PME book -- introduction Maybe you remember when your career seemed like a real adventure -- a thrill that you could enjoy every day. But maybe it's less of a thrill now. Maybe you're feeling like there's drud gery every time when you go into work. I'm an RN. What I wanted from the very beginning was pretty easy. I wanted to work for myself. I wanted to work from home. I wanted control over my career. And I wanted to do something that would keep me engaged and interested. You can do all of these, too. You can make more money than you'd imagined t hat you could. You can have control over your career. You can provide a servic e that is valued by your customers. And you can have fun. And let's talk about money up front. Everyone else in the medical field mak es money. Why can't you? Nurses and other professionals need to get over the i dea that somehow their work is a kind of calling, that you should be content to not make an adequate income, or that it's somehow wrong to believe that you dese rve to be well paid. Because you do. This is not get rich quick scheme, it can involve hard work, and it can be f rustrating at times. But you can get control, you can provide a valuable -- and valued -- service, and you make a very good income. This is where this book comes in. Join me for an exciting ride. What's an insurance examiner? Providing insurance exams is a specialized service by medical professionals. I collect and provide information about folks taking out life and health insur ance for insurance companies. I do medical histories, physical assessments, lab specimens (urine, blood, and sometimes, saliva) and ECGs. What I provide is a way for insurance companies to assess the health status of their insureds so the company can avoid taking on risky customers who are sick, disabled, or engage i n risky behaviors. I do this on a mobile basis, and that's one of the things that sets me apart from my competitors. I cover a 50 mile radius around my home, and do exams at clients' homes, workplaces, or wherever it's convenient for them. Each exam takes around 15-20 minutes. There's maybe another 30 minutes of p aperwork and processing following that, and of course, there's time spent on the phone, talking to clients, scheduling appointments, and there's drive time. How much can I make? I've been at this for years. I actually started -- part-time -- in June, of 1980. I did it part-time while working as a medical surgical and gerontology n urse until I went full-time in December, 1982. I say this to let you know that I'm at the top of what folks are paid for this work. When starting out, you won

't make what I'm making now. But you can be making a very good income within a year. What's the difference? How can you move up so quickly when it took me a whi le? It's easy: information. When I started, there was little or no information available. I didn't have this book. I didn't even have the net. (How I lived then, I'll never know). You've got both. Count your blessings. I make an average of about $60 per client I see. I say "on average" because each insurance company pays different rates, and there are different pay rates for different services. But I know that if I see 8 clients in a day, I'm going to make $480. That's gross pay, in other words, that's what I'm paid before I c ount my expenses. Fortunately, this is a business without a lot of expenses. My biggest expen se is auto expenses. I drive a lot of miles every year, and that's one of the r easons why I drive a car that gets good mileage. But all of your expenses are deductible on your taxes. And that can give yo u a whole other set of advantages, which we'll get to later. So I'll come back to income. I'll be conservative. Let's say you're seeing 6 people a day, 5 days a week, 50 weeks a year. Doing that -- and that's not h ard work -- you will gross about $90,000 a year. Are you willing to spend a yea r working up making that kind of income doing something you'll enjoy? What does the work involve? There's a couple of aspects to this business. First, marketing. I'll get that out front. To succeed (and make a good inc ome) you will need to market yourself to insurance agencies and other companies. You'll need to get your name out to local agents and their office staff. In o ther words, you'll need to sell your services. Sales may sound scary. It's not. When I first began, of going to insurance offices, introducing myself, telling eaving some business cards. No hard sell, no bad-mouthing saying hello. Now, you'll need a website. It's all a lot have imagined. my selling consisted them what I do, and l my competition, just easier than you might

Next, you'll get exam orders from insurance agents. They will provide clien ts' names and contact information. Then you'll contact the client to set up your appointment. Next, you go to the appointment. In 90% of cases, your work will consist of a health history (names and addresses of your client's doctors, information abo ut surgeries, hospitalizations, and family history), collecting a urine specimen , and drawing a blood sample. Occasionally, you won't have to do blood, and occ asionally, you'll have to do only the blood and urine. Sometimes you'll need to do a mobile ECG. While these aren't that frequent, you will need to be able to do them, which means you'll need to have an ECG machine. The type you'll need u sually sell for $500 to $1,000 on eBay.

After completing your appointment, you'll check for any errors on your paper work, centrifuge blood samples, and ship specimens to the lab. What equipment do I need? For sales: you'll need business cards and a website. For getting there: a reliable car. Preferably, one that gets good mileage. An up to date GPS. Communications: I have a land line which I use for my office and for faxing . You don't have to do that, but you do need a recent cell phone. A smart phon e is a very good idea. Office stuff: reliable, high speed internet. Reliable printer with fax or s can capabilities. Computer, of course. Preferably a laptop. You'll also need a shredder. You'll want to keep copies of exams you've done at least until you' re paid for them (I keep a file with 5 months of exams, in case something gets l ost -- it occasionally happens -- out a month of 2) but at some point you'll nee d to discard the paperwork, and HIPAA regs mean you can't throw them intact in t he trash. Clinical stuff: ECG machine. Centrifuge. Briefcase (soft side bags are bes t), scale, measuring tape, tourniquet, clipboard, sphygmomanometer, stethoscope. Urine testing strips. A watch with a second hand (for measuring heart rates). Bathroom scale. Lab kits and exam forms, both of which you'll get from the ex am company you're working through. How an appointment works. Here we go, step by step. What I'm telling you here is the most valuable pa rt, so listen up. This process will enable you to complete an average exam in 1 5-20 (yes, it will take you slightly longer at the beginning; I'm talking about how long it will take after some experience). After getting the contact information, call the client. Here's your script. "Hi, Mrs. Jones, I'm John Doe, calling for Jill Doe, your insurance agent with XYZ Insurance Company. I'm calling to set up a time for the little physical th ey need for the life insurance you're taking out. Is there a day or time that w ould be good for you?" Now stop. Let them think about it. Often, folks will s uggest a time. Make sure your schedule is in front of you so you can see if you can do that time. If the client's any distance from you, suggest the following: "I'm going to be in your area next Tuesday morning around 9. Is there any chance we could do it then?" Your clients know how much gas costs. They are often very eager to help with that expense. It's possible they won't be able to do the time you sug gest, but you will never know unless you ask them. After confirming a time, make sure you've got the correct address. If in do ubt, ask them to spell the name of the street or location. Confirm the time: " That's Friday, the 18th, at 10 in the morning, right?" 2 issues come up here: fasting and urine. I suggest a few hours fasting (un less the insurance company you're doing this for a specific amount of time). If I'm doing the appointment in the morning, I encourage them to try to not eat af ter midnight. However ... make sure you tell them the following: "If you can, avoid any food or drink for a few hours before we do the exam. If you do, you'l l get better results on the lab work. But make sure you drink plenty of water,

because we'll need a urine specimen." ALWAYS mention drinking water. Some folks don't understand, and think they can't have any water, and it can get pretty grim by the time you get there. Also ... if people are dehydrated, they will have difficulty getting the uri ne specimen. And if they are dehydrated, YOU will have trouble getting their bl ood sample, even if you are good at it. Now, give them your phone number and name. I want folks to have that. I su ggest they call if they have questions or need to change the appointment time. Given the chance, people will usually try to let you know if there's a problem, but it's difficult if they don't have contact information. You get to a client's location and meet them. After saying hello, shaking t heir hand, doing all the nice things your mother taught you to do, ask, "Do you have a table we could use? I need to fill out some paperwork." Most people will. If they don't, use your clipboard, but it's easier if you have a table. I don't need a lot of space on a table (in other words, they don 't have to clear the whole space off) but a small area is good. Now set your stuff down, and ask, "Do you want to go get the urine specimen? I can go ahead and start on your paperwork." This accomplishes 2 things. Often, you're going to have somebody who has he ld their urine for hours. (I don't know why, but they do). So they really, rea lly, REALLY need to go. This takes care of that. And if they tell you can't uri nate, it probably means they are dehydrated. Which means getting the blood samp le will be far more difficult. Bringing this up first allows you to correct tha t. If they can't get the specimen then, brush it off, and tell them it's no pro blem, that you can start on the paperwork with them, but suggest that they drink a couple of glasses of water, and work on the urine at the end. If they go to get the urine specimen, ask for their driver's license. First , you need to verify their identity, and secondly, this allows you to start fill ing out the lab slip. When they return, make sure all specimen containers are labeled with the cli ent's first and last names, and a lab bar code that matches the lab slip you're filling out. Then go through the questions on the exam form. Most companies want informa tion for the last 10 years, but the form will usually specify how long to go bac k. Provide full details. For example, if the client had surgery done 2 years a go, get as specific a date as possible. Give the name and address of the hospit al, as well as the name and address of the surgeon. Give details as to any comp lications, or note, "no complications." Details are important. You are eyes and ears for the insurance company. Pl us, if the client has a medical issue, your details can show the insurance compa ny if there are no complications, or if the client is managing their illness wel l. List all medicines the client is taking. Provide names, dosage, and frequen cy taken. And after you've finished all the questions, give the form one last glance t o make sure you've asked everything. Ask yourself: would my answers make sense to someone who wasn't here today? Finally, get the client's signature on the fo

rm. Now, to do an ompanies only for go to the next page, and get the client's height and weight. You need actual measurement on those. You can't take their word for it. Many c have a place for chest and abdomen measurements. These should be done men.

