the mechanical stress needed to fracture particles into smaller fragments, which are easier for the body to remove, and there is less risk for side effects. When used in the removal of tattoos, for example, the notion that the laser exerts a photoaccoustic effect and not a photothermal effect, appears reasonable. Therefore, this can shorten the number of treatments needed.

In evaluating which laser to purchase, I believe you need to consider the following factors:

Is it effective? For this, you can look for published studies and also news about the lasers. One limiting factor is that since Picosecond lasers are relatively new, there may a paucity of studies, and even if available, the sample size is usually small. You should try out each laser for yourself to determine the relative efficacy.

What are the technical specifications? 1000 picoseconds equal 1 nanosecond. To me, in a simplistic way, the lower the wavelength is in picoseconds, the more potential it has. If a greater range of power and fluence is available, the more flexible it is. It is arguable whether you still need a Nanosecond mode, but it is always reassuring if the mode is present.

What is your primary reason to purchase the equipment? I believe that in Western countries, the primary reason is to remove tattoos. In Asia, the main reason may be to treat hyperpigmentation like melasma.

What is your budget? The Picosecond laser doesn’t come cheap and you need to set aside a budget of about USD$200,000 or more. You need to plan carefully to optimize your return of investment.

Are there any local factors that may influence your purchase? For example, the strength of representation of the distributor/agent in your state/country is important. The major manufacturers usually have their appointees in each state/country. The track record of the distributor/agent in servicing and repairing machines is important. Another local factor to consider is whether the machine can be used on your local electricity grid or whether you need to make special adaptation.

Should you buy a new machine or a used one? Because of the short history of the Picosecond lasers, there may not be many used units in the market. Check the usage clocked, the ease to service the machine and the potential costs to service and if need be, repair the equipment.

I have reviewed the following Picosecond lasers: The Discovery Plus from Quanta, the Pico Plus from Lutronic, the Picoway from Syneron-Candela and the Enlighten from Cutera.

A comparison is given at Table 1.

Name of Laser


Discovery Pico Plus

Pico Plus





Quanta System S.p.A

Lutronic Corporation



Wavelength 1


Nd: YAG 1064 nm

Nd:YAG 1064 nm

Nd:YAG 1064 nm

Nd:YAG 1064 nm


PICO, pulse duration

Maximum energy

450 ps

800 mJ

750 ps

600 mJ

450 ps

400 mJ

750 ps

600 mJ


Q-switched, pulse duration

Maximum energy


800 mJ


800 mJ

Not applicable

2 ns

600 mJ


Opti-pulse, pulse duration

Maximum energy

6ns + 6ns

1.2 J

Not applicable

Not applicable

Not applicable


Photo-thermal, pulse duration

Maximum energy

300 ms


2 J


Not applicable

Not applicable

Wavelength 2


FD Nd:YAG 532 nm

FD Nd:YAG 532 nm

FD Nd:YAG 532 nm

FD Nd:YAG 532 nm


PICO, pulse duration

Maximum energy

370 ps

300 mJ


375 ps


750 ps

300 mJ


Q-switched, pulse duration

Maximum energy

6 ns



Not applicable

2 ns

300 mJ

Wavelength 3


Ruby 694 nm, QS, 30 ns, 1200 mJ

595 nm Gold Toning

785 nm

Not applicable. In the process of introducing 670 nm


PICO, pulse duration

Maximum energy

Not applicable


Will be in picoseconds, not available in Singapore yet



Q-switched, pulse duration

Maximum energy

30 NS

1200 mJ


Not applicable

Not applicable


Photo-thermal, pulse duration

Maximum energy

2 ms




Not applicable

Not applicable

Wavelength 4


Not applicable

660 nm RuVY Touch

Not applicable

Not applicable

Fractional laser or equivalent


Yes, 8 mm fractional round hand piece

Yes, Focused Dots 1064 nm

Yes, Resolve hand pieces

Yes, Micro Lens Array Fractionated System









Versatile. High energy.

