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I know lots of doctors, but most of them are not very good at handling money. The fact that they got into medical college means they are bright and must have been in the top of their class, but most of them have very little business sense. Why is this so ?

Even though every clinic is a small business, most doctors have no exposure or training in business management . While they are very hard working and intelligent, they are often not good at managing other people or building teams.

Sadly, most of them are not willing to learn . One of the occupational hazards of being a doctor is that because they did so well academically, many of them they think they know it all , and cannot be taught anything. How sadly mistaken they are ! If you do not know what you do not know, how will you ever learn new stuff ?

Most doctors do not have role models they can emulate. Doctors are often intensely political and competitive. They are secretive and not willing to share what they have learnt with their colleagues - which means that most doctors have to make their own mistakes in order to get ahead.

Most doctors are in solo practise, which means they are stuck thinking small most of their lives. In their first decade of practise, they are so busy trying to attract patients, they they often lose sight of the big picture. By the time they become more mature, they are already ready to retire !

Sadly, giving cuts has become the norm today and most doctors are so used to taking shortcuts in order to build their practise, that they lose sight of basic customer service principles. This means that rather than spend time and energy keeping their patients happy, they waste a lot of it networking with colleagues who refer patients to them . Because these colleagues think the same way they do, there is very little attention paid to growing the business ethically.

Some senior doctors take a perverse pride in the fact that they are not interested in earning money ! They consider medicine to be a service profession and feel that earning money is below their dignity . They will often look down ( or pretend to do so ) upon doctors who are richer than they are.

Most doctors do not use technology cleverly. While they are often aware of the latest gadget and gizmo in their own specialty, they are often not smart enough to use technology for managing their clinic , growing their practise or marketing themselves.

Many are woefully financially naive. When they first start practise, they are so used to working for free that they do not think about paying themselves at all ! When they start their clinic, they treat the clinic's income as their personal income. However, this is actually the income of their business - they should only be paying themselves a salary as a CEO. The clinic should be profitable enough to pay them a salary and should be able to run without their presence ! Most doctors are so busy working in their practise , that they fail to work on their practise !

Doctors do not learn to leverage their strengths; and because they are so busy competing with each other , they do not learn to cooperate and grow the pie for their profession. They fritter away the goodwill they have earned from their patients on personal gratification. Sadly, the leaders of the profession are intensely political , and because they are so focussed on looking only after their personal selfish interests, they do little for the profession as a whole. By the time they are senior and are capable of looking at the big picture, they are thinking about retiring !

Most doctors are good at what they do, which is taking care of their patients . While this is good for their personal wellbeing, it's not good for the profession, which lacks leaders who can provide wise counsel for their colleagues and peers.

There's lots of pressure on IVF doctors when an IVF cycle fails. Patients want a baby - and since they have not succeeded, they want answers as to why the cycle failed !

Doctors will take one of 3 approaches.

Many are nihilistic. They know that the tests we have today do not help much. Our technology is still fairly crude, because the commonest cause of failed implantation is genetically abnormal embryos, and we still cannot detect or prevent these, given the fact that human reproduction is a very inefficient enterprise. The best option for most patients is to just try again, and this is what they will advise.

Unfortunately, this straight-forward forthright approach is very difficult for most patients to accept . They want answers to their questions !

Unfortunately, the truth is that our technology is still not good enough to provide these answers.
After all, how can you track the fate of a microscopic ball of calls after they have been placed in the uterus ?

Some doctors are very aggressive. They will run lots of tests and often have pre-printed " panels of tests" for testing for everything under the sun - whether it's relevant or not ! Many of these tests are very expensive and can only be done in selected laboratories, which the doctor has a " special tie-up " with ! Most of these results are just lots of gobbledygook , and it's not possible to to make any sense of the results, because they have never been validated ! However, many patients are very happy with this approach. They feel the doctor has been " very thorough" - and now that a problem has been found, it can then be " fixed" , so they now have a better chance of having a successful IVF ( even though this is just a delusion !)

Some doctors are conservative. They will perform tests selectively, as needed, based on a careful analysis of the IVF cycle, and explain why these tests are needed; and what information they can provide, which can be used to modify the treatment plan for the next cycle.

Until patients learn to ask the right questions, they are unlikely to get the right answers !

This is a guest post from Mr Aditya Patkar, Sales Director, Plus91, in which I am an angel investor.