Next check blood pressure (some companies ask for 3 readings -- to me, it's easier to just do 3 readings for every client) and a resting heart rate. Finally, get the client's blood sample. You know the general outline of how to do this, but here are a couple of suggestions to make it easier. First, if the client shows any sign of being nervous, suggest that they lie down for the b lood draw. Men are especially bad about fainting. I always ask if they are OK with blood draws. Most people will tell you if they are not. I always check bo th arms before I do any sticking. Make sure you have plenty of light, but go on the rule that "if you can feel them, you can find them." Finally, after you've found a good vein (the median cubital vein, if possible), get your client to ma ke a fist with their other hand, and hold it under the arm you're sticking. The n prep the skin, don your gloves, and do the blood draw as quickly as possible. After you're done, place the cotton on the site, and encourage the client to pu t pressure with the other hand for a couple of minutes, and put a band aid on th e site. After you've packed up all of your materials, glance around to make sure you 've picked up everything. Finally, ask the client if you can have one last look at the site where they were stuck. Ask them if it feels all right. If everyth ing's good, you're all set to go. And in spite of what this sounds like, this r eally can be all accomplished -- for probably 90% of your clients -- in 15-20 mi nutes. It will take a little longer at first, but you really will develop a rhy thm to the process, and will be able to get it all done quickly -- and well. How to get started (I'm assuming you have experience in blood draws. If you don't, you will ne ed some. If you have a degree or certificate in a medical field (such as RN, LP N/LVN, CMA, or EMT) you have almost done some blood draws. But you need to be c omfortable doing them on your own if you're going to make it in this field). First, you'll need to get hooked up with one (or more) paramedical exam comp anies. These companies effectively serve as brokers between you and the insurance c ompanies. They deal with hassles, provide lab kits, and take care of billing. In return, they take a percentage of what the insurance company pays. Most examiners starting off think they can go out on their own, effectively eliminating the middleman. (Ask me how I know ... ) But you really can't. Or, to put it more bluntly, it's not worth the troubl e. A good company earns their percentage by taking care of headaches you really don't want to deal with. When you're starting off (assuming you're a complete newby) they won't pay you much. It's part of the learning. But with 6 months o r a year of experience, and getting direct order from agents, you can write your own ticket. I'm currently paid 92% of billing. That's what you want to aim fo r. But starting off, you probably won't get anywhere close to that. I'd recommend contacting all of these companies. Explain that you're new to this, but wanting to get signed up with them, and begin working. Mention that you're signing up with several companies. If they know that, they may offer you

more money. They will email you a huge packet of things to fill out, and they' ll offer you money. When they do that, thank them, and make a list, showing the company, and what they're offering. If one company's offering a very low rate, question them about it. "Why, the XYZ company is offering me ____. Can you ma tch what they're offering?" Here are the companies. The following companies should have a local office. Go to their web site, and look for "locate an office," or something like that. Find the nearest office to your location and contact them directly. 1. EMSI (emsinet.com) 2. ExamOne (examone.com/examiners) 3. Portamedic (hooperholmes.com/Aspx/Core/Core.HomePage.aspx) 4. Paramore (paramedicalexam.com) 5. MedicExams (medicexams.com/employment.php) 6. Superior Mobile Medics (supermedics.com) 7. APPS (appsnational.com/index.aspx)

Making Averages Work for You in This Business I've received a couple of questons about my "$100,000" chapter. Here's a few tho ughts to clarify what I was talking about. The questions have mostly been 2: "How do I find companies that pay $60 per exam ?" and "What do I do if I don't want to do the lower-paying orders?" First, finding companies (I mean exam companies, not insurance companies) that p ay $50 (on average) per exam is not difficult. As I say over and over, it means signing on with several companies that pay -- depending on the company -- from 7 5-87% of amount billed. The second question is far more difficult. Basically, if you don't want to do th e lower-paying orders, my system won't work. Here's why. An agent calls you directly, saying she needs you to do an exam and urine for th e XYZ Life Insurance Company, and the applicant is 22 miles away from you. Now, you happen to know that an exam and urine for XYZ will pay you $23.17. And with mileage you feel this isn't worth your while, and you tell the agent that, and s uggest that she call someone else. Now, the problem is that most agents -- often after even one such refusal -- wil l simply not call back. The reason is that you have become more trouble than you 're worth. And insurance agents -- like anyone else -- seek to avoid hassles, an d do things the easiest way. And if they can call your Local Big 4 Paramedical C ompany, and the Local Big 4 office will take all exams, they will start calling them. Our job is to be of service. Repeat that to yourself. If you start to be seen as someone who doesn't have an interest in service, you will be out of business, a nd soon. There are lots of agents I deal with who call me a lot. Let's say an agent calls me twice a week on average. If I make (again, on average) $50 per exam, that ag

ent is worth $100 a week. $5,200 a year. And over $25,000 over the course of 5 y ears. Some of the calls that agent makes will not pay enough to be really worth it. So me will. But an agent who works for a bunch of insurance companies will -- again , on average -- be worth. And how. I am not in this business for charity. I make a living from it, and I don't tole rate mooches, pains-in-the-neck, or agents who only call me when their favored e xaminer won't do a pre-set for 3 a.m. But if you are seen as someone who is help ful and ready to be of service, business will come to you. Not automatically, bu t word gets around. The crazy thing about averages is that if you try to beat them, you'll end up ma king less. In other words, if you say, "I'll only take exams if they pay at leas t $50, no less," you'll end up losing business. The agents who would bring you t hose high-paying orders just won't call at all. And while in theory you'll be ma king more per exam, in reality, in the long run, you probably won't even stay in business. Take the orders. Even on ones that just don't look like they're worth your time. And in the long run, it will be very much worth your time.

How to Make $100,000 a Year in This Business I know I promised in the title that you could make $90,000 a year in this busine ss. But I'm going to show you one better. This is an easy, do-able plan whereb y you can earn $100,000 in this business next year. And every year after that, i f you are so inclined. The plan is this. You sign on with several companies, and get a high percentage (say, 85-90%, likely depending on the company). At those percentages, you will p robably average $55-60 per case. Of course, some pay more, some less, but figure on an average of $55. (This plan also assumes you've got a lot of agents callin g you directly. If you don't, this will be an incentive to start making those sa les calls). You do 7 exams a day. Six days a week. That may be more than you want to work, b ut it's not an insane amount of work. I saw 6 people today, and that involved a huge -- for me -- amount of driving. (And the driving was made worse because of all the last minute shoppers on the Friday before Christmas). At 7 exams a day, working 6 days a week, you -- if the averages hold -- make $11 5,500 for a year. Now, of course, you will have quiet days, days when the phone doesn't ring, and days when appointments are hard to make. But you may also have days when you see 10 or 12 people. Again, averages work for you. That $115,500 is gross pay. In other words, it doesn't take into account your ex penses. You still have to consider your gas, and other costs. And let's say you don't make $115,500. Just 6 exams a day would gross you $99,00 0. Most folks reading this are making less than that. A few of you are making th at or more. And if you aim for this much, and miss it, let's consider the possibilities. If you just see 4 cases a day at this rate, you'll hit $66,000 (4 exams x $55 each x 6 day x 50 weeks, which means I'm assuming you're taking 2 weeks off. I hope

you are). Are you making that much now? If you aren't, could you aim to do it n ext year? But what I want to do is give you something to think about for the next year. An yone making money like that is doing a good job, giving good service, and is ple asant to deal with. But it's not the hardest task in the world. You -- yes, you can make that much next year. Start to think about it.

