In this episode, hosts Brad and Michael share the story of a plastic surgeon whose hands-on approach helped create a thriving practice. Things took a turn when an unhappy patient uncovered weak spots in its operations and the risks of a practice built around one person. Tune in to learn how contracts, delegation, and internal protocols can foster sustainable growth while protecting your practice along the way.
Listen to the full episode using the player below, or by visiting one of the links below. Contact ByrdAdatto if you have any questions or would like to learn more.
Transcript
*The below transcript has been edited for readability.
Intro: [00:00:00] Welcome to Legal 123s with ByrdAdatto. Legal issues simplified through real client stories and real world experiences, creating simplicity in 3, 2, 1.
Brad: Welcome back to Legal 123s with ByrdAdatto. I’m your host, Brad Adatto, with my co-host, Michael Byrd.
Michael: As a business and health care law firm, we meet a lot of interesting people and learn their amazing stories. This season’s theme is Unintended Consequences. We sometimes find ourselves in a situation that can be traced back to a seemingly inconsequential or unrelated decision.
Brad: All right, Michael, what do you have for us today?
Michael: I have a fascinating story that I came across recently, Brad.
Brad: All right, I’ll be the judge whether or not that’s fascinating, but what’s it about?
Michael: It’s about a Drill Sergeant gone soft. When you picture, Brad, the stereotypical Drill Sergeant, who do you picture? And Brad, yes, you can reference a Drill Sergeant from a movie as long as you [00:01:00] promise not to take us down movie talk
Brad: First. I’m super proud of you going to movie talk. I think I’m finally paying you off that I’m around you a lot, so I’m rubbing maybe in a good way on you for movie talk. Second, determining the best Drill Sergeant of all time, it’s actually like a three-way tie – depending on where you’re looking at. So we have Sergeant Emil Foley from An Officer and a Gentleman.
Michael: Old movie.
Brad: Yes. That’s great though. Sergeant Hulka from the movie Stripes
Michael: Old movie and yes, awesome.
Brad: And maybe the most famous Drill Sergeant who will be someone who actually was a US Marine Drill Sergeant before his movie career, known as Gunnery Sergeant Hartman from Full Metal Jacket. Now, I’m curious, who do you picture?
Michael: Full Metal Jacket, Sergeant Hartman. I have to lean into the old movie reference Brad. And he just was so hardcore with his training methods and there’s so many memorable lines.
Brad: And believe it or not, I read that many of the lines from [00:02:00] the movie were ad libs because they were like, just do what you would do. And so, that’s why he just was able to make such incredible statements
Michael: Stuck in our brain forever. Well, I heard a story, Brad, about someone famous who you would never guess was a former drill sergeant, unless of course you’ve actually heard the story too. It’s an unsuspecting person because he is known throughout the world as one of the softest, calmest humans around
Brad: Kermit the frog?
Michael: Well, that’s a frog, Brad, not a human. Oh, well, unless you count the person, the puppeteer.
Brad: Wait, but Muppets aren’t real?
Michael: No. Brad. We’ll have a little therapy session after we’re done. So here’s some more details to help get, hopefully to improve your guesses about our mystery sergeant. The man that I’m talking about, served in the Air Force for 20 years and actually reached the rank of master sergeant. [00:03:00] He was infamously known as a yeller, and he was feared among everyone who served under him.
Brad: Soft spoken, but a terror before that. Yep, still don’t know.
Michael: Okay. Well, here’s the twist. He hated it.
Brad: Oh.
Michael: He hated the yelling and screaming and felt like he was having to play this kind of role his entire career. And actually, he was a pretty chill person when he was not working.
Brad: Well, at least he didn’t take his job home with him. So that’s kind of cool.
Michael: Well, that’s true. So I would give you another clue. He was stationed in the Air Force base in Alaska, and this is where he first saw and was inspired by snow and mountains.
Brad: So he became a famous skier?
Michael: I guess that’s slightly better than Kermit the Frog as a guess, but no, Brad. He was so inspired that he actually started painting [00:04:00] the snow and mountains to help manage the stress of being a world class yeller at work.
