3 Reasons To Add This New Specialty To Medicine

by:  David Kashmer, MD MBA (@DavidKashmer)


By now you’ve probably heard of 3D printing.  Sometimes, 3D printing enthusiasts are referred to, collectively, as “makers”.  Well, let this maker tell you:  3D printing has wide applications in Medicine–so much so that it could do very well as its own specialty.  Here are three reasons we should create a new specialty in Medicine that focuses on 3D printing:


(1) Truly Personalized Medicine


The push to serve patients with a focus on their unique needs is on in full force.  Whether it be genetic testing to predict response to anti-coagulation, recognition of the necessary Prograf dose as adjusted for metabolic variation, or a focus on specific social factors, personalization of the practice of Medicine is becoming a buzzword that’s hotter and hotter all the time.


3D printing is a way to truly personalize that medical experience.  The vascular surgeon can size your aortic graft preoperatively from a model created from your own CT scan…or surgeons can even replace / stent your trachea with a new one generated from images of your old one.


This can already be done and is getting easier with time.  So, much like the rise of Radiology focused on imaging studies, let’s consider getting really good at creating personal models, devices, and anatomic replacements by creating a field devoted to just that.


(2) One-off, Specialized Medical Devices


Having a hard time fitting an ostomy appliance near an open wound?  Is the effluent from the ostomy leaking into the wound bed?  Why bother with all that?  Create a custom printed ostomy appliance from a 3D scan of the patient’s abdomen.  (We can already do that.)


Want to get really fancy?  Upload your custom-tweaked design as an .STL file to the “app store” of compassionate-use approved, one-off medical devices.  (Here’s something that’s an early version of what I describe.) No manufacturer could justify a large batch run of the perfect device you’ve created for a small (but important!) patient population…but those of use with printers (and those same patient issues you have) could go to the “app store”, download the .stl file, and create that medical device to solve their patient’s issue.


A field devoted to creation of these models, knowledge of filament types, and understanding of model usage would go a long way toward spreading this technology.


(3) …In Hard To Reach Places and Beyond


A 3D printer and system could allow creation of useful devices and models at even hard-to-reach, remote locations.  Consider rural centers, international areas, and even forward military venues.  Need a prosthesis fit to your patient’s stump?  Make it from a white light 3D scan and printer.  Viola.


A team of Makers could easily be responsible for creating the prosthesis from imaging.  It could ensure both fit and tensile strength.


Soon, Grasshopper, The Future Is Coming


Just imagine a day where a patient has a CT scan and, immediately, necessary equipment and devices are created according to their own personal requirements.  As physicians, we could create everything from special use medical devices (eg ostomy appliances that fit near difficult wounds) to highly personalized cervical spine immobilization collars.


Want to take your gallstones home with you?  (We can’t give them out anymore right?) Well now we can give you an awesome copy for your morbid fascination or other interest.


Who Would Pay?


Hospitals currently have add-on services such as baby photos and other fee-for-service add-ons.  Perhaps 3D modeling could be another.  Filaments like PLA and ABS are inexpensive, after all, and the initial costs would come, mostly, from a one-time hardware expense of less than twenty thousand dollars.


…and if the hospital couldn’t make a business model out of the direct revenue, it could definitely justify the expenditure in terms of patient satisfaction and niche marketing.  After all, I would be much more content, as a patient, if a physician could show me how my spleen was injured using a model of my very own spleen.  I’d like to take that home with me, and would give even higher Press-Ganey scores to hospitals that could create that model of my particular injury and send me home with it.  Will that hold for most patients?  I don’t know…maybe a study is in order.


Let’s consider creating a subspecialty of Makerology, where we develop a system of creating special use medical devices (we could even have an app store for the .stl files) for rural, international, or under-served areas.

2 Reasons Rudolph Is The Most Famous Reindeer Of All

By:  David M. Kashmer, MD MBA (@DavidKashmer)


Yes, you know Dasher (and Dancer and Prancer and Blitzen…) but why, when you think of Santa’s reindeer, is there really just one who’s top-of-mind?  Here we explore what makes Rudolph the Red-Nosed Reindeer, and what his classic tale can tell you about your startup business.




When the Montgomery Ward department store wanted to create its own coloring book in 1939, the tale of Rudolph was born.  What is it about the character that has made Rudolph “the most famous reindeer of all”?


Rudolph is unique.  Sure, he was laughed at.  Aspersions were cast.  Yet, like it or not, Rudolph has one very obvious feature that is ingrained into what he is.


