Karen I would be happy to sit

Karen I would be happy to sit down with you at the clean up lab and discuss the scenario as i”ve consulted and currently consult for many mobile practiuces worldwide and have set up many or helped many get established. As every market is different regarding client mentality, are they used to mobile already or not, competition, how to charge, how to deal with rteferral facilities… The themes are always the same and the number one thing is just be the best probe on the floor in your region or as close to it as you can get.

Here is an excerpt we published a while ago on the subject for general concepts when we were in the launch phase of the Curbside guide which many mobile sonographers bought in bulk and sold or gifted to their top clients to keep thinking ultrasound and continue with the treatment phase wiht support from the book:

5 tips to practical and profitable mobile ultrasound application in small animal practice

1. If the pet is sick it needs a probe to rule in, or out, pathology.
2. Utilizing ultrasound earlier in a patient workup can lead to an earlier diagnosis and accelerated treatment plan.
3. Mobile in house ultrasound can work symbiotically with mobile surgery.  This can allow your clinic to keep the client, patient, and revenue all in house. making for a happier human and animal clientele.
4. Sampling of abnormal organs at the time of an ultrasound can furthermore expedite the diagnostic process.
5. Dr. Eric Lindquist and contributing specialists published The Curbside Guide to the Diagnosis & Treatment of Common Sonographically Detected Disease:  Canine & Feline in November 2015.  The Curbside offers current information on diseases commonly diagnoses through ultrasound and is an excellent clinical resource to bridge the gap between diagnostics, telemedicine and patient care.

Im trying to find a word document that I had with info I emailed another colleague some time ago if I find that Ill send it to you or publish it here.

Some more key points in

Some more key points in examining a mobile ultrasound market. These are Ninja recommendations here guys so please keep to yourselves in the sonopath community as a professional courtesy and pleasde don;t use these against me in my own markets or those of my clients as they know these already and many many more:)

1) Be able to scan at a high level. Every adrenal, every cbd, every pylorus, every pelvic urethra, every cardiac doppler view. EWihtout the full SDEP image sets you will get burned. I created SDEP from mobile thought process so if you perfect SDEP its your first step. Interpretation capability can vary but general abilities are essential and never assume a pathology is something. Listen to the voice in back of your head that says “Could this be anything else?” And get telemed support stat if need be. Give prelim info to the client and say “This is an odd scenario” or “I want to get better clarity on this case” to buy time while giving immediate clinical triage suggestions.

2) Be solid with a needle mainly fna but also core bx and dont be afraid of it. If you are afraid of a needle say in bricks and mortar til you get over it and dont go mobile til you are flipping  aneedle around like a ninkja sword. Timid needles kill your business. You will often be judged by your needle, lack of complicaitons, and quality of sample and read… i.e. why we doi telecytology. Needle ability is more important than if you got the dx right or not an dif you pay attention you leanr form every sample interpretation.

3) Be the 15 minute buddy. Put your troubles behind you before you walk into the clinic and be that good person everyone wants at the BBQ. Get your job done and get out and never let them see you sweat or in a troubled mood. Its a buisness buzzkill. Let the competition be moody but you are the positive mojo sonographer no matter what you see in their operations. Then scream at the top of your lungs driving to the next clinic if need be:)

4) When in doubt go with what you know and what you would do next as a clinician and get telemed backup. You have to be 90-95% correct in getting the case in the right direction but not necessarily 95% correct on the dx. If you have been a GP and have cut and dealt with owners then suggest what you would do.. identify with your client and draw a mental pictiure of what they will see in surgery on that perforating GBM or friable CBD and gently get the case out of their hands if you think its too much for them to handle or assure them its a pancreatitis case you can treat that here… it goes both ways.

5) Be fiscally responsible with your bills and always pay on time. Dont overextend yourself it will influence your + mojo in all you do. Ensure your billing is like a swiss watch. Nobody should ever have to discuss billing. Its a business buzzkill. Never let clients go beyond 60 days and encourage 30 day cycles and get a credit card on file. Eating the 3% transaction fee is far worth not having to chase down payment and let them know they earn flight miles that way. Makes for fast billing end of month.

6) Know your competition, be better sonographers an dclinicans and better at th eabove points than they are. Always be the top professional practciing diplomacy no matter what may come at you. No matter whethe ryou like your colleague or not always excuse them out of a miss that you find…. like th edeep pekvic urethral tumor they missed…when you et the question why dit he other guy miss it?  A: “Well the colon gets in the way and sometimes its luck of the approach…” Always always excuse them out. Its the right professional thing to do. If your colleagues don’t do the same then eventually they dig their own hole and you just constantly defer to the 15 min buddy scenario. When you don’t have an excuse for collagues miss or non miss but normal to abnormal scenario over a week or days then just say “Not sure I wasn’t there for the first scan & who knows what went on as pathology is a dynamic process and it pops up over night form normal to abdnormal especially HSA and LSA.”

Here are my proceedings form IVUSS 2012 Jackson Hole, WY ont he business of ultrasound:

Business, ultrasound,  & workflow efficiency; what makes a mobile ultrasound business fly long term.