Tao principles for making the practice work From http://solodoctalk.blogspot.com/ This is from a very fine blog. The writer is a doctor, working in a solo practic e. Some of his stuff doesn't apply to us, but I've found that a lot of it does. 1) When the phone is not ringing, organize your desk. Transform your anxiety into a positive action. Organize your contacts. Call them . Reach out. Go to networking functions. Don't just sit there. Send your establi shed patients a newsletter. Or even a thank you for being your patient. Get orga nized, and that phone will start ringing again! 2) When your weekly numbers drop, let go of controlling your practice. I've found this to be true from the beginning. There's an energetic loop with th e flow of patients. The more you want to control your weekly numbers the more th ey bend away from you. Yes, I know this goes against the mathematical explanatio n of regression to the mean, but this is the Tao of practice. Your mental state will influence your outcomes. 3) When the checks slow down, visualize the free and easy flow of money. A little Tao dictates substituting negative thoughts with positive visualization s. The more one hords one's money, the more one constrains it. If no one spent a ny money, then there would be no economy. It's the flow that keeps things moving . Getting into the mindset of the flow frees you from the constraints of countin g the daily numbers. Things always balance out somehow. 4) When you can't sleep at night because of worry, breathe out the worry and bre athe in visions of success. Success is already around the corner. It's out there for the grabbing, but spend ing too much time worrying is going to alter what you do for your success. A lit tle worrying is ok, if it motivates you to action. But too much worry is an ener gy drain that does not benefit your practice. So breathe out those worries, and breathe in your success. 5) When your practice doesn't feel ideal anymore, find your center. It's when you are centered that you truly know what your ideal practice is. If y ou've strayed from this point, don't fret about it, just find your center again. Write about your practice -- how it is, and how you want it to be. Just write. You don't have to have the answers right away. Writing this out, your subconscio us will start working on those answers that will wake you up in the middle of th e night with a "Eureka!" 6) And finally, the ultimate Tao: Keep yourself healthy and balanced. Keeping yourself healthy and balanced, will keep your practice healthy and balan ced. Many doctors sacrifice their own health in service for others. Although alt ruistic, eventually this will catch up with them. A significant portion of docto rs suffer from depression or substance abuse. So take time to keep a healthy min d in a healthy body. Meditate. Exercise. Eat heathily. Keep your system clean. P lan Spring and Fall detox diets. Keeping yourself balanced will make you a bette r doctor. If you have extra free time because your numbers are not up yet in the

early years, don't fret about that either, go to the gym or spend extra time wi th your family and friends. Enjoy the ebb and flow of life.

Being Hard on Your Clients About Blood Sticks There's no "one" secret to getting a good blood draw. A number of factors work t o make it easy on you, and (relatively ... ) pain-free for the one you're sticki ng. But resting the arm on a hard surface is right up there in the top five. Why? Because when someone's arm is on a soft surface (such as their knee or a pi llow) or not on a surface at all (here I'm thinking about folks who want to hold their elbow cupped in their other hand), there's a tendency for the arm to move . Ever so slightly. But move it will. And when it moves, that vein you've got fo r a target will move too. Ever so slightly. But often just enough to cause you t o miss. Resting the arm on a hard, elevated surface will help you to have successful blo od draws. A stack of books would work. Or a hard arm of a sofa or chair. Actuall y, a sharps container works great, but it's kind of weird, and I don't recommend it. But just be sure to give your clients a hard time. They'll be glad you did. : )

What to Do When the Applicant Doesn't Have to Fast The short answer? Tell them to fast anyway. Of course, there are the obvious exceptions: diabetics come to mind. But apart f rom those, fasting never hurts the lab results, and usually helps. If you don't tell folks to fast, you will walk in to the appointment, and the ap plicant will have the last bite of a Big Mac in her mouth. Or will have a beer i n hand. (Not that I have anything against Big Macs. Or beers. But you get the id ea). Obviously, the best fast is the long one: from 10 p.m. or midnight until you get there at 8 or 9 a.m. But you can't get everyone that way. Even if the applicant can only fast for a couple of hours, it will help. Suggest, say, an 11:30 a.m. appointment after a light breakfast, and nothing after that. Or 6 p.m., with a l ight lunch, and nothing but water (and "water" is not a generic term for "liquid s," unless you want to do a blood sugar after someone has had 3 sugary soft drin ks) after that. (Remind people that fasting does not -- under these circumstances -- involve goi ng without water. Otherwise, things are pretty grim by the time you get there). Just encourage fasting. Agents will appreciate your doing so, and most applicant s will understand if you explain it to them.

Making Averages Work for You in This Business I've received a couple of questons about my "$100,000" post. Here's a few though ts to clarify what I was talking about. The questions have mostly been 2: "How do I find companies that pay $50 per exam

?" and "What do I do if I don't want to do the lower-paying orders?" First, finding companies (I mean exam companies, not insurance companies) that p ay $50 (on average) per exam is not difficult. As I say over and over, it means signing on with several companies that pay -- depending on the company -- from 7 5-87% of amount billed. The second question is far more difficult. Basically, if you don't want to do th e lower-paying orders, my system won't work. Here's why. An agent calls you directly, saying she needs you to do an exam and urine for th e XYZ Life Insurance Company, and the applicant is 22 miles away from you. Now, you happen to know that an exam and urine for XYZ will pay you $23.17. And with mileage you feel this isn't worth your while, and you tell the agent that, and s uggest that she call someone else. Now, the problem is that most agents -- often after even one such refusal -- wil l simply not call back. The reason is that you have become more trouble than you 're worth. And insurance agents -- like anyone else -- seek to avoid hassles, an d do things the easiest way. And if they can call your Local Big 4 Paramedical C ompany, and the Local Big 4 office will take all exams, they will start calling them. Our job is to be of service. Repeat that to yourself. If you start to be seen as someone who doesn't have an interest in service, you will be out of business, a nd soon. There are lots of agents I deal with who call me a lot. Let's say an agent calls me twice a week on average. If I make (again, on average) $50 per exam, that ag ent is worth $100 a week. $5,200 a year. And over $25,000 over the course of 5 y ears. Some of the calls that agent makes will not pay enough to be really worth it. So me will. But an agent who works for a bunch of insurance companies will -- again , on average -- be worth it. And how. I am not in this business for charity. I make a living from it, and I don't tole rate mooches, pains-in-the-neck, or agents who only call me when their favored e xaminer won't do a pre-set for 3 a.m. But if you are seen as someone who is help ful and ready to be of service, business will come to you. Not automatically, bu t word gets around. The crazy thing about averages is that if you try to beat them, you'll end up ma king less. In other words, if you say, "I'll only take exams if they pay at leas t $50, no less," you'll end up losing business. The agents who would bring you t hose high-paying orders just won't call at all. And while in theory you'll be ma king more per exam, in reality, in the long run, you probably won't even stay in business. Take the orders. Even on ones that just don't look like they're worth your time. And in the long run, it will be very much worth your time.

Dealing With Change We often hear that "no one likes change." While I'm not sure that's true (I think I'm a big exception), let's go with it f or a minute. Change is going to happen, and we need to learn to deal with it.

For examiners, change is a fact of life. If you do this full-time (and even for part-timers), every day is different. You see different people, for different co mpanies, for different agents, at different times, and different places. So even if you think you don't like change, the reality is that you deal with it every day of your life. And if you can embrace change, even relish change, you' ll find that it can make your life better, easier, and even make more money. Here's an example. You've been with a company, maybe one of the big 4, for a whi le. You know the manager, know how their system operates, know how to order supp lies, even know the office staff. Going independent means a whole learning curve to master. You have to learn all of the above "stuff" from scratch. And there are fears. Will I get paid on time? What if I'm dealing with unscrupul ous people who don't pay me at all? Will I be making a huge mistake? Will I be a ble to go back, if being independent doesn't work? I think it's good to face fear. Facing it, even grabbing hold of it, often lets us realize that the things we fear are not as bad as we thought. Ask yourself: What's the worst thing that could happen in this situation? Think about that for a few minutes. Writing it down helps, too. Get a piece of paper ( or open a new page on your computer) and start writing. List every bad thing tha t could happen to you in whatever new situation we're dealing with.

How to Deal With Pre-Sets I don't know anyone who's fond of pre-set appointments. But they are here, and u nlikely to go away any time soon, so here are some ideas that will make things e asier for you when dealing with them. First, sometimes the applicant didn't set the pre-set. Or doesn't remember. Or s omething. In other words, I can't tell you how many times I've had applicants go , "Huh?" when I call to confirm a pre-set appointment. So, never assume they kno w about this. Explain who you are, explain that you're calling to confirm the ap pointment set for (say) "Next Monday, at 10 a.m." You will quickly enough know i f they know what you're talking about. Second: pre-sets aren't usually as set-in-stone as either the agent or the Big 4 secretary is telling you. Unless it's impossible for me to do a pre-set (such a s when I'm going to be gone for vacation or something like that) I'll usually ta ke the case, and call the applicant. If -- and this happens a lot -- it's pre-se t for Saturday at 8, and I'm already booked, the applicant is usually fine to do the appointment at 9, or whatever. Third: If an order's sent to you, and you can't do it at the time set, explain t o the applicant, "I'm sorry, they didn't ask me first about the time. I do this for a bunch of insurance companies, and I was already booked up at that time." M any applicants assume that a pre-set appointment is with an employee examiner, a nd that it's just a matter of directing Employee Jones to go to the appointment. Educating them goes a long way toward resolving the situation. Fourth: Some pre-sets will not call you back. I've dealt with many such situatio ns, where the person plans to be there, but for some reason will not call back t o confirm. When I have to leave a voicemail about a pre-set, I tell them, "I'm c alling back about the appointment set for next Tuesday at 11 a.m. I need to conf irm the details with you and [Here's the important part] I need to get direction

s to the place where I'm supposed to meet you." I will not -- unless the appoint ment is a block away -- go to an appointment without some contact with the appli cant. I need to confirm time, remind them to fast, remind them about needing a u rine specimen, and get directions. Telling them that you need directions will so metimes nudge folks along to call you back. Finally, if someone doesn't if at all possible. If not, ain that the individual has e contact. If they grumble, t is). call back after several attempts, I call the agent, call the office who sent you the case. Or both. Expl not contacted you, and that you can't go without som get weepy, and complain that gas is so expensive. (I

What's important is to take control of the pre-set situation. Control keeps you from being jerked around, and helps you do a better job for yourself, agents, th e company, and the individual you're examining.

