In my work, one question that comes up on a regular basis is, “How do I deal with the patient who hijacks the appointment by dominating conversation?”
If you have been around for a while, you know what they mean. This is the patient who talks to the point that little or nothing can be accomplished. They are not receiving the care they require and are sometimes inconveniencing other patients (and you) by running appointments over.
Most of the time the conversation is benign enough – vacations, family issues, grandchildren, etc. Sometimes it is a person with an agenda of some sort – all hearing care providers are shysters, hearing aids should not cost so much. My favorite, of course, is the engineer intent on schooling me on hearing aid technology and acoustics. Only rarely does it have more than tangential relationship to them or their communication partner’s hearing.
Dominating the Conversation
It is important to take into account that dominating conversation is a maladaptive communication strategy employed by many people with hearing loss. They have learned that if they are talking, they don’t have to worry about mis-hearing, looking conversationally inept or even cognitively impaired.
But this maladaptive strategy, as with anything “mal” (bad) will eventually turn against those who wield it. In a therapeutic environment, it can delay or even prevent the patient from obtaining the care they need.
Keeping this patient on track is important to their own well-being. Allowing the patient to continue down that unproductive path does them no favors. How, then, to walk the delicate line between confident control of the appointment and alienating your patient?
Attention is a reward! As someone who does a lot of public speaking, when doing a presentation, I always seek out the nodders. These lovely people regularly smile and nod at the sage information I am providing. They are the participants who are engaged, interested, and, most importantly, they agree with me. Glancing their way occasionally gives me energy. Conversely, if I am addressing a group that is listless and bored (it is my job not to induce that, by the way) my energy also flags.
When I was in college, in Psych 101 we were discussing operant conditioning. All that B. F. Skinner stuff about reward and punishment. Behaviors that are rewarded are repeated and those that are not are extinguished. The story is told of a particularly devious group of Psych 101 students. The entire class conspired to condition the professor to lecture from the far corner of the room. As he got closer to that corner, the class would attend to him actively, and as he moved away, they would look away. Sure enough, in short order he was delivering his lecture jammed into the farthest corner of the room.
He was completely unaware of how he had been manipulated, and was, I am sure, quite chagrined when he found out.
Sometimes it is OK to be a “bad audience”
If a patient or significant other begins to wander down rabbit trails that lead nowhere, take away the energy and give them nothing to respond to. Look at your chart or at the patient’s communication partner.
Your attention fans the flames; your lack of attention tamps them down. Once you have re-established yourself as the speaker, you can once again be actively engaged.
A provider I was working with recently was having just this difficulty. In discussing her upcoming patient (Mr. and Mrs. Dawson, for our purposes, Mister being the patient), the provider (we will call her Trudy) told me that Mrs. Dawson was quite a talker.
We discussed strategies to address this, one of which was, “Don’t fan the flame!” If she starts on a tear, wait for Mrs. Dawson to run out of gas. Withhold eye contact, don’t nod or verbally agree. Not even a quiet “mmmhmm”. When she stops, take a beat, re-establish yourself as the speaker and get back to the business at hand. Fine! Will do! We had a plan!
Things were going pretty well. Mrs. Dawson was not dominating too very much, but suddenly got onto a topic she could really get her teeth into (having virtually nothing to do with her husband’s hearing loss, by the way). Trudy was keeping quiet and Mrs. Dawson finally came to a stop. Wanting to be a courteous person, Trudy simply said two words, “That worked.” You should have seen Mrs. Dawson’s eyes brighten! She revved right up, probably thinking, “Trudy is really interested in this – I will do her a big favor and tell her all the details I just left out.” And off she went on another several minute monologue.
Trudy, realizing her mistake, glanced over at me with a look that said, “Why the heck did I do that?”
Remember, you are the driver. Your patients need you to keep them on track so that you can do what they came to you for in the first place: to improve their lives through better hearing.
Paul U. Teie, MS, has been an audiologist since 1991. He has spent much of his career in direct clinical care but has filled other roles in the hearing care industry as sales representative of a special instrument dealer and a hearing instrument manufacturer. Since 2007 he has provided sales and clinical training for large hearing care networks and currently trains for HearUSA/HearCanada.