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Why doesn't my hearing aid work better? and other questions you're sick of hearing

2007; Lippincott Williams & Wilkins; Volume: 60; Issue: 5 Linguagem: Inglês

10.1097/01.hj.0000285592.27507.c9

2333-6218

J Nemes,

Healthcare Systems and Technology

You know him well. He's the patient who comes in for his follow-up visit after being fitted with his first hearing aid. You recommended two, but he insisted one was all needed. You walk into the room and sit down and you just know the question he has poised on his lips, waiting to fire at you as soon as you say hello:Figure“Why isn't my hearing aid working as well as you said it would?” he asks accusingly, forgetting or ignoring that you told him he needed hearing aids for both ears. You probably resist the urge to shout, “I told you so!” Or maybe you actually give that reply, though phrased a bit more sensitively. One would hope that such encounters would be the exception, but, as practitioners will attest, common complaints and crazy questions are all part of everyday life in this profession. And, while you've undoubtedly made many patients happy with the care you provide, it isn't very often that they show up in your office and carry on about how pleased they are with their new hearing aids, muses Roger Larose, MA, director of audiology services at Hearing Treatment Centers in Chicago. More likely it's that one disappointment with their fitting that they have come to tell you about. And often, says Larose, they will blow it out of proportion. Besides, it's just human nature to complain, he adds. For hearing professionals who see patients every day, the questions that come up again and again are frequently frustrating, occasionally amusing, but always deserving of being addressed in a caring and careful way to make sure they are answered appropriately. Lecturing patients about what they did wrong only causes them to feel patronized or insulted. And if a practitioner seems to make light of a complaint, the patient may decide he is not getting the concern he deserves. And some days, no matter what you say, you can't win. One of the underlying reasons for the host of frustrating questions that patients pose is their refusal to “take ownership of their own hearing health,” says Gyl Kasewurm, AuD, an audiologist in private practice in St. Joseph, MI. She finds that many patients who come into the office expect the professional to hand them a device that will make them hear again without any effort on their part. “Many patients need an attitude adjustment,” says Kasewurm. “Their general attitude goes hand in hand with the type of questions they ask and their expectations of us as professionals.” To be fair, she acknowledges that hearing care providers too often foster this type of attitude by singing the praises of the latest technology. If they exaggerate how well the hearing aids work, it's no wonder if patients are surprised to discover they have to work at improving their hearing with the new devices. Moreover, many of today's hearing aids are so expensive that patients expect them to do the job of hearing for them, says Robert Sweetow, PhD, director of audiology and professor of otolaryngology at the University of California in San Francisco. He says that practitioners need to walk a fine line between promoting the very real benefits of the newest technology and cautioning patients that they'll have to put in some hard work to get the best results possible. Sweetow adds, “We have to begin marketing ourselves as rehabilitation specialists and explaining that the hearing aid is only one component of a very complex package to help a person learn to communicate better. If the hearing aid is seen as the only solution, then patients might as well buy them on the Internet.” A LITTLE HUMOR CAN GO A LONG WAY While people all have their own methods of interacting with patients, experienced practitioners recommend using a combination of humor, kindness, and understanding when confronted by patients asking the same questions over and over. Sometimes a straightforward approach works well too: Acknowledging what the patient is upset about validates the person's anger. After doing that, says Sweetow, the professional should zero in on the specific problem (if there is one) and focus on rectifying the situation.Figure: Connie JohnsonIf someone comes in angry or cranky and has a laundry list of complaints, professionals might want to employ a touch of humor to help ease tensions before the situation turns adversarial, suggests Connie L. Johnson, BC-HIS, who has been dispensing hearing aids for 28 years. Johnson, who works at the Woodward Hearing Aid Center in Sacramento, CA, says that practitioners can use humor to calm patients. Once the initial anger has receded, the professional can assure the patient that he or she will take all the time needed to solve the problem at hand. “We gain their trust first