Patient Centered Care in Argentina

Abi Nardi
Licenciada en Fonoaudiología
Óptica contactóloga
Especialista en Audiología
Villa Dolores, Cordoba, Argentina

I am licensed to practice audiology and language therapy, a career path that takes 5 years to complete plus the final thesis in my country, Argentina. After graduating I dedicated myself to the area of audiology.

I have worked in a very prestigious hospital in a big city, and currently work in a smaller city, in a private practice and municipal clinics, knowing different social, emotional and economic realities, where each person goes through similar pathologies in different ways.

In my family I grew up learning to see the “patient” as a person first. My mother is an optometrist, and she always listened to her patients, showing me how to learn about each as persons first and what they contribute, before their pathologies.

However, in my years of the University I didn´t have, not even half a semester, a subject that taught me to LISTEN, CARE and ACCOMPANY a patient. Conversely I had the ones that taught me to carry out and understand tests, know pathologies and ways to solve them, from a purely scientific approach. I am obviously grateful because it is necessary to incorporate these topics and they are the basis of an audiologist’s college career.

But in my country it´s normal to attend patients within a certain time and try to unilaterally resolve the conditions — without remembering the environment, social, economic and emotional level of each person.

After gaining some experience, I needed to know a little more every day, to update me and learn. One day I found this website, got to know Kris English and through her the IDA Institute. I had been trying to provide patient-centered care for years in a disorganized way and without given it a name. I also had no coworkers interested in PCC, until now.

I Tell You What I Have Learned…

Person Centered Care (PCC) is a practice that is difficult to understand. It moves us from a structured job, or rather a traditional one, which is what we have been taught to exercise in a unidirectional way. I have learned that PCC proposes a more complex, dynamic professional exercise; we must be adaptable to what our patients are expressing and we must discover what they value. It means getting more involved in each consultation, paying extra attention to each situation that occurs in the meeting, managing to understand all aspects of our patient life.

There are situations that we cannot control, such as the culture where we live, that of our work, economic tools, our educational past, but nevertheless there many other situations that we can control.

I never spent hours explaining an audiogram, I have never been only theoretical; I always went further, observing whoever chose me as an audiologist, LISTENING to what he has to say, without asking closed questions, allowing freedom to express oneself. I know that it’s a unique experience each patient brings to their hearing loss, since for each one it means something different, having different thoughts, feelings and experiences according to how this loss is affecting him in his life.

Recognizing that the way we interact with our patients has a significant effect in the auditory result means we see the importance of how to build a therapeutic relationship. And so we can position ourselves as clinicians, where we not only explain options, but we must also work with the goals and values of our patients, situating ourselves with EMPATHY. We help them  chart a path with a plan appropriate to what we believe best for them, according to what they explicitly and implicitly propose to us in their narratives.

What Keeps Me Going…

I will never forget a patient who entered the consultation, referred by a colleague, who described him as a patient who didn’t accept his diagnosis: profound bilateral sensorineural hearing loss.

We sat down… no one spoke for a  minute, we just looked at each other, waiting for the other to speak…when suddenly he said to me: “ How comfortable I have felt for a moment, where nobody told me what to do or how, just waited for me to decide to speak…Now I´m going to tell you…”, Then I asked a few questions, since my patient described himself without questionnaires. And I asked myself: profound hearing loss? Without any testing? It turned out to be a patient with a wrong diagnosis.

That encounter occurred in 2019, and since then I have treated eight patients sent by him.

This is where, through PCC, I can fully appreciate what to do with this information and how to take advantage of it. Today I feel supported, accompanied, on track, I found academic training on the subject, I found those who gave it a “frame”

I Know that it’s in me and in every professional who wants it, the ability to respond to the emotions that derive from the hearing loss of our patients.

With these insights, I try to encourage colleagues to get involved and soak up this knowledge that is very simple to implement but complexly difficult to apply, especially if we don’t manage to deconstruct our way of looking the traditional clinician-patient relationship.

I understand the added value that we can achieve, but the structures of traditional education don’t put in value, hence it’s difficult to see and adopt it. The important thing is that if we manage to move from the traditional approach and adopt this way of working, we’ll quickly see that benefits are found for both parties: we manage to improve the patient’s health and we as professionals will have fidelity on their part. The idea of ​​building loyalty to our patients, listening to them, making them feel at ease beyond getting involved in their problems and trying together to reach the best possible option for their condition. Simply by using the responsible practice of PCC.

Here is the future of our way of working effectively, responding to the global need of each person.

