I would bet that every hearing care office that dispenses hearing aids has read almost every article published concerning PSAPs.  If fact, I suspect that many audiologists and dispensers have offered opinions widely and often.  I suspect many of these opinions are anti-PSAP or anti-OTC. 

That position is understandable—dogs are being kicked.


At Times Like This, A Prospective View Comes in Handy


Consider the following opinion piece by Siligman and Tierney, published in the NYTimes on May 22 of this year:


We Aren’t Built to Live in the Moment

We are misnamed. We call ourselves Homo sapiens, the “wise man,” but that’s more of a boast than a description. What makes us wise? What sets us apart from other animals? Various answers have been proposed — language, tools, cooperation, culture, tasting bad to predators — but none is unique to humans.

What best distinguishes our species is an ability that scientists are just beginning to appreciate: We contemplate the future. Our singular foresight created civilization and sustains society. It usually lifts our spirits, but it’s also the source of most depression and anxiety, whether we’re evaluating our own lives or worrying about the nation.

…A more apt name for our species would be Homo prospectus, because we thrive by considering our prospects. The power of prospection is what makes us wise.


The authors go on to tell of how this prospective view affects us more than we ever thought, and how it should be nurtured and expanded.  But, most of all, it should be understood.


Audiologists Aren’t Built to Live in the Moment Either


Now, you are likely asking, is there a lesson here for audiology and the issues that confront the profession now and will certainly continue into the future? 

What is the most common concern of most audiologists?  Individually, what would be your answer at present?

  • Not enough time to read all the journals?
  • Not enough time to employ the “best practice” recommendations?
  • What will I wear to the next AAA gathering? (And, who will buy me lunch?)
  • Is my ad in the Sunday paper big enough?
  • How can I “beat” that office down the street?
  • How much does my yearly gross have to be in order to sell my office at a hefty profit?

In the day-to-day operations of any office, issues like patient/consumer satisfaction, cash flow, budgeting, advertising, physical plant concerns, and the like, seem to take all of a person’s time and energy.  These concerns are necessary to assure business success.  Likewise, less physical and more esoteric (future) concerns are equally important, and perhaps even more important to patients and for future practice viability.

I hope that most clinicians have more professional concerns than the last four items on the list above.  I hope that some audiologists have concerns that could be included on a “homo prospectus” list.


Building a Prospectus on Who We Are


One of audiology’s large and looming problems—at least in my way of thinking—involves “niches.” As a field, we looked at others and modeled our behavior after the way they did things.  For a while it worked out nicely.  But, this shared model seems to be under siege and will likely be disruptively replaced with something new.  I think many of us tried to occupy a niche that did not suit our range of abilities.  Audiology allowed others to define our niche.  Perhaps we did not think prospectively.

Developing one’s own professional niche is important.  Thinking ahead to determine and plan for that niche is essential.  And providing a rational base for the future of that niche is critical. I suspect that anyone in the “Homo Prospectus” group is already planning for the coming changes.  And, I suspect that many who were not in the “Prospectus” group are now somewhat regretful.  The prospective group will find opportunities in the coming order, and those opportunities may not be in the dispensing niche in which many are now positioned.

I find that there are lessons and suggestions in many places—not surprisingly, even in the New York Times.  I am amazed that all these people write things that describe my chosen career, that seem to reference my colleagues, and clearly apply to me.  Finding these articles is a joy.  While that may not necessarily put me on the “homo prospectus” side of things, it sure does give me pause to think about the future.


feature image from shareable snippets

That response is attributed to Willie Sutton, a famous bank robber of the 1940s and 1950s, when asked why he robbed banks.  I have quoted it a couple of times during my career, not because I robbed banks, but because it is, in essence, brash and logical. 


The Logic of Efficiency


It also has some vague application to the hearing aid field—not the robbing aspect, but rather the underlying logic of efficiency.  This efficiency thing is also at the heart of directed mailings, advertising, and appeal to people who have an obvious need. It’s also at the center of ads for cars, dishwashing detergent, and even medicine.

For quite some time I have harbored the thought that, were I still in the audiology business, I would look closely at what I had to offer to those people who fail in their attempt to use amplification.  Imagine what kind of consumer response you would get if you placed an ad that said something like:

There is no lack of data about the real “market penetration” of hearing aids, the instrument return rate for “lack of benefit”, and attempts to explain why a significant number of patients fail in their attempts to hear better.  There are also indications that support the lack of proper testing and the setting of instruments as an explanation.  One thing is abundantly clear:  people fail despite their output of time and money.  And, while that’s where the desire is, it’s not very efficient when it comes to providing help.


Try Again With Those Who Try


Perhaps it might prove fruitful and efficient if some clinicians attempted to “fix” those patients who have shown that they were willing to try hearing instruments but failed, for some reason, to gain sufficient benefit.  After all, they took the first step. 

Maybe there are methods or procedures that would suit them better.  Maybe there are simple solutions to help them benefit from their outlay in time and money.  Perhaps if some of these “failed” patients were “rescued,” this would demonstrate that appropriate audiologic care does indeed make a difference.

Many studies that have shown “first fit,” faulty, or absent probe measurements; inappropriately programmed instruments; and the like have proven unsatisfactory to many with hearing loss.  We should also not have to be reminded that many clinics that follow “best protocols” have a very high degree of success with their amplified patients. 

Those “best protocol” clinics and clinicians could provide a great benefit if they were to solicit “difficult” patients who failed with their hearing aids.  Proving that adding astute clinicians to data-driven procedures solves a lot of problems may go a long way towards demonstrating the skills and advantages of good audiology.


That’s Where the Money Problem Is


In contrast to Willie Sutton’s statement, money should not be the principle driver of any approach to helping people use hearing devices.  While there must be a consideration of reimbursement, patients who have tried and failed using amplification would seem to have pursued hearing aids despite the cost.  And, their failures reflect on all of us.  There is another saying that roughly translates “rumors of failure travel faster than rumors of success.” 

For Audiology, perhaps the appropriate rephrasing of Sutton’s statement could be something like:  “That’s where a greater need is.”  Proving the value of generating data and realistic expectations, then applying the best practice protocols to patients who have failed in their attempts at amplification, may be a good first steps.  We already know that these patients have taken a first step toward help, and they deserve an explanation of what happened.  We seem to be training new clinicians to follow correct protocols, but there also seems to be a lot of sellers out there who are not following these “rules.”

If audiologists provide value, shouldn’t they try harder to prove it to those who have failed?  The worst outcome of such a program would be that some of these patients would know why they failed.  The best outcome would be successful patients who understand the benefits of data, protocols, and knowledgeable professionals.  Either way, audiology wins.

You guys are smart—you figure out what such an approach is worth in terms of reimbursements, advertising, and good will.  And efficiency.


feature image courtesy of the FBI