Many types of hand pieces with different wavelengths.

Easy to use and ergonomic. Size fits in any office.

Known for PICO Genesis in skin toning.

In conclusion, whichever machine you purchase, there is bound to be some element of regret as each machine has its relative strengths and weaknesses. It is only human to always think that the grass is greener on the other side. Just make a decision and move on.

Have something to say? Write a guest post on Medical Spa MD.

Regenerative Aesthetics: A New Dimension to Anti-Aging

regenerative aesthetics

Guest post by Dr. Kavita Beri

Discussing regenerative technologies and procedures with your patients.

Aesthetics and Anti-aging is an exciting field in modern medicine. New technologies, procedural devices and cosmeceuticals make it an ever changing and expanding specialty.  As physicians, we are challenged to stay on top of what is new and what your patients hear and see on the media. As important as it maybe to stay in touch with the latest trends that surface the cosmetic and aesthetic world, having a strong foundation in Anti-aging physiology will help us make better choices in terms of what we would like to offer to our patients.

Regenerative aesthetics adds a new dimension to anti-aging skin care.  Our body has an innate ability to heal and regenerate.  Aging slows down cellular processes, but can we make treatments focused on maintaining the machinery that the skin is already equipped, with instead of just bandaging the surface.  Making aesthetics and anti-aging a holistic entity with services that help mind body and spirit stay in- tune with healthy skin will offer a wide array of options and services to your clients.  This will not only help clients be satisfied with the treatment they are getting for the skin but also have a “feel good” component that is longer lasting. The most interesting component of regenerative aesthetics is looking at aging skin as an ongoing chronic inflammatory process that is occurring over the years. Targeting this chronic inflammation by the various factors that influence it, will include a nutritional approach, lifestyle approach and anti-stress approach to helping the skin regenerate to its best.  To heal from any ailment, eating a healthy balanced diet, avoiding stress, having mechanisms coping with stress and of course having the mind be in tune with healing, helps the process tremendously.  Having information on lifestyle, healthy nutrition will give you clients more confidence in the care they will get from you. My experience has been, an honest approach to patients seem to get them to understand their own expectations and then can channel them to what they are looking to change about themselves. I make sure to tell my patients that it is so important to visualize themselves with healthy skin, having a mind focused in a positive image will help the anti-aging aesthetics be more effective. Personally, with my clients, they have LOVED this idea, and have made beautiful progress not only in having healthy skin as they are aging but also to understand their expectations and be more content with themselves.

I never forget to mention to my patient in the initial consultation: that there is nothing out there that will make the clock-” stop” from ticking…..and so starting  with the Truth….we will be able set our goals more realistically and bring light to a beautiful and dynamic field of regenerative aesthetics.

Marketing Strategies to Retain in 2017

Here's where you might look to focus your marketing and advertising efforts from the experts at

Like with any other retail, direct-to-consumer business, cosmetic medical practices need to be exposed in the digital world as there is a shift with marketing online. After all, 90%+ of your potential patients will start their search for a provider solution online, even if you're local and well known.

So, what do you do?

The first step is understanding that you have two different types of marketing; farming and hunting.

Hunting-marketing is what you're doing when you're buying advertising. It can work, but once your ad run is over, you're pretty much done.

Farming-marketing is somewhat different. Farming demands some work up front, but there are benefits that accrue long after that work is completed. Things like SEO, patient referral programs, customer service, front desk videos and other areas touch more of farming than of hunting. The main difference with farming is that you often own the distribution platform rather than just renting someone elses expensive space. The challenge with farming is that it's often not a quick-win but performs more like compounding interest.

There's need and a place for both.

Social media is [STILL] one of the best areas to get in front of potential patients

Social media is going nowhere. Almost everyone is hooked on their phones, stuck on their social media accounts finding something new or posting updates. Twitter, Facebook, Pinterest, and among others can be used as an avenue to get new patients. With the right hashtag and relevant content, you can access new patients. Make sure that your content is new and up-to-date with the current technologies and procedures available to patients.

