Absence of Pain Equals Absence of Pathology! Right?

How disturbing is it when a patient refuses routine diagnostics simply because they have no symptoms and they wish to save money? How distressing is it to have to treat that patient for a preventable disease that has finally progressed to a symptomatic, intolerable or critical state? To make matters worse, how unsettling would it be to have that patient disregard your treatment plan simply due to their reluctance to expend the time or funds; despite your assurance of a favorable prognosis?

Although there is no comparison to the element of human suffering associated with disease, the time and expenses that accompany the discovery and management of preventable conditions transcends all aspects of life. Awareness is the key to homeostasis- be it physical health of fiscal health. We are frequently reminded by utility companies through MC Hammer’s message, “You can’t touch that…” to be mindful about power-line safety. And the business of “Call Before You Dig” is inundated with requests from contractors and homeowners daily to accommodate everything from underground utilities to pet-containment systems. In kind diagnostic health care testing and outpatient surgical facilities are cropping up in every community. We are truly the Information Generation.

So, it would be prudent to ask ourselves: Is that a cable or telephone line- or might it be a power line that could render severe burns or electrocution; might that shallow ditch penetrate a utility feed and interrupt service for several days; is that a sebaceous cyst or a malignant growth; is the new suite harboring any construction challenges or budgetary concerns that will challenge the success of my project? We live in a “pay now, or pay later” world.

Prevention, management and the administration of curative measures will assuredly save you money, and efficient and functional planning will guarantee a substantial return on investment. As physicians and dentists you are uniquely aware of the benefits and value of preventative measures and focused remedies. It is not worth taking a risk when it comes to making the largest investment of your professional career the creation of a facility that will support and enhance your ability to deliver your professional services and support the well-being of your family? 

Our mantra regarding responsible design is best summarized in our Mission Statement: “Our company slogan, “Profit By Design” speaks to the purpose as well as the effect of design and engenders our philosophy that responsible design will assure a return on investment. To that end, we are committed to the creation of an office facility that reflects your professional image and enhances efficiency and productivity, while stringently managing the cost of its development.”

Wisdom is knowing what to do next. Skill is knowing how to do it, and virtue is doing it. - David Starr Jordan

Your prescription for design and project management is ready for you at designrx.biz or call 800-622-5563. It’s painless, and the results are guaranteed. Garrett Ludwig founded Diversified Design Technologies Inc. in 1971. The company has specialized in the design and  construction of private-practice, health-care facilities since 1975. During that time, he has designed more than 300,000 square feet of professional office space. He has a U.S. patent on his emergency services “crash cart” design. Ludwig has shared his

experience in dental office design in numerous trade publications, and continues to lecture on the subject throughout the United States. He can be reached at (800) 622-5563 and garrett@designrx.biz. Visit his Web site at http://www.profitbydesign.us.

Dental Design Projectoscopy (Feasibility Study)

By Garrett Ludwig

I can’t help but speculate that the aversion to performing a feasibility study is as much emotional as it is financial. Clearly there is a cost factor that may dissuade the fiscally feint-of-heart- despite  its proven worth. However, my perception is that a feasibility study  evokes the emotional equivalent to that of having a colonoscopy.  Interestingly, they both produce valuable insight to preventable  conditions. So, I will temporarily deem the invaluable “feasibility”  service to be a “projectoscopy” in an effort to make a point.

To date, the preponderance of my perseveration regarding  projectoscopies has concentrated on the costs and savings associated with construction, site development and purchase/lease  agreements. However, the emphasis of this article is function and  useable space.

We were asked to design a satellite office for an OB/GYN* practice- for whom we had designed three other offices. The history is noteworthy, since we had gained the confidence of the practitioners to act on their behalf and perform  the necessary pre-planning due-diligence- or projectoscopy. Previous projects with this client heightened their  awareness regarding the value of this exercise. Their faith in our ability to ferret-out mitigating factors was  particularly significant since the project was for a suite in a new (yet-to-be-built) building; and they had already  committed to lease the space. Under similar circumstances, the requisite response that former clients have expressed could be paraphrased as, “I don’t need no stinkin’ feasibility study”. “It’s a brand new building. What could go wrong?” The fact is, much!