Brad: So, I think I’m writing this one and I mean, feel pretty confident. I think it’s Vincent Van Gogh.
Michael: Okay, you’re just going backwards now. So after 20 years, he retired and he actually vowed never to yell again once he stopped working.
Brad: Is it the actor, John Krasinski, and he went to A Quiet Place?
Michael: Okay, you’re just not even trying anymore. So you ready for the answer?
Brad: Yes. I think our audience is too.
Michael: The mystery sergeant we’re talking about is none other than the painter Bob Ross. He is of course, known for his TV show with his quick painting techniques and more than anything, his calming voice.
Brad: I had no idea. I’m sure half the audience has no idea what you’re talking about either.
Michael: And believe it or not, this is a new one – we save our little [00:05:00] stories we hear for our opening banter, and I actually got this from Instagram reels.
Brad: Okay.
Michael: It’s my modernization of learning my interesting content. And yeah, I had no idea either. I was stunned, and I have memories during college of coming home from class, and my roommate would have Bob Ross playing in the background with this calm voice, and he loved it, and I could not stand it. So we of course, would be ruthless with each other about him watching it. But I have always had a nostalgic reaction to Bob Ross because it does remind me of my college days.
Brad: college days equals AKA Bob Ross, which then equals drinking lots of beer. Okay, got it.
Michael: Oddly, you’re not wrong there, so that’s a Pavlovian response. Let’s jump into our story today about unintended consequences.
Brad: Perfect. Michael, what story do you got for us today?
Michael: All right. Today’s story is about a plastic surgeon in the [00:06:00] Southeast who is building a busy practice. We will call him Dr. Tony Stark.
Brad: I’m quite worried. Who is this man sitting next to me? What have you done with my partner Michael Byrd? Wait, we got some movies here, Sergeant, and now we’re going to Marvel characters. Never mind. I don’t want you to answer that. I do not object to anything you ever want to use. You’re welcome to use Tony Stark, even though I think we used his name in another show.
Michael: Yes, I think we did too, and I don’t plan to go deep in the movie talk today, so don’t get your hopes up. But I was trying to think of someone famous who captured the frenetic pace to life that our Dr. Tony led.
Brad: And for you people out there who are not Marvel dorks like me, Tony Stark, AKA Iron Man is from the Marvel movies, and he is known for always being this bigger than life kind of person, but working tirelessly in high pressure situations, both in his personal and professional life.
Michael: Dr. Tony was building a thriving practice that we’ll call Iron Man Plastic Surgery [00:07:00] and honing in on a unique surgical procedure that was drawing a claim to him around the world. When he was not operating, he was creating videos, he was appearing on shows and podcasts and otherwise educating the world about his unique procedure that he believed solved a very unique problem in plastic surgery. And so, he also had several ancillary service lines he was developing, including white labeled skin products with the Iron Man name.
Brad: Nice. That’s kind of cool, but for many successful surgery practices, they not only have to have a robust surgery practice that you were describing, and they probably have a great non-invasive practice, AKA Med Spa, but they need to develop their own skin products with their – some of them will develop their own skin products with their names on it. Often these products are white labeled, meaning that there some other outside vendor or brand is actually developing it, [00:08:00] but the practice liked it so much that they’re able to stick their name on top of it.
Michael: Very good, Brad. So Dr. Tony also started building a wellness brand that he felt dovetailed into his unique procedure. He had various Iron Man supplements that he sold to help optimize a patient’s health for surgery, and he would also prescribe GLP 1s for patients who needed to lose weight before their surgery.
Brad: And I would say this, what most plastic surgeons love about the wellness and weight loss being added to the practice is the sustainability, sustainability in the form of patient care, and obviously financial viability. A medical practice adding these types of treatments, also known as longevity, means you’re providing continuous care for these patients, both in the aesthetic side, meaning how they look, and then wellness side, how they feel inside. And this helps evolve with the patients in this, as the patient changes and their health care needs changes, you still can work with them, which means you have long lasting patients, [00:09:00] and that means the medical practice has also a long lasting or ensuring their financial viability.
