Georgina 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.

Challenges

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.

The 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 →

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

Christchurch, New Zealand

Two models of disability, the medical model and the social model, currently represent the opposing ends of the continuum of what defines disability (Berger & Lorenz, 2015).

The medical model sees disability as an individual’s bodily event and so concentrates on aetiology, diagnosis, prevention, and the treatment of the physical, sensory and/or cognitive impairments. Past scholars of disability often took this negative deviance medical approach; bioethicists and eugenicists have spent most of their energy on justifying the morality of preventing or even eliminating people with disabilities by the use of prenatal testing and abortion, or by withdrawal of care (Parens, 2001).

The social model of disability, at the other end of the spectrum, moves away from the impairment itself to consider the socially imposed barriers for the disabled, such as inaccessibility and unequal rights. It also considers the prejudicial attitude (i.e., stigma) that is constructed around any disability and results in sub-ordinate social status and a devalued life (Berger & Lorenz, 2015; Bickenbach et al., 2014). The social model evolved from the disability rights movements in the UK and USA in the 1960’s and 70’s, and carries the notion that a society should embrace all members and address socially imposed barriers.

Regardless of which model is used, stigma seems to be a universally understood experience. Stigma occurs as a process by which people stereotype, label, judge, and then discriminate against others who are different (While & Clark, 2010) and so they spoil any sense of normal identity for the other person.

Goffman (1963) outlined three causes of social stigma:

• overt, external deformations;
• personal trait deviations such as mental disorder or addiction;
• tribal/cultural deviations from a norm in terms of physical appearance like skin colour, dress style, religion, or behaviour.

Goffman added that stigma is the phenomenon whereby an individual with an attribute is deeply discredited by their society and therefore rejected as a result of the attribute.

Understanding Our Reactions

We are drawn to the unanticipated and the inexplicable in an effort to make sense of the experience, a universal part of our cognitive architecture that natural selection has bequeathed us (Garland-Thomson, 2006). We also experience aversion to others who do not fit into Goffman’s (1971) concept of normalcy. This aversion is a primitive response, demonstrated at the minimum with glancing or staring as a sifting mechanism to define safe or “otherness” status among those around us. For example:

I used to travel with a fellow Board member who had one of the first cochlear implants in New Zealand, which is very obvious as he has no hair to hide it. Walking through airports with him was fascinating as I watched others observe, try to decide what it was, understand/comment to their fellows about it and then finally return to their own activities. Before it could be socialised out of them, children had no concern about direct enquiry of David – “What’s that thing on your head, mister?” Being stared at by an adult can mean a lack of understanding, or at worst a social disregard, but children have the “curiosity excuse,” and he loved to take the pieces off his head and explain them to the fascinated child, while the parent often squirmed in embarrassment.

Although on the surface innocuous, staring is actually a strong reaction towards another person and excites the brainstem’s primitive level neural activity (Garland-Thomson, 2006), which is part of our fight or flight system. Stigmatic judgements are made with such fast glances and decisions. The inclination to stigmatize others has long been documented; for instance, in Roman times thieves and slaves were visibly tattoed to identify them as non-equal human beings.

Stigmatising another person can not only make the stigmatised person suffer negative consequences but can, conversely and perversely, enhance positive feelings of membership of the stigmatising tribe by the rise in self-esteem and sense of power that “doing others down” can bring (Falk, 2001). This tribal group-think against the stigmatised person has been used to justify terrible attacks seen worldwide, in which a stigmatised person – often intellectually disabled —  holds little value and so can be beaten or killed as they are considered sub-human.

The Impact of Labels

 When a label or stigma is applied to a person/group, there is a surrounding negativity or taint which engenders feelings of lesser worth in those subjected to the labelling. Being the subject of stigma can adversely affect the behaviour of the stigmatised by changing their emotions and beliefs (Major, 2005). The stigmatised person can become isolated, and then depression and lack of self-esteem can follow (George, 2015). Internalised stigma also leads to decreased hope and self-efficacy, and a poorer general quality of life (Nabors et al., 2014). This impact is not unique to hearing loss – just think about our seniors who have age labels, hearing loss, vision loss, cognition loss and physical disability labels to carry. Continue reading →

Jeanine 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- centered 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 patient 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, especially the service sector, literature and from this customer loyalty has been found to have 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.