As for your present pool of patients, you can always show them your newest procedures or convince them you are still their go-to physician. New technologies and procedures are created and developed every year, and you could show your patients that you offer those that would help you in your practice. Not only that, people would see you as an expert of new methods in cosmetic medicine and you are constantly learning to improve your practice.

The goal here is to add value so that you're not muted. If the only thing you ever do is hard-sell your services or blather on about how great you are, well, you're stuck in first gear. Get your head out of your ass and figure out how you can serve your patients by teaching them something that they didn't already know, and that they value in some way.

It's not about you. It's always about the buyer.

Keep your website updated

This is crucial with any business since search and your rankings are critical to the top of your marketing funnel. If you keep your site the way it went live the first time a few years ago, it may not look good, and the search engines can see the tumbleweeds blowing across the page. (They don't like that.)

Internet users want to look at a modernized site that has a quick loading time and is easy to use and navigate... AND it's critical that it works on mobile devices, especially phones. Do not forget to update not only the look of your site, but also the information housed in the website. You do not want an old telephone number or a defunct email address on your CONTACT US page that may cost you your new patients.

Update your site regularly... meaning that you should have some content that changes every week or so (which is why blogging is so effective).

Positive reviews

This is the lifeblood of every doctor. Reviews help new patients discern if the physician would be the right fit for them. Teresa Iafolla of eVisit says that you may need to urge and encourage your patients to write reviews about you, your clinic, your staff, the procedure and anything else. Put them up on your website or broadcast it over your social media accounts, chances are patients will find them.

Beware of posting fake reviews or 'buying' reviews online. If you get caught the search penalties can be pretty severe.

These are simple tips that you may have to apply on your website or social media accounts to build your online presence further. You don’t even have to pay for these strategies either. While these are simple, it could go a long way. Do not forget these tips and it may help boost your revenue and sales.

If you have any questons, visit us at and fire off a question. We've been growing cosmetic medicial clincs and medspas for more than a decade and will be hapy to help.

Handling A Bad Online Review Of Your Medical Practice

Dr. Lawerence Broder of Beleza Med Spa in Austin, TXGuest Post by Dr. Lawerence Broder of Beleza Med Spa in Austin, TX

Online review sites have done a lot for promoting practices for many doctors who have worked hard to establish a good reputation among themselves and their staff. Unfortunately they can also do a lot of damage when vindictive or disappointed patients go out of their way to leave negative reviews on these sites; some true statements of less than stellar service and other negative reviews that aren’t quite accurate. It seems that those who have a complaint are twice as likely to make the effort to make their grievances known so learning to handle these bad reviews and perform the proper damage control is essential to keeping your practice in good standing.

As mentioned, there are generally two types of negative review circumstances, one in which the patient or consumer has a valid, accurate complaint for a service that was less than what it should have been and they were let down in receiving care that was less that you hope for from your staff. Then there are those whose expectations are probably not in alignment with what you provide as a practice and may have unreasonable demands or are easily aggravated.

When a client has been let down by an off day at your practice, the best move is to take responsibility for the situation sincerely and offer both an apology as well as a remedy for the disappointing service. Recognize that replying to a negative review is often an opportunity to prove your genuine interest in your patients by responding to their complaints. Those who have a legitimate complaint should be handled professionally and an offer for a redo might be suggested. Some irrational complaints are bound to occur, but this still provides an opportunity to respond with a level head and a rational comment so that others who might come across the review can judge for themselves between the two comments. Regardless of the nature of the complaint, even if it’s completely absurd, be sure to respond to show that your practice hears the complaints and feedback of their clients regardless.

It’s important to maintain brand consistency when responding to reviews online by responding with a name that coincides with the practice instead of your own personal account or name. The name you respond with should show the name of your practice as well as your title as the owner or main practitioner. If you have someone else who manages your social media accounts on your behalf, make sure they login with the appropriate account before posting.

