The reluctant patient does not have the language of healing. If they did they would walk in and say, “I need hearing aids.” Addressing this patient’s emotional needs falls squarely on the shoulders of the hearing care professional, and the task must be accomplished before any remediation of the hearing loss is possible. This article details five progressive steps that can be used to convert the reluctant hearing-impaired visitor into a patient.

Imagine a man walks into your office and says he wants to discuss hearing aids with you. You can tell from his body language and vocal inflections that he is fearful and apprehensive. He looks angry. He sounds agitated. Indeed, it has taken many years of consternation to gain the courage for him to even get into his car and drive to your office. It is monumental that this man is now speaking with you face to face. Indeed, it is a monumental moment for him.

This person proceeds to tell you he has suffered with hearing loss for more than 30 years. He knows he needs hearing aids, but he says they cost too much. He also has says he has friends and relatives who have spent thousands of dollars on devices that sit in drawers. He doesn’t want to waste his money. He tells you he’s been to every office in the area shopping around. He wants to know what makes your product different. He refuses to fill out any preliminary paperwork. He just wants a few minutes of your time.

You assume from his mannerisms that he may be beyond help. He’s another angry, agitated consumer who is not motivated to get the necessary help he needs. What can we do to reverse this trend?

Innovative breakthroughs in hearing technology simply will not address the underlying emotional issues that have plagued this gentleman for the better part of a half-century. Addressing this patient’s emotional needs falls squarely on the shoulders of the hearing care professional. Indeed, this task must be accomplished before any remediation of the hearing loss can occur.

An internal commitment on the part of the professional is required to do this. An internal commitment means that your mission and purpose as a helping professional are aligned with the needs of each patient that walks in your door looking for help.

To better understand internal commitment, it helps to contrast it with external commitment. Both are essential to your success. External commitments require an adherence to ideas, concepts, and procedures that are in the domain of the company. An external commitment is a contractual agreement, a fiduciary pact you have made between yourself and your employer in order to ensure that your office is productive and attempting to make a profit.1 This is critical for the long-term success of both you and your office. Contrast this with an internal commitment. This is an internal agreement with yourself to venture into the unknown when the reluctant patient is set in place by the professional who is more interested in results than reasons. How a professional gets to this position of risking may be the determining factor in your success in the hearing care field.

In the authors’ opinion, this is a profound issue that needs to be pondered. This article will focus on five concepts designed to address the emotional needs of your patients.

1. Shifting to a Learning Stance
In traversing this country putting on seminars for hearing care professionals one truth jumps out: Hearing care professionals are far more comfortable talking than listening. During these seminars, we ask the audience to list the things that they want to accomplish during the initial stages of an appointment. Without exception, hearing care professionals want to tell, educate, and advise the patient. This thought process has been ingrained in us from the beginning stages of our professional education. We are the professionals, and this implies that we have answers—based on science and physiology—to the patients’ questions.

We are trained to deliver this technical/clinical message, and we are most comfortable when delivering this technical message. However, we have to ask ourselves, is our message being heard? Unfortunately, all too often, this clinical mindset creates a passive attitude that leads to a disconnected patient. Have you noticed that when you are able to tell someone your story, and that person listens without judgment, you feel that you have been heard on a deeper level? These circumstances are the bonds of intimacy and they are the missing link in our field.

As a helping professional, the first step is addressing the emotional needs of the patient. This requires a shift from being a message deliverer to one of learning all you can about the emotional needs of the individual in front of you. Indeed, our message of improved communication will never be embraced until the patients emotional needs have been addressed. Addressing the emotional needs of any patient requires that we shift to a Learning Stance.

In order for this patient to open up to you, it’s critical for you to be yourself. Being yourself means to be authentic. Authenticity requires a self-effacing, unpretentious, down-to-earth attitude. This takes courage and curiosity to get at the heart of what brought the patient into your clinic after many years of anger, denial, and frustration. It is monumental that he/she is even in your office looking for answers to communication problems.

The case history is the ideal time to transition into the Learning Stance. Shifting from certainty to curiosity, from debate to exploration, enables you to fully engage the patient. When you are able to emotionally connect with the patient, you can begin to problem-solve together.2 It all starts with shifting to a Learning Stance.

2. Establishing Patient-Professional Communication Flow
Once you have tapped into the emotional needs of the patient, communication can take place between you, with the primary flow of communication going from the patient to you. All clinicians have experienced the following: You are taking the case history on a reluctant patient who has been dragged to your office by a concerned loved one. Initially, this patient does not want to discuss a hearing deficit. However, as you doggedly continue to ask questions you stumble upon one that triggers an emotional response. This patient starts to open up and talk about the years of frustration and anger associated with the hearing loss. Too often we interrupt this flow of communication to complete the hearing test. This behavior on our part is logical. We have been trained to do this. It is our comfort zone to complete the hearing test during the initial stages of the visit. Next time you find yourself in this situation, resistant all temptation to do the test immediately. Instead, sit back, take a deep breath, pause, and ask the patient a thoughtful question about how they’re feeling.