This Cater and Cater (2009) 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 1^st emotional commitment category and show the importance of meeting the emotional need of patients to allow a successful and loyal patient/audiologist relationship. Continue reading →

Carolyn Edwards, M.Cl.Sc., M.B.A.

Auditory Management Services

Toronto, Ontario Canada

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.

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 themselves 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 you are observing resistance in your 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 consistent use of amplification or assistive listening devices. The underlying fears will often emerge out of those discussions. Continue reading →

Kris English, PhD

The University of Akron/NOAC

Anna Hollingdale, MSc, is an Audiologist in West Sussex, England. She recently touched base after an audiologic counseling course at the Ear Foundation in Nottingham with the following patient encounter:

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

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 relay 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 example, 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. Rathr, 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.

Kris English, PhD

The University of Akron/NOAC

Matt White is an audiologist in the UK National Health System, and works in Doncaster in South Yorkshire, England. He recently participated in a counseling course at the Ear Foundation in Nottingham, wherein he described the following patient encounter:

Matt White, BSc (Hons) Aud

My patient was a man in his late 70′s who has had a rubbish time over recent years. Multiple organs are in failure, one kidney has also been removed for cancer treatment and he’s had other cancer issues too as well as issues like pancreatitis. His mobility is greatly compromised and he carries a “do not resuscitate” order with him as his physicians have told him that the efforts required to resuscitate him are likely to kill him, but in a much more horrible way than just going. He told me that his family is already grieving him in advance and he just can’t wait to be with his wife again, who passed away a few years ago.

I wasn’t sure at first what type of person he was going to be, some elderly people that I see in this condition have given up and just want to die. Others, like this gent are very positive and just want to get what they can out of the time they have left. This chap, for example, was off to get his cataracts done under local anaesthetic so he can see better. He talked about seeing the faces of his great-grandchildren more clearly. He talked about all this while explaining that he just wanted to hear as well as he could, which I was able to improve for him in the appt. Explaining all the non-hearing related parts of his life seemed to help him.

All I did was listen.

“All I Did” … But It’s Actually a Lot!

Audiologists almost inevitably downplay their supportive role as listeners, not from false modesty but because little has been said about the skills involved. These skills come easily to a few, but can be a genuine challenge to many others. Happily, they can be learned. As with any skill, it helps to break it down into steps. Consider the following steps that might occur as an audiologist meets a patient:

• As we prepare our own work, we keep alert for expressions of patient troubles, sometimes only indicated nonverbally or “between the lines.”
• When we perceive our patient is a “troubled sender” (Pollack et al., 2007), we consciously decide to “stop all the clocks” (W.H.Auden, 1937), re-prioritize, and put our agenda to the side.
• In doing so, we put the patient’s needs before our own tasks. Needless to say, easier said than done! It takes an act of selflessness to suspend our natural self-absorption (Nichols, 1995).
• We create an emotionally safe place and time for the patient to express those concerns and offer our support.
• We sustain undivided attention and focus. We do not day dream and wait it out.
• We consider whether follow up is warranted (referrals, e.g.), or whether the patient just needed to make a human connection.
• We willingly choose to open ourselves to another’s distress and share pain for a brief time.
• And then, when it seems appropriate, we find a way to transition the conversation back to the appointment, and manipulate the remaining time available to complete the “business” portion of the appointment and keep everyone on schedule.

Mastering each of these steps requires training, practice and feedback.

Learning to Mask is Hard. Learning to Listen? Much Harder!

Brownell (1996) once posed the question, Does listening require conscious effort? He answered his own question with a resounding YES.

“Although individuals can hear when they are passive, effective listening is active and mindful” (p. 55).

Someday we will find a more meaningful way to say, “All I did was listen.”   When our listening is exactly what the patient needed, and when it was a conscious decision on our part, and when the patient leaves feeling better than when he arrived, “just listening” isn’t “just” anything but in fact becomes the epitome of patient-centered care. Listening is an advanced clinical skill, always worth developing and considered by many to be a life-long learning process. When students modestly describe a successful “listening moment” as accidental, let’s be sure to articulate the sophisticated skills they employed, and the value of these skills.

References

Brownell, J. (1996). Listening: Attitudes, principles and skills. Needham Heights, MA: Allyn & Bacon.

Nichols, M. (1995). The lost art of listening. NY: Guildford Press.