Michael Porter, and other modern thinkers in business strategy, espouse this idea of competing on uniqueness.  Look here.  There was no way Rudolph could successfully compete with other reindeer on their terms.  What reindeer could dance like Prancer, or pull that sleigh with the strength of Blitzen?  (Ok, who knows if Prancer dances and Blitzen is strong–but, I mean, come on:  Prancer and Blitzen!) The key is to find some difference that it can preserve.  Just as Rudolph has a singular, unique feature, much of modern strategic thinking for startup businesses focuses on being something special…





…and being something unique, alone, is not enough.  Rudolph’s nose generally got him laughed at until it did something incredibly useful.  Once that red proboscis had saved the day, it didn’t seem so silly to have a large, red nose.


The ability to translate uniqueness into value is an important essence of building competitive advantage.


After the holiday season, when we all get back to work, it may be worthwhile to spend some time thinking of exactly what the “big red nose” is for you or your business.


How, exactly, will you design a valuable uniqueness into your startup?  How will you find what it is that makes your team go to the front of the pack?


Until then, Happy Holidays from all of us at the blog.

1 Key Tool To Influence Decisions


Generation Y Surgeon




By:  The Generation Y Surgeon (@GenYSurgeon)




Yes, You Negotiate Every Day


Whether you know it or not, negotiation takes up a huge part of your day. You negotiate with other attending or consulting physicians, nursing, administrators, insurance companies and even with your patients. Negotiation is an invaluable skill, and learning how to negotiate will save you time and headaches. I strongly recommend reading Getting to Yes and/or Getting Past No by William Ury. Both books are short, easy reads and are quite fun to apply to your daily interactions.

Over the years I have learned what works (and what doesn’t) when I interact with my patients and, to some degree, with my colleagues. It wasn’t until I read Getting Past No that I was able to put it into words. If only I had read this earlier!


The Golden Bridge Technique

The entire book is gold, yet learning how to build a “golden bridge” remains my favorite tool. I find it most useful when I’m in disagreement with a colleague or when dealing with difficult families. What does it mean to build a golden bridge? It refers to making sure you have satisfied the demands of the four most common obstacles in coming to an agreement:


(1) involving the other party (or parties) in devising a solution

(2) meeting unmet interests

(3) helping them save face

(4) and making the process as simple as possible.



Building The Bridge

Now think of all the situations to which you can apply this skill. Think of your last interaction with a difficult patient or decision maker. Were they overwhelmed and feeling powerless? Did they truly understand the situation and consequences? Were their expectations reasonable or unreasonable? Was there something about the patient or their family that was important to them and unknown to you? Had they previously acted in a way that was embarrassing or damaging? Had they somehow offended you or your staff during a stressful situation?


…For The Patients

We have all dealt with patients (or their families / representatives) who have felt like this. One way to augment your interaction with them, especially in times or stress, is to build that golden bridge. Involve them in the decision making process by asking about their expectations and realigning them early on. Prod them for information on their concerns and wishes so that you become aware of any unmet needs. If they acted rudely or made outrageous demands, then let them know it’s ok. Give them a chance to save face by allowing them a fresh start and by all means, do it with empathy. Chances are this is the worst day of their life (and just another regular day in yours). Finally, boil the options and interests down into a few simple choices. When you are able to provide your patient with a few simple choices (that they “helped” to create) you will find that everyone is happier with the outcome.


…And For The Docs

Now think of the last time you disagreed with another provider…no matter how hard you tried, you couldn’t convince them to accept your idea or plan. They resist because they weren’t involved in the creation of such a great idea, and allowing you to be right may make them feel like they’re in the wrong. Their interests in maintaining control over the patient or care plan is not met by accepting your plan as the best, and of course that takes a bit out of their ego. Next time you encounter this situation, try building a golden bridge. The conversation may go something like this:


” Dr. Bossman, do you remember when you taught me about Treatment-X? We applied Treatment-X to Patient Y and it really worked great. Could we talk about how that may work for our current patient?”


…and voila. You’ve engaged them in the decision making process while allowing them to both maintain control and save face in front of the group. As an added bonus, you’ve reminded them of another time when they made an excellent choice which will also increase your influence over their present decision because they will want to be consistent with “their” previous choices. Wouldn’t it be nice if all your negotiations in hospital could go this well?!


Build The Bridge…For Their Needs And Your Success

In closing, I will again urge you to invest some of your time into reading a little more about negotiation. It’s a skill that most providers undervalue even though they use it everyday. In the beginning, using advanced tools like the golden bridge may feel like manipulation–however it is NOT. Yes, we all know that the surgeon’s ego is strong (and it has a purpose), but this technique is about influencing things when, at times, other people’s issues may be getting in the way of the best outcome.  Negotiation is not about winning arguments or getting what you want, it’s about coming to a solution that maximizes results for everyone. Try it!

3 Things You Need To Know About Your Intellectual Property (IP)

By: James Kashmer (Linkedln Profile here.)