Explain Yourself! Explaining yourself is important in everything we do in this business, not just unusual situations. Because while you know what you're doing, 99% of the people you see don't have a clue about what you're doing and why. Sometimes people will ask, but more often, they'll just look puzzled. If they ask, you answer. If you don't know the answer, say so (nothing is more amazing in life than honesty), b ut tell them you'll get back with them about the answer. So I'm pretty chatty with folks. Even when I don't feel like it. Explain, for ex ample, a lot of stuff about blood draws, since most people (even those familar w ith them) are pretty nervous about it. I explain why I'm putting a touriquet on their arm and why I'm breaking the seal on the needle. (Which also has the effec t of letting them know that the needle is new: some older folks remember when ne edles were re-used. They might not ask out loud, but some of them will wonder if the needle you're using on them is new). I explain that the tubes are vacuum tu bes, and that the blood will just go in, and that there's nothing they have to d o. That sort of thing. Part of being a professional is that we have knowledge that the general public d oesn't have. Anyone can sweep a floor. You, however, have particular knowledge a nd skills that you're using to do your job. Just let your clients know that you do, and what it means to them. They will appreciate it, and it will make your jo b easier.

What's Scaring You? Let's say it's Sunday night, and here's your assignment for the week: I want you to do something that scares you. Or something you've been avoiding. Or somethin g you just hate doing. , get them to do it. In other words, if you just hate mowing the yard, and you c an find someone who will do it for $20, let them have the business. What I'm talking about is something that only you can do. But you're not fond of it. For most people, this involves something (or someone) personal. We hate making t hat sales call. Or we avoid calling that agent Ms. Jones, because she's always i n a bad mood. Or you hate doing paperwork.

When we dislike something, we usually spend far more time avoiding it than doing it. If we just go ahead and do it, it's often over with quickly, and out of the way. So make it a goal this week to do something you're not looking forward to. Make that phone call. Or do the paperwork every day, so it's not this pile staring at you on the desk. The important thing is not to spend time dreading something. Just do it. Don't m ake life complicated.

2 Kinds of Insurance You Should Have I'm not talking to you about life insurance. Or health insurance. These are 2 that are really good for you in your business. Because you -- like m e -- probably do a lot of driving. A lot. The first you should have is a AAA (American Automobile Association) membership. Technically, it's not insurance, but one of the benefits is to insure you in ca se of car trouble. AAA membership provides for a limited number of roadside assists during a member ship year. What it means is that if your battery dies, someone will come along a nd jump start for you. Or if your tire goes flat, someone will come out and chan ge it for you. Or if your car just dies some place, you can get it towed. You can argue that you can always jump start a car yourself, change your tire, o r whatever. But I like the assurance of having someone else do the dirty work fo r me. (Not to mention that AAA membership provides for discounts on a whole slew of go ods and services. Things like hotels, resort admissions, etc.) One suggestion, too, to women reading this. There are always guys who will feel pity for a damsel in distress. Women should not hesitate to use this to their ad vantage. If you're having car trouble and a guy offers to help, take him up on i t.

The Other Insurance You Need Of course, you have auto insurance. But if you don't have comprehensive on your policy, you're missing out on the cheapest bang for your buck that you can get o ut of your policy. Comprehensive is a very inexpensive addition to your policy. It provides for sev eral things, but in most cases (be sure to ask your agent) it will replace a bro ken windshield, or other auto glass. I am not a big believer in having too much insurance. Lots of folks have way too much, and pay way too much. But I break my rule with comprehensive and buy the very inexpensive no-deductible coverage. Because the first time you get a broken windshield, you'll have paid for several years of coverage. With my no-deductible comprehensive, when I get a broken windshield (which happe ns every year or so) I take the car in to the glass place, leave it for 2 hours,

and pick it up with a fresh windshield. All I have to do is give them my auto i nsurance policy number. Like you, I drive a lot. And like you, I face hazards on the highway. I like haz ards I can manage. A broken windshield is one I can manage quite easily.

How to Lose Business, Quickly What's the easiest way to get agents to stop calling you? Easy. Be very bad at blood draws. Because it's the one big thing your appointments are afraid of. There are always a few people who are afraid of getting weighed. Or a few with c oncerns about privacy. Or they're embarrassed about something in their medical o r family history. But you all know as well as I do that the main thing people are wimps about is g etting stuck. You can make a lot of mistakes with this business. You can be unpleasant, chew g um, have BO, whatever, and most people won't be thinking about it 10 minutes aft er you're gone. But hurt them with a needle, and they remember. For a long time. Make this a goal for your business: you will hurt people as little as you can. O f course, getting stuck is no fun. Of course, you're going to have days when you r sticks just don't seem to work. But make hassle-free, (relatively) pain-free n eedle sticks your priority number one, and business will come to you. Sometimes your biggest advertiser is your competitor. Cause if you've got compet ition that's hurting people, but your reputation for blood draws is good, agents will come flocking to you.

The Importance of Business Cards Business cards are cheap, but they are among the best sales tools you'll ever ha ve. Do a Google search, and you'll find inexpensive sites selling cards. Buy a thous and of them, and keep them on hand. When I give an agent my cards, she doesn't get just one, as if they were somehow selling for $5.99 each. I give her 5 or 10, and ask her to pass any extras alon g to someone else if she thinks about it, or if not, "Just trash 'em," and you l augh. And she'll laugh, too, but you'll be surprised at how many agents will ind eed pass the cards to someone else, and 2 months later, an agent will call you a nd say that the first agent had given them one of your cards. Business cards are miniature billboards. Put your name on them (obviously), cont act information (phone numbers ... all of them), your address, email, website if you have one, and a slogan such as "Mobile paramedical exams at your client's h ome or work location." If you can get them relatively cheaply, and if your picture won't frighten any c

hildren who happen to see the card, put your picture on the card. People love pi ctures, and the agent can also pass the card along to clients you're going to ex amine, and the person will see that you even look friendly, and that you don't h ave a 2 foot needle in your hand.

Getting More Business A reader writes: I recently went into paramed exams full time and on my own. Previously, I was do ing this parttime and now have talked to a good number of agents promting my new company. Unfortunately, they aren' t calling me. Is it the time of year or mayb e the agents are concentrating on medicare as the window of opportunity is now? Give me advice as to how to increase my business. I have developed some informat ion sheets that the agents can share with their clients as to how prepare them f or their paramed exams. The response has been positive from the agents so far bu t again I have yet to receive calls. What can I do or how did you go about promo ting and getting calls for paramed exams. Getting customers is the hard part. When we promote our business, we're asking t he agent to take a risk. Will this examiner alienate a hard-won client? Will thi s person be rude, unprofessional, or whatever? And will the examiner be hard to deal with? Ironically, part of any good sales is not appearing desparate. Even when you rea lly, truly ARE desparate. Because people can smell desparate a block away. And w hen we seem desparate, the agent starts to wonder why, why we're desparate, and why we don't have any more business. Even crazier, you'll find that the busier y ou get, the more your services will be in demand. These are my suggestions for getting agents to call. I go in at times when they will be there (mid-morning is often good for this). Of course, if the agent is n ot there, I leave some cards with a secretary, but speaking to the agent individ ually is the best. I want to seem professional, but approachable. I don't dress in a full business suit, but in what I call business casual. I try to be genuinely friendly (I tend to like most people, and this is not a difficult thing to do for me) and introd uce myself, and explain that I do paramedical exams. If the agent seems unintere sted, I ask if I can leave a couple of my cards, and leave it at that. If on the other hand, the agent is friendly, interested, or whatever, I explain a bit more, telling them what area I cover, that I can do exams at the client's home or work, that sort of thing. If the agent says, "Well, Joan Doe already does all of my exams," then I respond , "Well, that's cool, but" -- and here's the important part -- "if Joan's ever u nable to do one for you, I'll be happy to pinch hit for her." If I know Joan, an d know her to be a good examiner, I might say so: "Yeah, she does a good job." T he important thing is to get a foot in the door. And if the agent later calls an d says, "Joan is going to be out of town this weekend -- could you do an exam fo r me on Saturday morning?," I just respond, "I'd be happy to." Never, ever say s omething like, "I wish you'd call me more often," or something like that. If you are friendly, approachable, and willing to be of service, agents will call. Remember, too, that examiners often go in and out of this business. If you make a steady effort to introduce yourself, hand out cards, even stop in the office j ust to say hello, agents will remember when their faithful long-term examiner de cides to do something else.

