The Other Side of the Story, April 4, 2014, 4:19 pm
[Perhaps the best way to respond to Dr. Zide's wall of perfect reviews is the counterpose another wall--one constructed of the doctor's own PUBLISHED writings. Below is an example of one. As you read it, ask yourselves, if Dr. Zide were the wonderful things his glowing reviews say he is, would his business be slow, and would he stoop to using underhanded sales techniques to sell his surgery?]
What You Can Do Is Not What They Want
Barry M. Zide, M.D.
New York, N.Y.
The patient sits in front of three doctors. She is very well dressed, a 45-year-old, clear-thinking woman who just wants to look better. You are the doctors and you each give her your best suggestion.
Doctor 1: Full face and neck lift, deep plane or subperiosteal dissection, with canthopexy and fat-sparing blepharoplasty and probably the forehead, too. You tell her she’ll look great; she’ll probably be swollen for 4 to 6 weeks, the lids will be slanted up for a couple of weeks, or
Doctor 2: Straight superficial musculoaponeurotic system face lift, retroauricular and scalp incisions, and fast-sparing lower blepharoplasty without fat removal. She’ll be 90 percent back back in business in 3-plus weeks. You tell her she’ll look very good by then, or
Doctor3: Short scar face lift and basic blepharoplasty, and she’ll be up and running in 9 to 12 days. You tell her not to worry about small touch-ups.
All other factor being equal, the cosmopolitan patient will pick Doctor 3, for the same reason she’ll go for the Botox (Allergen, Inc., Irvine, Calif.) over the forehead lift and/or corrugators dissection. The do not care how well trained you are really or what you are capable of doing; they do not care about spliced photograph halves showing preoperative and postoperative views. They want no down time, smaller cuts, and simple injections. Patients seem to be moving away from anything surgically complicated. Patients want to hear “It’s minimal surgery,” “I operated on the following famous people," “Have you seen my ads?” (which means you get a price break). “There is practically no downtime,” and “I was chosen as a top doctor in this area.”
I was talking to a first-class dermatologist the other day and I lamented to him that it is too bad that we do not have a permanent filling material available. His response was, “Barry, who wants that? I want the stuff to resorb. They keep coming back, and by the time they might sue for anything, the stuff is gone.” I must be naïve. I actually thought I was supposed to finish a case. I guess that is why Botox may be great for the doctor. If some eyelid ptosis or lip droop occurs, it will go away.
Last year, business was slow for quite a while, and the patients who came were hesitant; they seemed tentative, shopping, looking for a bargain. So in response, for a more fruitful “harvest,” I decided to become what I really do not do well and what others seem to do better than I: I started to trying to be a better salesman. I read books on the power of persuasion,1-3 I went to courses, and I became determined to become a “rainmaker”2 in my office or at least try to increase the humidity. I learned a lot.
I wanted to impart some helpful words that I have memorized and other tips that have helped me increase my patient bookings and my incoming traffic. For every patient, my premise is the same they have some innate fears (i.e., the money, the surgery, the anesthesia) and they need to be convinced or maybe slightly persuaded. Certain key points may be worth mentioning.
Key point 1: It is important to bond with the patient before you discuss surgery. Do not ask the patient before you discuss surgery. Do not ask the patient why she/he has come right away. Make small talk about job/family/life/children/hobbies/schooling, anything for the first few minutes, and then ask about their area of concern. Whatever you do, do not suggest anything more unless they ask for it. You can pry (e.g., if they come for the nose and there is a small chin, you might show them some preoperative and postoperative photographs and comment on how the chin helps a lot). Just do not suggest it. Otherwise, if a problem ensures, then you are the one who did it to them. No matter how much you want to do more, think soft sell hard hint.
Key point 2: The shopper may only be looking at the bottom line. If that’s the case, you might try to explain to the buyer/patient that what you offer is worth more. It’s helpful to enumerate your special points of difference (the POD). For me, for example, I emphasize my hospital title and affiliations, and I tell them how long I’ve been in practice. I often provide patients my pager number and tell them I will answer them directly and not to go through a nurse on call. I tell them about using only board-certified anesthesiologists. The prospective patient must think and be sure that they will receive special treatment. If all you are interested in is getting traffic to your office, and you charge no consultation fee to bait them into coming, in my opinion, you are not much different from a used-car salesman. In short, I do not like shoppers, but sometimes, you can enlist them as a patient without being Wal-Mart.
Key point 3: I want you to memorize five or six good questions. When you see hesitation ask:
“Can I assume that there may be a number of things that have to be done before you would be totally comfortable in making a decision for yourself?” Now here’s a point. Let’s say you are talking to a woman whose husband decides most key issues, especially financial ones. If she says she would have to discuss it with him, offer a second consultation for review pictures and procedure at no cost when he is available. She cannot schedule without him, and neither can you.