Pollak, K.I., Arnold, R.M., Jeffreys, A.S., Alexander, S.C., Olsen, M.K., Abernethy, S.P., et. al. (2007). Oncologist communication about emotion during visits with patients with advanced cancer. Journal of Clinical Oncology, 25(36), 5748-5752.

Jane Seaton

Seaton Consultants, Athens GA

A few years into my career as an educational audiologist, I was shocked to hear a mother whose child I had seen at 10 months of age tell a parent group how devastated she was to hear the audiologist say that her daughter would never talk. Assuming (incorrectly as it turned out) I was that audiologist, I was appalled to think I would have said anything that could possibly be interpreted this way. Reflecting back on my reaction then, I now realize how often our comments can be taken out of context or misinterpreted in stressful situations such as when parents first learn of their child’s hearing loss.

What Was Said / What Was Heard

Margolis (2004) reported approximately half of new information is forgotten immediately, and half of unfamiliar information is remembered incorrectly. Add in the increasing cultural diversity and non-native English speakers being seeing in all audiologic practice settings, and we have the perfect recipe for miscommunication.

It has been well documented that most children with congenital hearing loss are born to parents with typical hearing, and the vast majority of these parents have little or no prior exposure to or experience with deafness. To say that identification of hearing loss through the universal newborn hearing screening process is often unexpected, shocking and stressful for new parents is a huge understatement. In our eagerness to help families access state-of-the-art technology and services as quickly as possible, we may unintentionally compound parent confusion and stress by providing lots of new information in a short period of time at the end of a diagnostic appointment. Too frequently little time is left for questions or feedback concerning what parents have heard from the audiologist.

Reducing Misunderstandings

Parents report they need for us to take time to listen to them and encourage them to ask questions (Luterman and Kurtzer-White, 1999). However, when the diagnosis of hearing loss is unexpected, some parents may not feel emotionally ready or knowledgeable enough to ask questions until they’ve had time to process what has been heard. It can be helpful to encourage parents and caregivers to let you know how they are feeling prior to, during and after their initial diagnostic appointment. Asking a parent what they will tell a spouse or other family member about our results and recommendations is a strategy that can help us know what has been heard and what information needs repeating or re-explaining in nontechnical terms. Use of an interpreter for non-native English speakers can be helpful, but this also adds another link in the communication process where misunderstandings can occur (Alberg, 2003).

Helping parents clarify their “next step” (e.g. scheduling another appointment, talking with pediatrician, contacting their early intervention service coordinator) facilitates parent empowerment and should be automatic each time a family is seen. Providing names, job descriptions and reasons why other professionals in the EHDI and/or education systems may be contacting parents can lessen some of the confusion felt by families when starting their journey with hearing loss. I’ve often found that parents appreciate a brief phone call 2-3 days after we’ve met to find out how they’re doing and answer any questions, even when we have a follow-up appointment scheduled later.

Audiologists as Reflective Practitioners

I admit I was relieved to find out that I wasn’t the audiologist being referred to in the situation described above, but I often wonder how many times misunderstandings have occurred without my realizing it. Donald Schön described the need for reflective practice more than 30 years ago, and it is probably more valuable than ever today (Scaife, 2010). Now that a wealth of information is available instantly from a variety of sources, the value of taking time to listen to ourselves as well as our clients and their caregivers is immeasurable.

References

Alberg, J. (2003). BEGINNINGS serves families with diverse needs. Volta Voices, 1, 15-17.

Luterman, D. & Kurtzer-White, E. (1999). Identifying hearing loss: Parents’ needs. American Journal of Audiology, 8, 13-18.

Margolis, R. (2004). Audiology information counseling: What do patients remember? Audiology Today, 16, 14-15.

Scaife, J. (2010). Supervising the reflective practitioner: An essential guide to theory and practice. London: Routledge.

Simon Howe, Clinical Scientist (Audiology), BSc (Hons), MSc

Audiology Department
Manchester Royal Infirmary

Rehabilitate (v): To restore to good health or useful life

As an Audiologist working for the National Health Service in the UK, it is my job to rehabilitate both patients with hearing loss and those with vestibular deficits. Whilst full recovery from vestibular deficits is likely, up to 2/3^rds can become chronic, disabling conditions (Yardley & Luxon, 1994). As General Practitioners (GPs) tend only to refer those cases of dizziness persisting for months for a specialist opinion, the majority of patients seen in our Vestibular Rehabilitation Clinic at the Manchester Royal Infirmary have developed chronic dizziness, present for many months or years.

