Audiologist-Centred Patients are the Outcome Goal of Patient-Centred Audiologists

Jeanine photo 2015Jeanine Doherty, Au.D., M.Phil., M.B.S, B.Soc.Sci.(Hons.) of Hearing Excellence

Christchurch, New Zealand

Loyalty of patients to their Audiologists is a “win” for all parties. In a business sense, loyalty means repeat business and word of mouth referrals from current patients, and both of these are less expensive than attracting new business (Morgan & Hunt, 1994). Thus, a relationship-based strategy builds a firm’s competitive advantage (Morgan & Hunt, 1994; Sumaedi et al, 2015) and patient-centred care can clearly fit this bill.

As a clinician, my experience is that it is the long-term relationship with repeat patient visits that helps make my career so rewarding and keeps me engaged; and for the patients, the trust relationship they develop over time with their audiologist must make their interactions much more rewarding emotionally.

Audiology can learn from the general business literature, especially the service sector. This literature indicates that customer loyalty has two main components (Cater & Cater, 2009):

  • Affective (emotional) commitment, which develops from trust and social bonds (liking each other and learning about each other and so includes listening to patients), with trust the more important by far. Health is a “credence category service,” and trust is very important in such a context (Chang et al, 2013). Humans also have an additional resistance to change, which acts as a loyalty antecedent (Silva, 2015).
  • Relational (rational) benefits such as access, marketing and pricing can lead to perceived satisfaction, but satisfaction ranks second to emotional commitment in establishing loyalty.

heartheadThis Cater dual-factor model of motivations of general service industry loyalty includes all the factors in the audiology-specific model developed by Grenness et al (2014). The themes from their patients’ data show that they seek individualised care, clinical procedures including information sharing and shared decision making, and the recognition of the importance of the players who make up the therapeutic relationship (i.e., audiologist and patient). These themes would fall into Cater & Cater’s 1st emotional commitment category and show the importance of meeting the emotional needs of patients to allow a successful and loyal patient/audiologist relationship.

Business literature tells us that people are willing to pay a premium for only two reasons – solution to problems AND/OR creation of good feelings (Maister, 1993). The health industry description of loyalty, or willingness to return and pay more, says it is influenced by satisfaction and trust which are analogous to Maister’s solutions and feelings.

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Reflections on Response to Change

CarolyneCarolyne Edwards, M.CI.Sc.

Director, Auditory Management Services

Toronto, Ontario Canada

Response to Change or Response-ability.   Most of us as human beings do not invite change into our lives as a natural part of each day. The reality is that we fall into pattern, and that pattern is comfort and security. We do anticipate some natural progression in our work or personal life but when unexpected events change the course of our lives, most of us resist that change at the outset.

The way we resist change takes many forms. We can stay in denial or surprise, we can blame others or we can fight against the change. Specifically, resistance may come in the form of delaying – give me more detail, flooding others with the details, intellectualizing, moralizing, OR impulsive action – everything is suddenly fine, I need a solution fast, blaming others without warning OR sustained confusion or denying the impact (I’m not surprised). Over time, if we accept the changes that have occurred, we can find a flow, and change becomes an ally rather than the enemy we originally perceived.5276781_s

Resistance is the outward expression of fear – I am afraid – of being vulnerable, of having to change, of losing control, of not knowing what to do, of being different and being rejected because of the difference. Each of us has our own fears based on our life experiences, and yet the underlying fear of the unknown is understood by all of us.

Listening to our clients’ responses is essential to determine where they are in the process of change, because the reality is the diagnosis of hearing loss brings change.

