Mystery Shoppers, Audiology Ethics, and Two-Timing Neutrinos

This week’s post is long because it is a dialog between two, maybe three, people over the past few days:  myself,  a self-anointed Mystery Shopper, and the Mystery Shopper’s friend, Hubert.  See what you think.  Consider how YOU would have responded and send in your corrections/additions/redacts and other commentary to improve my crabby response.  This is your chance to be a  Secret Santa  to Hubert, Mystery Shopper, and Hearing Economics!  

From:  Mystery Shopper to Hearing Economics

Hello Holly,

I have really enjoyed the blog coming via email every week. I have been doing some PR work for a local company and have become concerned about the ethics in the profession. I guess every profession has some unscrupulous people in it. On top of my own recent observations,  I received an email from a long time friend who suffers from tinnitus. Although he won’t admit it his hearing loss is severe.  Here is a guy who has a PhD in Physics, has started several successful companies, took early retirement and studied neurology to keep his mind busy and yet he still refuses to get a hearing test. In fact I just asked him to make my Christmas present this year, his audiogram. I think he will do it. During the past three years I have been encouraging him to get a hearing test and have sent him a number of articles on tinnitus and some possible things that might help him including hearing aids.

This is the email I received from Hubert a few days ago. I am wondering how widespread this mistrust of the Hearing Profession is. There must have been a study of some type done. Is it possible to do a survey on your blog?

Have a great Holiday Season.  Your Mystery Shopper


From:   Hubert to Mystery Shopper


I asked my physician about the tinnitus center that you mentioned.  It turns out that he too suffers from tinnitus.  He said that a couple of years ago he had tried a regimen similar to what they are offering (including individualized audio recordings, hearing aids, etc.) and that he had not noticed any improvement at the end of the treatment.  To his knowledge there were no successful treatments at this time.  I don’t know how knowledgeable he is but it at least makes me want to see some good clinical data before investing in a treatment.  One of these days when I am over there I may look them up and ask them for references to some of their data.

For some reason I think audiologists are considered to be on a par with snake oil salesmen.  I don’t know if that is fair but I do seem to get a lot junk mail promoting hearing aids.  It seems that once you get on Medicare you are a target for all kinds of sales pitches.  I am sure that there is some good stuff out there but it is difficult to separate the wheat from the chaff.  I suspect that you run into some of that skepticism when you are out talking to potential customers. Perhaps a good marketing strategy would be to team up with family physicians that could refer patients since most people trust their family doctor.  I think that a successful strategy needs to overcome this built in skepticism, allowing a company to compete on some grounds other than price.



From:  Holly to Mystery Shopper

Hi Mystery Shopper,

Most important comment – I like your suggestions for a survey of consumer views of the hearing health care industry.  You may want to check David Kirkwood’s post on that topic.  Now, on to my more caustic comments.

I’m glad you’re enjoying the blogs, thank you for subscribing.  I guess I’d recommend that your friend do the same as he seems to have a very confused idea of what an audiologist is – might he be confusing “us” with hearing aid dispensers? I’m not saying all audiologists are good and all hearing aid dispensers are bad, so let’s skip that extreme and unproductive line of reasoning.  But, there really is a difference in the two and certainly a man with his education should be able to quickly discern that by academic requirements alone.Toward that end,  (education of consumers) I’m happy to recommend him to  Hearing Health Matters! as well as my own practice’s blog site .

As for his idea of approaching physicians,  I was on the ground floor on that back in the late 1980s when I gave a 15-minute presentation at AAA in Nashville making that exact recommendation.  I based it on data from my practice, comparing cost/revenue for the first two years, when I used traditional (e.g., hearing aid manufacturers’) advertising versus two years following, when I ceased advertising and switched all  efforts into promoting primary care liaisons.  It worked for me but remains a discussion point in our literature.  Should your friend make an effort to educate himself by accessing those discussions, I can point him to our books on Audiology Practice Management for general discussion, and to two 2-hour courses on Strategic Marketing I recorded for several years ago.

The discussion in our literature hinges on the attractive offers made by manufacturers to dispensers and audiologists to underwrite advertising in exchange for agreeing to sell manufacturers’ units.  A good number of us–most with established reputations, loyal patients, and reasonable bank accounts – eschew those offers for all the reasons that turn your friend off.  Others – mainly newer practices needing to get a jump start – choose the manufacturer route with direct-to-consumer advertising as their only perceived means of getting some cash in the bank.

As for ethics, I’m not sure where that comes in unless any/all of us–regardless of our means of obtaining patients/customers–are misrepresenting inferior products as superior products, selling to those who do not need the product, lying, libeling, slandering, stealing, sharing patient data, falsifying our credentials, placing our patients in danger through faulty equipment or misuse of equipment/tools, etc.  There IS a difference between being annoying, unfeeling, or just plain stupid business-wise versus being unethical.  They are just not the same thing.