Work towards transparency in all your online messages and responses. Instead of working to hide any negative feedback (which can make it seem as though you’re brushing negativity under the rug), respond professionally and resolve matters as they come up. This will help in building a reputation as a trustworthy practice that provides top notch service and fixes their mistakes when necessary.

Dr. Lawrence Broder is a cosmetic surgeon and founder of Beleza Med Spa in Austin, TX. Dr. Beleza now has 5 locations in the area and is one of the most successful medical spas in Austin.

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Five Tips to Maximize the Value of Your Medical Spa Practice

medical spa value

Maximizing the value of your medical spa.

Guest post by Dr. Lee Laris, Medical Director and Chief Cosmetic Surgeon at Phoenix Skin Medical Surgical Group in Phoenix, Arizona.

Would you like to improve the value of your medical spa practice? We’ll share simple tips to get the ball rolling: Here are Five Tips for Improving Medical Spa Practices:

1. Cut Through The Clutter – there’s an avalanche of information regarding ways to better one’s medical spa, especially by general practitioners. The truth however, is that each practice has its own set of rules that are relevant to improving profit margins and patient satisfaction.

A cosmetic surgeon who you befriended during general medicine training may’ve had phenomenal success – by adding just about every gem of cosmetic surgery on the planet to its menu of services. In a medical spa, however, this rule may not apply. It’s therefore important to discern what’s good and bad – and relevant to a medical spa’s niche.

2. Get Acquainted with Accounting – if you want to run a lean-mean medical spa machine, get familiar with numbers – fast.

Even though you’re in the business of medicine, it overlaps with the business of business. As a B2C company, an appraiser will explore several areas when assessing the business’ value, including monies, business model and how marketing is being conducted. By learning each area firsthand, you’ll know where to plug the loopholes, and add more value to what’s already being done.

3. Divide And Conquer – from the get-go, improving the business’ value may seem like an overwhelming feat. You’ve managed to build a tidy empire thus far, but how can new changes be applied, without disrupting the day-day-business, or affecting the quality of care?

Project managers are available to discuss the application of value add-ons, including name changes or new pricing strategies. One very important agreement to compose with a lawyer would be a non-compete contract, to eliminate the risk of current staff starting a replicated version of the medial spa.

4. Exit Strategy – once there’s value added to the medical spa, and a certified appraiser is able to confirm a substantial increase in the growth and revenue of the medical spa, application of the exit strategy will be in effect.

The exit strategy should be composed well before the implementation of the plan, and some suggestions include using the perfect timing. Just as how it’s easier to get a job while on a job, most medical spas will sell for faster and higher when it’s currently a booming one. An accountant or lawyer can help.

5. Legal Ties – it goes without saying that running a medical spa practice takes hard work and dedication. Still, if there are no legal contracts in place for employers, business partners and patients, the practice will likely succumb to a fall. Don’t allow this to happen. Consult and retain a top-notch lawyer to periodically review old contracts and scheme up new ones. The laws are furthermore changeable, so it’s essential to keep up.

The Benefits of Implementing Strategies

  • Legacy – for years to come, most medical spas will bear the same name, since this is what patients will be accustomed to. Though nothing is guaranteed, chances are that owners can pass on a legacy in their name, and one that was built from the ground up.
  • Client Retention and References – while you’re busy working to add value to the practice, customers will be busy booking appointments due to the quality of services. Customer retention and referencing also lowers the advertising budget, and eventually return customers will make up a large part of the business income.
  • Higher Profit Margins – value add-ons means making more, during the ownership of the practice, and ultimately when an offer for sale is made.

There’s always room for improvement in any practice – including medical spas. If this is your passion, and you’d like to ardently grow, seeking out the most effective ways to upgrade is the way to go.

About: Dr. Lee Laris graduated from Gannon University in 1981 and continued his education at the College of Osteopathic Medicine of the Pacific where he received his Medical Degree in 1987. His internship was completed at Grandview Hospital in Dayton, Ohio.