Addressing Resistance

When we are resisting change, we cannot hear others and often we cannot hear ourselves either. We may be aware or unaware of our resistance; we can feel the fear and don’t know what it is.   Resistance becomes the only way we know how to communicate at the moment. As professionals, when we are observing resistance in our clients, it is often more effective to address the actual behavior at the outset than the fear itself. For example, the behavior may be the inability to attend the scheduled appointments, the lack of questions, a parent’s inability to follow through with agreements to work with their child, a child’s rejection of support, the desire to talk about the same concerns repeatedly, the disinterest in follow-up appointments, or an adult’s inconsistent use of amplification or assistive listening devices. The underlying fears will often emerge out of those discussions.

Often professionals have confided to me that they are afraid to speak and confront the obvious resistance, and yet the reality is that there is no other place to begin. ” I notice that you don’t want to attend sessions any longer. I feel frustrated because I’m not seeing any change in Emma”s listening skills. What are you feeling?” or “When you stay silent and don’t say anything, I feel alone in the planning and I wonder if we are on the right track.”   Notice that what is important is for professionals to risk speaking honestly about the impact of the client’s response on themselves rather than avoiding or deflecting to another topic. The former will necessarily create change while the latter will hold the status quo in the professional-client relationship.

Our job is to take the first risk in sharing; that is what will open the door to a more honest communication.


Honor Resistance
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Patient Education: The Flip Side of Audiologic Counseling

Kris English, Ph.D.Kris English, PhD

The University of Akron/NOAC

Audiologic counseling is like a two-sided coin: one side attends to patients’ emotional and psychological struggles, and the other side, to their need for clear, relevant, and compelling information (Clark & English, 2014). Goleman (1995) would describe these two goals as communicating either with the feeling mind or the thinking mind. The concept of “being of two minds” is a familiar one, but communicating with a patient’s thinking mind (more specifically, our efforts in patient education) hasn’t attracted much attention in audiology.Slide1

Patient education can be taken for granted,  but that would be a grave mistake. If not careful, we might apply a range of ineffective practices, such as:

  • Using words our patients can’t process;
  • Providing more detail than patients can remember;
  • Conveying information unrelated to patients’ questions;
  • Providing information without helping patients apply it to their lives.

Let’s ponder that last point for a moment. Information designed to “help patients apply it to their lives” elevates patient education to a new level of responsibility. We are not only talking about providing information, but also using information as a vehicle for change.

This concept is relatively new. Falvo (2011) notes that while “many people think of patient education as the transfer of information … the real goal is patient learning, in which patients are not only provided with information, but helped to incorporate it into their daily lives” (p. 21). We are being invited to redefine this process, to evolve from a monologue of information-giving into an interactive framework for change.

The concept of “effective patient education” can be new territory for many audiologists. How do we find our way? This article outlines a suggested checklist to guide us, applying classic teaching/learning principles culled from exemplar patient education materials.

A Checklist for Audiology

Patient education has a familiar starting point:

Knowledge Dissemination. We have much information to share about test results, anatomy, etiologies, genetics, recommendations, treatments. However, as part of effective patient education, this step is just the first of several considerations. Even as we disseminate information, we cannot assume the patient understands us, or will remember what we said accurately. Let’s consult this checklist of concerns:

Slide1

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When We Think “Adult Patients,” Do We Also Think “Family”?

Kris English, Ph.D.
Kris English, PhD

The University of Akron

Whether we scan our bookshelves, review our folders, or – more likely – enter keywords in a search engine, we are likely to find the terms “family” and “hearing loss” almost exclusively associated with children and their parents. Interestingly, apart from a few exceptions (e.g., the National Council on Aging), adult patients with hearing loss are not immediately linked to the context of family. We have valuable information on the role of our adult patients’ communication partners (e.g., Preminger & Lind, 2012), but it seems important to point out that family means far more than communication. Historically, family has also meant moral, financial, and logistical support, “a feeling of belonging … honesty, trust and unconditional love.

Perhaps audiology has paid little attention to what it means to serve adult patients in a family context because we assume it is a “given.” However, some recent research indicates we should give this topic deeper consideration, and not take our practices for granted.