A doctor today has many opportunities to reach out and touch his patients. Clever technology can help him do so very easily and inexpensively – but many doctors do not take advantage of these simple tools ! Why should you bother ? For one , it makes you popular amongst patients – and will help you become even busier ! Patients will rave about doctors who take the time and trouble to contact them – and this will help you to stand out ! Doing so will also help to educate other patients, who will be happy to offer you their blessings because you have shared your wisdom with them. Finally, contributing to the knowledgebase of the community improves the community you are a part of – and help you become a respected leader in your community !

So what do you need to do?

1. Reach out to many people as possible. The internet lets you update and express your views, either as 160 character bursts on twitter, or as a long thoughtful post on your blog , detailing your experience.

Twitter: On twitter you can start putting up bursts of interesting cases you see, new techniques you hear about, and information about your local medical network which may help people in your area! Go onto www.twitter.com, register yourself and type away.

Blogging: If you are doing research which you think people should hear about, blog about it ! Many people will find it online as they search for information about their problem , and they will be happy to treat you as a trusted authority if you provide this information on your blog. Go to www.blogger.com and start your own blog !

2. Allow people to contact you: Step one is to get a website. It helps you disseminate information about your services for patients looking for the same. This is not advertising, it’s offering a service to patients who need information and education about their medical problems and treatment options. Patients face many choices and are hampered by a lack of reliable information. On your website, please don’t only talk about yourself ! Rather, tell patients more about what diseases and disabilities you treat, what are the latest treatments, and maybe even offer them a second opinion to help them get the best possible treatment ( even if they do not come to you !)

One of Plus91's missions is that every Indian doctor should have their own website ! Check out what we offer at www.websitefordoctors.in. We will hold your hand and guide you through the entire process to maximize the impact on your patients .

3. Using Software: Modern EMR ( electronic medical software) comes with integrated communications tools which allow you to painlessly and seamlessly contact your patients, either through email or SMSes !

Plus91’s EMR packages allow you to send SMSes to sendalerts, appointment reminders and prescription reminders to your patients !This is a new level of service, and patients will be thrilled to know that you provided automated intelligent alerts to help them get the best medical care ! You can see our products on www.plus91online.com


These are just some pointers on how technology can help you to to interact with your patients – without spending much time or money ! Leverage your time and expertise using modern technology – Plus91 will be happy to help you to do so, so you can delight your patients !

Doctors love coining new terms , and this seems to be especially true for IVF specialists. Infertile couples have to learn a whole alphabetic potpourri of medical terms - ranging from IVF to GIFT to ICSI to ZIFT. It's easy to get lost and confused; and most patients can't seem to make sense of any of these !

To add insult to injury, many IVF doctors claim to use "the new and latest" technique to improve pregnancy rates. Obviously, every "new" technique needs a new name - so the confusion gets compounded. It's a competitive business, and IVF doctors always try to keep one step ahead of other doctors ! While this is good because it allows patients access to the newest technology, the downside is that many doctors will then promote a particular technique – not because it is better, but simply because it is new !

It’s easy to get a lot of press coverage for a lot of these “new” advances, because reporters are often not medically sophisticated, and most are quite happy to oblige their doctor friends. Poor patients get even more confused – and will often flock to the doctor featured in the latest article, in the hope that this new technique will give them a baby ! This then sets up a vicious cycle, where doctors compete with each other, in order to be featured in the press. It often becomes a game of one-upmanship, where the doctor with the best PR firm wins !

The newest kid on the block is a term called IMSI ! This stands for Intracytoplasmic Morphology Selected sperm Injection – quite a mouthful ! This is simply a modification of the standard ICSI technique, in which the sperm are magnified even further. The rationale is very logically appealing – let’s use higher powered magnification, so we can select the “best “ sperm for ICSI ! One would therefore expect that this technique would result in higher pregnancy rates after ICSI.

Unfortunately, this is not true in real life. Not only does IMSI not improve pregnancy rates as compared to ICSI, it can actually decrease them. The reason is simple - IMSI takes longer to perform than ICSI because it's much harder to identify sperm when using such high magnification. At such a high power, the field of view is obviously very limited, which means that the embryologist has to scan for much longer to pick up the selected sperm. This means that the embryologist has to keep the fragile eggs ( into which the sperm have to be injected ) on the micromanipulator for longer while doing IMSI, and since eggs are very sensitive, and do not like being kept outside the incubator, this extra exposure can cause them to get damaged.

However, it's very easy to take patients for a ride, and many clinics are now pushing patients who have failed ICSI cycles in other clinics to do IMSI, claiming that the success rates are higher with IMSI.

Caveat emptor - let the patient beware ! More is not always better - and often established techniques are much better than newer ones !