PCC= Atención Centrada en el Paciente

Abi Nardi
Licenciada en Fonoaudiología
Óptica contactóloga
Especialista en Audiología
Villa Dolores, Cordoba

Soy Licenciada en Fonoaudiolgía, una carrera que lleva 5 años de cursado más la tesis final en Argentina,  mi país.  Luego de graduarme me dediqué al área de audiología.

He trabajado en un Hospital muy prestigioso en una gran Ciudad,  actualmente trabajo en una ciudad más pequeña, en un consultorio particular y en Dispensarios Municipales, conociendo diversas realidades sociales, emocionales y económicas, donde cada persona atraviesa de manera muy diferente  la misma o similares patologías.

En mi familia crecí aprendiendo a ver al “paciente” como una persona ante todo, mi mamá siempre se involucró y escuchó a sus pacientes (en el área visual), demostrándome así que cada uno es uno y lo que trae, antes que las patologías.

Sin embargo en mis años de estudio no tuve, ni medio semestre, una materia que me enseñara como ESCUCHAR, ATENDER y  ACOMPAÑAR a un paciente, por el contrario  si tuve las que me enseñaron a realizar y comprender estudios,  conocer patologías y maneras de resolverlas, desde un enfoque netamente científico. De las cuales obviamente estoy plenamente agradecida, porque es necesario incorporarlas y son la base de la carrera.

Por lo tanto, en mi país es normal atender pacientes en un tiempo determinado e intentando resolver de manera unilateral las afecciones. Pero sin recordar entorno, nivel social, económico y emocional  de cada persona.

Ahora que la experiencia incomoda, ya que cada día debo conocer más, actualizarme y aprender; me encontré con una gran referente en un tema que nunca dejó de movilizarme y sigue haciéndome perder el sueño.  Aquí conocí a Kristina English y  a través de ella a IDA Institute y  a esta práctica que llevo años utilizando, de manera desorganizada y  sin haberle puesto nombre. Sin  colegas con quienes  pudiera compartir. Hasta ahora.

Por lo tanto les cuento lo que he aprendido…

PCC Atención Centrada en el Paciente, es una  práctica que cuesta un poco comprender, ya que nos corre de un trabajo estructurado, o más bien tradicional que es lo que nos han enseñado, a ejercer de una manera unidireccional. Siendo que PCC plantea un ejercicio profesional más complejo, dinámico; adaptable a lo que nuestros pacientes van expresando y nosotros debemos ir descubriendo. Debiendo estar más involucrados en cada consulta, poniendo atención extra a cada situación que se presente en el encuentro, logrando comprender todos los aspectos de la vida de cada paciente.

Hay situaciones que no podemos controlar, como la cultura donde vivimos, la de nuestro trabajo, herramientas económicas, nuestro pasado educativo;  pero  sin embargo hay muchas otras que sí. Por ejemplo yo nunca pasé horas explicando un audiograma, nunca he sido solo teórica; siempre fui más allá, observando a quien me elige como audióloga, ESCUCHANDO qué tiene para decir, sin llenar de preguntas cerradas, dejando libertad a expresar. Observando.

Conociendo que es una experiencia única la que cada paciente trae (pudiendo presentar similares o iguales patologías) ante una pérdida auditiva; ya que para cada uno significa algo distinto, teniendo pensamientos, sentimientos y experiencias diferentes según cómo esta pérdida le esté afectando en su vida.

Reconociendo  que la forma en que interactuamos con nuestros pacientes tiene un efecto significativo en el resultado auditivo del mismo, es cuando debemos ver la importancia de cómo construir una relación terapéutica. Y así lograr situarnos como clínicos, donde no solo explicamos opciones,  sino que debemos trabajar con los  objetivos y valores de nuestros pacientes, situándonos con EMPATÍA. Logrando  diagramar un camino con un plan adecuado a lo que creemos mejor para ellos, de acuerdo a lo que nos plantean explícita e implícitamente en sus narraciones.

Io que me hace seguir adelante….

Nunca olvido un paciente que entró a la consulta (derivado por una colega, quién lo describió como paciente que no aceptaba su diagóstico: hipoacusia neurosensorial bilateral profunda).

Luego de saludarnos, nos  sentamos… nadie habló por un minuto, solo nos miramos, esperando uno al otro para que hablara… cuando de repente me dijo: “qué a gusto me he sentido por un momento, donde nadie me dijo qué hacer ni cómo, solo me espero a que me decidiera a hablar… Ahora te voy a contar…”, luego realicé pocas preguntas, ya que mi paciente se describió solo sin necesidad de cuestionarios. Y me pregunté: ¿Hipoacusia profunda? Sin haberle realizado siquiera un estudio. Resulto ser un paciente con diagnóstico equivocado desde su narración hasta las pruebas realizadas posteriormente.

