The Aesthetic Medicine Patient-Centered Consult

All too often the “bean counters” are telling us how we are falling short. They come up with some scheme to get us to see more patients than we can reasonably see or how to “create” more procedures than are called for. This is bottom-line or practice-centered medicine and in my opinion is unethical and immoral. It is also outside of what we are called to do and is unnecessary and counter to a healthy practice. What I believe builds a healthy practice and is simply at the heart of doing what is right for patients, is the patient-centered consult. This type of consult is designed to get to the root of the patient’s issues and do all one can do to help them achieve their health and aesthetic goals.

In this age of population-based medicine we have all been told to do the minimum, but that doesn’t change the fact that our patients are concerned with optimal health and results. Olympic athletes do not win their contests by training to the minimum nor will our patients be served by providing the minimum. Let’s look at an example of how population-based medicine is creeping into the exam room in a way that is not fully understood by physicians and yet has great impact on the individual (many similar examples can be seen in medicine today):

The drug companies tell us that Plavix is about 30% better than aspirin. What they do not tell us is that it is relatively 30% better. In absolute terms it is about 1% better. What does this mean? Well, in one study on CVA the relative risk reduction was quoted as 25% but the absolute reduction was 0.9 for ASA vs 1.2 for Plavix or about 0.3% (1). Now Plavix costs $5.00 per pill and ASA is about $0.05 so to the individual on a fixed income is the absolute difference of 0.3% worth $4.95 per day? Maybe, maybe not depending on many factors. Certainly it may be worth it to society but society is not paying the bill…the individual on a fixed income is. This is the confusion between population based and individual medicine. Some have even advocated taxing or eliminating Aesthetic procedures to reduce overall health costs in the US. This may help some number followed by economists but is it serving the individual who is interested in a specific goal?

So what is the patient-centered consult? Medicine is complex and in particular, Aesthetic Medicine is complex, yet it has been reduced to sound bites on TV. Commercials ask the question “Is it better than Botox?” or “Is it better than a Medical Peel?” yet they do not give the answer or any real helpful information. Patients have, in general, no realistic idea of what can and cannot be done for them. The patient-centered consult is an educational experience for the patient that helps them understand what is realistic and what is not.

It starts with gaining a detailed understanding of what the patient’s concerns are, not what treatments they are interested in. Most aesthetic patients come in thinking they know what they want. As an example many think they need an upper lid blepharoplasty but what they really need is a brow lift. Other come in asking about fillers but really need Botox or vice versa. The understanding of what they are concerned about is found not by asking what they are interested in but rather, what their concerns are. We start in a conversational manner. Most often a patient will start by saying something like “I think I need Botox right here.” My answer is generally something like, “Well, that is certainly something we can do, but what is it that makes you want Botox?” The next several questions are directed at helping the patient target the real issues behind the concerns such as texture, tone, tightness, wrinkles, poor size, volume etc.

I use a consult tool I call the $10,000 mirror. We have a simple hand mirror that has no magnification on one side and 3 to 5 times magnification on the other. I hand it to the patient with the magnified side facing them. The interesting thing is that most people when given the mirror will start looking very intently at themselves and even start picking and brushing at things on their face. I then have a checklist of items I ask them about. We go through the checklist item by item and discuss its impact on the overall appearance of the face. Once this is completed, I formulate a plan of all that can be done for them, that will include things I can do but also things others may be able to do. As an example, I do not do face lifts, but if the result they are after is best served by a face-lift, I put that on the plan. It is rare that we don’t do most of what they will benefit from.

Remember this is patient-centered not practice-centered. This will also build trust in your patient, as it is proof to them that you have their best interests at heart. Something the bean counters seem to never think about.

Once the plan is composed it will generally be a list of several procedures. I then go through the list, from most comprehensive to least. So it might be a list that includes a referral for a face-lift, a laser peel, a non-ablative laser treatment (also discussed as a part of maintenance), Botox and fillers. The list is prepared so that the patient will go home with it. It is positioned as a “wish list.”

As an example, one of my “I need Botox” patients left with her list. Upon leaving she said “Well I am ruling out a face-lift as that seems like to much, but I am going to do the laser peel along with the Botox and after my tax refund, start the maintenance program you have outlined.” As you know, with the ever-increasing cost of Botox it is essentially a lost leader, and at best, a breakeven event. The easy thing to do would simply have been to give the patient Botox, but with the consult, we went from a lost leader to a multi-thousand-dollar procedure with the probability of many thousands more in future procedures and maintenance programs. This was done in a patient-centered way. The patent chooses the procedures – you do not sell them. This is not an attempt to avoid the discussion about money…in fact money is at the center of these consults. Patients want an honest and upfront discussion of cost and we give it. Remember, without a margin you have no sustainable mission, so do not be afraid to discuss money.

