At the end of any interview with a potential new provider, I ask whether they have any questions for me. Many have none, some ask about hours and other working conditions, some ask about clinical protocols. The other day I got a question I had never received before. It made me think. “What do you think,” she asked, “is the most important attribute of an effective hearing professional?”
Wow! What a great question! She definitely got points for that one.
I had to quickly gather my thoughts. I have plenty of ideas of what are some of the qualities of an effective HP, but what is the common thread of all these characteristics. Is there an axiomatic characteristic that underlies them all? I didn’t have much time to come up with a sage response, but I think I did OK. And, after considerable thought since then, I think I was pretty true to myself, at least. Your answer may differ, but what I came up with was mindfulness.
What I mean by mindfulness is being in the moment with one’s patient. It comes from the tradition of meditation, during which all that exists is the present. While in meditation, ideally, all that exists is one’s breath, one’s body, and the immediate sensations of one’s surroundings. Thoughts, concerns, worries are briefly acknowledged and allowed to pass by.
Admittedly, I am not a particularly good meditator. I am comforted, however, by the perhaps apocryphal story of the individual who was attending a seminar by an acclaimed Zen master. They approached the master and said, “I always fall short in my meditation. I can’t maintain total relaxation in the moment. My mind keeps intruding with thoughts and concerns.” To which the master responded. “Pity, you are no different from the rest of us.”
Mindfulness in the Clinic
I know I am not the first to come up with the idea of mindful counseling. But the following is what I mean by the concept. Let me just say that I do not mean conducting counseling from lotus position. My knees and hips no longer do that! What I do mean, however, is that my total concentration is on my patient and what they are telling me. While they are telling their story, my mind is open to how they feel, what they mean, what are the implications of what they are saying, and what I have to offer to address the problems they bring.
What behaviors tend to detach me from the moment?
Distraction – While I am with my patient, future and past must wait. Personal concerns, work issues, my plans for later in the day or next summer are not part of my consciousness. I do not multi-task. Multi-tasking is really not possible after all. Actually we are not capable of performing multiple tasks simultaneously, only executing them sequentially very quickly. My only concern should be my patient and remaining in the moment with them.
Over-reliance on a “script” – There are those who advocate memorization of a written script. I have never thought much of the idea. Even if ideas originate from somewhere other than myself, I need to express them in my own way. But I do know that, after having seen thousands of patients in my life, a “script” of sorts has the tendency to emerge. I find myself using the same descriptions, the same words over and over, on auto-pilot.
Once, when I was a young and callow audiologist, I had just tested a middle-aged woman who had a symmetrical moderate SNHL with very good word recognition ability. I was blithely describing her hearing loss, explaining to her how easy it was going to be to fit and how well she would do with hearing aids (all on auto-pilot). I looked up to find she had tears streaming down her face. What to me was a simple solution to a simple problem, to her meant that I was verifying her worst fears, that she was no longer the person she used to be, that she had tangible evidence of her advancing age and perhaps even her mortality. Had I been more in tune with her, I would perhaps have couched my counseling in a less matter-of-fact manner, softening the blow. My “script” had backfired.
Not Listening – This would seem to be a no-brainer. But if I am not careful, rather than listening to my patient, I am sometimes waiting for an opportunity to talk. My patient has said something that has kicked up in my head a topic that I feel energized to expound upon. As my patient continues to talk, this impulse becomes more and more urgent, to the point that I am no longer listening – I am rather looking for an opportunity to provide my patient the great benefit of my wisdom. When this happens, I need to heed the advice of Queen Elsa in Frozen. Just let it go! If it is that important, there will be another opportunity to bring it up. Otherwise, I should be more interested in listening than talking. In the initial phase of my encounter with a patient, I need to keep the Patient Talk to Me Talk ratio to something like 3:1. This is my patient’s time to open up and tell me their story. Later there will be plenty of opportunity for me to expound.
I also need to recognize that my patient does not need to know everything I know. I have observed providers who, perhaps through inexperience and lack of confidence, overwhelm their patient with their deep knowledge of acoustics, ear anatomy, hearing aid technology, aural rehabilitation and where they went on vacation last year, whether it relates to their patient’s problems or not.
I find it best to keep my comments focused on information that relates directly to the issues my patient raises. And that, mainly after I have obtained and assimilated all the information I can about them.
How can being in-the-moment benefit you and your patient?
Mindful counseling can help to establish rapport and found a true connection. People want to have a therapeutic relationship with someone they know and like. Listening is a very likeable attribute. Who does not want to be listened to, to be taken seriously, to have someone be interested in what they are going through?
Being in the moment also allows for “listening deeply”, as described in detail in a previous article. When I am focused on my patient alone, I am free to listen beyond the words to the meaning, the emotion, and the implications of what they are telling me. It keeps my mind free to focus on how the information I am acquiring can be used to serve this specific patient’s needs.
Yesterday is history, tomorrow a mystery. Let’s live with our patients in now.
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.