As reported in The Hearing Review online (November 6, 2015), Phonak has convened a select group of hearing healthcare experts to provide evidence-based recommendations to hearing care providers on how to better engage family members. Chaired by Dr Louise Hickson, the objective of this group is to facilitate family involvement throughout the hearing remediation process. The group proposes an audiologic treatment shift from a site-of-lesion focus to a family-centered care perspective as a means of increasing the value of our services and the uptake of hearing devices. This paper is the first in a series of several common (mis-)beliefs about the approach, which will be challenged by the authors.
It almost never fails; at every lecture course or workshop on counseling in audiology, someone from the audience says, “I would like to do more counseling; I just don’t have the time.” And the myth continues. Certainly, most audiologists have a limited amount of time available to meet with their patients. It is how they use this time that is important. Making counseling the priority for your patient contact can result in improved relationships, increased patient satisfaction, and better outcomes.1
Incorporating counseling into audiology practice is more a matter of time management than it is insufficient time. Learning to prioritize appointment activities is perhaps the most pivotal component of the process. Deciding that it is important to work together with patient and family when determining treatment needs, goals, and processes should ease the transition to a counseling-based patient interaction. It is not so much what we do in audiologic encounters as it is a matter of how we do it.
Typically, audiologists spend a great deal of time reviewing the intricacies of an audiogram. Patients frequently listen with little input and even less understanding of the jargon and symbols that have been discussed (see essay by Kris English here). Since the patient truly is the only expert of their own hearing ability, having the patient and family tell their story, rather than the audiologist telling them what their hearing loss is, will validate for them the reason for their visit to the audiologist. It will also provide essential information about the patient’s perception of the loss and how they are able to function. The audiogram gives us little information about how hearing loss affects the individual and his or her family, therefore, spending large amounts of time explaining it reduces time for relevant discussion and counseling.
When a history is taken, a series of “Yes” and “No” questions are asked—Do you have any ringing in your ears? Did you ever have ear surgery?—with limited input requested from the patient. Instead of using a Yes/No history form, an alternative means of obtaining patient and family information is through narrative techniques. By asking relevant, open-ended questions, the audiologist can learn specific aspects of how a patient lives with their hearing loss, how family feel about it, and where treatment goals need to be focused. Asking questions like, “What happens when you have a conversation in a restaurant?” can inform the audiologist not only of the situational difficulty that may exist, but allow the opportunity to explore the emotions that can occur with communication obstacles.
And finally, when discussions occur, audiologists frequently sit well-protected in white lab coats behind office desks with the patient and family’s participation limited. Casting away the white lab coat and office desk, and having a discussion at a round table or with comfortable furnishings where the patient, family, and audiologist can be equals, will help establish a counseling relationship and foster a shared understanding of the patient’s problem and the possible solutions. Before you know it, you’ve integrated counseling into your practice!
Are you experiencing the same? What is your take on including a family member and spending more time in counseling rather than talking about the audiogram?
Please share your views with Joseph Montano by emailing him at: [email protected]
1. Zolnierek KB, DiMatteo MR. Physician communication and patient adherence to treatment: A meta-analysis. Medical Care. 2009; 47(8)[Aug]: 826-834. doi: 10.1097/MLR.0b013e31819a5acc
About the authors: Joseph Montano, PhD, is Associate Professor of Audiology and Director of Hearing and Speech at Weill Cornell Medical College, New York Presbyterian Hospital; Kris English, PhD, is Professor/Interim School Director at the University of Akron/NOAC, Akron, Ohio; and Louise Hickson, PhD, is Professor of Audiology, Head of the School of Health and Rehabilitative Sciences, and Director of the Communication Disability Centre at the University of Queensland in Australia.
Mythbuster #2: Mythbusters Myth#2: I Will Be Exptected to be a Marriage Counselor, by Nerina Scarinci, Kris English, and Ulrike Lemke