By “Family,” We Mean …45891913_s

Families are universal in all cultures, but definitions vary widely. A simple, popular, and inclusive definition is “two or more people who consider and define themselves as a family.” Another inclusive definition is “any group of intimates with a history and a future” (Ransom & Vandervoort, 1973). Biological and legal ties are traditional but not required. It is likely all readers know of someone who was “adopted” as a cousin or aunt or brother because of long-standing involvement and support that transcended simple friendship. To be “considered family” when not actually related is usually accepted as a high honor.

How Families Function

We can’t be expected to become family experts, especially since even experts contend that “Every family is the same. Every family is different.” By definition, though, families are generally interconnected and interdependent: in other words, what affects one family member to some degree influences the unit. Regarding health care, it has long been observed that families shape patients’ beliefs and attitudes about health, lifestyle, and health care (Lipkin, 1996), and that families often help patients make decisions about how and when to seek health care, take medications, follow prescribed diets, etc. (Jecker, 1990; Reust & Mattingly, 1996).

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(I know you are speaking, but what are you saying?)

When the health problem is a hearing loss, interconnectedness again comes into play. Hearing loss directly interferes with interconnectedness; when a loved one starts missing out on family life, it matters to family members to obtain help. In a very real sense, hearing loss is a family problem.

 

 

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Ear To the Ground: The Value of a Patient’s Story

sundarGirija_audGirija Sundar, PhD

Salus University

As a clinical audiologist for over 25 years or so, I have encountered numerous people with hearing loss, only to conclude that this is not a homogeneous group. What differentiates each patient is his or her unique story; fortunately for us, if we allow the story to unfold, we will learn how to help. Here is an example:

One of my patients described a get-together in the family. He has three children and five grandchildren. They had all arrived from different parts of the northeast, and he had not seen them together in some time. Once the entire clan was in the dining room, everything (chairs, cutlery, plates, people, mouths) was in constant motion. The dining table was the only thing that did not move.

My patient’s eyes could not quite keep up with the pace of activity; dependent on the visible word, his social encounters were manageable when limited to roomful of one or two people, and he’d developed his own strategies to cope with his hearing loss in simple listening conditions. But too many people in one room with the scattered sources of sounds left him unnerved.41785891_s

Sounds blended together in a din, and he retreated into the sanctuary of his study, leaving his dinner unfinished (the need for respite, per Clark & English, 2014). He could not tolerate the blurring of words; he could not participate or even observe. The very people he loved seemed insufferable and tiresome. His retreat, however, was misconstrued by his grown children and created quite a bit of tension in the following days. His wife’s observation of the possibility of hearing loss being at the root of this behavior allowed the rest of the family members to somewhat understand this gentleman, and upon his daughter’s insistence he decided to seek some help.

He was quite forthright when I asked him what made him see an audiologist at this particular time. Although in the beginning he only wanted a hearing test, routine questions regarding his communication difficulties brought his real story: he felt an alienation from his family.

He often had to imagine what they might be saying. “No one wants to listen or take the time to listen. Going out with people you comfortably socialized with has become something of an ordeal…it is claustrophobic; when you are in the middle of a group of people and cannot participate in the conversation, it is as though the people around you suffocate you. You know what I mean?”

I asked him if he wanted hearing aids. He did not: he only wanted to know if he had bad hearing loss. The answer told me my patient did not yet realize himself that the issue was his hearing problem (unique to him and his life), not his audiometric hearing loss. Because I understood his story, I could help him make the connection between his hearing problem and the alienation that had been hurting him so much.

Reference:

Clark JG & English, K. (2014). Counseling-infused audiologic care. Boston: Allyn & Bacon.

