# Best of 2017: A Cage of Monkeys

Originally published April 18, 2017.  You start with a cage containing four monkeys, and inside the cage you hang a banana on a string, and then you place a set of stairs under the banana.

Before long, a monkey will go to the stairs and climb toward the banana. You then spray ALL the monkeys with cold water.  After a while, another monkey makes an attempt. As soon as he touches the stairs, you spray ALL the monkeys with cold water.

Pretty soon, when another monkey tries to climb the stairs, the other monkeys will try to prevent it.

Now, put away the cold water. Remove one monkey from the cage and replace it with a new monkey. The new monkey sees the banana and attempts to climb the stairs. ALL of the other monkeys beat on him.  After another attempt and attack, he seems to know that if he tries to climb the stairs he will be assaulted.

Next, remove another of the original four monkeys, replacing it with a new monkey. The newcomer goes to the stairs and is attacked. The previous newcomer takes part in the punishment – with enthusiasm – because he is now part of the “team.”

Then, replace a third original monkey with a new monkey, followed by the fourth. Every time the newest monkey takes to the stairs, he is attacked.

Now, the monkeys that are beating him up have no idea why they were not permitted to climb the stairs.

Neither do they know why they are participating in the beating of the newest monkey. Having replaced all of the original monkeys, none of the remaining monkeys will have ever been sprayed with cold water.

Nevertheless, not one of the monkeys will try to climb the stairway for the Banana.

Why, you ask? Because in their minds, that is the way it has always been! (see at Disgruntled Millennial on Facebook)

I’ll bet you’re wondering, “What the heck does this story have to do with Audiology?”

Since I have some space left and you may still be reading, let’s start with why significant innovation is almost always disruptive.  I dislike the term “herd mentality”, but it seems appropriate in light of many examples.  People act like they do in many situations because others act that way too.  Whenever a new approach pops up, they get agitated because “that’s not the way to do it”, or “that’s not how I was trained”.  They react accordingly.

This barrier to abrupt change happens often in politics—recent events and observations support that conclusion.  It certainly happens in medicine and healthcare.  In support, I recommend Elisabeth Rosenthal’s book An American Sickness: How Healthcare Became Big Business and How You Can Take It Back, Penguin Press, New York, 2017.  And it surely is also happening in audiology, as evidenced by the thoughts and opinions of many regarding the FTC and over-the-counter hearing devices.

For years, the hearing aid industry has attempted to get more people aware of and interested in hearing aids.  They (we) reach fewer than 25% of hearing impaired people who would likely benefit from hearings aids.  For years, we couldn’t get better “penetration”, to use a peculiar concept that would seem to imply that our industry is “dull”.  And, for those many years, we did not change our approaches all that much.

Now, along come the Feds and their data-driven ideas, testimony from “outside” organizations, regulations, and maybe even laws, which they propose would allow for more people to get device help for their impaired hearing.  And, many audiologists and dispensers don’t like that.

What’s the matter?  Can’t audiology and dispensers justify their position in health care?  Are we afraid of what might happen?  After all, we put ourselves in this position.  Don’t audiologists have anything to offer in this proposed new scenario?  Or will we respond by shouting “it’s not like it always has been”?

Dr. Rosenthal’s mission, stated in her epilogue, should be echoed in the goals of every health care provider, including audiologists: “…to advocate for a return to a system of affordable, evidence-based, patient-centered care.”

I hope that you will consider reading Rosenthal’s book.  I hope you will take some lessons from it.  I think these might top the list:

1. Understand who has “skin in the game”.
2. Be prepared to change.