Many patients experiencing an acquired loss of vestibular function will recover fully without the need for any therapeutic intervention. So what causes some patients’ vestibular deficit to become a chronic balance problem? Firstly, the long-term prescription of vestibular sedatives by GPs is commonplace, and inhibits the natural process of recovery, and secondly, the natural behaviour for motion-provoked or situation-specific dizziness is to avoid the movements or environments which elicit the symptoms, again hampering recovery. Often these avoidance strategies can result in almost phobic thoughts related to these triggers of the dizziness.

Exercise-based vestibular rehabilitation is the primary therapeutic approach for such patients, focusing on promoting central compensation for the acquired vestibular deficit. The application and benefits of vestibular rehabilitation are well documented (Hillier & McDonnell, 2011). However the more I work with patients with chronic balance problems, the more I find myself increasingly perplexed by their unpredictable prognosis. Three things strike me as unexplained:

1. Some patients struggle to make any meaningful progress with vestibular rehabilitation, despite apparently adhering to their exercise programme.
2. The time taken for patients to recover seems to be completely independent of the degree of vestibular deficit.
3. Attendance at rehabilitation appointments and adherence to exercise programmes is inconsistent, even if the patient’s difficulties would appear to act as sufficient motivation.

Reassuringly, it appears I am not alone in seeing this variability (Herdman et al, 2012), therefore there are clearly other factors at play which are influencing recovery. But there is a piece missing from the puzzle; something still unaccounted for in all the research thus far.

The Missing Piece

Chronic balance disorders can be functionally limiting conditions because of our reliance on balance to fulfil the most basic of personal, household, and occupational responsibilities. Difficulties in performing these tasks can increase dependence on family and friends, and can place strain on relationships. Where such a support network is not readily available, the resulting social isolation can have profound emotional effects. Reduced activity levels can also lead to an increased incidence of co-morbid conditions which can in turn exacerbate the psychological impact. Some chronic balance disorders can also be unpredictable in the frequency and severity of their presentation and this can further increase emotional stress.

So here is the paradox, the missing piece: this inter-relationship between dizziness and emotion is well recognised and documented (Yardley, 1994), and yet there is a very poor correlation between patient and clinician ratings of dizziness severity (Honrubia et al, 1996).

In many ways this poor correlation is not unlike the mismatch we might see in Aural Rehabilitation between the hearing difficulties the clinician might predict from a patient’s audiogram and their self-perceived disability. In fact hearing loss and loss of vestibular function are not dissimilar. Difficulties are often specific to certain activities or situations and can therefore cause a change in self-concept; the functional capabilities of the patient have changed and this can have a profound effect on their feeling of self-worth.

Understanding Continue reading →

Eileen Rall, AuD

Children’s Hospital of Philadelphia

So why am I sharing with you some of the mistakes I’ve made along the way? Usually when I am sharing “life lessons” with my daughters or my students, I am trying to give them the opportunity to learn from my stumbles so they don’t have to experience them on their own. One of the most important skills we can have as professionals (and as human beings) is the ability to recognize when we can do something better or even more importantly, when we do something wrong. Maya Angelou’s quote, “When you know better, you do better” is something I try to live by every day.  This philosophy is one of the reasons why I love where I work. At CHOP, we are constantly re-evaluating our clinical practice to identify areas where we can be better – what a humbling and yet exciting place to be. To do that well, you have to practice reflectively (Schön, 1983; Thompson, 2008) and be ready to say that the things we do every day can be better.

One of the areas that I feel I have grown the most in is my avoidance of making assumptions. When you first start out in this field, you are (as I was) unconsciously incompetent – you don’t know what you don’t know. I remember trying to soothe a parent’s anxiety when scheduling her child’s surgical procedure by telling her, “Don’t worry, it is a really simple procedure, they’ve done it thousands of times.”  I assumed that if she understood the routine nature of the surgery, her anxiety would vanish.  It did not; instead, she very sternly said to me “Don’t ever tell a parent that their child’s surgery is simple and ‘nothing to worry about.’ You clearly don’t know what it is like to be a parent.”  She was right, I didn’t know. I assumed that I could put myself in her place and comfort her; instead, I ended up offending her. Flash forward 8 years to me anxiously sitting outside the OR when my youngest was having this same “simple” procedure – it was the longest 14 minutes of my life and I would have bitten off anyone’s head who dared to tell how I should feel.