Siguiendo con este caso, en lo que fue del año 2019,  he atendido a ocho pacientes enviados por él.

Aquí es donde a través de PCC logre valorar al máximo qué hacer con esa información y cómo aprovecharla. Hoy me siento respaldada, acompañada, encaminada, encontré formación académica sobre el tema, encontré quienes le dieron un “encuadre”.

Sabiendo que está en mí y en cada profesional que así lo desee, la capacidad para responder a las emociones que derivan de la pérdida auditiva de nuestros pacientes.

Con esto intento animar a colegas a involucrarse y empaparse en este conocimiento que es muy sencillo de implementar pero complejamente difícil de acceder si no logramos desestructurar nuestra manera de mirar al clínico-paciente tradicional.

Entendiendo el valor agregado que podemos lograr, pero que las estructuras de la educación tradicional no ponen en valor, de allí que cuesta verlo y adoptarlo. Lo importante es que si logran correrse de lo tradicional y adoptar esta manera de trabajo, verán rápidamente que se encuentran beneficios para ambas partes. Ya que logramos mejorar la salud del paciente y nosotros como profesionales tendremos fidelidad por parte de ellos. Aquí me paro,  la idea de fidelizar a nuestros pacientes, escucharlos, hacerlos sentir a gusto más allá de involucrarnos en su problemática e intentar juntos llegar a la mejor opción posible para su afección. Sencillamente utilizando la práctica responsable de PCC.

Aquí está el futuro de nuestra manera de trabajar eficazmente, respondiendo a la necesidad global de cada persona

Yoga Principles and Audiologic Counseling

Kirsten Ellis, BA(Hons) MSc
Southend University Hospital
NHS Foundation Trust

In Yoga, we are encouraged to minimise distractions. Now, I am speaking from a student’s point of view, as I certainly don’t possess the in-depth knowledge that my dear yoga teachers do. When laying in Savasana (the prone relaxation pose at the end of a class, and sometimes at the beginning) we are reminded that there are no distractions, there is nothing else we need to do at that moment apart from being present in the space. Often easier said than done!So to my surprise, when relaxing in Savasana one evening and listening to the teacher guide us through meditation, she reminded us that we were there for ourselves, we had no expectations on us at that time, and that this was a safe space for us to just “be.”

“Don’t bring your story.” – The Breakthrough

On hearing this my mind lit up (probably much to the disappointment of my yoga teacher) – how can this be carried over into our counselling?  The clinical ego wants us to bring our “story” to each appointment.  It tells us to reassure the patient that we know best, that our experiences and training (our story) are how we can best manage someone seeking help.

Additionally, in a more literal sense we don’t want to belittle our patients’ experiences by comparing them to our own. How often have we felt disheartened at being told “I know how you feel,” or “I’ve been though that, it’s not so bad”?

To truly listen, we shouldn’t bring our story to the appointment. By releasing our story and subsequent distractions, we can truly be present to listen.

The Yogi and the Clinician

My yogi has helped me work through what feels uncomfortable, or through a busy state of mind to find peace in the present moment. When we are truly listening, are we also not working to find peace within ourselves to be fully present for the person in front of us?

I’ve often found myself in the midst of what I would feel is a difficult conversation, trying to push my clinical ego aside and allowing my patient to just talk. For me, this echoes working through what I feel is uncomfortable, allowing my patient to work through vulnerability to achieve a sense of calm (not necessarily a conclusion) in the appointment.

What are we doing to be self-aware, and how are we responding to this state?

To summarise my thoughts, I am reminded of a recent patient who attended for a review of his hearing aids. On the outside, one would assume he was a patient who could not hear well, felt his hearing had changed, and that an update was needed. However, once he came and took a seat, his body language communicated some further inner turmoil.

He confessed that he had been mishearing and forgetting important dates, the most recent being his daughter’s landmark birthday celebration. I let him talk. With tears in his eyes, he told me that he had sought an appointment at his GP for an assessment for dementia. My clinical ego wanted me to reassure him, and tell him everything is fine and to push on with the appointment. But instead, we sat and explored his concerns. We asked each other questions and we sat through conversation and silences that were uncomfortable for the both of us.  We came to an agreement that we would get his hearing aids as good as they can be for his dementia assessment, so that we can face things confidently with our heads held high.

My general feelings once the appointment ended were that because of our interaction and agreement, we were both fully self-aware, in a compassionate environment that allowed for vulnerability (Hanson, 2009). Upon further reflection, I was struck by the parallels of Rogers’ (1961) three conditions of person-centered counselling: congruence with self, unconditional positive regard, and empathic understanding – all essential audiologic counselling skills. Of the three conditions, the foundational skill of self-awareness/congruence with self seems to generate almost no interest among audiologists.