I’m intrigued at your friend’s PhD in physics but reluctance to educate himself before forming opinions.  For instance, the research published in peer-reviewed and industry journals, using deductive methods and survey methods, states clearly that the only long-term treatment of tinnitus that rises above placebo is hearing aids – AND that only about 50% of those with tinnitus will be helped by that “treatment.”  While I can understand a physician drawing a non-scientific conclusion along the lines of “I tried it and it didn’t help so it’s bunk,” I am hard-pressed to understand how someone with a scientific PhD, trained in critical thinking, could be satisfied with such “logic.” Surely, we’re past the “half-full” versus “half-empty” glass level of analysis!

That said, you are of course correct that every profession (and here, I am being broad-minded as the public appears to be and including all of us in hearing health care) has its detractors – some educated, some not.  It’s disappointing that some of our own brethren don’t work harder to improve our status in the eyes of the public, but some of us do and we frequently get rewarded by attracting intelligent, rational people who take the time to investigate, then pick us out of the bunch because we appear to know what we are doing and do not take short cuts such as crass advertising.

Finally I must retaliate by poking a bit of fun at your friend’s profession . Now that the Cern experiment has been replicated and we are forced to reckon with neutrinos that don’t follow the rules, I am dismayed to have to think of a world in which causality is out the window, as a casualty of rules of physics that no longer apply.  If it turns out to be so, then I can’t help but wonder about those physicists – just a bunch of used car salesmen pushing a product that wasn’t real with assurances that didn’t hold up.  I’m going to demand my money back on all those neutrinos I ordered from!

Best, Holly


From:  Mystery Shopper to Holly

Good Morning Holly,

What a great reply to my email and I think you would really like my friend Hubert after you two had some interesting discussions  about the hearing profession pushing hearing aids and physicists pushing neutrinos.

Following up on Hubert as our case study. He went to his primary care MD for a annual physical and this is the first time he mentioned he had tinnitus. I have no idea why but I believe he only did it this year because I have been bugging him so much. Now why is it that a hearing test is not included as part of a physical exam? I have had a number of executive physical exams but I never had a hearing test until three years ago. If a hearing exam were required — and this is probably a health insurance requirement issue — then people would be more likely to get started on the right track with a reputable test clinic. The primary physician would review the test results as he would results from a colonoscopy and recommend follow up action.  I believe that Hubert is correct, most people trust their primary MD and would follow recommendations for getting a hearing device after explaining the consequences of not getting them. Ordering aids off the internet probably would not be one of the recommendations.

Here is a  problem I  experienced within the past two weeks. Twice a year I do a round of hearing tests to see if my hearing has changed but also to see how various clinics give hearing exams. This process may be akin to “mystery shopping” but I feel I am entitled to second opinions. Recently, I went to a  Sam’s Club Hearing Center because I am fascinated with how Sam’s is doing business and also to compare with Costco and independent clinics. I was much more impressed by the Sam’s facility than the Costco hearing centers I have seen. Great large sound booth and state of the art MedRx audiometer. I then went to an independent clinic where I was given a test in an open office and told to tap the desk when I heard a tone. There was no questionnaire to fill out regarding health or hearing issues. Just a 15-20 A/C  test and I was out of there. I would hope that people would go into this clinic and say “this is not good”. but I am not sure this happens since the clinic stays in business. There needs to be something equivalent to a hotel rating guide for hearing clinics. I now have a 0 to 1/2 star candidate.

I am becoming a real cynic but I think the whole industry is migrating to the same process that I use when I get fitted for a new suit. Measure, choose basic suit, make alterations, come back for final fitting and  then I am on my own. After some time, if I like the fit of the suit I wear it a lot; if I don’t I seldom wear it.

As always great to be able to share my thoughts with you and have a great Holiday Season.


From:  Holly to Mystery Shopper, Hubert, and all Blog Readers

Happy Holidays and wishes for a wonderful 2012 to everyone, even Hubert.  And–just for Hubert–in case those two-timing neutrinos really can travel faster than the speed of light, here’s a new physics joke  reportedly tweeted from the Cern lab:


The bartender says, “We don’t serve neutrinos in here.”

… A neutrino walks into the bar.

Take your time. Think about it.


Photo courtesy of Undress4Success


About Holly Hosford-Dunn

Holly Hosford-Dunn, PhD, graduated with a BA and MA in Communication Disorders from New Mexico State, completed a PhD in Hearing Sciences at Stanford, and did post-docs at Max Planck Institute (Germany) and Eaton-Peabody Auditory Physiology Lab (Boston). Post-education, she directed the Stanford University Audiology Clinic; developed multi-office private practices in Arizona; authored/edited numerous text books, chapters, journals, and articles; and taught Marketing, Practice Management, Hearing Science, Auditory Electrophysiology, and Amplification in a variety of academic settings.