Dr. Laris is Board Certified in Hair Transplantation and Dermatology and is a member of the American Osteopathic Association, The Arizona Osteopathic Medical Association, The Osteopathic Physicians and Surgeons Association of California and the American Osteopathic College of Dermatology.

Fee-splitting Botox & Restylane In Medical Spas

Fee-splitting Botox & Restylane In Medical Spas

medical spa fee splitting for botox and restylaneHave you ever paid a commission for Botox and laser treatments? Although it’s very common ... it’s also very illegal.

During the past several years, a very troubling trend has developed in the medical spa industry. Nurses, nurse practitioners, physician assistants and laser technicians are being paid by commission in order to incentivize them to bring new business into the spa. This is very lucrative for both the spa and the individual, but unfortunately, in most states, it is illegal.

However, by accepting commissions for Botox treatments, she was engaging in illegal fee-splitting. Not only could she face significant monetary sanctions if she continued to do so, but both she and her supervising physician risked immediate suspension or revocation of their licenses if the state learned she was taking commissions.Fee-splitting refers to dividing or sharing fees from medical services between a physician and a nonphysician. In most states, all fees generated for medical treatments must be paid directly to a physician or physician-owned corporation. No one other than the physician—including nurses, physician assistants or any nonphysician medical practitioners—may receive any share of a medical fee.

Although the prohibition against fee-splitting has been on the books in most states for years, the practice of paying commissions has become quite prevalent in the medical spa community. This is probably because, in medical spas, most medical directors do not want to spend time firing lasers or injecting since other services can be more lucrative. As a result, injections and laser treatments are delegated to other medical professionals, who, in turn, develop a large client base. An easy way to compensate those professionals is to pay commission.But the consequences for fee-splitting are severe. In most states, the state licensing board has the power to revoke, suspend or refuse to renew licenses in response to fee-splitting allegations. Accordingly, regardless of the monetary incentives, it is always advised to avoid paying or receiving commissions. A safe alternative to fee-splitting is to use a pre-set bonus structure—the nonphysician can still be rewarded for performance, but the bonus is not related to the number of treatments performed.

Recently, a client called me with an urgent concern. This client, a registered nurse in Chicago, worked in a medical spa as an injector and laser technician. She was well-compensated: In addition to an hourly salary, she was also given a commission—a percentage of net revenue—for every Botox and laser treatment she performed. And boy did this nurse perform—during the past 12 months, she personally had generated more than $350,000 in revenue for the spa.

Her concern arose from a conference she had recently attended where she learned that most states have laws prohibiting fee-splitting. She was informed that taking commissions on Botox and laser treatments might land her in hot water with the state nursing board. She explained that this didn’t make sense, given that she had been receiving commissions for years, and that the physicians who paid her surely wouldn’t risk their licenses by doing something illegal.

It is imperative for any medical spa professional to seek legal counsel immediately if being paid a commission for medical treatments. The laws of each state vary and are often difficult to find, but as is often the case, ignorance of the law is never an excuse.

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Thoughts On The "Ideal" Breast Implant

Thoughts On The "Ideal" Breast Implant

Guest Post: Aaron Stone MD

Thoughs on the Ideal silicone / saline breast implant.

The 2 main types of breast implants available for decades have been the saline filled an silicone gel filled breast implants. Each has its pros and cons.

Silicone gel implants have a more natural feel and look. Unlike silicone gel, implants containing only saline do not blend well with surrounding tissues at the edges of the implants. This is due to the chemical properties of salt water which is chemically charged as positive and negative charges that attract each other as opposed to silicone gel which does not carry a charge. Thus saline is more cohesive than silicone. What this means in clinical terms is that saline implant margins are more visible than silicone gel implant margins, especially when the soft tissue (breast gland and fat) between the outside world and the implant is thinner. Thus, in those patients with smaller breasts (less glandular tissue and/or fat) it is preferable to place saline implants under the chest muscle.

