Peter Huchinson, Class of 2016

The University of South Florida

When I hear the word tinnitus, my eyes widen and endorphins race to my brain. Ringing in the ears—one of the most common issues associated with any type of hearing loss— is the topic of research for my doctoral project. When I hear the words ringing, buzzing, whooshing, or pulsing my hyper focus kicks in and I say to myself “this is my thing”. I have read article after article discussing statistics about who tinnitus affects, what might be the cause of this debilitating ringing, how it is measured in humans and animals, and the general lack of understanding in this subject. So when I found myself face to face with a patient who was so deeply disturbed by her tinnitus, that she was willing to request a nerve section, I realized that I did not know that much at all. What I realized that I lacked, was personal connection, empathy, and the counseling ability that I knew was going to be crucial to this case. Additionally, I realized how much I did not know regarding tinnitus and management in a clinical population. I learned two important lessons with this patient; the first being serving the patient and not just the condition. The second being that sometimes there are things that are simply out of my control and my scope of knowledge.

Providing patient-centered care is something that sounds appealing and makes logical sense, but often I find difficult to practice. When I see a moderate, sloping, high frequency hearing loss, I think about the hearing aid I will recommend at the end of the appointment. When a patient complains of dizziness upon getting out of bed, I consider BPPV. These initial thoughts are natural, and there is nothing wrong to start thinking about the issue at hand and the recommendation that I will make. The problem is that I often find myself stopping there. I forget to consider the needs and desires of that particular patient. I forget to consider the patient’s activity limitations, participation restrictions, and perceived or experienced stigma. I forget to consider the emotional journey that the patient has been on for much longer than the last 30 minutes that they have been in my sound booth.

I realized that I needed to practice better patient-centered care the day I first met the patient with the debilitating tinnitus. Tears poured from her eyes the entire appointment. I tried to offer knowledge, suggestions, and recommendations, but the tears would not stop. Upon reflecting on this appointment, I realized that I tried to provide informational counseling, when what she needed was emotional counseling. I tried to suggest technology and rehabilitation programs without developing a common ground with the patient.

“At the end of the day, patients are autonomous beings, and they decide whether to follow our recommendations. Those decisions depend heavily on the partnerships we develop via counseling. And this approach is an evidence-based practice. Finding common ground has been shown to be a key to a successful clinical outcome. (Brown, Weston, & Stewart, 2003)” (Clark & English, 2014)

It did not matter what I suggested at the moment. At the moment, my patient wanted support counseling. She wanted to know that we haven’t reached the end of the road. She wanted to know that the people she was looking to for help understood what she was going through, and that we weren’t going to just give up. She wanted to start a relationship of complete care and trust, instead of a regiment.

A different issue that I encountered was including and counseling this patient’s husband. Counseling loved ones is something that my (lack of) experience has not afforded me yet. The husband, while being caring and defensive for his wife, tried time and time again to get information out of me that I was not confident to or capable of answering. “What is causing this? What is the likelihood of it getting better? Why are you passing us off to the physician? Why won’t you give us answers?” This reminded me that counseling the communication partners, as well as the patient, is an equally important activity. I had not appropriately devoted time to helping the husband understand my role in the process. He heard my suggestions for technology and other options, but he had not heard me validate his or his wife’s personal journeys.

The other lesson that I learned was that sometimes there will be cases that are out of my ability to handle or out of my scope of knowledge. When the husband pressured me for medical advice I had to be careful regarding what information I could offer. It was a situation that I had never been presented with before, and it made me realize that I need to be prepared to refer a patient when their issues are beyond my ability to help. I think that much of this tension could have been avoided by developing a more trusting relationship through better patient centered care.

Regardless of what happened during the appointment, I am thankful for the learning opportunity that this patient and her husband offered me, as a growing clinician. I learned the importance of listening to the patient’s journey and experience, and I learned that I need to know when I am no longer capable of providing adequate care and when to refer. I hope that every student and young clinician has an experience where they feel uncomfortable, unprepared, and less than qualified. These are the experiences which transform us from mere button-pushers and technology experts into the exceptional clinicians that our patients deserve.

Reference

Clark, J. G., & English, K. M. (2014). Counseling-infused audiologic care. Upper Saddle River, NJ: Pearson Education, Inc.