Assumption: All Swans Are White

Sometimes we assume we know how someone will feel about information they receive. I was leading a lab in amplification.  We brought in a friend of mine who had clearly been suffering with hearing loss for a few years.  She was even evaluated by an audiologist the year before and hearing aids were recommended but not fit.  The students were responsible for doing a complete evaluation and then develop a treatment plan that would include amplification.  She did indeed have a hearing loss so the students launched into what hearing aid that they were going to get her instead of reviewing her test results. They assumed that, because she reported that she had been previously diagnosed with hearing loss and hearing aids were recommended, she understood her diagnosis. She did not. I watched her eyes glaze over as the students enthusiastically described the advanced-feature hearing aid they were going to order.

I interrupted their plan and asked the patient – do you have any questions? – and she responded, “Are they saying that I have a hearing loss?”  As smart and as previously well-counseled as she was, she thought that if she took enough allergy medicine before the test, her hearing loss would have gone away.  We assumed she knew – we didn’t realize what her truth was. Simply put, she was not ready for this conversation.

We Can’t Assume Readiness

Since “readiness” is a process involving stages of awareness, acceptance and adjustment, it is quite possible our patient is not yet ready, but “in process,” or as the Ida Institute describes it, in the midst of a patient journey.  We are not mind-readers; we need to ask “readiness” questions with the 0-10 scale or other tools to meet patients where they are – not where we think they are. Once the students developed the requisite common ground (Brown et al., 2003), my friend felt comfortable with their plan and is now a champion for using amplification, sharing her positive experience with anyone who will listen. That would have never happened if we continued with our assumptions and didn’t address her questions.

I recently had to share some difficult information AND generate ideas for a new opportunity at a team meeting. My assumption, and how I ended up making an ass out of me (not U), was that everyone at the meeting came with the same information. BIG MISTAKE.  The result of the meeting was elevated negative emotions, hurt feelings, significant anger with me and hardly any enthusiasm for the opportunity I hoped to move forward on. As a team leader, I needed to take a step back and support each team member to get them to the same place before we could move forward. Now, instead of working on the opportunity, I am doing damage control.

So what am I hoping you take away from this? Try to not make assumptions – instead take the time and acquire the skills to learn the truth. The definition of assume is “to suppose to be the case, without proof.”  Try to remember to seek out the “proof” and, if you are successful, in the end you will stumble a whole lot less.

References:

Brown, J. Weston, W., & Stewart, M. (2003). The third component [to patient-centered care}: Finding common ground.  In M. Stewart et al. (Eds.), Patient-centered medicine: Transforming the clinical method (2nd ed.), pp. 83-99.  Abingdon, UK: Radcliffe Medical Press.

Ida Institute. (n.d.)

Schön, D. (1983). The reflective practitioner: How professionals think in action. NY: Basic Books.

Thompson, S. (2008). The critically reflective practitioner. NY: Palgrave Macmillan.

Kerri Hudson, AuD

Audiology Solutions, Inc.

I work as a contract audiologist for a small private mobile practice. We provide bedside hearing services to patients who live in nursing homes or at home with assistive living services. I recently had a few interesting visits with a lovely lady and her son.

My patient is in her 90’s and resides in an assistive living facility. Meals are provided and she receives limited help with daily living needs. Her hearing loss is treated with BTE hearing aids bilaterally. Her son reports unspecified dementia with no other significant health concerns. He is a friendly, middle-aged man with a wife and grown children.

Interactions with the patient and her son were tense from the start. As I entered the room, they were arguing about the temperature of the room. The son was patient and accommodating at first. I attempted to start the case history. However, the patient refused to look at me, and would instead look to her son to answer my questions. She became quickly frustrated, stating that she could not hear a word I was saying. I attempted to redirect her attention to me. The son began to intervene by asking me if he could give his mother the directions himself. Before I could stop him, he was soon screaming at his mom. Things quickly began going downhill.

I began to give the patient instructions for the evaluation. Again she became very upset. Hoping to use some of my training in counseling, I tried my skills. I expressed to her that I felt her frustration so maybe we could talk about the situation.  No sooner had I begun, the son informed me that she was frustrated and suggested that he take over in giving the instructions. I convinced him to let me continue and was finally able to start the test. A few thresholds were obtained before the patient suggested a break due to discomfort and fatigue. The son began to sigh in frustration and appeared to be in a hurry to get everything completed. Continue reading →