It's important to remember that hard selling doesn't work in this business. If y ou're a hard-ass with them, they assume you'll be a hard-ass with their clients.

More About Portamedic One reader sent these comments: "Their office made me fill out so many forms, and jerked me around so much, they kept telling me over and over "we'll start you this week" then they would ask f or more info--- they even made me give them a copy of my passport! They have a manager, a lady who is so rude, I was talking to the receptionist an d she just interrupted and said "I am who you need to see" When in all honesty, another manager Lisa, told me to avoid her at all costs and just give the receptionist my package and get out and wait for her to call. She said she could get me 40%. Promised me!!! After treating me like crap, she handed me a huge stack of her cards and said se nd me directs, well I was just looking to supplement my income, because my loyal ty is with EMSI, I asked her what kind of commision she offered, and she laughed in my face. Nothing she said! Unless I can send her 150 cases a month.... Then she said, after that, we can talk..... Later in the week she heard about the 40 % and took the steps needed to prevent me from starting. Huge waste of my time...yes her cards went in the trash ~" Wow. In all honesty, I feel a little bit sorry for people in an office like this . They are dinosaurs, waiting for the climate to change. It's not going to chang e. Offices that treat examiners like this are probably treating agents and folks be ing examined the same way. And they can't figure out why they're losing business every month. Portamedic has just gone through closing a number of offices. More will come later, I suspect. A couple of observations. First, you did the right thing to throw out the cards. Someone like this is toxic, and all it will do is drag you down. It's not worth the hassle, even if the pay were better. Second: 40% is insane. Maybe it's within the realm of reasonable if the examiner is new, if the examiner is not bringing in any cases, etc. But otherwise, no. T here's no reason to work for that little. Offices that bring people in for that amount (or less!) are just guaranteeing that there will be a revolving door of e xaminers, people who are desparate or curious or testing the waters, and when th e first irritation comes along, the examiner quits. I don't blame them. Bottom line? If someone doesn't respect you when you first contact them, it's li kely that nothing will change. Everyone has bad days, and I don't hold that agai nst them, but someone as described above is someone who's a perpetual pain. As I mentioned earlier, I've dealt with Portamedic for years. The office I dealt with had a superb manager who was fair, honest, and treated people well. Not su rprisingly, he had a loyal and competent staff, both office and examiners. But t hey closed his office last week. This is part of the logic in some upper-management at some of these companies: g et rid of a local presence, and expect business to increase. It won't. They did a similar move in late 2001, after the 9/11 events, when business overall (my pe

rsonal work, to my surprise, didn't suffer much) decreased: they decreased exami ner percentage pay by 1%. The logic here escapes me. If I want more of something , I pay more for it, not less. But dinosaurs didn't move quickly, and they paid the penalty. I suspect that som e of these companies will suffer a similar fate. The smaller, more nimble compan ies (there are dozens of them) move quickly and respond quickly to the market an d examiners. It's partly because they don't have multiple layers of management. But the primary reason they can respond quickly is because they don't think they are somehow owed business, and they know they have to fight for it. That's good for customers and good for us as examiners.

Avoiding Problems With Urine Collections If I have any doubt that the person I'm seeing will be able to collect a urine s pecimen, I get that first. This helps if they forgot, and can't get the specimen right away because they ha ve time to drink some water while we're getting the rest done. In other words, I suggest getting the specimen first, and if they say, "Oops, I forgot," then I c an get them to drink some water, and we'll try again at the end of the appointme nt. Also, if someone tells me they just can't possibly have "enough," I encourage th em to give it a try. Most people -- unless they are really dehydrated, will be a ble to get enough for our purposes. Reminding them about the specimen when making and confirming the appointment is important. Encourage them to drink a lot of water prior to the appointment. It h elps the urine to be a clean one, and also helps them to get the specimen at all .

That December Problem There's something I call the December problem. Folks who are busy, busy, busy with everything else, and just don't want to make an appointment with you. Of course, if they just aren't going to do it, there's not a lot you can do. But these things might help. 1. Stress amount of time. Normally, 20-30 minutes is how long an exam takes. (If you're new to this, it might take slightly longer). But when pressed, I can eas ily get something done in 15 minutes. This involves a minimum of niceties, no ch it-chat, and an easy blood draw. Almost anyone can take 15 minutes. 2. Consider working slightly crazier hours than you're accustomed to: maybe star t earlier, work later, and expand some weekend times. 3. When you speak to agents, offer to go with them for appointments that are pre tty sure things. I don't normally do much of this, just because sometimes folks aren't quite as sure as the agent thinks, and I end up not doing an exam, but th is is definitely a time-saver for clients. 4. Don't drive yourself crazy. Some people just aren't going to do anything in D ecember. Your agents will understand if you keep them informed. Just let them kn ow what Mrs. Jones told you, and that should work.

5. Be courteous to clients. If they don't want to do something when it's good fo r you, they have a reason. If you don't pressure them, they will appreciate it. 6. Know that the Christmas week is pretty much shot for work. Take a few (or mor e) days off, and enjoy the season.

Saving Time With Blood Draws To save time on blood draws, always examine both arms first. This helps you find the best vein, and saves the time and frustration of more than one stick. When people volunteer that "they always stick my ___ arm at my doctors," I just tell them that each day is different as to how the veins stand out, etc., and I have to make the call that day. (If you say it with a smile, people don't get mad). T he ONLY time they get to dictate which arm are the obvious cases, such as a woma n who has had one breast removed, and has been told to avoid sticks on that arm.

Another Way to Avoid Time-Wasters If you want to waste time when doing your work, there are various means of doing it. This is one of the big ways. You will find that there is a percentage of the population who are hypochondriac s, and love to talk -- at length -- about illnesses and meds. You must gently in form them that you cannot talk about this, that you must get their exam done, an d be on to your next appointment. If they ask you for medical advice (hypos love medical advice) remind them that it is unethical for you to advise them medical ly. Which it is. Again, don't be unkind. But it's not your job to give them medical advice. And y ou don't know enough about them to provide it. But given the chance, these folks will take huge amounts of time. Let them waste it on someone else.

So You've Got Somebody Who's Rude ... I'm sorry you're getting some rude clients. When it happens, say to yourself (I am serious here): "I will be out of here in 20 minutes." Then get in your car af ter you are done, turn the music up loud, and forget about it. There will ALWAYS be rude people. It's part of life. You will also find that normally the rude on es are a very small proportion of your appointments. They just SEEM like a lot o f people because we remember them so well. But don't EVER let rude/irritating/an noying/whatever people make you quit.

What if I Get an Order I Can't Take Care Of? Basically, I take ANY order called in to me. I want the agents to be in the habi t of calling me. If it's too far, or if for some other reason I can't personally do the exam, I tell the agent, and say that I'll find someone who will take car e of it. I just get the information, and call someone I know will do it. But the agents keep calling back. That's good. In other words, I don't suggest, "Here's this number. Call them to get this one done." I take the information myself, an d call the number. I don't make any money from such a call, but I do keep the ag ent from contact with one of my friendly competitors.

How to Make More Money The fastest way to get a higher percentage is to sign on with several companies. Make certain that each one knows you are doing this. And keep insisting on a hi gher percentage. When "favors" are asked of you (doing exams at odd times, etc.) make certain that you don't do the "favor" without linking it to a percentage r aise. Be ruthless about this. If it troubles someone, too bad for them.

Can You Meet Me at McDonalds? Or Wal Mart. Or wherever. Sooner or later, if meet you some place ions I suggest: not nt's office, not at it hasn't happened already, you'll get this request: "Can I else?" This is someone who doesn't want to do any of the opt at their home, not at their work, not at their insurance age my office.

Instead, they want to "meet some place public." Usually, McDonalds is the first place they suggest. And my answer, except under the most unusual circumstances, is no. I think your answer should be no, too. Reasons? 1. Something odd is going on here. I don't know what it is, but there's a reason they want you to do their blood work at a fast food place. And whatever the odd ity is, I'm just not going along with it. 2. It's unprofessional. Would you want -- even if you were suggesting it -- to m eet your doctor at McDonalds? Of course not. Doing this kind of thing degrades y our work. Don't be dragged down by such nonsense. 3. Even if no one at the location objects -- big "if" here -- do you really want to draw blood, collect urine, whatever, at a location like this? This is not a knock on McDonalds or any other place. It's just not their job to provide a plac e to get this done. I'm very flexible. I will basically meet people where it's good for them, at a t ime that's good for them. But everyone has lines that we must draw. This is one of them. You -- as a professional -- must control the surroundings where your wo rk will be done. This kind of a public place is not where you should be doing yo ur work.

