Mrs. Stromberg, Where Are You When I Need You?

Angela Loavenbruck
March 15, 2016

I had a wonderful English teacher at Scranton Central High School. Her name was Muriel Stromberg and she had a Mamie Eisenhower haircut.

imagesI realized as I was writing this that probably no one reading this column would have any idea what a Mamie Eisenhower haircut was, so I’ve provided a photo.

I don’t remember a lot about Mrs. Stromberg’s class except for her hairdo and a ritual she had as a teacher. Every morning she entered the classroom and wrote this sentence on the blackboard:

“The biggest enemy of the Best is the Good ‘Nuff.”

I have cursed that woman many times in my life because that sentence has caused me time and anguish over whether some project or another was “good enuff” or really the best I could do.

When is Good Enough Enough?

My old teacher’s phrase came to mind as I reread a series of articles posted on HHTM last year by Brian Taylor where he discusses whether we are entering the era of the “good enough hearing aid” and if so, whether this “just good enough market” represents disaster or opportunity for the audiology profession.  After all, he states, “The commoditization of amplification technology does not mean the sky is falling for the profession.”

images-7While it may be true that we sometimes overdramatize the effects that potential disruptive change might have on our profession, it is not the commoditization of amplification technology that is worrisome – it’s the commoditization of audiology services that keeps me up nights.

The Only Thing We Have to Fear is…..

I don’t think we need to be afraid of PSAPS or consumers looking for “good enough” technology solutions to the communication problems caused by their hearing loss. Good enough does not have to mean mediocre – it means understanding what technology your patients really need the most and focusing on providing that technology more economically.

Good enough devices are one thing, but “good enough” audiology practice images-9is never enough.

If we practice patient-centered, evidence based audiology, our evaluation will have identified and diagnosed the problem, identified the issues most important to the consumer, and provided the consumer with the amplification options available to improve communication.  The options could include PSAPS or non-wearable amplification devices, or no device at all – as long as best practice methods are used to arrive at our recommendations and to verify/validate whatever we recommend.

What we do need to fear is the notion that any of these devices can dance by themselves and that our services are not a critical part of hearing healthcare.  We also need to greatly increase the number of audiologists who understand the value of evidence based best practices in the delivery of hearing health services and use them as a matter of course. We cannot differentiate ourselves from other providers unless we practice our profession.

Only the Best Will Do

So, in honor of Mrs. Stromberg’s call for only our “best”, here are suggestions about what must be ensured.

  1. Our training and education accreditation standards must include a thorough grounding in evidence based best practices;
  2. Our Code of Ethics must clearly indicate our professional responsibility to use best practices in all settings;
  3. Audiologists in all practice settings must differentiate themselves by using best practices;
  4. Audiologists in all practice settings must delineate and assign monetary value to the services they provide, and communicate those values to consumers. We cannot continue to hide the value of our services in product based price structures. I do not see this as a bundled vs. unbundled argument. In fact, I think it is essential to bundle audiology services and amplification products into a cohesive package that is based on patient needs. But each service needs a value and the efficacy of those services must be conveyed to consumers and third party payers.
  5. Our professional organizations must lead organized efforts to delineate the value of audiology services to legislative and regulatory policy makers.  How can we put our membership dollars into a greatly expanded effort to do this? What if we stopped paying for unnecessary certificates and instead created a fund to develop a focused campaign to educate policy makers. The fund would have millions of dollars – think what we might accomplish as a profession!advocacy
  6. Finally, I think the voices of the legions of consumers who do recognize the importance and benefit of audiology services have not been heard, and I think we should develop a way to convey those powerful voices to policy makers.


Angela Loavenbruck, aka The Crabby Audiologist, has been in private practice since 1975. She has served as president of both the New York State Speech & Hearing Association and the American Academy of Audiology.  She was awarded the Joel Wernicke Award by the Academy of Dispensing AudiolAngela Loavenbruck, Hearing Health Mattersogy for her work on behalf of the AuD.  Angela has been Associate Professor at Teachers College, Columbia University and has spoken widely about ethics, private practice and accreditation standards. She and her husband recently celebrated their 50th wedding anniversary and have three children and three wonderful grandchildren.  Angela is also renowned for her Italian cooking and award-winning blueberry pie.

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