The audiogram is critical to being able to diagnose hearing loss and to properly fit hearing instruments. But if you agree with me that the most important goal of the hearing evaluation is building a solid case that obtaining hearing instruments is among the best things your patient can do to help themselves and their loved ones, then the most important component of the hearing evaluation is the needs-assessment.
The needs-assessment has two goals. The first is to gather information. We certainly have a need to understand our patient’s medical and otological history. As important is to identify specific situations that have been giving our patients difficulty. By doing so we are able to identify for them technology that will address these specific situations.
Much more can be said about this goal in the needs-assessment, but today my purpose is to discuss the second goal of the needs-assessment:
To encourage your patient to think about their hearing loss in a way they have likely never done before.
I venture that the typical patient “in denial” has spent little time in quiet contemplation of their hearing loss or how it affects them or others around them. If it is considered at all, it is as an annoying fact of life that they would rather not deal with. When the subject does come up with family and friends it is usually not a pleasant conversation. “You need hearing aids!!!” “I am sick and tired of you saying ‘what’. ‘huh’, ‘what was that’ all the time.” “The TV is up so loud I can’t hear myself think!” Not conversation-starters conducive to constructive or rational discussion.
In the needs-assessment we have an opportunity, in a non-judgmental atmosphere, to encourage our patient to consider their hearing loss in the absence of such confrontation. For example, when the patient’s primary communication partner is in attendance, we have an opportunity to foster a conversation between the patient and their partner that is much different in tone and substance from those typically occurring in their homes.
How do we facilitate such conversations? By engaging the primary communication partner in the process in a way that does not encourage the kind of rancor to which these conversations are typically prone. A conversation might go something like this:
Primary Communication Partner (PCP) – Sometimes Joe is just sitting in the corner not taking part in whatever is going on.
Hearing Care Professional (HCP) – Can you tell me about a time recently when that happened?
PCP – Sure. Just last week our daughter and her family were over for dinner and Joe missed most of the conversation. He finally went to the family room and put on the football game (vey loudly, I might add).
HCP – How did that make you feel?
PCP – It made me sad. Janie’s kids thought they had done something wrong to make Joe go away. And I know Joe wasn’t happy either – just frustrated because he couldn’t hear.
Patient – I had no idea you felt that way.
PCP – I feel that way a lot, honey.
You may think this an apocryphal conversation, but I have been part of or witnessed such conversations many times over the years. This is not the direction conversations like this have gone for these folks in the past. An exchange that goes this direction can change lives. I have seen it happen.
It is also clear that many patients, particularly those who are less-than-convinced that their hearing loss is real nor affecting others, have done little personal reflection around their hearing. We can be useful in providing an opportunity for such reflection.
When done in a neutral, non-threatening, non-confrontational and positive manner, we can facilitate change in our patient’s attitude toward their hearing loss and its treatment. Some simple questions asked in this kind of an environment can get your patient to verbalize, and therefore make real to them, rationalizations for their attitudes toward their own hearing.
This is where a terrific tool from the Ida Institute called The Line comes in. The Line involves asking your patient two simple questions, each with an equally simple follow-up.
The first question is:
“On a scale from 1 to 10, 1 being very bad and 10 being very good, how would you rate your overall hearing ability?”
The follow-up depends upon the patient’s answer. If they rate their hearing as on the good side of The Line, ask why they didn’t say it was poorer (“Why 6 and not 3?”). You can remind them of situations they have told you are problematic for them and ask why they did not rate their hearing as poorer. This will make them face the difficulties they are indeed experiencing.
If, on the other hand their perception is that their hearing is poor, ask why not better (“Why a 3 and not a 7?”). This will reinforce their self-perception of hearing loss as interfering with their daily life. In both situations, by hearing themselves explain their rationale they will be making themselves a much stronger case for doing something about their hearing sooner than later.
The next question is addressed in a similar fashion:
“How important is it to improve your hearing now?”
Again, if the answer is low, ask why not higher and vice versa. The patients’ own rationalizations will tend to be the strongest arguments for proceeding with the hearing help they need.
Make no mistake; persuasion is part of our job. The most effective persuasion comes from oneself. When someone tries to hammer change down my throat, I am likely, nay certain, to resist. When I talk myself into something, I just might change.