Getting From Here to There 99% of what I do is done at the client's home or office. Getting accurate, relia ble directions is important. Here's what I do. When an order is called in to me, and when I've set up the app ointment, I tell the client I can meet at their home or office. Make sure you kn ow whether the address they're giving you is at their home, office, or whatever. Next, repeat the address. Don't assume the city name: you may be thinking of a s imilar street name, but be also thinking of the wrong city. Ask them for directions. I'm a big fan of GPS on-line directions (more about tha t in a minute) but your client will know about construction work, a short-cut, w

hatever. If they are hopeless about giving directions, are not fluent in English, or what ever, ask to speak to someone else who can give directions. Remember to ask for landmarks that will help you find the location: stores, prom inent buildings and the like are good for getting you oriented. Make sure you have as many contact phone numbers as are available. If you're spe aking to them on their cell phone, ask if they have a home or office number, "ju st in case I can't get through." Build redundancy into your work. Whenever possible, I check internet directions while I'm speaking to them. This isn't always possible, but when I can, I do. This allows me to check obvious que stions I might have about getting there. (A word of caution. I don't tell people I'm checking for internet directions. Mo st younger people (say 35 and below) will assume you're doing that. Some people will feel insulted, as though you are checking after them, which you are. Older people in turn will often have no clue what you are talking about if you tell th em you're going to mapquest the directions, and you'll end up having to try to e xplain it). I use Google for directions, because it has proven reliable in the past. Just go to Google and type in the full address. For most addresses, Google will bring back 3 options: Google maps, Yahoo maps, a nd Mapquest. I usually use Mapquest. Click it on, and you'll get a map. Go below the map, and see "get directions to above location." Type in your start ing location (where you'll be when you're heading to the appointment). Read the directions. If it seems like you're talking about 2 different spots, clarify tha t. For very new housing developments (very much an issue in North Carolina now) one of the 3 options may be unable to find the address. One of them usually can. If none of them can, that's usually an indication that either (1) the address is v ery new, or (2) -- and more likely -- you've got a wrong mis-spelling, a wrong c ity (very easy to do when a bunch of cities are close to each other. Finally, print out the directions and staple them to the exam order. I don't usu ally print out the map, unless it's an unusual situation, or an area I'm not fam iliar with.

If You're Not Busy ... Everyone has slow days. Days when the phone stops ringing, when no one will make appointments, and when you start wondering what you've done wrong. The reality is there's nothing wrong. These slow times happen. When they do, cat ch up on paperwork, make sales calls, or go to the beach. What you should never do is tell people you're not busy. Because people wonder w hat's the matter if you're not busy. It's a little like if you went into a nice restaurant at 6 p.m. on a Friday. And there's no one there. If you're like me, you start to wonder why no one is ther e. Has something happened? Has the chef been fired?

Probably not. You just happen to have hit the restaurant at a quiet moment, and things will likely pick up by 6:30. I'm always "busy," in the sense that I have things I need to do. Being busy does n't just mean having an appointment, although that's what pays the bills. So whe n an insurance agent calls and asks if I'm busy, my answer is, "Yep, I sure am." Because when you tell someone you're not busy, they either think something's gon e wrong, wondering if you're not as good as you were, or they wonder why they ar e calling you when no one else is. The other problem is that there are people who will take advantage of your quiet spells, and make unreasonable demands, be rude, or whatever. These are the folk s who will call you at the last minute, interrupt meals, or whatever. But if the y think you're busy, they're less likely to do that, and will tend to respect yo ur time. Get in the habit of telling people you're busy. "Busy" is busy, even if what you 're doing is playing ball with your children, or going out for dinner with a fri end. Respect your own time, and others will, too.

Here Comes the Snow Where I live -- mid-state North Carolina -- we are too far south to have much in the way of snow. And far enough north to get some cold, right-on-the-edge rain storms during winter. Which means that every few years, we get freezing rain. Let's say they're predic ting it for tomorrow. So what do we do to prepare, whether you live in Florida o r Minnesota or even in between in North Carolina? When bad weather is forecast, I try the day before to get everything finished up . Paperwork completed, calls made, and shipments out. That's because if the powe r goes out, I can't fax. And Fedex may cut off pick-ups early. If tomorrow arrives nasty, I have to make a judgement call about appointments. T he bottom line is it's not worth damaging my car to go to an appointment. Not to mention endangering my life. If -- for whatever reason -- you think it's not wo rth the risk, call appointments as quickly as possible, let them know, and offer to re-schedule. If agents are involved in scheduling, bring them into the pictu re. Most people are very reasonable with weather conditions. Just don't leave them i n the lurch. And if you have a day -- or two, or three -- where the weather prev ents you from working, just do what you can do. Make phone calls, clean up your desk, whatever. You'll recover from this, too. Just don't risk your life. You're too valuable for that.

Just Ask Here's your suggestion for the day. Make use of it! People are far more inclined to grant a request if you give a reason for it. The reason doesn't have to -- necessarily -- be a good one. Just give one. If yo

u can give a good one, all the better. If you're already driving 33 miles to an appointment next Tuesday, and you've go t someone in that area, you might phrase it like this: "Look, I'm going to be in your area next Tuesday. Any chance you could do the appointment then? I'd be gl ad to do it another time if you can't, but [ here's your "reason"] I'd be able t o save a lot of driving if we could." If you ask nicely, the worst thing they can say is no. But often folks will say yes. Most people -- in whatever capacity you're asking -- are happy to help you out i f they can. Give them the chance. Ask them. Go on the assumption that they want to do good for you, and you may very well find that most of them will. Ask.

When You Make a Mistake My daughter got her driver's license on a Thursday. On Friday -- the next day -- she was in an accident. It was her fault. And it wa s clearly a mistake. And since then, I've tried to stress learning from that mis take. She's scared, humiliated, and it's going to hurt her financially. (She wil l have to pay all of the costs associated with the accident). But a mistake is a mistake. An accident is an accident. Unless you are staying in bed all day, you are making mistakes. The secret is le arning not to identify yourself by your mistakes. When you have a bad blood draw, all it means is, "I didn't do well on that stick ." It doesn't mean, "I'm a bad person," "I'm a failure," "I'm a bad nurse/parame dic/examiner/whatever." You get the picture. When you make a mistake, learn from the mistake. Do what you can to rectify the mistake. And then go on about your life. You occasionally fail, but you are not a failure. You make mistakes, but you are not a mistake. You have accidents, but your life has a purpose. If you learn nothing else today, learn this: your failures don't define you. The y are a part of your life, but they are not your life. When You've Got an Important Client Of course, all of your clients are important. Having said that, some are more important than others. Think Well-Known Persons, local politicians, folks with more money than some of us, etc. It's easy to get intimidated by such people. And it doesn't help that some folks like this are good at intimidating others. So, how to deal with them? My bottom line is that I treat everyone alike. I've used this rule long enough t hat I'm good at it. This means that if I already have an appointment scheduled w ith someone else, and Mrs. Moneybag-Jones wants me to bump the first appointment to make room for her, it doesn't happen.

Treating everyone pretty much alike makes it easier on you. If you defer to VIPs , they will sense it, and some will treat you like the hired help. Far better to operate with a little distance, and assure them that your time, too, is valuabl e, but you will do your best to fit them in. Treating everyone alike also makes such people less intimidating. I operate on t he principle that everyone pretty much puts on their pants one leg at a time, an d I am not easily impressed, at least not by riches, Importance, or whatever. Wh en all else fails, and you are shaking because this person is so important, use the underwear rule: imagine them sitting in front of you in their underwear, and they will seem less intimidating. (The more attractive a person is, the less ea sily this rule works). Bottom line? Relax, and enjoy every client you have to see. Most of them -- impo rtant or not -- are interesting people. Plan to enjoy the few minutes you have w ith them, and do a good job.