So let’s start, shall we? Let’s develop a professional version of the prone relaxation pose Savasana – and breathe.


Hanson, J. (2009). Self-awareness revisited: Reconsidering a core value of the counseling profession. Journal of Counseling & Development, 87(2), 186-193.

Rogers, C. (1961). On becoming a person.  Boston: Houghton Mifflin.

Can We Be Person-Centred and Sell Hearing Aids?

Anna Pough, BA MSc

Hearing Therapist Audiologist

British Society of Hearing Aid Audiologists

Everything we do in our hearing care consultations must have a purpose. Given our daily time crunch, it is a true challenge to purposefully apply person-centred practices such as shared decision making, ownership and rapport – and simultaneously work with the realities of the retail imperative. We need to support the person in the purchase and use of a product that no one wants, all the while working with barriers of stigma, bereavement of selfhood, and limited understanding of hearing instrument technology.

These responsibilities take up a lot of “bandwidth,” and it can be very tempting to resort to habits, shortcuts and routines. Hence the question: can we be person-centred and also sell hearing aids?  Following are three ways we can answer with YES.

YES: Begin with Carl Rogers’ Concept of “Person-Centredness”

Psychological therapy was initially based on the professional’s didactic perspective of how therapy should be undertaken and how success would be measured. Rogers was a radical thinker and changed this perspective. He believed that genuine meaningful therapeutic change would only occur when certain core clinician behaviors were applied: empathy, unconditional positive regard (acceptance) and congruence (being genuine)(Rogers, 1961). Specifically:

  • The clinician should work alongside the client as an equal partner in the therapeutic intervention;
  • By building on ‘unconditional positive regard’ and ‘empathy,’ the client is supported to recognize and acknowledge their own behaviours and responses through ‘congruence’ from the therapist;
  • A person’s own life experience provides the basis for their own standards of living in the real world, and influences their acceptance of therapy.

Rather than the therapist controlling the clinical interaction, Rogers explicitly addressed the issue of power and challenged the presumption of expertise. When he was described as “giving power back to the patient,” he insisted on clarifying: “It is not that this approach gives power to the person; it never takes it away” (Rogers, 1977, p. xii).

His theories developed further through psychological research and have become a cornerstone of most current interventions. [Read more about the Rogerian approach here.]

YES: Review Maslow’s Hierarchy of Needs

Abraham Maslow and Carl Rogers were both considered founders of a humanistic approach to psychology.  Maslow’s now-classic pyramid-shaped model (“hierarchy of needs”) reflects five states, starting with the need for sustenance, procreation, and existence, and then for safety and security. When these needs are met, relationships become important, leading to a need to be liked, respected, and to have a place in the group, which allows us to have an identity or self-actualisation; we can be who we choose to be. He later amended and addressed some concerns about this model, but as a concept it remains a useful visual tool.

If we accept that behaviours are based on these needs being met or not met, then we can place Rogerian principles of acceptance, congruence and empathy within this hierarchy as being integral to function within a “normal” life. In other words, a person-centred approach is positioned within the concept of having a “normal life” and being valued as “normal.”

By understanding better where the concept of person-centred services originated, we can appreciate the work required to maintain its principles in our day-to-day practice. By being congruent, empathic and by practicing real reflective listening, we can help people move from denying they have a hearing problem to purchasing and wearing hearing instruments – in effect, achieving a degree of self-actualization by improving a “self” problem. [Read more about Maslow’s theories here.]

YES: Remember that “Change is Hard” – But Achievable

Providing support as recommended by Rogers, and helping a person advance along Maslow’s stages, involves change — which can make people feel uncomfortable, insecure, and off-balance. And yet, people do change, and the process is often described by the Transtheoretical Model (TTM) (Prochaska and DiClemente, 1983). Developed in the 1980s, this construct helps therapists help their clients understand how and why they behave as they do, and how they could change.  TTM is a combination of several ideas examining change and influence, habit and acceptance, and describes the progression through various elements, each having their own response.  Anyone who has used the Ida Institute Motivational Tools, or anything similar, will recognise these stages of change pathway as the foundational model. [Read more about TTM here.]

Applying Theory to Practice

These models and theories can be directly contextualized to hearing healthcare and the consultation process. I began this piece by stating that everything we do in the consultation process must have a purpose. Each element of the consultation process must have a solid theoretical and clinical rationale, but embedded within this, each element also should also have a clear commercial perspective.

