- Hey guys, welcome back to the Dr. Cliff AuD vlog.
This is Vlog Number 36.
And today, I want to bring you up to speed
with what's going on with the build out
of the new clinic, and I want to talk
a little bit about a video that I posted earlier this week
that was really talking about person-centered care.
But let's get into the clinic stuff first.
So as many of you know now, because I posted
about this about two weeks ago or so,
we had to hire a new general contractor
because our general contractor that we had originally
started with had to leave the job.
And so we've kinda been scrambling around
trying to make sure that this new general contractor
is seeing the vision of what we want to do
and ultimately carries that out
in the way that we want it to be carried out.
And so we've spent a lot of time, Ashley and I,
really going around to different vendors
because any time the general contractor,
you know, a general contractor leaves
and a new one comes in, they tend to work
with different subcontractors,
or really, the subcontractors that were working
with the previous general contractor
aren't necessarily going to be wanting
to continue on with that job.
Whatever the case may be, we've been going around
and trying to find some different vendors
to help with things like flooring, the countertops,
the cabinetry, the electric, you know, all of that stuff.
And so we've spent some time
finding vendors for those things.
And it's kind of exciting because we got to go back.
And we're kind of changing a few things.
The flooring's gonna be different,
the cabinets are gonna be different,
the countertops are going to be different.
And we've spent a lot more time on it this go around
then we did the previous go around.
I think we learned our lesson of trying to be
a little more hands off,
and now we're definitely a little bit more hands on.
And I'm probably gonna need your guys' help
because there are a couple of selections
that I want to get your opinion on.
And if you're not subscribed to my channel already,
please subscribe because I'm gonna be posting
an actual post where you guys can basically let me know
which flooring option that you like.
And we may be doing something with the cabinet colors
and stuff like that to see what you guys actually like.
And that might sway our decision
on which material to go either way.
We're trying to keep things reasonably within a budget,
which is kind of the next thing
that I want to talk about.
So when we were starting our build out earlier in 2020,
we had a budget of around I think it was like $290,000,
something along those lines.
So when we got started, we actually,
Ashley and I paid a $10,000 down payment.
And then there was an $81,000 draw
from our loan for our build out.
So a total of $91,000 is basically what we paid
to get the clinic up to the, where it is right now
that I showed you in a video two weeks ago
on the Clinic Update video.
And we had the new general contractor in
and give us a new bid on what the place would cost
to get it from where it was at right now
all the way to it being finished,
and the budget was around I think 280 plus thousand dollars.
And so I'm like oh man, I mean that's just,
did we just waste like $80,000 is kinda what I was thinking.
And I'm like no, I mean we're probably gonna end up
going with some nicer things.
At least we'll make sure that everything's
done the right way, but really at the end of the day,
this build out's gonna turn into something
that's probably around, you know, $400,000 build out,
you know, something close to that, maybe a little less
than that, as opposed to something
that was more close to $300,000.
So that's kind of a gut check moment.
And Ashley's trying to keep me reeled in
and not having me select all of the high end finishes
for the clinic so we can keep it
to a relatively respectable level.
We still need to talk to the bank
and talk about increasing the loan amount
to cover all of that.
And if we can't do that, then it's gonna become
a very tricky situation of us having to basically pay
for a lot of these things out of pocket.
And I don't know if we can afford that,
to be quite honest with you.
So we'll see what ends up happening.
Of course, I'll keep you guys posted
on the progress of the clinic going forward.
But again, keep your eyes out for some posts on YouTube,
which you'll see if you scroll down through your videos.
'Cause I'm gonna be posting a couple photos there
for you guys to select which option you like the best.
Okay, so that's it for that.
What I want to talk about next actually is the video
that I ended up posting this last week.
It was on patient-centered care.
So I've been working fairly closely
with the Ida Institute.
The Ida Institute is all about person-centered care,
so putting the actual patient at the center
of everything that you do rather than putting yourself
as the clinician at the center of everything that you do,
or putting the disease or whatever the ailment is
at the center of the focus.
And the easiest way that I can equate this,
and something that I explained in that video,
was this idea of when you go into a medical office
of any kind and you go there and you feel
like you're just a number, that they don't care about you
as an individual, all they want to know
is what your symptoms are, and then they'll prescribe you
whatever the appropriate treatment is
that's typical to treat that particular symptom,
and then they're done with you, to a large degree.
Well patient-centered care takes a,
or person-centered care/patient-centered care
takes a completely different approach.
So that approach is really getting to know
the individual, getting to know the patient
and what's important to them,
and then designing the treatment around those values
that that patient has and what they want as an outcome.
And so it takes a lot more time to do it this way.
And, but I mean I feel like this is inherently
what I've been doing, even since I started grad school
working with patients.
I always wanted to get to know my patients
a little bit better.
I wanted to know really what they wanted
to accomplish with treatment.
I wanted to know what things were most important for them.
I wanted to have their main communication partner
be involved in the process so I could understand
what their perspective is on my patient's hearing loss.
And it really leads to what I believe
is better treatment outcomes, because I'm making
a treatment decision based on what the patient
ultimately wants to achieve, rather than just slapping
any hearing aid on their ears, amplifying up
to prescriptive targets, and then sending them on their way.
Now the other aspect of this is that I had received
a comment on the channel,
and I just wanted to clarify this.
So there was a comment basically saying
that this whole patient-centered, person-centered care
approach model is a contradiction,
a complete contradiction to Real-Ear Measurements,
which I advocate for.