When Someone Makes Threats Note: I am not talking about physical threats here. If someone physically threat ens you, I recommend that you get away from them as quickly as possible -- in ot her words, don't be a hero and try to fight them -- and immediately call law enf orcement, and press charges, if possible. Don't take physical threats without im mediate, prompt, and sustained response. No, what I'm talking about are verbal threats of various actions. Usually, the t hreat involves one of 2 things: either "I'm going to sue you," or "I'll report y ou to whatever licensing board you are under." The first threat happens on rare occasions. People who become self-employed or c ontractors always worry about lawsuits. The reality is that almost no one even t hreatens to sue, much less actually goes through with it. The second threat is e ven less rare, because almost no one realizes that licensing boards (such as the Board of Nursing, on my part) have a disciplinary process. There are people who like to make threats. They will threaten to sue you if you have bad breath. For the few times (out of the thousands of people I've seen), I just usually look directly at them, and say, "You have to do what you have to d o." Call their bluff. They have no intention of going to the trouble of suing yo u. It's just something they say. However, if the words "lawsuit" or "sue" come u p in a conversation with a client, take the following actions: 1. Gather every bit of information you have about this case. Lab tickets, exams, exam orders, any notes you might have made. Make a photocopy of the your appoin tment book for the time you saw the person (or whatever you use). 2. Sit down and write down everything you know about this case. Write down how y ou received the order, from who, whether by phone, email, or whatever. Give a hi story of your contacts with the person. Tell about the circumstances of the exam , where it was completed, how you got there, how long it took, what the weather was like, everything. Tell about what the person looked like, how they acted tow ard you, and whether anything unusual occurred: difficult blood draws, odd behav ior on the individual's part, etc. 3. Finally, be honest and straightforward with the person. Answer their phone ca lls or other contacts without getting angry and yelling. If they scream, shout, whatever, make yourself sit still and not respond. When they are finished shouti ng, simply ask, "Are you through now?," and then respond, "When you are ready to

discuss this in a civil manner, I will be happy to speak with you. For now, tho ugh, I'm hanging up the phone." Then do it. I began doing exams in 1980. I have seen thousands of people. I have done the ab ove kind of "history" exactly 3 times. One time involved a man who would not ret urn phone calls, and I could not schedule the appointment. Then he was involved in a very serious auto accident, and the agent called, screaming about it. Nothi ng more was said, but I thought it prudent to write up the details and did. The second involved a man who -- again -- would not return phone calls. (This is why it's good to make notes about your contacts and attempted contacts). This was a round Christmas time several years ago, and he was killed in an auto accident wh ile on a Christmas vacation. No one ever suggested I had done anything wrong, bu t when I heard about the death, I thought it was a good idea to document, and I did. The last involved a woman who claimed a botched blood draw. It was one of those very odd situations where everything went fine, but she called back an hour late r screaming that she had no feeling in her arm. I did this exam for one of the B ig 4 companies, and they were very helpful, and their insurance covered the doct or's visit she went to after my exam. They were even -- the manager later told m e -- planning to reimburse her for time lost from her work (she was a hairdresse r) until she began claiming that she was unable to work for 6 weeks, and that sh e made $150,000 a year as a hairdresser. (The manager of the office I was dealin g with said later that if he could make $150,000 a year in the hair business, he was going back to cosmetology school. I was inclined to go back with him. The b ottom line was that the exam company no longer believed her. We were probably no t the first time she had made such claims, and likely not the last). But the reality is that lawsuits are just not a real issue. Do the very best job you can, be pleasant and straightforward with those you deal with, and document when necessary. And if someone threatens to sue you, take a deep breath, realiz e it's likely an idle threat, and go about your business. Just don't let someone like that ruin your day. Much less your week.

When You Can't Get a Problem Resolved 99% of problems can be resolved on the local level. If you are having a problem (I'm talking here about problems with an exam company) try, try, try to deal wit h your local manager. Most people are not trying to cheat you, and they are not trying to do you wrong . Here are a couple of suggestions in those less than 1% cases where dealing loc ally just isn't working. 1. Don't make threats. Telling someone you're going to sue them, that you're goi ng to quit doing any cases for them -- these kinds of statements just don't help to resolve a bad situation. It goes without saying that especially you never, e ver make physical threats. If someone makes a physical threat, the one threatene d likely will (and should) call in law enforcement, and this will make things ve ry unpleasant for you. 2. Don't lose your temper. Speak calmly and rationally. If you are angry, wait u ntil you are no longer angry. Don't raise your voice. Go on the assumption that the person you're calling is going to try and help you resolve your problem. The y probably will. 3. Realize that the person you're dealing with has problems, too. Make it easy f or them to deal with your problems. Easy means you are pleasant and kind to them

personally. 4. Start off your conversation with something like, "Hi, I've got something I ne ed help with. Can you help me?" Most people in these situations like to be helpf ul. Give them the chance. 5. Provide whatever documentation they need to resolve the situation. If you've already sent the documentation, say something like, "I think I've sent that, but I'll be glad to send it again, if you need it. Are you sure it's not there?" In such a situation, don't argue with the person if they say they don't have it. I f they don't, they don't, and nothing is helped by telling them it's there in th e office. It probably is, but just send it again. 6. When you've sent what they say they need, follow up a day later. I like to ca ll folks, and say, "Hi, I'm just checking to see if you've got everything you ne eded." If they say they'll check on it, suggest that you can stay on the line if they want to check. 7. Here's the hard part, and it needs to be done before a problem comes into pla y. Try to find names and contact numbers for those above a local office, if ther e are any. (This would be regional managers, etc.) Don't contact these people un til one of 2 things happen: the local office says they can't deal with a situati on, and refuses to try any more, or they quit returning phone calls. If you have to deal with such regional management, I call them by saying this: "Hi, I'm Joh n Doe, and I'm an examiner with your Smallville office, and I'm having a small p roblem we're having trouble resolving. Could you help me with this, or tell me s omeone who can?" 8. Once an issue is resolved, thank those who helped resolve it. Almost no one t hinks about this, but people really appreciate it, and remember it. 9. Finally, if an office is a string of trouble, that's probably the time to qui t doing work for them. I usually break things off in a friendly fashion by sayin g something like, "I'm made some changes in the way I do business, and I'm afrai d I won't be able to do work for you folks for the time being." I only say this if an office is really a headache, and once I've made up my mind, I don't change that. But even under such circumstances, being friendly, kind -- but firm -- he lps to keep this on a business and professional level. Which it is.

Some New Years Resolutions for Your Business Or resolutions for any time. A new year can be a sobering thought. We remember the past and we ponder the fut ure. And some of us do resolutions. Resolutions are often good things, guideline s to help us navigate our way into the new year. Here are a few to help your bus iness this year -- or any year. 1. I will seek to be of service. Being of service covers a whole lot of things, but it's mostly in your attitude. If your attitude is, "I'm going to do the best job I can, and I'm going to provide a good, helpful service toward everyone ass ociated with me in this field," you've just covered about 90% of the job. 2. I will try to maximize my profits. I will aim for higher paying accounts, wor k with companies that pay more, and cultivate agents who do high quality work. 3. I will cut expenses. Are you paying too much for cell phone service, or inter net access? Are you driving a huge gas-guzzler? Seek to ruthlessly cut expenses, and make your dollars work more efficiently.

4. I will quit complaining. Complaining is an acid that eats into your life. Whe n you feel a complaint coming to your mouth (or even in your mind), ask yourself , "Will this do any real good? And can I do something to correct this situation, rather than just complaining about it?" 5. I will quit hanging around complainers. Negative people wear you out. Avoid t hem whenever possible. If you can't avoid them, just nicely tell them, "I really don't want to hear that," when they start their complaints. It really does work . 6. I will get better. I will finish this year a better examiner, more proficient , more skilled at all the things that make up my work. Don't be mediocre. 7. I will use time to my advantage. Drive time can be a time to learn (think boo ks on CD, meditation time, whatever). Time doing exams can be done more efficien tly. We all have 24 hours a day. Successful people just use that time more effic iently. 8. Finally, I will enjoy myself. Your work really can be fun. You have a challen ging, important job. Do it well, enjoy the work and the people you meet every da y, and learn to thrive on the challenges. Every day is going to have irritations , mild disappointments, and occasionally annoying people. Just don't let those m inor speed bumps become the focus of your life. Deal with them, and enjoy the ri de.

How to Avoid Getting Stood Up for Appointments Probably 95% of my appointments are there, and waiting. But there are always a f ew who will miss. It's a fact of life. The secret is how to minimize those who m iss. Here are some hints that will help. 1. Never pressure someone to make an appointment. If you are sufficiently annoyi ng, people will sometimes say yes to get rid of you, but you may count on them n ot being there (or not answering the door) if they make an appointment under suc h circumstances. You will have agents who want you to pressure people. I just ha ve to say that I don't do that, that it doesn't work, and that it's not happenin g. 2. It goes without saying that you should ignore agent suggestions that you "jus t show up" or something of this nature. As Nancy Reagan used to say, "Just say n o." 3. Give people your phone number. Encourage them to call you if they have questi ons or need to re-schedule. Most people are genuinely nice, and will make an eff ort to not inconvenience you. Make sure they have a way to contact you. 4. If you have any doubt -- especially if the appointment involves much driving at all -- confirm the appointment 24 hours ahead of time. Just call, say you kno w it's been a few days since you made the appointment, and you're wanting to mak e sure everything's on go. If you get a voicemail, leave a simple message asking them to call you and confirm, and say that you'll need to confirm the appointme nt before you come out. On a voicemail, also mention that if they need to re-sch edule, that's fine, just let you know, and you'll accomodate them. 5. Be nice. If you're annoying, shrill, painful to talk to, or whatever, people will avoid calling you back. Make a point of smiling when you're talking to peop le and your voice will resonate with friendliness.