 

The Most Important Instrument in Audiology

Kris English, Ph.D.Kris English, PhD

The University of Akron

From 1999-2009, I had the opportunity to teach an online course in counseling for audiologists earning an AuD through the Central Michigan University/Bill Wilkerson Center Vanderbilt University distance education program. It seems hard to believe now, but when the AuD program started, many enrollees had little experience with email, so to get the ball rolling, the first assignment was to complete the Keirsey temperament questionnaire and email me the results (Rational, Artisan, Idealist, or Guardian).  My goal was two-fold: (1) to jump-start the “know thyself” reflection process and (2) to help students become familiar with my email address.  I wasn’t looking for any trends, but … take a look:

graphTen years and 25 semesters later, with results from 390 audiologists (all with Master’s degrees and an average of 15 years experience), the summative data show a very strong tendency toward Guardian temperaments (82% in the middle bar, compared to 40% in the general population on the left). Since then, I have posed the same assignment to AuD graduate students (from 2008 to 2015, right hand bar), and have also frequently asked attendees at workshops to spend 10 minutes on this exercise, with very similar results. For instance, among 27 practitioners in a recent workshop, our results were 0% Rationals, 15% Artisans, 15% Idealists, and 70% Guardians.

“Knowing Thyself” Stimulated Change

Of course, this exercise does not represent rigorous science, but it does give us food for thought. We would expect certain temperaments to be drawn to some professions more than others. For information on each temperament, visit the Keirsey website; specific to our topic, we learn that Guardians:

  • Are given to service and preserving social institutions
  • Have a natural talent in managing goods and services
  • Keep things running smoothly in families, communities, schools, churches, hospitals, businesses
  • Take pride in being dependable and trustworthy
  • Believe in law and order… honoring customs and traditions … following the rules and cooperating with others…
  • Are meticulous about schedules and have a sharp eye for proper procedures

Keirseysource: https://www.keirsey.com/aboutkts2.aspx

The four Keirsey Temperaments are aligned with Myers-Briggs results in the table above. A Guardian can be further categorized as Supervisor, Inspector, Provider, or Protector: in other words, someone who assumes responsibility for people and things.

At first I took these results with the proverbial grain of salt, but an intriguing pattern kept occurring. By mid-semester, the distance learners would begin to wonder if their “Guardian natures” interfered with patient counseling. They generally agreed that the Guardian characteristics matched their self-perceptions, but in the context of audiology, perhaps being someone who “assumes responsibility of people and things” was actually a problem.

The question that generated the most discussion was a simple one: “Who owns this hearing loss?”  Distance learners (“don’t worry, I’ll take care of everything”) wanted the answer to be “the audiologist owns the hearing loss” by virtue of education and expertise. This premise is probably not unusual: Palmer (1998) contends that “Virtually all professionals have been deformed by the myth that we serve our clients best by taking up all the space with our hard-won omniscience” (p. 132).

But subsequent discussions about patient autonomy and the difference between compliance and adherence challenged assumptions of ownership. If we have been “deformed by the myth” that we own hearing loss, then we effectively assume all responsibility to help, putting the patient in a passive role. However, we have enough experience and evidence to know that this approach is ineffective. Patients, of course, own their hearing loss, and improving their situation ultimately depends on their decisions, not ours. It does seem likely that the Guardian temperament can assume too much responsibility and in fact interfere with patient outcomes.

Thus challenged, Guardians bravely explored patient trust, the evidence relating communication styles to patient outcomes (Zolnierek & DiMatteo, 2009), shared decision-making, and health care partnerships – none of which require a Supervisor, Inspector, Provider, or Protector! Their willingness to step out of their comfort zones and test out new ways to “be” with their patients spoke volumes.

The Most Important Instrument…YesYou

… in audiology is not the otoscope; it’s the person holding the otoscope (you/me/us). In a typically hectic day, it can be easy to forget this maxim of health care: “The most therapeutic instrument is the self”  (Charon, 2001, p. 1899). All instruments require regular calibration, and we are no exception: we must routinely monitor our assumptions, the impact of our words and body language, our presence in the room, our willingess to share ownership (and its implied power) of a patient’s problems. We do bring training and experience to each patient encounter, but we also bring OURSELVES: our temperament as well our commitment and values.  From these intangibles, patients decide whether we are worthy of their trust.

