Low-cost marketing can reap big results.

P roduct, price, place, and promotion. Every business-school academic will tell you those four "Ps" represent the essence of marketing. But after 28 years as a healthcare strategy, marketing, and public relations professional, and after countless frequent flyer miles earned consulting across the country on the topic, I'd like to add a few more "Ps." These are people, passion, persuasion, performance, and perseverance. Marketing and public relations are not about facing the challenges of PPOs , H M O s , and IPOs. They are not about the size of an organization's budget. In fact, even' time I conduct an evaluation of a marketing or public relations depar tment , I am asked, "Are we spending enough?" My answer is, "You're spending much too much." Although an important part of the marketing mix, most advertising and sales activities have proven to be wasteful expenditures. Few people refer or choose a healthcare provider because of ads or savvy sales techniques.