6. Know that occasionally -- despite your best efforts -- someone will not be th ere. Maybe they'll forget, maybe they're scared, but whatever the reason, it jus t won't happen. It's part of the business. Try not to get angry, and know that t omorrow will be better.

You're the Best! After you've been in this business more than a few months, you will have have th is scenario happen. Names have been changed to protect the guilty. An agent calls, and their first question is, "Are you still doing exams?" (Which -- as long as I've been doing this -- strikes me as about as dumb as someone ca lling CarMax, and asking if they still sell cars. But this is the usual routine) . After answering yes, the agent introduces himself, and says, "I've been using Su sie Doe to do my exams, but I am not happy with the work she's doing. I've talke d to other agents, and they tell me you're really good, and I'd like for you to start doing my exams." Now the first time or 2 this happens, you positively beam for the rest of the da y. Finally! Someone is recognizing my skill! Finally! My hard work has been rewa rded! Your honeymoon with this agent will last for several weeks or months. Then, howe ver, you will find that this agent is unhappy with something you've done. And th e agent will stop calling. Someone else will get the phone call you got. When an agent calls me like this, I try to enjoy it while it lasts. It's flatter ing to be told that I'm the best around. But an agent like this is a malcontent who can't be pleased. The examiner before you couldn't, and you -- despite your best efforts -- won't be able to, either. All of us are going to have agents move their business to us. That's a good thin g. But when someone tells me I'm the only one who does a good job, that's ridicu lous. I have competitors, and they're mostly quite good. What's my advice here? First, when someone mentions a competitor, I try to prais e them. You heard me. Because people expect you to criticise your competition. B eing a nice person in such situations is good for you. Plus, you deflate the mal content. Secondly, as I've suggested before, treat everyone alike. When agents like this come into the picture, it's easy to try and please them. They will tend to ask y ou to do things you shouldn't do (such as cancel another appointment for their c lients). Just politely tell them you appreciate their business, but you're alrea dy booked at that time. Or whatever. The bottom line is that we shouldn't treat old customers badly in order to curry favor with a new agent. Treat everyone ali ke. In the end, it's the best thing you can do for your business.

How to Make Everyone Love You OK, so the internet police are going to get me for that headline. No way you're going to get everyone to love you. However ...

There's a sure-fire way to endear yourself to agents and those you are examining . It's flexibility. Probably 95% of the people I see make an appointment one time, and keep it. Howe ver, some have to cancel or postpone. It's going to happen. If I'm easy-going about it, if I'm nice to people when they call to postpone, th ey will be happy. If I'm rude to them, unpleasant, or make it difficult, they wi ll be less happy. Ironically, being hard to get along with about postponements guarantees that you 'll get stood up more. Because if people dread calling you to let you know they can't make an appointment, some of them just won't call at all, on the theory th at forgiveness is easier to get than permission. This is the way to be flexible, and still guarantee that most appointments will make at the time you set them. First, as much as possible, go with the needs of those you're making appointment s with. It's not always possible, and it's certainly not wrong to suggest a time if it's good for you. (I'm not suggesting you be a doormat). But if someone wan ts to do this at home, try to accomodate them. Same if they need to do it early, late, whatever. Secondly, give them permission to call you. Of course, you give them your phone number. I give them that, and suggest that if they have questions (it almost nev er happens, but people feel better if it's OK to ask) they should call me. I als o suggest that if they have a scheduling problem come up, they're welcome to cal l and reschedule, if need be. Again, this almost never happens, but people want to feel you're not some kind of ogre who just set their appointment time in ston e. Finally, before hanging up the phone, confirm details: "OK, so I'll meet you at your house next Tuesday afternoon at 4:30, right?" Be pleasant. Be nice. Everyone won't love you. But most of them will.

How to Mess Up Your Career in One Easy Step This is not the usual things you think about. It's not about a bad stick on an a gent's husband. Or forgetting an Important Person's appointment. This is about not renewing your license. Yeah, your driver's license is important. But forgetting to renew that is a mino r nuisance compared to forgetting to renew your professional license. I'm an RN. In North Carolina, we have to renew those every 2 years. Failing to d o that -- or forgetting to do so -- opens a nurse up to a charge of practicing n ursing without a license. And that is a major headache. I'm like most people. I put off paying bills until they're due. But with a licen se, I try to renew it as soon as I get it. Because the annoyance factor is so la rge. Whatever your license or certificate (RN, LPN, EMS, whatever), when it comes up for renewal, renew it. It wouldn't hurt to note on your calendar when it comes u p for renewal just in case the mail got lost. Keeping on good terms with your li

censing authority is important, and makes life easier for you.

Estimating Time Between Appointments In a previous post, I wrote about using Google maps for directions. When Google returns directions, it provides an estimate of how long getting there will take. People always want to argue with that time. They assume they can get there faste r than Google estimates. Maybe you can. If you drive really fast, and if you hit no traffic whatsoever, y ou might shave a few minutes off their estimate. (It assumes the posted speed li mit). But generally speaking, I've found it to be pretty much on the mark. I ten d to go a few -- say 5 or 6 -- miles above the limit, and I'm usually just a cou ple of minutes faster than the estimates. But generally speaking, the Google est imates are good. Use them, and you will be able to accurate say when you can get somewhere. Folks you're seeing will appreciate it.

Using Google Maps I've become addicted to Google maps. So should you, if getting where you need to fast is important. Of course, you know the routine. Go to Google.com . Fill in the address you're g oing to. If you've got an accurate address, the first listing on the Google response page will show a small map, and the address you've entered. An entry pad below the a ddress will say "Start Address," here you enter the address you're coming from. (If the Google response page doesn't show a map as the first entry, you've proba bly got a bad address. Consider whether you've mis-spelled the address -- easy t o do -- whether you've entered the wrong city, a wrong house number, or a wrong zip code. I don't normally enter the zip code, just the city and state, because it's easy to have the wrong zip, and it messes up the search. Giving the address with the city and state works just fine). After you've entered your start address, and pressed "get directions" you'll hav e returned a map with directions along the left side. The "print" icon is on the upper right hand of the page.

When You Feel Like Complaining When you feel like complaining, give a thought to someone else: the insurance ag ents you work for. If agents were perfectly honest, they would tell you that they wish we weren't h ere. That's not a slam on you, it's just the reality. Because the hard-working agent has probably put a lot of time, energy, and effor t into a particular sale. Then we come along. And we have the potential to mess up that sale. Because -- to the folks you're examining -- you represent the insurance company. (Many of them assume we're insurance company employees).

If you dress badly, smell, have bad breath, whatever, that person wonders if the insurance company has something wrong with them. Same if you are late, don't re turn calls, are rude, or just plain weird. Even worse is when we botch a blood draw. Truth be told, agents are more than a little scared of us. So when an agent is hounding you to get something done quickly, it's because the y want this sale to go through. Same when an agent is irritated because somethin g gets lost. And if you're working through Portamedic/EMSI/ExamOne, they're just passing on the grief that an agent's giving them. The point I'm trying to make this beautiful weekend is this: if you can make you r work easy and hassle-free, everyone benefits: you, the client, the agent, ever yone. No one expects perfection. But if you are easy to deal with, pleasant, and competent, you'll find that work will flow to you. Likewise, if you are annoyin g, rude, whiney, complaining, and less than proficient, don't be shocked that pe ople when people avoid sending business your way.

Listening to Clients One morning, I saw a man with veins from hades. We've all seen them. I was baffl ed. Couldn't see or palpate anything. I was ready to cut off a finger ... : ) Then the man quietly volunteered that although they always have trouble with his blood draws (not something we want to hear!) that they usually had luck if they did it here (and he points to a spot) and go in at an angle, very shallow. This man was not a nurse or doctor, and had no medical background. What he did k now was his own body. And I got the blood, doing exactly what he told me to do. The point I'm making is to listen to your clients. Ultimately, you have to make the final call as to whether you'll stick someone at a particular spot or not, b ut even the dumbest people are smarter than we sometimes think. Listen to them. Hear what they have to say. And very often, they'll make your job easier.

For Men Only If you're a man, you need to identify yourself to your clients. Because the enlightened times in which we live, the folks you're seeing will not assume that you are a medical professional. Women don't have to deal with this. The assumption will always be that a woman w ho's doing this is a nurse, lab tech, or whatever. Not for men. I can't tell you the number of times I'll be into an appointment, and the individual will say so mething that indicates that they think I'm an insurance agent. I try to be nonchalant about this. But it's something I try to do with everyone. I usually weave it into the conversation by saying something like, "When I was a hospital nurse, blah, blah, blah ..." In other words, I'm letting the individu al know that I'm a nurse, that I'm trained, that I didn't start doing this last week. I once wore a lab coat. I quit that pretty quickly, and don't recommend it. Peop le get nervous when they see a lab coat, and their neighbors talk. I wear what i s often called "c