References

Charon, R. (2001). Narrative medicine: A model of empathy, reflection, profession and trust. JAMA, 286(15), 1897-1902.

Palmer, P. J. (1998).  The courage to teach.  San Francisco: Jossey-Bass.

Zolnierek, K.B., & DiMatteo, M.R. (2009). Physician communication and patient adherence to treatment: A meta-analysis. Medical Care, 47, 826–834.

Parents Teaching Students

Vasil AAAKara Vasil, Class of 2016

The University of Akron/NOAC

Picture this: You are in the sound booth, right in the middle of an audiologic assessment. A few missed head turns or latent ABR waves in, you realize that maybe these parents’ fear has been realized, and their child has a hearing loss. They’ve sat in your office, putting the puzzle pieces together of the child’s birth history, medical complications, and behaviors in the home. You now have concrete evidence, in the form of behavioral testing, an ABR, OAE’s, or whatever it may be. Now it is time to break the news to these parents that their child has a hearing impairment. Whether they are expecting it or not, you, the audiologist, have a job to do.

Despite coursework in pediatrics, counseling, and aural rehabilitation, many graduate student clinicians have never been in this situation. Even when evaluating pediatric patients of all ages and walks of life, the majority have not yet concretely identified and reported to parents a permanent, sensorineural hearing loss. As many clinicians would agree, I do not believe this is a skill that can be taught solely in the classroom. Some may feel that there has been a barrier between the clinician and the parent – what is appropriate to say, and what are these parents thinking about when they leave the office and return home with their child?

Learning from the True Experts

This past semester, that barrier crumbled a bit. In a pediatric amplification course, my professor, Dr. Mark Krumm, brought in four parents of children with hearing loss. These parents were all from the local area and had met in a support group. Their children had sensorineural hearing loss of varying degrees and were treated with hearing aids and cochlear implants, technology that I consider myself quite familiar with. However, one thing I do know is that it’s not about the technology. Hearing these parents’ testimonials about their relationships with their audiologists, their children, and their families was a truly eye-opening experience. The experience reminded my entire class that the parents of our pediatric patients are trying their best and have heartfelt compassion for their kids, and, no surprise – they know their children a whole lot better than we do. These parents know what makes their children tick, they know what the technology will and will not accomplish in their home, and they also probably know their audiologist’s cell phone number for when they will inevitably need it. 

The parents who visited my class talked about the desire for a trusting, collaborative relationship with their audiologist, with referral to the appropriate professionals when we just don’t have all of the answers. An article published in the American Journal of Audiology confirmed these statements; parents and caregivers want their voices to be heard, and they want their child’s treatment implemented in a coordinated and professional manner. Fitzpatrick, et al. (2008) interviewed 21 parents about the strengths and weaknesses of the standard audiologic care system. Although most parents were satisfied with the range of services provided and the quality of services, they did have a few suggestions for us to consider. Family-centered care and a high level of support have been linked with higher rates of follow-up, better participation in early intervention services, and ultimately improved outcomes for the child.

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Gradual Hearing Loss and Sensemaking

 

Kris English, Ph.D.Kris English, PhD

The University of Akron

Recently, a friend described how her grown son currently chooses to be homeless. She doesn’t know how to find him, and doesn’t know how he manages. Needless to say, she is worried sick. Looking back, she now recognizes the early signs of mental health problems during his teen years, but at the time, she didn't recognize them as such. After all, it's not unusual for teens to be rebellious, non-communicative, disorganized, or moody. As any parent would, she applied what she knew in general about adolescence to make sense of her son's decisions and actions; only when her explanations no longer made sense (this is not how teens typically act) did she feel ready to consider broader, more complicated explanations and seek help. The diagnosis of mental health problems was a first step toward making sense of a profoundly unfamiliar situation.