Michael: Yep. Totally agree. Well, Dr. Tony, Brad, he believed that he had more than 24 hours in a day, unlike most normal humans. And so, I actually picture him being that guy that wakes up at 3:00 AM and goes to bed at 11. You see those videos of Kobe Bryant that would have like a workout at three in the morning, and then breakfast and a second workout in the morning. So he would work out four times in a day instead of two a days. That’s our guy, Dr. Tony. And he never seemed to lose energy to do more and more.
Brad: And that’s pretty impressive. And I’m wondering, going back to where we started this show today, I wonder if you had a Drill Sergeant that really helped keep him motivated,
Michael: Maybe so, Brad, maybe so. All right, Dr. Tony, did, Brad, start running into some friction because of this busyness?
Brad: Did he actually realize someone sat [00:10:00] him down and said there’s only 24 hours a day? Or was he like, falling asleep on the job, which is kind of scary if you’re a surgeon?
Michael: Both fair questions. I don’t know. But he had created an unsustainable model that was way too dependent on him to succeed. So start with this. He had a specialized surgery that only he could perform – So you have that. And then he personally recorded all the content that was to educate people about these surgeries. On the business side, he felt like he needed to be heavily involved because patients flew in from all over to see him, and on the side, he was also being the CEO of his business.
Brad: And as you’re talking about this, it reminds me of like a lot of startups, especially the entrepreneur who kind of kicked started it, you’re involved in every single aspect of that business. And as it grows, you eventually have to get to the point and wonder, is that the [00:11:00] highest and best use of the time? And I think we’ve talked about this in other shows, Michael, but the concept is, do I need to start firing myself from certain jobs? So is it really important for Michael to show up and make the coffee every morning? Maybe you could get someone else to make it. I mean, you make a coffee though, so you know, congratulations on that. Or maybe is, am I the person that needs to really be doing all the record keeping? Or am I the person needs to set up the room for a video? The more you can fire yourself from jobs, I know this sounds like little details, but the higher you get up there, the more you might say, I might need someone else to be a CFO, or I might need someone else to take over the CEO role.
Michael: No, all good points. I mean, I’ve been trying to fire you from all your jobs for years, and you can’t go get away.
Brad: I walk right into that. Yeah, you can cut that. That’s cuttable material there, people.
Michael: But no, you’re right. I mean, you start a business and you’re wearing so many different hats and you have to figure out how to have people step in [00:12:00] for the highest and best use of your time.
Brad: Okay. So I’m going to ask this question. So being Iron Man, he had a lot of hats on, so he had to eventually take his Iron Man hat off. So, what did Dr. Tony do with all these hats?
Michael: He knew he couldn’t immediately solve finding someone else to help with the surgeries because that would require highly specialized training to teach someone this famous procedure. So, he hired someone to be president of the practice on the business side, and we’ll call him Mr. MBA.
Brad: Okay, well, I’ll say it this way, Michael, you and I have been in enough ruins with the founders, and it’s a struggle sometimes for them to really think about when they invented something or they did something, they’ve grown it, but eventually they get to the point where they actually, their skillset might not, you know, they might not be the best person any longer to be the CEO, but it’s still hard for them to think about spending money on bringing and recruiting in. Typically, a higher paid employee or second highest paid employee [00:13:00] depending on your practice to come in as that CEO. But it’s important, I think, for a lot of practices or businesses to adapt and to realize how important it is to bring someone with that skill set that they weren’t trained in.
Michael: You’re right, it’s a big deal. I mean, it’s a six figure job that in addition to getting over the ability to let go of something, it’s a massive investment to do it. And the good news with an MBA is they do obviously have a high level of business acumen. The challenge that’s often faced is they don’t know, in this case, the business of plastic surgery, and they definitely don’t know the practice as well as the doctor – as well as Dr. Tony. So, it would take a lot for Mr. MBA to fully understand the nuance of this highly specialized even within plastic surgery, highly specialized practice at Iron Man Plastic Surgery. [00:14:00]
Brad: All right, Michael, how’d it go with Mr. MBA?
