by Michael Metz, PhD
“You are an ethicist! and speak with knowledge.” (comment to “A Changing Ethical Structure“)
When I began submitting posts at HHTM, I sought to provoke discussion on several topics, in hope of soliciting informed Comments. Occasionally, I get a complimentary, concise and definitive one as shown above.
Not all comments are soft balls — The practices and limitations of Audiologists pose issues which are difficult to discuss. Attempts to do so often result in criticisms which are unsubstantiated, controversial, non-supportive, and/or in the minority.
“Where does the audiologist fit in?”
Another comment to the same post last month is controversial and open-ended. I hope others will not only read it, but consider offering a short response of their own, as I am doing today. Here’s the comment, followed by my responses to several items raised:
…What needs to be done is that the word “audiologist” be removed and a more appropriate word coined in its place. An audiologist could be essentially a technician, and a hearing aid fitter/specialist could be a clinician. I don’t blame audiologists for encroaching into both avenues because they think that they know everything there is to know from the audiological standpoint, as well as the patient standpoint. The audiologist at a hearing aid manufacturer is a parroting device for hearing aid technology and rarely knows much about the psychology of hearing impaired people. Its true that too much education clouds the ability an audiologist to fulfill both roles. The education is in audiology and the money is in hearing aid fitting and dispensing, and which is why audiologists continue to deny space to HAD’s by ways of limiting them in tasks that lead to diagnostic conclusions. I have noticed that because of this approach audiologists are not getting professional recognition and respect of the hearing impaired community. The “superior than thou” attitude of audiologists is not paying off. I notice that audiologists have education as their foundation, which is great, but almost very little application of such assets in our field. Lets face it: Helping the hearing impaired needs the approach of a physician, or a psychologist, and definitely not an audiologist!
Our profession is 80% psychology, and 20% technology. Where does the audiologist fit in? Any answers?
Responses, if Not Answers
- The first and most substantive issue involves the statement “…a hearing aid fitter/specialist could be a clinician.” In many states, functioning as a clinician would be illegal, as a fitter/dispenser cannot claim to be a clinician and cannot provide clinical services. These laws, to my knowledge, do not disallow audiologists from doing both even though billing for many clinical services is a problem. The “mix-up” between audiologists and hearing aid fitter/dispensers is a root problem facing audiology today.
- Furthermore, I think there are many audiologists in the employ of HA manufacturers who are quite knowledgeable. Sales people in the field may not be quite that well versed, but they would seem to me to be better than, oh, say, an attractive sociology major detailing physicians about pharmaceuticals. Such HA field reps must be working well since I read that hearing aid sales are rising. If you want better informed reps, bias your purchases towards the ones that meet your requirements, provided the products prove similar.
- And, just to be clear, I used to teach that anyone can “make a diagnosis”, but if you are not licensed as a physician, you are guilty of practicing medicine without a license, and you better never be wrong. A diagnosis is the prerogative of a physician, not an audiologist. And certainly diagnosing is not an option of anyone not trained in any clinical skill.
- I certainly agree with “The “superior than thou” attitude of audiologists”, and I also reluctantly agree that it is not “paying off” for many. In support, I would offer the public viewpoint as reflected in the national legislative efforts. It’s generally not a good sign when the government steps in to regulate a field.
- Finally, all arguments for justification cannot place a traditionally trained clinician of any other discipline in a better position to provide help to a hearing impaired person. The fact than many audiologists are not providing all the help they should or could is not an argument for substituting a psychologist or technologist in the place of an audiologist.
- Audiologists have historically been a part of the medical laboratory input aiding an otolaryngologist. Audiology contributions are substantial to the care of hearing impaired patients. In fact, if one inspects the work environments of audiologists, one will conclude that one of the largest employers of audiology skills probably involves ENT clinics. The fact that most of the clinic-employed audiologists sell hearing aids is a partial answer to your last question.
No Time to Bunt – Keep Those Comments Coming
During these times, when the efficacy of audiology is under fire, all audiologists need to address such issues as are raised by these comments. Hard questions are not answered easily. Thank you for your comments, be they hard balls or soft balls.
Mike Metz, PhD, has been a practicing audiologist for over 45 years, having taught in several university settings and, in partnership with Bob Sandlin, providing continuing education for audiology and dispensing in California for over 3 decades. Mike owned and operated a private practice in Southern California for over 30 years. He has been professionally active in such areas as electric response testing, hearing conservation, hearing aid dispensing, and legal/ethical issues. He continues to practice in a limited manner in Irvine, California.
feature image from John Paciorek