Lessons from a magician: The one-ahead principle

Max Malini, a world-famous magician was asked to do a trick at a gathering of politicians in Washington DC. Malini protested that he was unprepared. With persistent cajoling, he asks those gathered if anyone had a deck of cards. Of course, no one had a deck and Malini removes a deck from his pocket. Malini shuffles the deck and has a prominent senator select a card and show it to the audience. The card is returned to the deck and the deck is shuffled. The magician spreads the deck and shows that the card is missing. He then asks if anyone is carrying a knife. Since no one has a knife, Malini offers a knife from his pocket. Brandishing the knife towards the senator, he begs his indulgence while he cuts through the silken lining of his tuxedo jacket where he finds the selected card.

The audience was dumbfounded as to how a particular card turns up in the senator’s jacket.

Now, as an amateur magician, I have taken an oath not to reveal how magic tricks are performed. But readers of this column are special, and I will share with you how Malini performed this “miracle”. (Please don’t turn me in to the Society of American Magicians as I will lose my magic license and they will take away my magic wand!)

The modus operandi

Over the previous two years, Malini bribed a well-known Washington tailor to sew a certain playing card into the lining of tuxedo jackets of several prominent senators. When the moment arose that one of the senators asked Malini to do a trick, the magician was “one ahead” and completely prepared to perform a miracle.

The one-ahead principle applied to health care

It is important to prepare in advance or to be one ahead in the health care practice; 10 suggestions for preparing to be “one ahead” include:

1. Training the receptionist or anyone answering the practice’s phone proper telephone etiquette
2. Preparing for electrical outage and the computers shut down
3. Having a cybersecurity plan if patients’ data are stolen
4. Managing a staff shortage or when someone calls in sick or on vacation
5. Crisis management-example of phone tree to contact staff, protecting medications that require refrigeration
6. Managing the schedule so that patients are allotted time appropriate for their medical condition and particular patient needs. For example, a follow up patient for a cholesterol level and blood pressure check, does not require as much time as a new patient or a patient with newly diagnosed cancer or Type 2 diabetes.
7. Contingency when majority of referrals are from a single source or all your eggs in one basket
8. Anticipation practice merging with a hospital or bought by a private equity firm
9. For surgeons: contingency when vendor doesn’t have backup equipment or devices for surgical procedures
10. Advance preparation for physician sickness or necessary leave of absence from the practice

Bottom line:

In the world of real estate, few phrases are as ubiquitous as "location, location, location." This profound truth is easily overlooked. In health care, the message is preparation, preparation, preparation! Being prepared and proactive for all adverse events brings more success than knee-jerk reacting when a curve ball has been thrown your way.

Neil Baum, M.D., is a professor of clinical urology at Tulane University in New Orleans. Baum is the author of several books, including the best-selling book “Marketing Your Medical Practice-Ethically, Effectively, and Economically,” which has sold over 225,000 copies and has been translated into Spanish.