Saline implants may look very good when lying flat on a table. However, when upright the upper portion of the implant collapses (wrinkles or ripples) as the cohesive saline falls

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The Other Side Of Medical Tourism - A Surgeons Nightmare

The Other Side Of Medical Tourism - A Surgeons Nightmare

Medical TourismGuest post by Samuel Bledsoe MD

There is an element of a gamble inherent in the medical tourism industry as it currently exists.

An interesting thing happened to me at work the other day.  It was Friday afternoon, and I received a call from a primary care doctor. The phone call began with, “I’m really sorry about this, but I have a surgeon’s nightmare in my office.”

This is not a good way to begin a conversation.

He began to tell me about the patient. This particular woman had a Lap Band placed several years ago. For one reason or another, she decided that she would like this converted to a different procedure. She drove by my hospital to get to the airport, hopped on a plane and flew over hundreds of other well-qualified bariatric surgeons in order to reach a surgeon in Mexico where she had her Lap Band removed. She then returned 6 months later and had a sleeve gastrectomy. This is where things go bad.

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Google +: A Refreshing Chapter In Social Media

While hesitant to try yet another Social Media platform, I have left thousands of Facebook fans behind for Google + (and so should you...)!

Guest post by Craig Koniver MD

I know, I know, another social media platform is about all you need to read about these days. From Facebook to Twitter to Pinterest to Instagram to Foursquare, it always seems as if there is another "latest" and "greatest" social media platform to pay attention to. But, trust me when I say this, I think Google + is THE one to pay attention to. And here are some reasons why...

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Physicians + Lifestyle Design

Physicians + Lifestyle Design

By Greg Bledsoe MD MPH

Over on Freelance MD, I've posted a couple of articles about taking responsibility for yourself and "building your own ship" , and we've also gone through a few common reasons why physicians aren't the best at career modification.

In this post, I'd like to spend a little time introducing you to the idea of "lifestyle design," something that has become a bit of a buzz-phrase in the business world but as far as I can tell hasn't penetrated the world of medicine just yet (for a lot of reasons).

I'll begin with a personal story...

When I jumped off the academic track in 2006, I wasn't exactly sure what I wanted to do as a career but I knew I wanted something unique.  My idea was to design a career that was flexible, fun, adventurous, and meaningful, all the while paying my bills and being a responsible spouse and parent.  Simple, huh?

I spent months thinking about how to do this as a physician.  I searched websites and blogs.  I spoke with mentors and colleagues.  I read the literature, all to no avail.  There seemed to be no conversation about a career like this in medicine.  I mean, there were a few articles about volunteer opportunities or non-traditional careers, but nothing really like what I was trying to create.

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Patients Billing Their Doctors For Being Late

Guest post by Pam Wible MD

Should patients be holding medical spas or plastic surgeons to the same standards as other businesses?

Meet Elaine.

We lost touch for a while, but caught up with each other recently.

Like most girlfriends, we shared adventures of love, travel, and work. I told Elaine that I left assembly-line medicine. Now I host town hall meetings-inspiring citizens nationwide to design ideal clinics and hospitals.

Elaine shared: ”If I’m kept waiting, I bill the doctor. At the twenty minute mark, I politely tell the receptionist that the doctor has missed my appointment and, at the thirty minute mark, I will start billing at $47/hour.”

Wow! I had to hear more.

Elaine scheduled her physical as the first appointment slot of the day. She waited thirty-five minutes in a paper gown before getting dressed, retrieving her copay, and informing the receptionist to expect a bill. The doctor pulled up just as Elaine was leaving.

Prior to her initial visit, Elaine signed the standard agreement outlining no-show and late fees. On follow up, Elaine knocked on the door and discovered her therapist with another client. He apologized for his scheduling error. Elaine sent a bill; check arrived the following week.

Elaine values herself and her time.

When the Comcast guy told her to wait at home between 3:00-6:00 pm, she said, “Expect a $141.00 bill. Is that okay with your boss?” A compromise: The driver agreed to call fifteen minutes ahead of arrival.

