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Improving Your Patient Selection


Whether in the practice of medicine or the business of healthcare innovation, solid clinical judgment can make all the difference.


I once saw a patient in consultation for a nasal deformity. She claimed her husband didn't like the way her nose looked, she was 100 pounds overweight, a Type 2 diabetic, and a smoker. I said no, I would not operate on her.

Doctors call that patient selection by exercising clinical judgement. In fact, of all the things doctors do—make decisions, do procedures, and communicate with patients—exercising clinical judgement is the most important yet probably the least valued by payers and many patients. Doctors can spot it in a heartbeat.

Most new businesses fail. Most new products fail. Most entrepreneurs fail. Most investors fail. So, it would seem, the biggest error they all make is that they don't kill their ideas early enough. In other words, they make poor selections and errors in judgement. Yet, everyone knows the dismal odds of success and they persist. Why?

1. They try to get back what they have already lost instead of just accepting the sunk costs.

2. Their egos get in the way of good judgement.

3. They are afraid to fail.

4. They have multiple blind spots.

5. They didn't take personal responsibility for their last failure so they didn't learn from it.

6. They believed what they think had value had any significance.

7. They couldn't handle the truth.

8. The opportunity costs of quitting or doing something else were too high.

9. They didn't follow their gut.

10. They had lousy clinical judgment.

Clinical judgment comes from experience and failures are supposed to inform your experience. Maybe the next time that little voice in your head is whispering "no" you should pay attention and just move on the next patient.

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