by using humor, then telling them we are there to solve their problems,” says Johnson. Humor is essential to connecting with patients who are upset, says Sweetow, who relies on a self-deprecating style of humor. He will often poke fun at men in general, and their reputation for being bad at multi-tasking. He'll joke that males, whether they wear hearing aids or not, can't watch a football game and have a conversation with their wife at the same time. Most men chuckle because they can relate to that scenario, he says. Humor aside, Sweetow prides himself on being a better counselor than audiologist. He believes it's imperative for the practitioner to empathize with the patient's situation and be a good listener. Since he wears a small, behind-the-ear hearing aid, he can personalize some of the problems his patients experience because they recognize that he has gone through similar situations. He suggests that practitioners who don't need hearing aids talk about the experiences of their parents or grandparents. Regardless of what strategies they employ, practitioners say it's a minefield out there. Every patient is different and some are just plain difficult. So, they caution, no single approach or tactic will be successful with everyone. What follows are several commonly asked questions, with tips from long-time practitioners on what they've learned to do to handle them successfully. We hope the experiences shared in this article will help readers respond when they are confronted with one of these all-too-frequently-asked questions.Figure: Robert Sweetow“WHY DO HEARING AIDS COST SO MUCH?” Sometimes patients come into an office armed with prices they've found on the Internet and want to know why they should pay more for hearings aid that they buy from a practice. When that happens to her, Gyl Kasewurm says she spends time carefully explaining the value-added personalized services they get from her. Usually, she finds, the information is well received. In explaining why the actual devices are expensive, Kasewurm takes a multi-media approach. On the large plasma TV screen in her office, she shows patients DVDs from manufacturers demonstrating the complex process involved in making hearing aids. The DVD details all the ways a digital hearing aid can be customized for the end user, something that isn't done for patients who buy their hearing aids online. Connie Johnson says she gets the price question all the time. No shrinking violet, she shoots her own questions back at patients: “Why shouldn't they cost a lot? What should years of research and millions of dollars in research and development cost?” She also uses the pharmaceutical industry and the high price of prescription drugs as a basis for comparison. Johnson encourages her older patients who complain about the price of hearing aids to consider how much they pay for the blood pressure or heart pills they take, which, as she puts it, are really just little particles of dust in their hand. “They're paying a lot for the research and development that went into those medications, and they understand that,” she says. “We try to help them gain perspective with comparisons to other things they can relate to in their life.” Sometimes Johnson encourages really hard-core cost complainers to visit a manufacturing facility on their next trip down the California coast to get a first-hand look at all that's involved in making a hearing aid. She says some patients have taken her up on the offer and stopped in to take a tour of Starkey's Anaheim facility. “When they come back, they're wowed at what they've seen,” she says. Robert Sweetow agrees with many of his patients when they are upset about the cost of some hearing aids. They do cost too much, he intones. Sweetow believes that not everyone needs the “Rolls-Royce model.” For some patients, he says, “a Honda” will do just fine for their needs if all they're doing is “driving it to the grocery store and back.” High-end instruments have lots of extra, wonderful features, he says, but adds that they may not be useful for every patient. He advises practitioners to be responsible and make sure not to recommend the most expensive hearing aid if a cheaper one will provide all the benefits a particular patient wants. “The consumer is paying for the honesty of the professional, which, unfortunately, isn't always there,” he adds. “WHY DO I NEED TWO HEARING AIDS?” Bob Klein, BC-HIS, a hearing instrument specialist at Willoughby Hearing Aid Centers in Portland, OR, says he would rather give away a hearing aid (temporarily) to a patient who needs two than let him leave the office with only one if that's all he's willing to pay for. So, even when patients are adamant about wearing only one hearing aid, Klein insists on ordering two for them. He only charges patients for one if they promise to wear both hearing aids for 30 to 60 days. When the patient returns, he asks him to decide which one to give back. “Usually