Is it Patentable?

Some ideas are so obvious that we ask ourselves “why didn’t I think of that!!!!” The truth is “obvious” usually means the idea is not patentable–especially when others “knowledgeable in the art” are also working in the field.

Before spending your money, it’s not a bad idea to get a sense of the “mine fields ahead” when deciding to pursue a patent. This can be done simply by visiting the United States Patent and Trade Mark Office Web Site (www.uspto.gov) and conducting a patent search. By doing this you should get a sense of how “crowded” the field is, and, from closer examination, where the mines might lie.


How Do I Protect It?

It is very important to protect your Intellectual Property (IP) starting Day l. You do this simply by putting on paper (preferably in a buond book) a detailed description of the idea and how it works along with your signature and date. (There’s a nice “inventor’s notebook” that I found on Amazon here.)  Once this has been done, explain your idea to someone until they fully understand it.  Then have them sign and date your idea.

Going forward from there, understand that (if you are “sloppy” with your IP and not make an effort to protect it) you may find out in court some day that you lost your patent protection. So use Non-Disclosure Agreements (NDAs) when you talk to someone who may be in the “business”.  Don’t copy and distribute information to anyone just because they ask for it.


What Is It Worth?

The truth of the matter is your IP is not worth much…until you start doing something with it.

The value of your IP builds as you accomplish key milestones. Examples of key milestones are: the granting of a patent, the building of a proof of principle model, the building of a working prototype, completion of clinical trials, and FDA clearance to market. In general, the further you develop your IP the more it should be worth. This is because you are reducing the risk and taking out the “unknowns” from the valuation methodology equations for potential investors.  This makes investors more likely to purchase your IP and, so, makes it more valuable.

At the end of the day, the larger question of what your IP is worth is not very straightforward.  It depends, also, on many additional factors (besides completion of milestones) including the size and growth of the applicable markets, competition, cost, and pricing.

We’ll cover some of these elements when we discuss more about your IP in upcoming entries.

As for now, remember:  your IP increases in value as you decrease potential downside risk for anyone who would be interested in purchasing your protected idea.  “Obvious” idea that’s difficult to patent?  Poor protection?  “Sloppy” protection maintenance?  Less valuable IP.

Until next time:  keep on developing your ideas, and get in touch with any questions or comments!

3 Questions To Avoid Failure With Your Medical Device Design

By:  James Kashmer (LinkedIn Profile here.)


In my 40 years in the device industry, some questions have come up over and over.  For example, I am often asked how companies go about deciding what Medical Devices to license or develop. The truth is the companies that I know and / or have studied rarely have a formal new product opportunity evaluation process. Consequently there is no “road map” I can offer on how to approach Medical Device Companies with your particular Idea or Invention…but I can give you some insider knowledge to help you on your journey…


Does Your Device Save Time or Improve Outcomes?

Inventions that improve surgical outcomes and / or decrease operative time are the engine that has been driving the Medical Device Industry the past 30 years. Chances are that, if you are a Surgeon with an idea or invention that does either one, you can find someone to help you get it to market.

These inventions do not even need to be complicated, technically advanced or really even clever.  For the surgeons out there:  the next time you are operating, ask yourself “What do I need that will enable me to improve the outcome or save time?” The same goes for all physicians who perform procedures.  What would help you save time or improve outcomes?


Are You Prepared To Fail?

There is NOT a shortage of new ideas or inventions that warrant licensing and development. Sadly this fact has been the engine that has driven me the past 20 years.

Unless you are truly entrepreneurial (in every sense of the word) do not waste your time or money pursuing your idea or invention.

If you do pursue your idea or invention, be prepared to fail. It is rare that an idea or invention gets to the market. It is even more rare for an idea or invention to be financially successful. Pursuing your idea or invention is often an expensive education.


Have You Really Thought This Through? 

A mentor once told me “keep your powder dry” when I was looking to start a new company. It was good advice then and now.  Here’s what he meant:


1. Do everything possible to conserve cash. Do not give up equity easily. Be aware of the valuation of your company and price it fairly. This becomes more important the more rounds of financing that is needed. In general the more milestones you have met the lower the risk to potential investors.

2. Do everything possible to minimize risk. Critically evaluate what you have and compare it to your potential competition. The earlier in the process you do this the lower your risk will be going forward.

3. Make time to pursue your “dream”. Remember, the longer it takes to get your idea or invention off the ground the harder it will be to get someone else interested in it.


Best of luck with your idea, device, or quest to invent one.  Check back in on the blog for tips and tools that I’ll be sharing to help you with your medical device voyage.

Thoughts?  Questions?  Let me know beneath.  Visit me here on LinkedIn anytime.