Most adults approach life’s uncertainties in the same way: we experience something we don't fully understand and start by working through “what we know.” Our car makes a funny noise so we look under the hood. We notice a new ache or pain, and make changes in our diet or environment (maybe more exercise?). Our computer freezes so we turn it off, count to ten, and turn it back on. In doing so, we are applying the sensemaking process, which helps us understand a change or shift in our world. If that process fails us, we consider taking the next step of asking someone for help.

Although much of audiologic counseling focuses on emotional and psychological reactions to hearing loss, our patients of course are also decision-making individuals whose minds seek logic, facts, and answers that make sense. Here we will consider how the sensemaking process applies to our patients as they ask for our help.

It Might Look Like Denial

Sensemaking in health literature is often applied to the diagnosis of a life-altering disease or disability (e.g., Pakenham, 2008), as in “why is this happening to me?” and “what will become of me?” Acquired hearing loss is certainly a life-altering condition, and both patients and audiologists attempt to make sense of it. We understand our role: in our initial encounter with a new patient, we begin with the query, “What brings you here today?” to help us understand the patient’s concerns, and then we test. However, we may not understand that the patient is also striving to make sense of this appointment. For many patients, a gradual hearing loss does not yet make sense, as reflected in these remarks: 

  • My family says I can’t hear them – but that can't be true because I definitely hear them complain!
  • People speak too fast these days.
  • It’s not my hearing, it’s the background music on TV that’s the problem.
  • How can anyone be expected to hear in such noisy restaurants? They used to be quieter.

Gill et al. (2010) describe these types of comments as “candidate explanations,” offered to convey a patient’s efforts to make sense of the situation. However, we may be inclined to interpret these comments as denial (or stubborness, embarrassment, suspicion) instead of reasonable efforts to understand a problem based on what the patient currently knows: that one's hearing seems to be generally adequate.

What patients don't yet know is their actual hearing status. How we go about informing them can support the sensemaking process.

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Audiology and End of Life

headshot for AACLaura Rickey, Class of 2017

The University of Akron/NOAC

First, I would like to share the story that inspired me to write about this topic. Dr. Kristina English shared it with me after a hearing screening. The story is as follows,

A family had been given the news that their grandmother’s illness had received every available tr eatment, and it was now time to think about keeping her comfortable in hospice care.  The patient had been a hearing aid user in the past but while managing several recent emergencies, the family realized the hearing aids were lost.  Now that the grandmother’s pain was under control, she wanted to talk to every one of her beloved family members — although she could talk, she couldn’t hear their responses.  So the family found the audiologist who had fit the most recent set of hearing aids and asked for help.  New hearing aids were quickly provided and the family made full use of them, sharing memories and stories, and laughter and tears with the grandmother for as long as she was able.  The time did not last long, however, and she peacefully passed away 10 days later.  The audiologist was contacted about her passing and also the memorial service.  She told the family she would arrange for a refund, but they declined.  They reported that they “got more than their money’s worth” in those 10 days, and they would rather have the audiologist hold on the devices for other families who could use the same kind of help.  The audiologist followed their wishes, and has lent the devices to other families in the same end-of-life situation. The devices are lightly engraved with the words, “Use with Love.”

After hearing this extremely powerful story relating to the end of life and audiology, I decided to try and find out more about this topic. I came to find that there is very little information in the literature about the end of life and audiology. This came as a surprise to me, as audiologists serve a population with whom the end of life topic must be considered. This got me wondering if, as professionals concerned with communication, are we focusing most of our interests on early life, and possibly negating a very important part of life, that is death? In the book, Death and Dying, Life and Living (Corr & Corr, 2013), the idea is shared that death is a very important part, if not one of the most important parts of individual’s life. There is absolutely no doubt it is important to make sure that children receive auditory input as soon as possible, but are we focusing so much on this aspect of audiology that we are forgetting about other times in life that communication is of the utmost importance? Is it possible that the first few moments, weeks or years are just as important as the last? Do audiologist have a place in end-of life care? Is it ethical to recommend amplification at the end of and individual’s life? These are all questions that, in my opinion, need answers.