Logically, by all expectations there shouldn’t’ be any issues with a new building. But as it turns out, there were many.  For the sake of focus, I will limit the review to the physical plant and the available space.
The architectural firm that had designed the building provided the attached plans of the subject suite to us. Upon  review, we noted that, in addition to the “horseshoe” configuration imposed by the stairwells, lobby and elevator  hoistway at the front and rear entrances, the center core of the suite was profoundly encumbered by:  structural  columns, two separate HVAC supply/return ducts and a roof-access ladder. The collective impositions created two  factors.**

1. The useable space, which is calculated by perimeter measurement, did not account for the losses associated  with the noted, internal obstructions. Additionally, it was determined that the advertised square-footage of the suite referred to “leaseable” space, not “useable” space. Although this is standard practice, in accordance with  BOMA (Building Owners And Managers Association) it is not always clear to the lessee that  “leaseable” space  includes half the thickness of the perimeter walls. Collectively the net loss was approximately 200 square feet.  So, before we even began the planning process, we were dealing with a deficiency in the perceived “available  space”.

2. The encroachment of these obstructive elements created an enormous challenge for functional use of the suite.  The horseshoe condition alone created potential “dead-ended corridors”- a distinct life-safety code violation. This  condition was profoundly exacerbated by the encroachment of the respective components on the central core of the suite, and the ability to maximize function, flow and life-safety code compliance.


Without implementing considerable changes, the project was virtually impossible to develop to meet the client’s needs. The referenced challenges are depicted in the “existing conditions” drawing below.

We first approached the architects and expressed the benefits of relocating the roof-access ladder to the stairwell.  They were receptive and agreed to that change. We then met with the mechanical engineer and proposed the noted changes in duct chase locations, as shown below. Again, our proposal was met with favor and acceptance. On a side note, with respect for the architect and engineer, I must point out that the original layout was based on the expected use of the second floor as two distinctly separate suites. As such, the placement of the respective “chases” was logical for that use. It was simply not accommodating to a women’s health practice on the entire floor.

This project had a successful conclusion, as is evidenced in the finished floor plan (below). Due to a modest 

investment of time and money, we were able to avert a near-disaster and develop a functional facility. The message here is that the greater majority of “projectoscopies” (feasibility studies) that we have performed have unveiled seriously mitigating issues related to budget, construction and space utilization. The savings in every case has been substantial. But, it is noteworthy to mention that, even if a change is not viable, the discovery of the compelling factors will, at the very least, forecast any implications that the condition might impose on the project budget. In some cases we have actually determined that a facility would not support the needs of the practice. As a result, the clients averted a poor investment in both time and expense. Knowledge is power!  Caveat emptor.

*The majority of my previous contributions on design have focused on various phases and conditions related to dental office design. The fact is that we have had extensive experience with medical specialty practices, as 

well. They include ophthalmology, otolaryngology, orthopedics, and women’s health.

** Space consumed by the duct chases and roof-access ladder created a loss in useable space of 48 square 

feet. That’s the functional equivalent of a handicapped accessible lavatory. Similarly, it is common to overlook the difference between “leaseable” space and “useable” space. In most cases the useable space actually ranges anywhere from 100 square feet to 300 square feet less than the leaseable space. In this case the combined loss was approximately 200 square feet.

Garrett Ludwig founded Diversified Design Technologies Inc. in 1971. The company has specialized in the design and construction of private-practice, health-care facilities since 1975. During that time, he has designed more than 300,000 square feet of professional office space. He has a U.S. patent on his emergency services “crash cart” design. Ludwig has shared his experience in dental office design in numerous trade publications, and continues to lecture on the subject throughout the United States. He can be reached at (800) 622-5563 and garrett@designrx.biz. Visit his Web site at www.profitbydesign.us.