Michael: He was solid. He was good enough. He was learning the industry as the practice was scaling, and so he and Dr. Tony knew they were going to break things as they figured it out on the fly, but felt that was the only way to keep the momentum, was just to go fast and do the best they could.
Brad: The business idea that people talk about all the time, I know we said it before, but move fast and break things, suggesting that there’s, it’s better to make the mistakes and learn quickly than to be overly cautious and be too slow.
Michael: And so, one of the first things they did to provide relief to Dr. Tony was to systemize the patient lead process. So with this famous surgery, patients were making inquiries from all over the world, and so they had to remove Dr. Tony as much as possible from the pre-surgery process. So they developed a system [00:15:00] that basically had Dr. Tony interacting with the patients for the first time the week before surgery. And they had built a lot into the process from a medical standard of care perspective, so that the quality of medical care didn’t suffer.
Brad: I like that portion of it, but I feel like at this point in this story, I think we might be getting closer or maybe hinting or hinting at the unexpected consequence.
Michael: Yes, Brad – gold star. One of the things they did not consider when they knew they would kind of “break things” was to factor in some guardrails from a risk management perspective. And so, one of the filters that got lost in creating this new system was the ability to identify if there was a bad patient candidate, AKA, a crazy patient filter, as they might say on the street.
Brad: I’m starting to get some of my spider sense or my Iron Man sense. [00:16:00] I don’t think it has one of those, it’s starting to go off. So what happened here?
Michael: Well, Brad, Ms. Roberta Ross was guided through the system and operated on by Dr. Tony. Ms. Roberta had significant body issues, body image issues that were undetected. These would make her a bad candidate for surgery because she would be impossible to satisfy with the results of the surgery.
Brad: Well, that is sad that Ms. Ross had body image issues. Maybe she can look up her at Uncle Bob Ross’s artwork and feel better about herself. Unfortunately, we see this a lot in the plastic surgery patients that do have severe or significant body image issues. And the question for these patients, do they need a plastic surgeon or do they need a psychiatrist? Often with these patients, no matter the number of times they have surgery or how great the surgeon is, they can never really be satisfied with the outcome.
Michael: So the cat was out of the bag. Ms. Roberta was operated on, [00:17:00] and was indeed not happy.
Brad: What?
Michael: And she spiraled post-surgery. She actually went to a special forum dedicated to this procedure that Dr. Tony performed. And remember Brad, no one else does this procedure, so it’s basically a forum for Dr. Tony and posted long diatribes on how horrible Dr. Tony was.
Brad: It’s very unfortunate, but unfortunately on top of the unfortunateness, very predictable. And if Dr. Tony knew about the significant body image issue, I’m quite certain he would not have touched this patient. And what we know is when you have an angry patient, they lash out in different ways. You said one of them, which they start posting things, but they might be screaming and be hostile to your team. But they can then start writing bad reviews besides that forum, all over your socials or anywhere else. They can file medical board complaints in this case, or worse, I mean, not worse, but even, and continue, they [00:18:00] can file malpractice lawsuits.
Michael: You know what happens, Brad, with Killer Bees?
Brad: Yes. Once one bee gets on the attack, the entire hive starts swarming.
Michael: So this forum I mentioned, became a killer beehive.
Brad: Oh no.
Michael: And everyone went on attack. It was actually pretty scary to see the negative momentum unfold.
Brad: That’s unfortunate. It sounds like when people start feeding off negative energy, it just grew.
Michael: Yeah, it was not good for Dr. Tony. But let’s go to break and talk legal application and hear what happened with Dr. Tony.
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Brad: Welcome back to Legal 123s with ByrdAdatto. I’m your host Brad Adatto, my co-host, Michael Byrd. Now Michael, this season, our theme is Unintended Consequences, and we have a couple of layers really discussed when talking about unintended consequences with today’s story. I mean, first, let’s talk about the go fast and break things strategy that Dr. Tony and Mr. MBA implemented with his surgical practice.