“Can I get your agreement on the analysis and treatment plan?” Here you might also ask, “Has anyone suggested anything different?” Try to focus on issues of importance. Tell them, “This is what I would propose for my wife/mother.”
“Is there anything else that concerns you at all, or that you are afraid of?” Remember now, people will present the surface objection first and you must really get to the deeper fear. For example, I once had a well-to-do woman who said she was concerned about anesthesia for her initial statement. I parried with the usual positive low-incidence-type data and my history of using board-certified anesthesiologists, and so forth. Then I asked, “Anything else?” and now she stated the real fear (i.e., how afraid she was of looking different). The true issue came second, and it usually does. It’s helpful to ask if she knows anyone, family or friend, who had a similar procedure and whether there were any problems. The key is to find out the true “fear factor” and obliterate it or there’s no chance. I used to discuss the complications at the first visit, but now I rarely do. I am only optimistic and positive. I discuss complications later, sometimes before they sign the consent on the day of surgery or at least after the surgery is “definitely” booked.
“What can I do to help you commit to go forward and look better? Is there anything I might have missed?” I know there is no such thing as an emergency blepharoplasty, and so do you. I love it when somebody wants a face lift in preparation for a wedding in 4 weeks. Forget it. The fact is, though, the longer you give the patient time to think about it, the less likely they are to schedule surgery. I keep a list of patients who haven’t scheduled after the consultation, and after a short wait I send a note stating how much I enjoyed meeting them and asking them to revisit. Often, a patient who was hesitant will reschedule. The letter is worth the effort.
A variation: “Is there anything prevent you from making a decision for yourself today?” or “What is your timing on this procedure?” At this point, I ask as I am getting up: “Have I covered everything that is important to you?” Then say (if you or your staff take your own photographs), “It’s important now to get preoperative photographs for two purposes: (1) for study before surgery and (2) to have something to review with you at your free second visit if you’d like more time to review your procedure.” By the way, I used to delve deeply into the technical aspects of the procedure, like deep plane versus straight superficial musculoaponeurotic system face lift, how it’s all done at the first visit. I stopped. As I said, save review of complications and technical detail for later, doing it at the consultation is a deal breaker, unless they ask for details. As I now walk the patient to my office manager, I may ask if she has her calendar handy so Susan (my office manager) can set her up for a time that is convenient for her.
I have found that using some of the above questioning methods has been more helpful. I do not serve wine or coffee to my waiting room patients, but I do provide a large bowl of candy, which is less tedious because I buy it in bulk from Costco or BJ’s. I have a bound leather volume of letters from parents and patients that says “Dear Dr. Zide” in gold on the cover. People really need to know that other like you, even though that sounds like an infomercial. (They should only see the e-mail of one of my recently ticked-off patients.) Testimonials, I have found, provide great incentive to prospective patients. This volume of letters from only happy patients seems like those people trying to tell you how the Thigh or Ab Master changed their lives. People will always read those letters and cards, so put them in something nice for new patients to read.
In addition, and I hate to admit it, anything in the way of a plaque or picture or paper citation that shows you’re a “top doctor” or “best surgeon” is probably helpful. Because I believe no one really votes for me or that the whole “best” approach is a scam, I tell my residents to have a plaque made for themselves no matter where they go. Most patients believe these plaques, and because I know it is all about perception, let them perceive you as special.
Overall, I am trying to get more “with it.” You all remember the three As, availability, affability, and ability, with the last being the least important. Now it’s the three Ps, pampering, promotion, and perception, the last being the most important. That is life though, and I am through fighting it. We as plastic surgeons have reached a pinnacle of higher surgical skills, and we are now competing with “surgical” specialties with much less comprehensive training in most cases. It’s really not always about who is better trained anymore. It’s about less ecchymosis and swelling and less time off, or at least the thought of it.
So here’s the deal for the patient: it’s not all about our skills as surgeons; rather it’s also about our skills as people, and we now need to be someone we were never taught to be as residents or medical students. We need to realize that at times we are selling a product, a great product, really—ourselves—and if the patient first likes us, they will probably like what they hear, especially if you ask the right questions.
Barry M. Zide, M.D.
420 East 55th Street, Suite 1-D
New York, N.Y. 10022
1. Dawson, R. Secrets of Power Persuasion: Everything You’ll Ever Need To Get Anything You’ll Ever Want, Englewood Cliffs, N.J.: Prentice Hall Press, 1992
2. Fox, J.J. How To Become A Rainmaker, New York: Hyperion, 2000
3. Girard, J. How To Close Every Sale, New York: Time Warner Books, 1989.
Received for publication April 16, 2002; revised October 1, 2002.