Consult to Psychology: Why the Hesitation?

Screen Shot 2016-05-09 at 10.52.07 AMMichael Squires, Class of 2014

The University of Akron/NOAC

In a clinical rotation I came across a patient who, I was told, was having a very difficult time with her hearing aids. I learned that she had been making almost bi-weekly visits to our clinic and had been through multiple trail periods with hearing aids from different manufacturers. The resident audiologists had gone above and beyond to make sure that this particular patient had as many opportunities as possible to realize her potential for hearing with hearing aids. The appointment that I had with her was no different than ones previous; her hearing aids were not working for her. She came in and sat down with a very stern look on her face. She began removing the sets of hearing aids from her purse and laying them on the table. She would mention that one was more comfortable than another but another pair seemed to be louder, and so on. When all sets of hearing aids were in front of her she began to cry. She looked at the audiologist and myself and said, “Am I going deaf?” She talked about how tired she has been and that she feels like she always has to try so hard to listen to people. My preceptor stepped out of the room to clean and check each set of hearing aids. I stayed behind with the patient and thought I would try to talk to her. I asked her, “Forget about the hearing aids for a moment. How have things been going otherwise?” I mentioned to her that she seemed a bit tense and asked if everything was alright with her outside of our clinic. She began to cry again as she explained that her husband had just been diagnosed with Alzheimer’s disease a few months ago. I was the first person to whom she had told this information. We talked briefly about how she should focus on feeling better and that her hearing aids would help her much more when she could be confident in them, and herself.

depressedelderWhat went wrong? It is obvious that this appointment had come to a point where an audiologist was no longer able to help. Unfortunately, this patient was never referred to anyone who could. There are many instances when a patient in an audiological setting should be referred to another professional for further examination. However, there is one such instance that is consistently ignored; depression. It seems intuitive that any major life changes, including learning of one’s hearing loss, has the potential to cause symptoms of depression. Audiologists are many times the first to notice depression and stress caused or exacerbated by a hearing loss. Yet, when these signs are noticed, whether they are caused by news of a hearing loss or some other event, what is the next step for an audiologist? According to the American Academy of Audiology’s Code of Ethics:

Rule 2a: Members shall provide only those professional services for which they are qualified by education and experience.

Rule 2b: Individuals shall use available resources, including referrals to other specialists…

If this is the case, then why are more referrals not being made to psychologists for patients who may benefit from psychological counseling? In my opinion, it comes down to training and experience.

In an article written English and Weist (2005) examining counseling in Doctor of Audiology programs, about 85% of the, then, 56 university doctoral programs included counseling, in some capacity, in their curriculum. Although, according to the American Speech-Language and Hearing Association’s list of CAA-accredited audiology programs, there are now 74 institutions offering a doctorate in audiology. Though there is no recent data showing the current number of counseling offered in Audiology doctoral programs, the American Academy of Audiology proposed new Educational and Community-Based Programs Objectives for Doctor of Audiology granting colleges, schools, and programs or audiology in 2012 (Keetay, 2012). One of these new objectives includes increasing the inclusion of counseling for health promotion and disease prevention in Doctor of Audiology curricula. The rationale states:

“Audiologists are often the first healthcare professional to identify hearing loss and/or balance disorders and to recognize the opportunity for promotion of healthy hearing and balance practices and prevention of hearing and balance disorders. Developing skills in counseling is essential to the provision of hearing and balance healthcare but can be overlooked in current AuD curricula…”

The fact still remains that professional audiologists tend to shy away from making psychological referrals. Could this be a residual effect of Master’s level training, or are counseling courses not incorporating the importance of not only identifying and empathizing with patient symptoms of depression and stress, but also making the proper referral to get patient help?

The fact that audiologists are “groomed” to be clinical counselors puts us in a position of responsibility to our patients to be able to effectively counsel them through problems regarding hearing healthcare. In their book “On Becoming a Counselor,” Eugene Kennedy and Sara Charles, M.D., state that the interview, or case history, is the chief tool for making an accurate diagnosis of depression. When an individual is identified as having the vast range of symptoms associated with depression a referral should be made for psychiatric consultation. They go on to mention that depression is often recurrent and if symptoms can be addressed when they are still mild, then the disorder can be treated before severe symptoms grossly affect a person’s life.

It is a duty of all audiologists to provide the best hearing healthcare possible for our patients. It is a duty of all healthcare professionals, including audiologists, to ensure that patients are given every possible chance to improve their overall quality of life. Upon entering a Doctor of Audiology program, many students recite the “Audiology Oath” written by Steiger, Saccone, and Freeman in 2002. This oath represents the idea that we, as audiologists, are to adhere to

professional standards that includes giving patients every opportunity to improve the quality of their lives. I would like to leave you with this oath as well as a thought. What are we able to do as students, professionals, and a field, to make certain that we are prepared to make decisions regarding patient well-being, even if those decisions require us to reach out to other professionals beyond the audiological scope of practice?

The Audiology Oath

As a Doctor of Audiology, I pledge to practice the art and science of my profession to the best of my ability and to be ethical in conduct. I will respect and honor my teachers, and also those who forged the path I freely follow. According to their example, I will continue to expand my knowledge and improve my skills.

I will collaborate with my fellow audiologists and other professionals for the benefit of our patients.

I will, to the best of my ability and judgment, evaluate, manage, and treat my patients.

I will willingly do no harm, but rather always strive to provide care according to the standards of the profession.

I will act to the benefit of those needing care, striving to see that non go untreated.

I will practice when competent to do so, and refer all others to practitioners capable of providing care in keeping with this oath.

I will aspire to personal and professional conduct free from corruption.
I will keep in confidence all information made known to me about my patients.

As a Doctor of Audiology, I agree to be held accountable for any violation of this oath and the ethics of the profession. While I keep this Oath inviolate, may it be granted to me to enjoy life and the practice of the art and science of audiology, respected by all persons, in all times.

English, K., & Weist, D. (2005). Growth of AuD programs found to increase training in

counseling. Hearing Journal. 58 (4), 54-58.

Keetay, V. (2012). Draft of responses to proposed healthy people 2020 objectives related to educational and community-based programs (ECBP) objectives. Retrieved Feb. 20, 2013 from y%20Responses.pdf

Kennedy, E., & Charles, S. (2001). On becoming a counselor: A basic guide for nonprofessional counselors and other helpers. The Crossroads Publishing Company; New York, NY.

Steiger, J.R., Saccone, P.A., & Freeman, B.A. (2002). A proposed doctoral oath for audiologists. Audiology Today. 14(5), 12-24.