Dennis Van Vliet, AuD, has been a prominent clinician, columnist, educator, and leader in the hearing healthcare field for nearly 40 years, and his professional experience includes working as an educational audiologist, a private-practice owner, and VP of audiology for a large dispensing network. He currently serves as the senior director of professional relations for Starkey Technologies, Eden Prairie, Minn.

I received a call from a longtime friend and colleague the other day. Her practice is in an urban area. Her typical patient works in a high technology environment and has needs that may require visits outside normal business hours, and lifestyle requirements that often call for more than a “common” hearing aid fitting. The reason for her call came from some long-range business planning she had been doing. As she looked at a broad range of contemporary business delivery trends, she became concerned about her current model for hearing care. So many products and services are available without face-to-face visits, she predicts that soon her patients will very likely expect and seek services in a similar manner.

She wanted to know my thoughts about her predictions and concerns.

The Blessing and Curse of Living in Interesting Times

My first response was to acknowledge that, while major hearing aid manufacturers for the most part support the current model of hearing care through traditional audiology and hearing aid specialists’ offices, there have been distance-service models emerging in the past couple of years. This has been made possible in part by the development of easy to fit receiver-in-canal and similar noncustom products. There isn’t much we can do about those models except to focus our practices on the patients who do need our expertise for custom-fitted products that are programmed for a patient’s specific needs. My personal preference is to avoid the generic fit receiver-in-canal tips in favor of custom molds for better comfort and security of fit.

What about the patient who acknowledges that they have a hearing loss, but doesn’t want to go to the trouble or expense of obtaining hearing aids? We all have had the experience of counseling someone with a hearing loss and communication needs that suggest that hearing aids may improve their quality of life, but they don’t act. Should we continue with our current system that serves a fraction of candidates, or should we explore alternate models that may reach more people?

The thought of a change in the delivery system has been the source of much anxiety for us as providers. There are many unknowns, and the fear is that a change will alter the status quo to such an extent that we will suffer the same fate as buggy whip experts did with the rise of the automotive industry.

Embracing and Harnessing Available Technology

We discussed this for a time. I offered the opinion that—no matter how service delivery options change—there still will be many people who need help learning how to use hearing aids, and need customized services. My colleague felt that, for her market, she would need to be more proactive to serve her clientele. She is looking into planning and designing to offer an array of distance services. The scope of services will depend upon what is possible with a typical infrastructure of telephone, e-mail, text, tablet and smart-phone applications, Skype, and similar tools. What will be available in the future will depend upon the market and what innovative manufacturers offer.

My patient interaction has certainly changed with the more common use of text, e-mail, and Skype. As I was writing this column today, I received an e-mail from a patient asking a very specific question about his hearing aids. I was able to snap a photo of a hearing aid like his with my phone, then provide a two-sentence response that, along with the photo, answered his question. The exchange took less time than a phone call, and much less time than an office visit.

Two years ago, I was able to talk to a patient in Dubai via Skype while I was in Los Angeles. I used a remote system to connect to his laptop and was able to make programming adjustments through peripheral connectors I had shipped to him. This type of capability is clearly not new, and is becoming less cumbersome.

For us, as service providers, what may need to change are our attitudes and protocols. For truly custom services, we probably cannot—and should not—eliminate face-to-face visits, but we may very well be able to provide good professional care via distance methods.

The Final Word? The possibility of distance service brings risks and questions about professionalism, licensure, ethics, and efficacy. It also brings opportunity. Provided carefully with the needs of the patient held foremost, telepractice can expand and extend our reach to people who otherwise may go unserved.

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