The dynamics of a mobile ultrasound practice never cease to evolve. We are placed in a new place multiple times a day with different staff, different workflows, different personalities and challenging cases or receive the same factors in a fixed facility. Regardless the dynamics that ultrasound brings as a diagnostic bridge constantly challenges us to enhance our diagnostic skills and exemplifies the art of veterinary medicine in a pure form. Knowing clinical sonography and medicine is only a small part of what we do. But clinical sonography and medicine are like words and music in the art, and represent the essential core to start from when attempting a learning curve with ultrasound. In regards to this concept in experienced settings, I have found that when cases or even business situations become complex, I go back to basics and rely on what got me to this level in the art: clinical sonography and medicine. The rest of the situation usually takes care of itself. If you are not wrong in the diagnosis then those that question you or throw political rocks cannot be right over time. The key to long–term overall success is to get the right diagnosis first and foremost and above all and the rest should take care of itself over time.

Clinical sonography and all its tangential knowledge is the motor to a mobile ultrasound business. But this motor may be inside a Ferrari, a Toyota, a Smart car, a Dodge, or a Yugo. The type of vehicle is dependent largely on the personality that drives it. I have always believed that each person wakes up and goes to bed with the same personality. We can’t change it and the person him/herself may alter it a bit but the personality at a professional age is pretty much steadfast. Hence, a mobile sonographer needs to first perform introspection on whether his/her personality fits mobile environments with late nights and early mornings, all extremes of client & technician personalities, traffic, 20-50,000 miles/year on the road, someone looking over your shoulder at all times, constant challenge of the art of veterinary medicine, and extreme pressure to be right or have the right direction for each case every time. But the personality trait that is most useful is that of being able to work independently with confidence and relay that confidence to clients and surrounding colleagues and support staff without an air of audacity or a chip on the shoulder. Intelligent reasoning in the midst of humble pie seems to be the secret to longevity in the personality and confidence in ability categories.

Building trust and acceptability individually with the client and globally with peripheral colleagues should be the mainstay target indefinitely in any practice and especially that employing ultrasound. This trust and acceptability derives from preparation in internal medicine and sonography but also in the moral approach to veterinary medicine and business as well as to remain a cul de sac of information for any client. One of the most challenging parts of this job is to ensure that information from one clinic doesn’t travel to the next by means of oneself neither directly nor inadvertently. What may seem to be an innocuous comment passed through a third party may be construed into an open door of scenarios that we have no knowledge of. Trust and acceptability also is achieved by identifying with the needs of the client. Supporting the technicians that assist you, knowing that you need to work efficiently and use their staff for a minimal time frame in the workflow (post processing saved videos, adapting to difficult patient behaviors, cleaning up after oneself), and adapting the client’s reality (within reason) builds trust just as much as arriving on time and getting the right diagnosis.

Confidence in sampling is where many services separate themselves into categories. I know of services that have “oversampled” pushing the fringe of “useful” sampling and have burned their reputation as “number turners” by means of the needle. I have known services that have had too many complications with the needle and are therefore not requested if sampling is a potential scenario for a case. Both these factors pigeon tail those services to the types of clients that support and foster such behavior. Those types of services have a tough time living down their reputations once established and therefore have to work harder to grow their businesses. After a solid working knowledge of clinical sonography has been achieved by an individual, the next step is solid use of needles for sampling that will lead the way to caseload of definitive diagnoses; the holy grail of learning in clinical sonography. Being able to line up and sample an organ and hit various targets at various depths 10/10 tries without error (in models or cadavers of course) is a good rule to follow before sampling live. This is a personal test that not only ensures adequate capability, but also breeds confidence when the client is looking over the shoulder watching the needle.

Preparing the client for realistic expectations is an art in itself. Knowing when an FNA will likely be adequate vs. when a core biopsy is necessary and adequately relating this to the client with solid eye contact to ensure they are listening takes practice. We must master solid reasoning and knowledge of cytology ad histopathology as they correlate to the sonogram in order to convey confidence in this subject and others.

Regarding further diagnostic or therapeutic recommendations for a case, try to not give more than 3 things to do initially; which may be followed by more as the case progresses. There is something about the number 3 that is the threshold to an attention span. You lose the client with 4 or 5 or 6 medications, tests, or differentials and your value perception drops exponentially even if they may certainly be valid points. Too many points leads to interpretation of the client as lack of confidence or direction in a case or “differentiating to death” a patient and leads to loss of value perception unless the case is particularly complicated. Mobile sonographers cannot afford to play “CMA” unless absolutely necessary especially when the competition has a long history of success and large caseload. Leave the more esoteric points to the final report but talk about only the probabilities as long as the client has solid eye contact with you they are likely listening. If the client is distracted or trying to get away to other needs, then he/she is either not confident with what you are saying and you need to work on enhancing that relationship, or you need to perform introspection on the case at hand because you may be going down the wrong road and the client is not wanting to confront the fact that he is not comfortable with your assessment based on his workup of the case. Or, the client is just too busy to listen to you. But this last point should be a very rare occasion in an established business. If a client respects your abilities and opinion you will be the one trying to get away from the conversation and not vice versa in most cases. Therefore, in sum, if you feel like you are “running away” from your clients to get to your next appointment in time every day you will have reached success in the business of clinical sonography, attained a high quality reputation, and will have a solid profit and loss statement at the end of the year.