  • The decision to attend the hearing assessment should be rewarded with value within that person’s concept of worth, value and self esteem. They should be able to recognise the empathy and positive regard we as Audiologists afford them.
  • They should feel that their time and effort to attend the appointment is worth their while. This implies consequently that our time and effort as audiologists and therapeutic partners, are valuable too. This is a value construct and is a commercial transaction, even if no money has passed between us at this point. People have begun to think about the relationship in a transactional manner: they give us their time, and in return we give them information, advice and professional expertise. This has a tangible value. We go further to establish the need for our expertise, services and, in time, amplification products.
  • We ask open questions, eliciting answers where we actively listen, noting salient clues about attitudes, behaviours, needs and expectations which we reflect back, thereby demonstrating empathy. We gather commercially pertinent information in a non-judgmental manner about communication difficulty, domestic and work relationship conflicts, and the relative importance of those communication ecologies.
  • The consultation process should also allow us to understand the person’s place on their own cycle of the stages of change. This will help us to support and frame their expectations, work with them to acknowledge and/or accept their hearing loss, and build the desire to make a shared decision to purchase hearing amplification where that’s the most appropriate solution.


As Audiologists, we must maintain an ethical and congruent relationship with the people with whom we work. Understanding the theoretical foundations of a person-centred approach enables us to be effective and efficacious in our relationships, within the parameters of the commercial reality of the retail imperative.


Maslow, A.H. (1943). A theory of human motivation. Psychological Review, 50(4), 370–96.

Prochaska, J. & DiClemente, C. (1983) Stages and processes of self-change in smoking: Toward an integrative model of change. Journal of Consulting and Clinical Psychology, 5, 390–395.

Rogers, C. (1961). On becoming a oerson. Boston: Houghton Mifflin

Roger, C. (1977). Carl Rogers on personal power. NY: Delacort Press.


Is it Possible to Practise with Compassion and Empathy?

Paul Peryman, MA, Dipl Aud (Melb), MNZAS-CCC, Audiologist

Van Asch Deaf Education Centre 

Christchurch, New Zealand

I work as a paediatric audiologist at van Asch Deaf Education Centre in Christchurch, New Zealand. I have worked there for 30 years. During that time I have practised within a family-centred care model, in conjunction with the teams with whom I work in the Centre.

Part of my work includes meeting families with preschool and primary school aged children who are deaf/hard of hearing (DHH). These families are referred to our centre from around central and southern New Zealand and stay in residence for four days. During that time, they meet and work with a team which includes myself, a speech language therapist, a specialist literacy teacher, a specialist early intervention teacher, and a New Zealand Sign Language tutor. The families also meet other parents who bring their DHH children to our early intervention centre.

The objectives of our residential courses are to provide assessments of the children and guidance to the families. Immediate post-course ratings of each specialist area of assessment and support are received from families before their departure. In common with the approach of the Colorado Home Intervention Programme, evidence for modifying and continuing professional practice within the residential course teams has been based on both family and professional feedback (both internal and external), as well as international research within each team member’s professional speciality.

Some reasons why our residential courses work well

  • An intense focus is provided on early language, hearing, signing, speech, visual communication, social behaviour, and literacy.
  • Consistency exists for each family from across the team members.
  • Family and child-centred focus – parents find this refreshing.
  • Generous time frames and flexibility in courses, allowing the tailoring of courses to family needs and referrer priorities.
  • Opportunities to meet other families and share experiences – especially beneficial for isolated families.
  • Unique and relaxed environment – helps families focus on themselves and their DHH child’s needs.
  • Presence of other deaf adults and children on the site is perceived as a positive characteristic.
  • Family travel, accommodation and meal costs are supported.

Hearing family stories and experiences

Working with these parents and families involves hearing stories. The stories are invited and prove highly informative for the team. Hearing the stories and reflecting back to parents requires the display of empathy and compassion, as parents are often at the same time quite emotional. Some have not previously had the opportunity to tell their story, and it comes as a relief to do so and to be heard.  Some parents have also had experiences of rushed audiological appointments, leaving them with little time to share observations and to ask the questions they want of the professionals. Those parents were feeling removed from the audiological management of their child; not understanding what was happening and what to expect. In some cases, parents didn’t believe the diagnosis, which they admitted had affected their willingness to persevere with the battle of keeping hearing aids on an infant who appears to hear.

How to balance limited time?

It seems to me that this state of affairs comes about due to my hospital colleagues being so pressed for time that they have to reduce their service to one of meeting the required evidence-based clinical protocols, against which they are audited. While some try to resist this pressure, it is ever present. They are concerned that too much valuable clinical time might be used up once a conversation is entered, leaving them unable to complete the protocols. Colleagues have also said anecdotally that they feel ill prepared to engage in conversations that might become emotional or difficult. There is a feeling that stopping and allowing time for conversation will affect their appointment schedules and therefore cause them stress (Severn et al, 2012).




