How Much “Transparency” is Necessary?

Empower Conference
Mike Metz
July 3, 2018

by Mike Metz

If you know a better way of functionally describing transparency than by stating “one can see through it clearly”, let me know.  I would also like to have an alternative definition for “sterile”, “truthful”, “correct”, and “perfect”.  These words imply a state that is not compromised. Semi-truthful doesn’t mean almost the truth, it means wrong. Semi-perfect is imperfect. These descriptors are absolute. Even though sometimes:

According to some style guides, absolute adjectives are always in the superlative degree. However, some absolute adjectives can be quantified by the addition of the word almostnearly, or virtually.[1]

When most people use these adjectives without quantification, they are used in an absolute sense. Transparent means nothing obscures the view. When referring to a contract, it means all is spelled out—the elements under consideration are completely stated. In a window, it means the view through the glass is completely clear.  In a healthcare file, it means everything is available for the patient or qualified observer. Everything.

When it comes to patient records, the issue of (absolute) transparency may not be completely understood by all. For the most part, state and federal laws regarding mandatory record retention requirements apply to hospitals or similar facilities rather than to medical practices.[2]  Most physicians keep meticulous files on each patient, not only for the assurance of correct practice, but in the event that future litigation can be countered with evidence of diagnosis and treatment being within the standard state of practice at the time of service.

Hearing aid sales offices are not healthcare providers in the legal sense. But audiology offices, dispensing or not, do fall under the healthcare provider umbrella and are therefore considered bound by their state (and/or over-riding federal) laws.


In the case of patient misconceptions, altered perceptions, and possible future litigation, it is a wise approach for anyone even remotely associated with healthcare to construct and keep complete patient/consumer records. And, if one keeps a patient file, it will be assumed that it will be complete and transparent. Absolutely.


What constitutes complete? Minimally, the patient file contains historical information concerning health issues that might have brought the patient into the office for help.  Of course, all test information, copies or notes concerning referrals, notes and correspondence regarding conclusion or diagnostic impressions, written plans for intercession, treatments and goals, sales contracts, and such matters.  One should also keep in mind that all the financial information is also part of the patient file. It need not be included in the “working” file, but it is subject to subpoena in any legal matter that might arise.  So, billing and payment records, such as the invoice and the statement pricing of any appliance, are technically part of the patient’s file.  Now, that’s (complete) transparency, in case you missed the absoluteness of the adjective.

Many hearing device sales offices include only a bill of sale— specifically required by some states—as well as the invoice statement as complete (assumedly used in the absolute sense) indications of the cost of the device.  That may be sufficient if the invoice cost is the same as the statement cost—that is, if the statement cost is also the true cost of the device.  If there is a difference in the invoice and statement costs, and the “true” cost is less than the invoice or shipping statement, the office (clinician) better have a good reason for not disclosing the difference.  And this reason must align with legal regulations as well as the ethical standards of professional organizations. 

A fine example of transparency can be found in the explanation of benefits (EOB) supplied to all those who receive Medicare Part B services from healthcare providers.  What was billed for each procedure, what was paid, what is owed by the patient, etc. 

If anyone in any clinical audiology practice has questions or does not understand these transparency issues (and why they are necessary, when they are binding, or to whom they do or do not apply), perhaps a refresher course or consultation with an appropriate professional—attorney, ethicist, or government agency—would be a wise choice.


[1] Accessed on 4-16-2018 at

[2] The Doctors Company, accessed at

*featured image courtesy flckr

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