Practice integrity in a challenging economy.

W e have heard a lot of advice lately—some of it good, much of it questionable—on how to make the best of a bad economy. Unfortunately, not even the most erudite of practice management gurus has a magic formula for making a cosmetic practice truly recession-proof. As consumers at every economic level hunker down for what is still predicted to be a bumpy ride ahead, even those few plastic surgeons who boast a largely " carriage trade " clientele are reporting significant declines in practice volume. Those of us with more typical practices—those that serve the needs of secretaries as often as CEOs—are definitely feeling the pain of fewer inquiries, fewer consultations, and fewer booked surgeries. With economic concerns on our minds, there may be moments when other considerations seem to pale in comparison. It is in those very moments, however, when we need to remind ourselves of what is most important to the long-term health of our practice. Arguably the most valuable asset of any medical practice is a solid base of satisfied patients. Not surprisingly, when it comes to patient–physician relationships, satisfaction is closely linked with trust. 1 Physician behaviors associated with higher levels of patient trust range from professional competence, such as providing a thorough evaluation and effective treatment, to " human " qualities, like demonstrating honesty and respect. 2 Personally, I do not know of any plastic surgeon who does not work hard to earn patient trust—not only because that is the way to build a successful practice, but also because building positive relationships with our patients is one of the most meaningful aspects of what we do. In challenging economic times, it is difficult to deny that virtually any potential cosmetic patient walking through the door is a welcome sight. However, there is an underlying danger that, in our eagerness to shore up our " bottom line, " we may be tempted to drop the bar a little lower regarding standards for patient selection and even patient safety, thereby jeopardizing the very foundation of our practice. Think back to a number of unfortunate and highly publicized incidents over the years in which well-trained individuals with excellent credentials apparently succumbed to economic pressure (or simply used poor judgment) by electing to perform cases that pushed the envelope too far, with disastrous consequences. Some extra soul-searching is definitely in order during an economic slowdown (or any other …