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Kindness Begins at Home

Diana Harbor, BA

Audiological Scientist & Speech and Language Therapist

The Ear Foundation Nottingham England

This week yet again I have been reminded of the very powerful force of kindness and its power source…the listening ear. Yesterday I had the privilege of being with a group of teenagers all living with hearing loss, using different technology from cochlear implants to bone implanted devices with different personalities and experiences of the world, some who had never met each other before. We all took part in an exciting improv, drama workshop at the Ear Foundation. Much of the afternoon was spent in small groups creating wonderful stories and weaving a single idea into a feast of creativity that JK Rowlings would have drooled at. And the real magic happened as Loydie, a DJ from Capital radio, revealed to us very simple techniques for keeping ideas going, for turning problems into new ideas and for getting the best out of each other. The power of using the phrase “…yes and” and how to do this while listening and maintaining eye contact.

The reason I’m sharing it here is I will be using it in practice and it was a light bulb moment for me. Well maybe that’s a bit dramatic but definitely some sparks and embers that I’m going to ruminate over and feed with other new ideas on the subject. So if you are partial to a camp fire…feel free to bring along your marshmallow on a stick and sit with me for a bit as I share with you what I’ve learnt.

The Power of “Yes and…”

“Yes and…” Ideas start to fly; we feel accepted and heard

In the improv workshop we all put the idea of “yes and…” into practice as we started a story with “let’s go to…”. As one teenager started with a single idea (“Let’s go to the beach”), his team mates were asked to reply with “yes and…”

Wow!! This simple phrase encouraged a wave of ideas from “yes and we could build a sand castle”, “yes and we could build it so high it reached into space”, “yes and we could eat our picnic on the moon”, “yes and we could discover a new specifies of plant life that ends world hunger” or “yes and we can ride in a Lamborghini with the top down.”

At the heart of “yes and …” lay the principles of listening first, starting from what was shared, then accepting and acknowledging the value of the idea offered and then moving it forward by sharing ourselves. We were all amazed how quickly our ideas flowed, how quickly we got to exciting places in our minds because the people around us were listening and affirming our ideas. When it worked well, we bonded quickly with our groups and we were sad to leave them as we moved into different groups. It feels so good to be looked at, heard and our ideas enjoyed.

Compare to the Impact of “Yes, but …”

“Yes but…” usually means “we can’t”

Loydie then asked us to try the exact same activity, but this time when ideas were shared around the group instead of saying “yes and…. ” we had to say “yes but…” Not to overuse the campfire metaphor but this equally succinct phrase was like pouring cold water on the fire, as ideas fizzled into soggy piles of embarrassment and stray sparks leapt up in defensiveness. Now all our energies were going into planning our negative responses, usually judgmental.  “Let’s go to the beach…” “yes but it looks like it might rain”, “yes but we could take umbrellas”, “yes but it’s windy too they won’t work”….You get the idea now …. Whereas before our conversations and ideas flowed in a safe circle of sharing and equal power, now we found ourselves feeling dismissed, having to force our ideas into the circle — and the quieter members of the group withdrew completely.

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How To Create Moral Distress: Compromise Values and Professional Ethics by Not Practicing Patient-Centred Care

Jeanine Doherty, Au.D., M.Phil., M.B.S, B.Soc.Sci.(Hons.), 

Hearing Excellence 

Christchurch, New Zealand

Trying to live up to a philosophical ideal of increasing the social, psychological, cultural and ethical sensitivity of our human encounters requires our personal, deliberate effort in an ongoing process. The action requires reflection, experience, introspection and the development of emotional quotient (EQ). It is not possible to complete a course about Patient-Centered Care (PCC) and think “Hey I can write on ‘Linked in’ now that I am a PCC clinician,” nor is it something that clinic owners should believe is ‘ticked off’ by sending their staff to a course.

While PCC is not yet fully conceptualised within audiology (although some essays on the topic are available), as Stewart (2001) wrote, we do know that PCC is not technology centred, not practitioner centred, not clinic centred and not disease centred. I believe PCC has to be lived in like it is your 2nd skin – our “thermals” as we would wear in a chilly southern New Zealand winter. PCC has to be infused, like ethics awareness, into all aspects of student training, as well as within the modus operandi of any practice arena.

