The Clinic of Uncomfortable Probings

I’m not sure when I first got the idea to open my clinic – if it was during medical school or later during my residency.  In any case, it had been kicking around the back of my mind for some time.  I remember during my undergraduate – I think it was my freshman year -  I was studying at USC and I had a major crush on this girl Erica in my political science class.  She was a Jewish girl, with long black hair and pale white skin.  I later found out that her father was the dean of the medical school, but at the time I just knew she was artistic and quirky and I was sort of fascinated with her.  

Anyway, I was a big fan of this director David Cronenberg who made these sort of venereal horror films and I took her on a date to see his new movie “Dead Ringers”.  I didn’t know it beforehand, but the movie revolved around twin gynecologists who go bad and it was not a great first date film.   I was probably 17 or 18 and still a virgin and while I was vaguely aware that there was such a thing as a gynecologist, I never really considered what they might be doing and certainly not in any graphic detail.  Erica was clenching my arm in the non-romantic way you might clench your armrest and during one particularly squeamish scene she says, sort of under her breath, “I should not have seen this movie the day before my pelvic exam.”

This was a fascinating new thought to me - that this girl had scheduled someone to be poking and probing around her private areas, that despite dreading it she would be going anyway, that she really had no choice - it was all very interesting and somewhat erotic.  And how did that emotion overlay with the unknown probing and poking that might be the result, say, of the very date we were on?  These different ways in which you shared your genitals with others went swimming around my mind.   And while much later in life I realized that men come into their own brand of anal and prostate inspection, at the time it all seemed uniquely feminine to me.

I don’t know if it would be correct to credit that date with my decision to enter Medical school.  After all, my mom was a nurse and my father was a butcher in the local Safeway before opening his deli, so surely there was some genetic diathesis towards a professional dealing with anatomy at some level.   All I can say for certain is that whatever the reason, shortly thereafter I changed my major to pre-med and upon graduation I went directly into the USC medical school. 

During this time I was able to have a mature enough relationship with another medical student - a girl named Linda - to actually bring up the subject of the dreaded gynecologist visit.   I had recently taken a workshop in patient empathy and I had many questions on how she dealt with this and what a doctor could do to make it better.  Was it very difficult for her?  Strange?  Uncomfortable?  Erotic?    Linda just dismissed me.  “You don’t think about it, you just do it.  It is like going to the dentist.”   And while I made no special note of it at the time, I am fairly certain that this is the first time I heard dentistry and gynecology mentioned in the same conversation.

Another piece of the puzzle came into play during the second or third year of my residency.  I was specializing in gynecology, and during these years the industry was taking a turn towards a marked preference for female gynecologists.  Many of the senior male gynecologists I met were struggling after years of having a successful practice.  As a result, most of my male classmates were focusing on fertility, reproductive surgery, or other non-patient-facing specialties.   This was disappointing to me because dealing with people, with patients and their emotions, was one of the most appealing things to me about being in the medical profession in the first place.  The only thing that seemed left to me in gynecology were the gender-reassignment patients, and while this is booming business now (thanks to the high-tech industry’s massive transfer of wealth to social misfits), 20 years ago it didn’t seem capable of supporting a career.

When I asked my faculty advisor what someone should do who wanted to be patient-facing but still have a successful practice, he recommended becoming a dentist.  I think he was sort of joking – maybe he was feeling some bitterness or jealousy towards that profession – and at the time I didn’t think much of it.  But the thought did start to percolate in my brain.   USC actually had an excellent dental school, and I spent some time checking it out.  That is when I met Justin.  He was a top student there.  We had many common interests and outlooks – most notably a desire to connect as directly as possible with our patients and provide medical services that actually helped people - and we became fast friends.    One thing led to another and four years later we opened our combined office of gynecology and dentistry.

At first business was slow.  We weren’t sure how to advertize, and weren’t sure how to specialize.  After all, advanced gynecology typically involved complicated microsurgeries and fertility-related procedures, while advanced dentistry was evenly split between teeth-whitening and other such cosmetic operations and serious orthodontic reconstruction.  It didn’t seem that there was much sharing of equipment or labs possible.  Our patients were also somewhat confused.  I had my gynecology patients and Justin had his dental patients, but we saw no overlap between the two.  We were operating two totally unrelated practices that happened to share the same waiting room and receptionist.

It must have been a year or two later that the final piece came together.  I was at the Jiffy-Lube, getting my oil changed.  I had been coming to Jiffy-Lube for years, totally out of habit.  My father went there and I just continued in his footsteps, every three months obediently following the advice of the little sticker they helpfully placed on my window.  I never actually thought about what services they provided beyond oil changing.  I suppose if I had been pressed I would have been able to derive something to do with lubrication from the “Jiffy-Lube” name, but even then I had no idea what that really meant, being totally ignorant of cars.  In any case, for whatever reason – perhaps they were out of magazines – on this particular visit I happened to read the various signs they had posted on the walls explaining what it was exactly that they did.  I was surprised to see that the list was quite extensive – checking fluids, changing oil, topping off various things, inspecting wiper blades, cleaning the windshield, and so forth.  Mostly as way of killing time I asked the clerk how they happened to come up with this list.