Establishing a flow of communication from the patient to you allows the professional to explore more deeply the emotional consequences of the hearing loss from the perspective of the person sitting knee-to-knee with you. It is this flow of communication that helps bond you to your patient, and helps define your role as a true “helping professional.”

The flow of communication allows you to transition from the case history to the hearing test. In most cases, you know you have established a strong flow of communication when you have completed the needs assessment part of the appointment (eg, COSI3) before placing the earphones on the patient. Adapting a learning stance and establishing a flow of communication from the patient to you enables the professional to seize the moment and complete the pre-assessment part of the COSI before the hearing test.

3. Shifting from a Learning Stance to a Teaching Stance
Once the COSI and hearing test are completed you can shift from a Learning Stance to a Teaching Stance. One of the hallmarks of any exceptional teacher is the ability to communicate in language everyone can understand. This means adapting your message to the level of your audience. As helping professionals we all are teachers on some level. After the hearing test we typically explain the results of the exam to the patient. This is the first of many opportunities to start teaching your patient the importance of improved hearing.

All of us have had memorable teachers. They are motivating and inspiring. We oftentimes connect with them on an emotional level. One ideal time to strive to be a memorable teacher is during the “explanation of results phase” of your appointment. The use of colorful metaphors and visual props to describe the hearing loss are two possible ways to become a more memorable and effective teacher. Instead of giving a long explanation of the importance of binaural hearing, give the patient a demonstration of why two ears are better than one.

The part of the appointment customarily reserved for you to explain the test results is an ideal time to adapt a Teaching Stance. Challenge yourself to come up with metaphors, props, and visual aids describing the hearing loss and effectiveness of amplification.

4. The Power of an Informed Buying Decision
The consequence of adapting a teaching stance is that it leads directly to an informed buying decision. This requires navigating the patient through the vast array of technology choices—a daunting task. The number of amplification options is truly mind numbing, and it is easy to overwhelm the patient with too many choices. When it comes to making a buying decision, customers want a small number of choices.4

The COSI and Quick SIN5 are two tests the patient can understand. After you have completed the pre-assessment part of the COSI and the Quick SIN under headphones, use the outcome of these tests to come up only a couple amplification options (ie, no more than three), depending on the patient. The options should differ in price and level of technological sophistication. An important part of helping the patient make an informed decision is that you can explain in concrete terms the limitations of certain hearing aid technology relative to the needs of the individual patient. Both the COSI and the Quick SIN are ideal for this purpose.

5. The Assumptive Conclusion
The power of the informed decision cannot be underestimated. The informed decision leads directly to an assumptive consequence of the patient accepting your recommendation. If you have first adapted a learning stance, transitioned to a teaching stance, and followed that with 1-3 thoughtful choices, the natural culmination in this series of events is the assumptive conclusion. Too often, in our experience, the hearing care professional focuses on the trying to talk the patient into accepting recommendations for hearing aids. Only after the patient feels they have been profoundly heard, can you deliver your message of better hearing through amplification. The patient will embrace your message of hope, and you can allow them to make an informed decision.

Simply stated, the reluctant patient does not have the language of healing. If they did they would walk in and say, “I need hearing aids.” To further illustrate this point, people often see counselors when struggling with major life issues. Why would we pay a stranger several hundred dollars per hour over a period of weeks or months to help us solve our most personal problems? The answer is that we do not possess the language that it takes for us to deal effectively with our own issues. We need to be guided in our thinking and self-discovery. That is exactly what must happen in the hearing professionals office.

Before the patient will embrace our message, we must address the emotional needs of this person. We must first listen to the feelings behind the words, and then acknowledge the feelings. We cannot assume we know what this patient is feeling. Even though we have observed these emotions hundreds of times in countless other patients, we must sit back and allow this patient to express their feelings—then listen for the emotions behind the words.

Applying some of the concepts presented in this paper will help you address some of the needs of these challenging patients and, it is hoped, enable you to become a more effective helping professional.

Brian Taylor, MA, is the Education and Program Development Manager for Amplifon USA in Plymouth, Minn. Von Hansen is a Communication Specialist and Consultant for AmplifonUSA. His office is in Lebanon, Ore.

1. Argyris C. Empowerment: The emperor’s new clothes. Harvard Bus Rev. 1998. May-June, 76, 5, 98-105.
2. Stone D, Patton B, Heen S. Difficult Conversations: How to Discuss What Matters Most. New York City: Penguin Press; 1998.
3. Dillon H. Client Scale of Improvement (COSI). J Amer Acad Audiol. 1997; 8, 27-43.
4. Zaltman G. How Customers Think: Essential Insights into the Mind of the Market. Boston: Harvard Business School Press; 2003.
5. Niquette P, Gudmundsen G, Killion M. Quick SIN Speech in Noise Test. Elk Grove Village, Ill: Etymotic Research, 2001.

Correspondence can be addressed to Brian Taylor, Amplifon USA, 500 Cheshire Lane North, Plymouth, MN 55446; email: [email protected].