Ethics, Legality, Morality

As we know, ethics, legality and morality are each different, though related, constructs. Something can be legal, yet immoral to an individual, as our values lead to our personal morals. Moral distress arises when clinicians are unable to act according to their moral judgement and their Profession’s Ethical Code (Rodney, 2017). This distress is located not only within individuals when their actions mismatch their values, but also from within the broader healthcare structures of the clinician’s workplace. The socio-political structures that can create moral/ethical distress have been studied mostly within nursing, but the relevance of the concept to audiology should not be ignored. Moral distress also emerges from situations that are against all the principles of PCC.

Harris and Griffin (2015) write that some organisational policies can lead to diminished care quality and cynicism with lack of teamwork and lower morale amongst clinical staff. In such a work-place, increased competition and mistrust develops between staff, while middle management level finds itself stuck between demands from higher-up levels (e.g. profit/cost outcomes) and the lack of teamwork and lower morale of the clinicians who are in moral distress. The physiological and psychological effects caused by the existence of moral distress can lead to burn-out, and then the staff member becomes ill, finds another better workplace, or just gives in, morally disengages, and carries on in a manner that is opposed to their values/morals (Musto, Rodney & Vanderheide, 2015). Lachman’s (2016) list of symptoms of burnout includes fatigue, general illness, headaches, insomnia, disillusionment, anger, negative self-concept and a loss of concern for others.

Profit vs Patient Outcomes

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From Person-Centered Moments to Person-Centered Culture

Laya Poost-Foroosh, PhD., MClSc.
AMS Phoenix Fellow & Research Associate
St. Michael’s Hospital, Toronto, Canada
Sound Advice Hearing Clinic, Toronto, Canada

Many organizations and healthcare professionals have person-centered aspirations and perceive their model of care to be person-centered. However, the complexities and constraints of actual practice may lead to person-centered moments, occurring in spite of health systems that actually impede person-centered care. As more organizations declare person-centered care as their preferred model of practice, challenges to effectively deploy person-centered care start to emerge. These challenges include both organizational challenges that are embedded in the organizational practice culture and individual challenges associated with lack of adequate training. These challenges could impact how person-centered care is perceived and enacted in different organizations. The following are two examples of encounters that have elements or degrees of person-centered care; however, they result in different outcomes and different care experience by patient.

A Person-Centered Moment

Emily is an 8-year old girl whose teacher suggested her hearing to be tested. Her parents took Emily to see an audiologist. The hearing assessment showed a permanent moderate hearing loss in both ears. When Emily’s parents heard the test results and learned that she needed hearing aids, they were shocked. They were also shocked to hear how much the instruments cost and how much commitment and follow-up it would take to manage Emily’s hearing needs. They felt the audiologist was kind and thorough with testing; she spent one full hour with them and explained the test results and hearing aid options and why it was important for Emily to use hearing aids. She also provided different hearing aid options. However, all of the options were beyond their budget, so they told the audiologist they needed to think about it. They left the clinic without any immediate treatment plans.

seeking “an emotional engagement with the patient that goes beyond sharing information” (Stewart et al., 2014, p. 10)

A Person-Centered Culture

This scenario has played out differently in another setting. In the second setting, Emily’s audiologist recommended hearing aids and Emily’s parents showed some hesitation to follow up with the recommendation. However, in this scenario the audiologist did not want them to leave without knowing what the source of their hesitation was. The audiologist did not know what the issue was; were the parents shocked with the news and needing more time to process it? Was the issue the stigma associated with wearing hearing aids? Or were there concerns with the cost of the intervention? So, she spent more time to get to know Emily and her family. She learned that there were some concerns with Emily’s hearing when she was younger but her parents did not take it seriously because Emily started talking, reading, and writing in line with typical developmental expectations.

They also thought the reason that Emily did not socialize in school like other kids her age was because she was shy. They did not attribute Emily’s poor academic performance to her hearing because they were never academically strong themselves. Emily’s dad works in a bakery and her mom has a part time job with minimum wage. Emily has three siblings ranging in age from 3 to 11.

After taking the time to get to know the family better, the audiologist realized the reason for Emily’s parents’ hesitation was a complex mix of guilt, regret, and frustration. While their most tangible concern was the cost associated with getting hearing aids, they also felt regret for not having noticed or acted sooner, and could not help but wonder if Emily had missed out on academic and social development over the years as a result of their own failings.

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Like the Emperor’s New Clothes … Invisible! Or at Least Tiny or Discreet?

Hearing Excellence Low Resolution-9533Jeanine Doherty, Au.D., M.Phil., M.B.S, B.Soc.Sci.(Hons.)