“It is pretty simple,” he explained.  “These are all of the little annoying things you have to do but don’t really want to because it is messy and uncomfortable.  It is like going to the dentist every six months.  You feel better afterwards knowing you did it, but if you really had a serious problem you would go to a mechanic.  We don’t fix anything here.”

I was electrified.  Suddenly I knew what our two specialty areas had in common, and I had our hook.  We would be the Jiffy-Lube of medicine, focusing entirely on routine but simple check-ups that everyone felt compelled to do but no one enjoyed.  I rushed back and pitched the idea to Justin.  He was instantly on board and we re-did our branding that very afternoon.  Within a few weeks we were officially operating the first “Clinic of Routine and Uncomfortable Probings”.

The premise was simple and thus immediately understandable to the customer.  With a single appointment, you get all of the unpleasant but necessary medical services out of the way, in-and-out, appointments accepted but walk-ins welcome.  We followed the Jiffy-Lube model right down to giving people magnets for their fridge to remind them of their next appointment time.   

Also like Jiffy-Lube, we began providing all of the services at the same time.  This was quite easy logistically for our initial focus areas.  The vagina and the mouth are quite far apart, and it is easy to give the respective technicians sufficient space to perform their procedures.  The standard stirrup chair and pelvic exam position is also perfectly angled for a dental hygienist to do their work.  Bottom line is that we were able to get up and running quickly.  It wasn’t until business grew and we expanded into proctology that we needed to invest in the development of specialized chairs and workspace that supported more avenues of simultaneous access for the clinicians.  

As we added each service, we always had concern whether the model would continue to work.  After all, most folks were used to these things being done by a personal physician who provided that emotional connection and human touch.  But time and time again, we found that this just was not issue.  First, most doctors who attempted to be human and personable were just lousy at it, which made the whole thing worse than if they didn’t try at all.  Second, it turns out that most patients actually didn’t WANT the human touch during these procedures.  As one of our customers said “I’d rather NOT be close friends with the guy who is sticking his finger in my a** or checking me for ball cancer – having my teeth cleaned is a great excuse for not having to say hello.”  Lastly, even for those who appreciated some human touch, the convenience factor far outweighed the benefit.   As another patient put it “I love my dentist.  If I ever need any work he’ll be the first one I call.  But for routine cleaning, these days who can deal with an appointment 6 months in advance?  At Probings, I can just pop in after dropping the kids at school and get my breast exam out of the way as well.”

As we got more customers, we grew more streamlined and more efficient, and were able to continuously lower our costs.  Eliminating all conversation and most eye-contact with the patients allowed us to hire highly qualified but much less expensive clinicians from non-English-speaking parts of the world.   In addition, many of the procedures are so routine that they simply don’t require extensive medical training – just the ability to follow proscribed steps exactly and respect HIPPA guidelines.  One of our star technicians commented that her work at Probings is actually easier than her previous job.  “After all, when you are feeling for testicular lumps, you don’t have to worry what the heck a triple thin no-foam extra-hot macchiato is supposed to mean.” 

Some people express some concern about quality, but in fact our specialization and efficient throughput means that our staff members perform far more exams during a year than a conventional specialist.  This translates directly into improved diagnostic accuracy, and our error rate is less than half of the industry average.   When you combine that with the increased frequency of visits, our customers are actually way ahead of those who stick to the old way.  On top of that, our affordable fixed prices have made us the darlings of both the insurance companies and the uninsured/self-insured consumer.

It hasn’t all been smooth sailing.  We’ve had our share of missteps.  Our focus remains on finding new services to provide without requiring the customer to explicitly ask for each procedure, but sometimes we get ahead of ourselves.  For instance, we had high hopes for the whole non-surgical cosmetic enhancement thing, particularly with men who can be shy about that.  That didn’t go over well at the time, but now with Botox on the rise we might bring that back.  And while our market research around driving business from teens and young adults made it seem like a natural, the political BS surrounding abortion in US ultimately made that add-on more trouble than it was worth.  It is really too bad, since our one-stop shopping approach nicely avoided the problems with the mishmash of consent laws.  No need to get consent if the patient herself doesn’t know.  But that’s all past and we don’t look back.  We keep an open mind and a flexible outlook, and take our lumps along with our successes.  And so far the latter have substantially outnumbered the former. 

Now as you probably know we have Clinics of Uncomfortable Probings all over, in 200 cities in 33 states.  With success comes imitators, of course, and we are no exception.  But our equipment and process patents keep the competition at bay, and so far no one has come close to matching our 25/25/125 deal – a 25 point inspection, in 25 minutes or less, for just $125.  It is all about process, having the equipment and the routine tuned perfectly.  For instance, once you have some water jets and metal picks and immobilized that customer’s head for teeth cleaning, adding ear wax removal is practically free.    Best of all, solid process makes it easy for us to replicate.  Last year, we made #2 on Franchise Magazine’s hot 100, losing by a hair to that company that does the gyms for overweight pets.

So where are we going next?  Time will tell.  We in talks to open the first clinics in China and India and we think those will be huge.   We fully expect the model will translate well.   In fact, some things work even better overseas.  We already use doctors in India to analyze all of the data from the US labs so that would be even more local.  And we also expect the abortion thing to do much better in China.  All in all the future looks bright.  And it really just goes to show how a little innovation and a lot of focus on the customer can create something great.