And I can maybe see how this could be a perception
of someone after watching that video.
But best practices, and Real-Ear Measurement
is part of best practices, you don't do
person-centered care in lieu of best practices.
So it's not like you're like, "You know what?
"I'm not gonna follow these procedural things
"that I need to be following to treat
"this individual's hearing loss
"because I'm so focused on them as an individual.
"And if they don't want it, I'm not gonna do it."
I mean it's kind of, it's really the opposite of that.
Patient-centered care means you're putting the patient
at the center of the focus, but it doesn't mean
that you can't still employ a lot of these traditional
medical things that you would end up doing with the patient.
You just have to make sure that you're explaining it
to the patient so they can understand.
And if the patient says, "You know what?
"I don't want you to do that procedure on me,"
then that's fine, that's totally fine, actually.
If they say, "I do not want that," then I don't have to
do it, as long as you understand the consequences
of us not doing a certain procedure.
But at the end of the day, I kind of equate it
to someone who would be going through cancer treatments.
And I get that this is a completely completely
different subject when you talk about cancer.
But there are some individuals where you go
and you talk to them, I imagine like an oncologist
would talk to these patients and say,
"Okay, here are your treatment options.
"These are the potential outcomes
"of those treatment options."
And the patient can be like, "You know what?
"You know, even if I basically pass away earlier,
"it is not worth it to me to undergo
"that particular treatment because of how it's going,
"because of the side effects, because of whatever.
"It's just not worth it to me to actually go through
"those medical procedures."
And you know what?
That's okay, because everybody
gets to make a decision on their own.
And I often tell my patients that my job
is to tell you what your options are
and your jobs are to tell me what you're willing to do.
Okay, so I will give you my recommendation.
But if someone says, "You know what?
"I don't want to do that recommendation," and you know what?
It happens.
I mean I recommend hearing aids for certain types
of hearing losses, and if a patient's like,
"Yeah, I just don't want to do that.
"I'm not ready for it," or whatever, it's like that's fine.
Like it's your job to tell me what you're willing to do
and it's my job to tell you what the absolute
best option to treat your hearing loss is.
But this notion that you can't do person-centered care
and follow best practices and do different
procedural things that we should be doing
can't coexist, that's not true.
Those things in fact have to coexist.
In fact, if you read the best practice guidelines,
a lot of the components in that initially
are to include the patient and their wants
and their needs and identify the things
that they want and need and then include
their family members, too, in that entire process,
which is a large component of what person-centered care is.
So by me preaching, and I preach a lot,
about the procedural side of things
and the best practice side of things
with hearing care, it does not mean that you do that
without putting your patient at the center of the focus.
And so I really just think that it's something
that was overlooked heavily in my videos.
I mean, I think I need to spend more time
talking about this patient-centered care aspect
of hearing treatment, because at the end of the day,
it is the teamwork that happens between the patient
and the hearing care provider that leads
to the highest outcomes.
You can probably get good outcomes
by just administering a treatment
and not taking into consideration anything
that the patient wants and just look
at the audiogram and saying, "Hey, we need to amplify
"sound to this level.
"I'm gonna verify it with Real-Ear Measurements
"and I'm gonna, basically I'm gonna select the hearing aid
"without letting you have any input
"on which one we're going with,"
and then expect you to do pretty well.
I think that that's something that could be done,
and in fact is being done.
But if you want to receive the highest level
of possible care, then patient-centered,
person-centered care has to be included
in all of the different procedural things
that I talk about on my channel.
I honestly think that the patient-centered,
person-centered care approach, we call it,
actually it's, technically speaking,
it's the biopsychosocial model,
is going to replace to a large degree
the traditional biomedical model,
which is where you go into the doctor's office,
all they want to do is see your chart,
identify your symptoms, treat the symptoms, right?
But I think it's going to end up replacing things.
In fact, I did a rant last week on the channel.
And I was ranting about insurance
and how all of that works.
Well there are a lot of individuals,
I'm not talking about hearing care professionals,
I'm talking about like medical doctors,
who are completely completely getting out
of the insurance game and they're going all private pay,
going kind of more of this concierge medicine type thing
because they don't like the aspect of insurance
dictating the level of care that they can provide.
It's a complete, you get paid based on procedures
that you do, and it doesn't reimburse you
or pay you for taking time with your patient
and actually identifying what's important to them.
I mean it's a complete 180 to have to let insurance
dictate the type of care
that you can provide your patients.
So what's happening?
A lot of these doctors are like,
"This is not what I got into medicine for.
"I didn't go into medicine just so I could
"prescribe treatments to these patients
"and not really understand what the problem is
"and not really be able to care for my patients."
And care is the key word there.
Caring is more than just administering
some kind of treatment to them, you know?
And so I think that we're gonna start seeing
a lot more of this, where the providers who really value
person-centered care are going to be forced
to leave these different insurance groups.
Because if they want to administer
this really high level of care
and put their patient at the center of the focus,
then they're not gonna be able to do it
with the insurance reimbursement rates.
It's just not going to happen.
So I urge you to go back and actually watch that video.
I think it was called "The Death of the Traditional
"Model of Hearing Care", something like that.
But just a couple videos ago.
So make sure you go and check that out.
Anyway, I have rambled on enough today.
Of course, if you like the video, go ahead and share it.
If you liked it, give it a thumbs up.
If you didn't like it, give it a thumbs down
and let me know why.
Other than that, guys, I will see you next week.
(upbeat music)