Hearing Excellence, Christchurch, New Zealand

In Hans Christian Andersen’s (1837) tale, an Emperor’s weavers said they made him some new clothes that would be visible to all but the stupid or incompetent, when in fact they had made no clothes at all. So he walked around naked, yet believed he was attractively well dressed and adequately demonstrating his position of achievement and power.

We must hope that hearing aid manufacturers are not looking at hearing aid visibility with the same deceptive reasoning, for in their push for invisibility as desirable, audiologists and aid wearers could be treated as if a bit stupid. Completely in-the-ear hearing aids were introduced by the manufacturers, in part, as a solution for stigma or the “hearing aid effect” (Johnson et al, 2005) and yet it can be argued that making the devices discreet actually contributes to self-stigma, a belief that hearing loss is a problem that should be hidden (Kelly & Wensveen 2014; Wallhagen, 2009).

Invisible hearing aids have also been shown to produce the highest mark-up factor for both manufacturer and audiologist (De Silva, Thakur & Xie, 2013). It could be suggested that our promotion of invisible aids is a social construction suiting our own benefit.  Or is invisibility also, or solely, an end-user concern? What is a patient’s desire for invisibility driven by? Vanity, stigma, gender, significant-other input? How do we counsel that size really does not matter?

Vanity and Stigma

Most human interactions involve an appreciable chance of being slightly embarrassed, or a slight chance of being deeply humiliated (Goffman, 1959). We spend a lot of energy managing the impressions we make in appearance and lifestyle to avoid embarrassment to the best we can (Scheff, 2013), Cooley (1922) wrote that our perception of ourselves has 3 principal elements:

  1. Our imagination of our appearance to others
  2. Our imagination of their judgement of our appearance
  3. Self-judgement about these imaginings, such as pride or mortification

The four traits of vanity common within sociology, psychology and philosophy literature are consistent with Cooley: (1) appearance concern, (2) concern about appearance perception, (3) achievement concern and (4) concern about achievement perception. Appearance concern and achievement concern are related to personal values, while the two perception components relate to self-concept (Wang & Waller, 2006).

Wang and Waller (ibid.) state that advertising messages use this knowledge to appeal to our need for physical beauty and achievement status. We see the symbolically positive appeal, for example in an expensive handbag or car advert, where customers are told their beauty and/or status will improve with ownership. In hearing aid adverts, we see a negative spin on product visibility; consumers, then, are led to prefer invisibility to protect their self-image. Continue reading

Taking Audiology Practice in Ghana to the Next Level

UnknownGeorgina Aidoo

Occupational Audiologist

Ghana, West Africa

I have always strived to search for the unique dynamics and realities in Audiology and ultimately discover what makes our patients incomplete without our services and our personal care. I have to face many encumbrances right from the onset of this journey, as being in Africa, and even in West Africa, my developing and third world country has made the trends very challenging, with diverse milestones which all bring learning experiences that are priceless. Pursuing a Doctor of Audiology degree will give me a wide range of opportunities and experiences to develop knowledge, skills and attitudes which will enable me to grow the field and advocate for change.


Audiology practice and management of hearing loss and balancing disorders usually does not command much attention in third world countries, even though various studies and estimates indicate that two-thirds of the world’s populations of hearing impaired people live in the developing countries. In many African countries, the general awareness of Audiology and hearing loss management is low, and lack of resources, ignorance, illiteracy, cultural diversity and national priorities among many other factors relating to technology enhancement and sense of focus has caused a lack of strong advocacy in this area. The Africa continent has a predominantly young population and many are at risk of getting diseases causing hearing loss (McPherson & Holboro, 1985). Overall, it is estimated that in the countries below Sahara, more than 1.2 million children aged between 5 and 14 years suffer from moderate to severe hearing loss in both ears. General prevalence studies show higher rates of severe to profound hearing loss in this part of Africa than in other developing countries.

Hearing problems are a severe handicap, particularly in developing countries where the ability to take part in normal conversations is vital for economic and social survival. However, many are illiterate as well as hearing impaired, and thus unable to communicate by writing and reading. It is difficult to get an exact overview of the prevalence and causes of hearing loss in Africa. Several studies have been conducted but they use different methods and not all are up to date. However, they do serve as indicators and together they provide a general picture of the situation.

Unknown-1The case of Ghana is no different. In spite of the fact that hearing and balancing disorders are common among persons in communities in Ghana, very few studies have been carried out. The pace of development is very slow despite how critical the need is.

It took an extraordinary effort for me to enroll in an Au.D program after saving for almost a decade all in relation with finding the true purpose my commitment to the field, and I continue to explore and advocate in quest of gaining deep knowledge to help spread Audiology, especially in Ghana and West Africa where silence has swallowed sufferers’ desire to seek help. Continue reading