Editor’s Note: An award-winning writer who has written monthly columns for Hearing Journal and Hearing Instruments for about 20 years, we welcome Dr Van Vliet and his unique perspectives to HR. Dr Van Vliet’s Final Word column is appearing in HR starting this month.
In February of this year, my wife Alison Grimes and I had the opportunity to travel to Australia to address the Australian Association of Audiologists in Private Practice in Hobart, Tasmania. Our hosts were very gracious, and in addition to participating in an intellectually stimulating meeting, we had the time to do some sight-seeing to explore the landscape and quite different animal population of Tasmania. As we toured through the eucalyptus forests, it was obvious that it isn’t only chickens that endeavor to cross the road. Many of the local species fail in the effort, and are killed by passing cars. Fortunately, we didn’t contribute to the problem and did not have to follow the local custom of removing road-kill marsupials from the road to prevent additional casualties to Tasmanian devils and other scavengers.
I only drove for a couple of days, and had little problem adapting to driving on the left side of the road. What I did have some trouble with during our 2-week visit was coping with the Australian accented speech. Different idioms and pronunciation created a layer of distortion that required a good deal of focused attention and requests for clarifications or repetition to ensure good communication. Of course, it worked both ways. One night at dinner, there was an especially good sounding special appetizer of stuffed fried zucchini flowers offered at the restaurant we had selected. Thinking I might like to share it with a couple we were touring with, I asked the young server how many squash blossoms were on the special plate. The horrified look on her face told us that there was a failure to communicate. After a short conversation and a good deal of laughter, we learned that she thought she had heard me ask about the “squashed possum.”
The experience with difficult communication gave me a new appreciation for the difficulties faced by patients with even mild degrees of hearing loss. Even though we share a common language with Australians, extended conversation was often exhausting to keep up with.
This leads my thought process to the question of how good a job we are doing with our fittings. We tend to think that since we have good relationships with our patients, we are doing the best that we can, but are we? Are they struggling to understand through a veil of distortion that we could somehow improve? We have good tools and technology. We expect that our efforts are always mitigated by compromise, but we want to achieve as much as possible. We endeavor to guide our patients through their journey with a mix of good counseling, hardware, and skilled fitting, but how do we know when we are doing enough? As with many things, the answers can be elusive, but we can get closer to them if we ask the questions. I’m confident that we all have discussions with our patients about their outcomes in a general sense. What is needed, however, is a systematic method of offering the option of assessing outcomes to every patient with the ability to compare results against norms or groups of similar patients. There are good outcome measures available to suit our needs, but the critical issue is likely to be the lack of time needed to select and administer appropriate survey instruments, and analyze the responses. A third party system that would handle the administration as well as initial analysis would be the best solution. I was told by one supplier that it can be done for about $10 per patient.
Beyond the initial goal of improving our results for individual patients, why would we want to go to such lengths? From personal experience, I can say that having objective data documenting performance is extremely powerful when negotiating for business from a third-party payor or other referral source. Furthermore, in spite of efforts to resist commoditization, there will likely be additional sources of competition for our patients in the coming future. Not only will we need to set ourselves apart from Internet and direct-to-consumer offerings by providing personalized service and products, we’ll likely need to prove that we are effective with objective data. Good data on outcomes are important to prospective patients as well as referral sources.
The Final Word? Making sure that we are doing all we can for our patients is more than looking at returns for credit and gathering anecdotal information from our patients. Objective evidence not only gives us reliable information to improve individual and group outcomes, but it gives us powerful ammunition to prove that we are as effective in our efforts as we claim to be. There may come a time when if we don’t have the evidence to show our worth, we may end up like a squashed possum on the road to success!