I was intrigued. Who pays for waiting?

Cab drivers charge hourly for waiting. Restaurants may provide a discounted meal for the inconvenience. Airlines cover hotel rooms for undue delays. Some physicians apologize. I offer a gift.

Central to medicine is a sacred covenant built on mutual trust, respect, and integrity. What happens when physicians fall into self-interest or self-pity? Or when physicians are so emotionally, physically or financially distraught by their profession?

Patients suffer. And their wait times increase.

So what’s a doc to do?

  1. Remember: Respect is reciprocal. If physicians are on time, patients will be on time. If physicians don’t cancel appointments with little notice, patients won’t either. Doctors should stop charging fees they are unwilling to pay themselves.
  2. Functional clinics attract functional patients. Patients fall to the level of dysfuntion within a clinic. A chaotic, disorganized clinic attracts chaotic, disorganized patients. Take care of yourself; uphold high standards and healthy boundaries.
  3. Don’t wait. Doctors should apologize for delays. And if presented with an invoice for excessive waiting, doctors should gladly pay the fee. Fortunately, most patients don’t bill at the doctor’s hourly rate.

My opinion. Share yours:

About: Dr Pamela Wible is founder of Ideal Clinics and writes at Freelance MD.

Is Social Media Worth Investing Your Time & Energy?

Is Social Media Worth Investing Your Time & Energy?

By Craig Coniver, MD

With the spreading of social media into nearly every aspects of our lives, it is worth pausing and reflecting upon their value.

Are you tweeting yet? Posting to your Facebook wall? How about connecting through LinkedIn? How big is your cirlce in Google+? With the onslaught of social media, there is mounting pressure to join each network, manage conections and monetize these various social media outlets. It seems as if social media has become the dominant measuring stick for how well you are doing as a business and how well you are connecting with others.

And while I think social media is something to be embraced, I do not think every outlet is for every person. Nor do I believe that social media serves as any type of barometer in your life (professional and personal). In fact, I think the more you are selective about where you garnish your social media energy and attention, the better you can use social media to your advantage.

Before I get to the specifics of the most popular social media outlets, I want you to come away from this article with one main point: social media presence does NOT equate to success. There is a lot of advice coming at us telling us to join all of the social media networks, trying to convince us that the only way to grow our business and connect with people is by creating these various outposts/hubs to connect with others.

The truth remains, however, that most of the time you can spend a lot of time and energy creating and maintaining these various social media outlets without actually realizing much results. And so while we embrace social media in medicine and beyond, we need to be cognizant as to the actual role of each social media outlet is providing for us. I think a better perspective is "what can I do for social media" not "what can social media do for me".

Let's review the major social media outlets. For each I will give you my personal experience and opinion:

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Can Nurse Practitioners Offer Botox?

Can nurse practitioners offer botox and fillers?

Guest Post By Carolyn Buppert, NP, JD

Can Nurse Practitioners offer Botox, Restylane, Juvederm and other cosmetic treatments on their own?

The answer to this question is going to be state-specific. Here are the steps to follow:

  1. Read your state's Nurse Practice Act section on scope of practice for nurse practitioners to answer these questions: What acts require physician collaboration or supervision? How is collaboration or supervision defined? (Boards of Nursing in the United States: State-by-State Web Links)
  2. Go to your state's Board of Medicine Websites and search for any policies on provision of botulinum toxin (Botox®). Note that botulinum toxin is a prescription medication, so a prescription or order for the medication must be written and someone must administer the drug. If your state has policies on botulinum toxin, note the requirements for prescription and administration. Some states consider administration of botulinum toxin a medical act, and some states consider it to be within the scope of a registered nurse. Prescribing is always a medical act.
  3. If you live in a state that requires no physician collaboration when nurse practitioners prescribe, then as long as the Board of Medicine has no requirements with respect to botulinum toxin, you are free to proceed with your practice idea. If your state requires physician collaboration in order for nurse practitioners to prescribe, then you'll need to line up a collaborator. In most states, the collaborator does not need be on site, but in some states, the collaborator must practice at the site with specified frequency. Follow the rules as they relate to any prescribing.