Michael: I think any entrepreneur has done this at some level, in many ways this strategy captures the energy of a young growing and dynamic business. You know, we always call it pirate mode. And there is a positive side to this strategy, and the unintended consequence is that when you’re going fast, the team doing so can only go fast in the areas where they’re actually subject matter experts. [00:20:00] Mr. MBA was not a subject matter expert on risk management for creating a systemized approach for intaking plastic surgery patients or leads.
Brad: Yeah, that’s another great point, Michael, so I think you deserve a gold star here. But the balance between speed and expertise and entrepreneurship, right, while moving quickly can indeed harness the energy and grow the business. It also can obviously lead to gaps in the knowledge, and especially in any type of specialized health care. But we’re talking about a gentleman who literally, that you said, no one else could actually do this. And understanding ways to then manage this risk in any injury. Again, health care being harder is essential to really building a sustainable model. So let’s go back to our story. What could Dr. Tony and Mr. MBA have done differently?
Michael: Yeah, I mean, when you’re putting new systems in place, you’re making changes to your practice, whether it’s operationally or otherwise, [00:21:00] you want to make sure you have the team in place to protect the practice from every angle. And so, Mr. MBA have that self-awareness of what he knows and maybe bring Dr. Tony in at a deeper level to test the systems. If Dr. Tony was the person that was kind of gatekeeping the appropriate candidates for surgery, and so you needed to get him involved from a patient care perspective. But you also, you know, if there’s still gaps, bring in other advisors, whether it’s health care council, accountants, financial advisors, or practice advisors. You want to make sure that everything’s covered so that you can keep an eye on compliance and risk and put these guardrails up to allow you [00:22:00] to keep going fast.
Brad: You know, I don’t know what’s going on, Michael, but you’re actually making a lot of good points. I must be finally rubbing off on you, so I’m glad to see it’s finally working. And audience, Michael’s point is good. It is essential for good entrepreneurs to really have a diverse team, right? You want a range of different expertise that come in and bring their skillset with them so that helps from a decision making, meaning that you’re not in some vacuum or where everyone’s – you’re siloed and you all have the exact same skillset. So by addressing these gaps, businesses can actually maintain the momentum without obviously, that Michael’s just describing, without compromising, which is crucial to these operational aspects that Michael kind of was talking to. So from that perspective, it is critical to really implement a structure process while growing and ensuring that the team members all have the necessary knowledge and tools to navigate, especially with health care, these complex issues you raise, meaning educate, educate, educate.
Michael: Brad, [00:23:00] and so talk about the things that could have been done differently to manage the system that allowed someone like Ms. Roberta to be operated on.
Brad: We were incorporating some type of filters during the patient intake process to identify potential mental health issues is really going to be critical, especially for plastic surgeons to ensure that the patient’s receiving care, it’s appropriate care for what they truly need. Meaning, what treatments are really needed to solve their issues, and a doctor should meet with a team and develop these mental health screening questions and on the intake forms, although you’re asking about anxiety and depression and past mental diagnosis or other surgeons that they had seen and what have been done. So like the more details you can get back from these patients, the better chance you can have of flagging someone that you may never satisfy. Again, going back to training your staff on, are there any behavioral cues that they might see during the intake process? Again, I said it again, [00:24:00] educate, educate, educate.
Michael: I mean, we’ve talked before, I think with our partner Jeff Siegel; the people that are talking about their unhappiness because they’re seeing the prior four physicians they’ve seen were terrible, but they’re really happy to be at this place. There’s cues like that to your point, that you identify and then again, to your point, educate and make sure everyone’s on the same page. Well, let’s go to the other side of the coin, Brad. Now we have patients that are going to get through and they’re going to be angry. We can’t avoid if you’re going to have patients, having the angry patient scenario, talk about some options to manage angry patients.