The face consult is just one example – we go through the same checklist with body contouring consults. A patient may come in interested in abdominal liposuction. After they understand how one area of the body is related to the next, they may find that for optimal results what they really need is upper and lower abdomen and flanks for a better definition of the waist and three dimensional profile. But again they are not told that what they want is wrong; rather they are educated about how what they think they want actually fits into a broader plan for optimal results.

Over the years this approach has been responsible for the most of the growth I have seen within aesthetic medicine practices. Not only will it almost always result in bigger or a greater number of procedures, it will also be responsible for many referrals. When you take the time to do a meaningful consult, your patients will tell their friends. We even get referrals from the friends of friends whom we have never met.

1) Steinhubl SR, Berger PB, Mann JT, et al. Early and sustained dual oral antiplatelet therapy following percutaneous coronary intervention: a randomized controlled trial. JAMA 2002; 288: 2411-20

Thomas A. Sult, MD invites you to enrich your life with laser medicine. Tom is Board Certified in Family Medicine. In addition to his medical practice, he is the supervising physician for a medical laser clinic and is the US Medical Director for Fotona Medical Lasers, involved in clinical and applications research and development for Fotona worldwide.

For 43 years, Fotona has offered the highest performance, best made laser systems in the world. Fotona laser systems purvey quality, reliability and durability for excellent medicine and the full spectrum of aesthetic procedures. Along with his business partner, Tom’s mission is to provide laser owners a model for success with advanced aesthetic systems, clinical, business & mktg training & ongoing support, while giving the patient safe, simple, even life-changing solutions.

7 Major Perks of Being an Independent Computer Consultant

Starting a small business as an Independent Computer Consultant can provide a determined IT Professional with 7 Major Perks that would be difficult to come by as an “employee” of almost any other IT Jobs available today.

Major Perk #1: Excellent Income Potential – An Independent Computer Consultant operating under the correct model of Proactive Network Monitoring, Remote Computer Support and Flat-Fee Billing, can:

Make more than the average salary as an employee of someone else, while working far fewer hours!
Know in advance how much revenue will be collected each month… as opposed to hunting for billable hours and battling slow months.
Choose EXACTLY WHEN to GET paid each month… as opposed to waiting for (or hunting down) slow paying clients.
Major Perk #2: Benefits – Such as Health, Retirement and Financial
As a self employed Computer Consultant, you’ll be able to PICK the benefits that are BEST FOR YOU (not settle on WHATEVER an employer would offer… IF THEY EVEN OFFER BENEFITS!)
Do you prefer low-cost benefits instead? No Problem! You CHOOSE THE PLAN YOU LIKE and you can pay potentially LESS than what you would contribute to a company plan.
As an owner of your own company, you’ll have MORE savings, investment and tax benefits available to you that are far greater than you could obtain as an employee
Major Perk #3: Unmatched Job Security – LET’S FACE IT: In today’s job market (or any other time in history for that matter), just how secure can your position be when you’re working for someone else?
As an employee, there are a whole host of reasons why you can lose your job:

Over 80% of terminations are a result of a poor boss/employee relationship.
The company may need to cut costs and eliminates your position
The company decided to outsource your position
The company changes management or merges with another company, who decides to remove you from your position
The company is going out of business
But when YOU’RE the BOSS, the only one who can fire you – is YOU.

Of course, as an Independent Computer Consultant, it’s possible that you can lose a client for some of the very same reasons you could lose your job as an employee.


However, the Flat-Fee, Proactive Support Business Model is built SO YOU NEVER RELY ON ANY ONE CLIENT BECAUSE no one client should EVER comprise of a majority of your income!

If you were to lose a client, your remaining client base will CONTINUE TO MAKE YOU MONEY until you ADD a new client.

As your own boss, you’ll have the power to temporarily increase your billings and boost your income by adding more projects or work across your remaining client base.

Major Perk #4: Flexible work hours – You’re the one who sets your office hours. Naturally, as the support provider for your clients, you’ll need to be available when they need you. However, if you want to get paid an overtime rate for any work your clients request outside of your regular business hours, you can.

Simply set the ground rules for your hours and rates in the support agreement that you have signed when you begin your relationship with your customer.

When you follow the correct Proactive Support Model with Flat-Fee Billing and Remote Computer Support, you should be providing the vast majority of your work from a remote location and not at the client site. And because your support model is based on preventative maintenance and not on constantly addressing emergencies, you’ll have a great deal of flexibility as to when you begin and end your work day.

Major Perk #5: An Opportunity for technical growth – If you’re working for someone else, it’s typically your boss who decides what products you’ll get to work with or learn. Fall into the wrong position, and your experience level and growth can be severely limited.

But as an Independent Computer Consultant, your clients will be turning to you for recommendations on which products or solutions to install. You get to decide on the products you will be working with. The choice is yours as to what you will be installing and supporting.

You get to learn the systems that you want to learn. If there is a product that you want more experience with and it’s the right solution for one of your clients, then you have the opportunity to go ahead and learn it.

Your clients will believe in you and your expertise. If you believe your choice in systems is the best and most cost-effective option for your clients, they will usually follow your advice.