About: Carolyn Buppert, NP, JD is an attorney practicing in Bethesda, Maryland.

Defamation via Twitter? Doctor Files A $1 Million Suit In Oregon

physician legal

By Joy Tu, VP Medical Justice

A Lake Oswego doctor has filed what appears to be the first Twitter-based defamation suit in Oregon.

Dr. Jerry Darm is suing Portland blogger Tiffany Craig for $1 million, alleging she damaged his reputation with “false, defamatory and malicious” statements made online, according to a complaint filed in Multnomah County Circuit Court.

The case stems from commentary Craig posted on Twitter and on her blog, Criminallyvulgar, where the 31-year-old IT worker writes about everything from the recent passing of former governor and senator Mark Hatfield to computer technology, gaming, the treatment of women in comics and her large collection of shoes.

From the news story:

Craig said she was watching the 6 o’clock news one evening in late June when she saw one of Darm’s television commercials. The doctor advertises his business, Aesthetic Medicine, widely and appears regularly on local talk show segments to give advice on dealing with wrinkles and other skin and body issues, hair removal, leg veins and weight loss.

“Through idle curiosity I Googled him just to see what he was all about,” Craig said. “I found pretty much the same information as the television advertising. … It got me thinking about how you would find information about doctors or other medical professionals if you wanted, without the advertising.”

Later, she posted on Twitter that “a little bit of research into @drdarm revealed a pretty nasty complaint filed against him for attempting to trade treatment for sex in 2001.”

In a blog entry that followed, she mentioned the TV commercial, criticizing the ad’s “results may vary” disclaimer:

“Seen that around? Sure you have,” Craig wrote. “If you watch television in Portland Dr. Darm is ubiquitous. Especially on those local channels that show endless reruns of Two and a Half Men. He wants to fix you up good and spend thousands on cosmetic procedures that will get funneled straight into his Lake Oswego home.”

“What he should have added with his Results May Vary disclaimer is Dr. Darm Handed Over His Medical License Due To Disciplinary Action.”

In 2001, the Oregon Board of Medical Examiners reprimanded Darm for “an inappropriate boundary violation” after a patient complained he offered to accept intimate physical contact as payment for after-hours laser treatment of “spider” veins.

Darm also faced discipline in California and in Washington based on the situation in Oregon, where the state medical board required him to complete educational courses about doctor-patient boundaries and risk management and prohibited him from treating adult women without a chaperone. Those restrictions were removed from Darm’s license in 2009.

Darm’s attorney declined to comment on the case but Craig’s attorney, Linda Williams, has filed a special motion to strike Darm’s complaint under Oregon’s anti-SLAPP statutes, which aim to prevent any “strategic lawsuit against public participation” on the grounds of free speech.

This procedural protection allows a defendant to request review of a speech-based lawsuit early in the process so the court can consider whether there is any probability the plaintiff can prove the case, Williams said. “If there is not,” she said, “the court can dismiss the case.”

The protection applies to speech in a public forum on topics of public interest.

Williams contends that Craig’s comments – speech made in the public forum of the Internet – were opinions based on facts in publicly available documents. A hearing on the motion is set for later this month.

Quoted from the Lake Oswego Review story: Defamation in 140 characters or less

Of course this is a non-starter as a complaint and Dr. Jerry Garm is shooting himself in the foot. Instead of quitely asking Craig to remove her tweet (being read by probably 5 or 10 people), Dr. Garm now has made everyone aware of his previous issues and has many more people aware of his "inappropriate boundary violation" issue. Not the kind of thing that gets you ahead and certainly a suit that he can't win.

About: Joy Tu is the Vice President of Strategy & Business Development for Medical Justice, a company that protects physicians from frivolous lawsuits.

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