This blog by James (Jim) Curran continues with the history of the first audiologists who were employed by hearing aid manufacturers and paved the path for future audiologists in this discipline. Jim has gone to great lengths to capture this history that would otherwise be lost, and as a result, his story will be told in several blogs scattered over the next months. He has been able to provide great insight into the problems, concerns, tribulations, and difficulties of the early seven audiology-degreed pioneers. What he describes was consistent, at least to some extent, with all of us who entered the “unclean” discipline of hearing aids in the formative years. Wayne Staab, Editor of Wayne’s WorldPrologue: I consider becoming unethical Jim Curran
In 1964, I was pursuing a Doctorate in Audiology at the University of Wisconsin (Madison). I met a fellow student, Don Schaefer, who was taking audiology courses at Wisconsin as an adult special, not so much to get a degree, but to learn something about audiology. He was a salesman for the Parke-Davis pharmaceutical company and part of his duties was to keep his ear to the ground about new technologies and other developments at the University of Wisconsin Hospitals that might be of interest to the company. So he had free reign pretty much throughout the hospital, and he noticed that hearing aids were the only medical device that was not dispensed through professionals. In those days you could step off the bread truck yesterday, and become a hearing aid dealer today. Minimal study was involved, and no license was needed, and as a result, the field attracted folks who had one thing in common: they had the gift of gab. This was needed to persuade people to buy the bulky, ugly instruments of the time, connected as they were by a noticeable cord running to a big earmold in the ear, instruments that had terrible sound and were overly expensive. Many of the dealers were educated, ethical and responsible, but they were in the minority. More used marginal tactics to effect a sale.
Further, so many people, (but not all), did not find the instruments useful, and you had to talk fast to keep them happy in face of the instruments’ shortcomings and convince them that they would get used to the aid. Some responsible dealers actually did develop reasonably decent fitting techniques, knew how to counsel people and adjust the aids when things were not quite right, and learned to minimize their mistakes so their patients remained loyal to them. For those dealers, hearing aid sales was very profitable and personally rewarding, for they were held in very high esteem for having solved their customer’s hearing problems. Others entered and left the field within months, fitted a few folks and then escaped from the complaints and after-fitting issues that invariably followed.
The sad thing was that audiologists in those days (1960s) knew very little about hearing aids, although they thought they did. And medical doctors knew even less about aids and did not want to dirty their hands. So the patient went to the doctor, might be referred by them to the audiologist (rarely), who in turn referred the patient to the dealer who did the actual fitting. On the one hand, audiologists knew infinitely more about the science of hearing and hearing disorders than any hearing aid dealer. On the other, a representative number of good dealers definitely knew more about hearing aid fitting than audiologists did, even with their lack of academic training. Despite this fact, audiologists took it upon themselves to specify (using totally unreliable selection methods, we realized later) that a given patient should be fitted with a given hearing aid at a specific setting. If the recommendation turned out wrong, and the patient did not benefit (which they often didn’t), the dealer had to take the brunt of the patient’s dissatisfaction. Further, if the dealer desired more referrals from the audiologist, the audiologist usually demanded the patient’s money returned if problems ensued. It was no wonder that the dealers hated audiologists for setting themselves up as experts and authorities when it was obvious that almost all audiologists did not know what the hell they were talking about. And usually, neither the doctor nor the audiologist, the two primary specialists in hearing, ever saw the patient again, because the patient returned to the dealer for follow up. Not a responsible state of affairs, and tragic in the case of children, for many dealers had no idea at all how to deal with a profoundly deaf young child.
Don Schaefer had a different idea: to open hearing aid offices that employed audiologists, so that the patient would receive the best professional help. Patients would be seen only if referred from doctors and other audiologists. Without realizing it, his idea was responsible for eventually turning the profession of audiology upside down, spearheading the movement of the profession away from a primarily diagnostic discipline as it was then, to eventually becoming the major force/player for the dispensing of hearing instruments. The more I thought about it, the more I became convinced that Don had the answer, and the way the profession had evolved over those past twenty years was wrong. Audiology started during WWII and early on was primarily a rehabilitative profession, serving to assist vets to adjust to their hearing loss issues, and hearing aid selection and fitting was one of the main thrusts of the program. But gradually, audiology moved away from this and shuffled rehabilitation to the bottom of the audiology totem pole. In its place, developing and performing site of lesion diagnostic measures became the preferred mission of the profession.
The professors of that time were trying to have audiology recognized by the university faculties as a serious, legitimate academic field of study leading to advanced degrees, and knew that audiology would not be admitted to the academy and graduate schools if the sale of hearing aids were part of the deal. So they eschewed the idea of hearing aid dispensing as part of our profession’s charter. This was a reasonable idea in the beginning, but which caused big problems down the road.
The next blog from Jim will continue with “I Was Unethical and Didn’t Understand it.”