Brad: We’ve talked about this in other shows too, but first off, for the doctors and other providers and staff, you need to start working on to being able to perfect or really become good active listeners, allowing the [00:25:00] patients to express their frustrations without interrupting, really demonstrating the value that you’re listening to their concerns, which for starters, helps to kind of deescalate the tensions because you’re listening. And while listening and before responding, learn to be empathetic. And that can help, again, calm them down. It doesn’t mean that internally you’re not struggling with what they’re saying and accusing you of, but you’re sitting there to listen. And then once you have the opportunity to talk, explain your policies and your procedures clearly, ensuring the patient actually understands the rationale behind whatever is the friction that is causing it, and discuss why the practice is doing A, B or C. The more transparent you can be while being calm and active listening, the more trust you actually will build up with that particular patient.
Michael: I mean, we’ve actually seen studies put out by malpractice carriers that say that the number one, to your point, [00:26:00] Brad, the number one way to reduce the likelihood of getting sued for malpractice is effective communication. The flip side is, is that sometimes doctors put their head in the sand, they don’t want to talk to the patient, they just have their staff interact when they’re angry and they don’t engage.
Brad: Because they have to have a hard conversation.
Michael: Yeah, exactly. And so, it goes a long way. It sounds so simple, yet so many make that mistake. But sometimes even if you do this, you’re still going to have an upset patient. What else can the practice do to resolve this issue?
Brad: Well, I’ll give you options. Doesn’t mean we agree with all of them, but sometimes it’s simple as offering a redo, which doesn’t really always work because especially with a patient like Ms. Ross, who you’ll never satisfy them because she just has that image in her head. So then you have the practice that will, can kind of fall back on a refund policy. [00:27:00] Now refund is, you know, the policy, a good one is you’re communicating upfront and you’re probably saying, here’s what’s happening. You’re not saying you did anything professionally incorrect, but you’re showing a willingness to listen to the patient and then to reimburse the patient for what they went through. And of course, in a good refund policy, you would have a refund agreement where the patient then releases you and, and other parties if they’re going to get that refund.
Michael: Yes. And I think we need to state the obvious, but just give permission to recognize that once a situation like this, emotions are triggered, particularly with someone with a mental health disorder. There’s no other way to say it – It’s super messy and you can only control what you can control, which is how you respond. But to think that you’re going to control how the patient acts is obviously not realistic, and so it is messy and dicey. [00:28:00]
Brad: All right. We’re almost out of time, Michael, so what happened with Dr. Tony?
Michael: Well, the killer bees attacked. Dr. Tony ended up being sued in a lawsuit by three patients, including by Ms. Roberta. He was subject to a half a dozen board investigations, and just tarnished online through this forum and other forums.
Brad: It’s terrible. Dr. Tony or other providers really should pause and make sure before they implement accelerations like that, they have good filters in place, and more importantly, that they have the, the staff well trained and educated how to kind of spot those red flags. Michael, what are your final thoughts?
Michael: No matter how fast you’re scaling your practice, it’s so important to have a crisis prevention strategy. So understanding compliance and risk and putting these guardrails that we’ve been talking about up to protect the business. And you also [00:29:00] want to have a crisis management plan because a crisis of some kind is not a matter of if, but when with any practice.
Brad: True. All right, everyone will, next Wednesday, we are back again, where we’re here to discuss unintended consequences with a celebrity, Michael, guest who’s a singer, a songwriter, a keynote speaker, and executive coach. We have the one and only Cameron Atlas joining us. Thanks again for joining us today. And remember, if you like this episode, please subscribe, make sure to give us a five star rating and share with your friends.
Michael: You can also sign up for the ByrdAdatto Newsletter by going to our website at byrdadatto.com.
Outro: ByrdAdatto is providing this podcast as a public service. This podcast is for educational purposes only. This podcast does not constitute legal advice, nor does it establish an attorney-client relationship. Reference to any specific product or entity does not constitute an endorsement or recommendation by ByrdAdatto. The views expressed by guests are their own, and their appearance on the program does not imply an endorsement of them [00:30:00] or any entity they represent. Please consult with an attorney on your legal issues.