Major Perk #6: Opportunity for professional growth – As a business owner, you’ll communicate regularly with the upper management and owners of your clients’ businesses. You are no longer the “technician” sent in to work on their systems… you are a fellow business owner… and your relationship will take on a peer-like connection. It’s the type of connection that can lead to greater opportunities for higher level networking and relationship building.

Business owners enjoy talking with other business owners because they can relate to them. Suddenly you’ve become one of their inner circle… a place that many people never get access to.

You’ll also have the opportunity to grow your own business should you so decide. If you choose to expand your operations beyond what you’re able to handle on your own and build your business into a larger corporation, that’s your choice.

You see, the starting point of Independent Computer Consultant can be a solid foundation for providing the client base, contacts and capital that will help your growing computer consulting business to continue growing.

Major Perk #7: A stimulating social environment – You’re in complete control over the companies you work with. Every employee or employer of every company you choose to work with provides an opportunity for expanding your social circle. The larger and more varied the client base you create for yourself, the larger the social network you’ll have to operate within.

Strong social circles are where great referrals can be found.

And great referrals provide the foundation for growing your computer consulting business.

Starting a small business of your own as an Independent Computer Consultant can provide you with so many benefits that are simply difficult, if not impossible to obtain while working as an employee of someone else.

Assuming you already have the required skill set to support a small business network, getting started as your own boss as an Independent Computer Consultant will be easier, less risky and requires far less capital then starting a small business of almost any other kind.

By focusing on building your business on the correct model of flat-fee, proactive maintenance and using inexpensive, readily available utilities to monitor and remotely support your clients, you can achieve great success very quickly.

3 Easy Steps to Becoming a Successful Independent Computer Consultant

In today’s world of inexpensive remote computer support and network monitoring, starting a small business as an Independent Computer Consultant can be one of the most rewarding career choices a computer support professional can make.

Fortunately, the road to success as a successful Independent Computer Consultant can be an easy one… PROVIDED that you’re armed with the right information.

With so many wonderful perks that come with being your own boss, such as an unmatched level of job security, an unlimited income potential and fantastic professional and technical growth opportunities, why do so few computer consultants ever attempt starting a small business of their own, when they likely have all of the qualifications they need to succeed?

Achieving success as an Independent Computer Consultant can actually be quite easy today, providing you know the steps to take, the pitfalls to avoid, and the tools to use to make the journey easier.

Assuming you already have the technical skills needed to maintain a small business network, then there ares only THREE remaining requirements for Guaranteeing your success as an Independent Computer Consultant:

1. You need to operate on the correct business model of flat-fee, proactive maintenance and remote computer support. Monitor your customer’s systems to minimize the risk of unexpected downtime and lost productivity. No more waiting for things to break and billing by the hour to fix them. Build your business around preventing problems from happening in the first place.
2. Use the right tools for the job. To succeed as an Independent Computer Consultant, you’re going to need to find a few clients to support, and then you’re going to have to have to support their networks well.
To find new clients, you’ll need to use tried and proven sales and marketing materials. If you use the correct materials, you’ll be able to quickly land new clients without hiring (or becoming) a salesman.
To support your clients, you’ll need to use the correct applications and utilities to minimize the effort you have to put in, while maximizing the performance of your client’s systems.
3. Desire! While starting a small business as an Independent computer consultant can be easy and done with little risk if done correctly… make no mistake. Running a business of any kind requires dedication. As with any venture worth pursuing, there will be obstacles that you’ll need to figure a way around, over or through. The better equipped you are though, the fewer and smaller the obstacles you’ll run into.

For almost any computer professional that has the basic skill set to maintain a small business network, a career as an Independent Computer Consultant is well within reach.

I hope that if you have the basic technical skills needed, that you’ll consider starting a small business of your own. Becoming your own boss can be an incredibly rewarding career experience.

An Expert SEO Consultant Can Design the Perfect Search Engine Optimized Website

As a small business, your marketing campaign should focus on climbing the ladder of search engines. Having higher ranking of them will increase your online presence and you will gain more traffic to your site. The optimization is essential for achieving this goal and there are SEO expert consultants that help make your business successful.

Search engine optimization involves various tactics including link building and targeting keyword phrases for your niche. By working with one consultant, you can be sure that all your marketing efforts will produce positive results.

What Does an SEO Expert Consultant Do?

SEO expert consultants provide one on one consultations for understanding the needs of your small business. One of the responsibilities of the consultant is to prepare a keyword analysis report to get you to the top of the rankings.

The consultants also create a website competition analysis report when doing research. Research is a critical aspect of search engine optimization. They must have the right research in order to use the best keywords. With the right keywords, they can target specific phrases that are being searched for.

Small businesses must begin with a great website that is designed with SEO in mind. They must also have search engine optimized content and work with expert consultants who create keyword analysis reports to target the best keywords. SEO also involves link development campaigns to get quality incoming links. Your business will be more successful when you work with experienced consultants who know all aspects of the optimization.

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