Do we Have a Place in End-of-Life Care?19278970_s

According to the National Hospice and Palliative Care Organization (2011), hospice provides expert medical care, pain management, and emotional and spiritual support not only for the patient, but also for the patient’s loved ones. Hospice care involves an interdisciplinary team of specialists including; the patient’s primary physician, hospice physician or medical director, nurses, home health aides, social workers, bereavement counselors, clergy or other spiritual counselors, trained volunteers, and physical, occupational, and speech therapists (Toner & Shadden, 2012), if necessary. Audiologists are not currently listed as interdisciplinary team members for hospice and palliative care, but should we be?

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“Can I Just Give You a Hug?”

Anna Hollingdale, MSc.

Anna Hollingdale, MSc.

Anna Hollingdale, MSc

Audiologist

West Sussex, England

Recently, a 73-year old female came to see me for a fine tune. The patient’s initial complaints were ones, as Audiologists, we hear often: “I cannot hear in noise” or “I am struggling to communicate with others.” It would have been so easy for me to quickly do a fine tune, or respond with the ‘limitations of hearing aids’ script but instead, I listened…

Soon I learned she has a busy social life and takes part in many activities, but having the hearing loss had started to affect all this. This patient has been coming to our clinic for over a year and had never had the chance to really speak about how the hearing loss was affecting her.

Once she had finished talking, I responded by reflecting what I heard, without adding any solutions: “It seems you are having a really hard time with this, it must be really tough for you.” This “invitation” then enabled the patient to open up even more, and share that she had been avoiding social events and was always looking for ways to cover up her difficulties. The hearing loss was significantly affecting her life and relationships with others. Notably, she did not ask for any answers. All this patient needed was for someone to listen and empathise with her.

At the end of the appointment the patient stood up and said, “Can I just give you a hug?”

I think this says a lot more than any words could!

Another Dimension to Patient Journey: Traveling Together, We Go Farther

Kris English, Ph.D.

Kris English, PhD

The Ida Institute encourages audiologists to consider a “journey” metaphor to better understand the patient experience. A patient’s entry into audiologic care is not an abrupt event, but rather is preceded by several influential experiences. We are charged to sort out those experiences, usually with a question such as “What brings you here today?”

The patient will relate salient facts, an important part of the journey — but not the only part. To date, the journey has also likely been lonely, stressful, confusing. If we fail to inquire about these concerns, the patient may fairly wonder if we even care. Without an indication that the audiologist is personally invested, the prospect of moving forward with no apparent  emotional support may seem daunting and unappealing. Consider, for 9062579_sexample, a recent study that found a low degree of adherence to hearing aid recommendations when audiologists dominated the conversation discussing technology (Grenness et al., 2015). Our challenge is to convey with our counseling skills that we are not just watching from the curb as patients travel past, left to their own devices. Rather, we are committed to travel this journey with them. 

The Ultimate Confirmation

It seems safe to say that being asked to give a hug is the ultimate confirmation of patient trust. Patients may initially resist hearing help, and therefore resist us, but if we can mindfully travel with them, help them drop their guard, consider change, and know we care, the subsequent relief can be tremendous! When a patient feels words alone will not convey that relief, and instead asks for permission to enter our personal space, trusting that our answer will be yes, she has made an important break-though.

Most patients don’t ask for a hug, but they all ask, somehow or other, for our attention and support.

Reference

Grenness, C., Hickson, L., Laplante-Levesque, A., Meyer, C., & Davidson, B. (2015). The nature of communication throughout diagnosis and management planning in initial audiologic rehabilitation consultations.  Journal of American Academy of Audiology, 26, 36-50.