they keep both,” says Klein with satisfaction, “and they pay for the second one.” He says that this issue has come up regularly during his 13 years of practice.Figure: Bob KleinWith patients who have fixed in their mind the idea that they need only one hearing aid, Klein uses glasses for purposes of comparison. “I tell them in the old days people used to wear a monocle to read. Now they wear glasses. Same difference with hearing aids.” Aside from all the research and technical information supporting bilateral fittings that Johnson can offer patients who ask why they need two hearing aids, she likes to throw in a bit of humor. “I tell them if God wanted us to hear with one ear, we'd have one at the top of our head like an antenna and it would swivel.” Then, she says, “I explain to them that there isn't a spare ear. I tell them you hear with your brain and your ears are the transmitters.” After this, Johnson says, she and her colleagues can elaborate on the scientific reasons why two hearing aids are usually better than one. “WHY DON't MY HEARING AIDS WORK AS WELL AS MY WIFE's?” Sweetow cringes when patients complain that their hearing aid fitting doesn't help as much as someone else's, even when the other person seems to have a similar hearing loss. Sweetow, who has conducted research in this area, explains to patients that no two people hear exactly the same way, even if they have an identical amount of hearing loss. “We don't hear in our ears, we hear in our brains, so another person with the same hearing loss may have different skills in listening and cognition,” he says. “No matter how good a hearing aid is, there's a limit to how much it can help a wearer if the person has poor listening skills.” Sweetow notes that recently there has been a resurgence in auditory training and aural rehabilitation programs that involve patients in the process of improving their hearing and communication ability. He believes that getting patients actively involved will go a long way to minimizing the kind of comparative whining that some patients engage in because they'll be more focused on their own situation and realize they are an integral part of their own successful rehabilitation. After 30 years in practice, Sweetow says he has the confidence to tell patients things they may not want to hear. “I tell them that if they're not willing to participate in their own rehabilitation, they give up the right to blame the failure on their hearing aids or on the professional,” he says firmly. Jerry Smith, BC-HIS, a hearing instrument specialist who owns 26 practices throughout Iowa, says patients often have unrealistically high expectations for their hearing aids because professionals are over-selling the benefits. That kind of promotion causes patients to be disappointed no matter how much improvement they've achieved with their new hearing aids because the benefit doesn't match their expectations. “We are selling expectations, but the strong counselors have happier patients,” says Smith, who has been in practice for 33 years. “If you do a good job of counseling before selling the hearing aid, you shouldn't get questions about why it isn't working as well as they expected.” Still, Smith adds that sometimes there are legitimate complaints about the functionality of a hearing aid that need to be addressed. He will try to identify the problem and adjust the device if, for example, there is feedback or settings need to be tweaked. Kasewurm has devised some good pointers to discuss with patients who are disappointed with the initial results of their new hearing aids. She tells them that better hearing is a process and that it includes rehabilitation. She explains that when she fits hearing aids on a new user whose auditory system has gone without stimulation for a long time, it takes time for the brain to relearn how to respond to sound and enable the person's hearing to improve. “It's a process that has to be learned and practiced,” she explains to patients. “I tell them when you purchase hearing aids you can't expect them to work as well as a new DVD player you take home from a store.” An important way to minimize disappointment for new hearing aid wearers is to outline realistic expectations at the outset and impress upon them that they will need to work hard to get a good result, says Kasewurm. Before discussing amplification, she conducts speech and noise testing so patients understand their hearing deficit and learn that they may need rehabilitation classes in addition to buying hearing aids. She also strongly recommends that a family member participate in the visits to her office so the patient gets the support and encouragement needed and the family learns that the hearing device isn't the only solution to the patient's hearing problem. “Patients need to know they're part of the outcome,” she says.Figure: Gyl Kasewurm“HOW LONG WILL MY HEARING AIDS LAST?” Sweetow tells his patients that their hearing aids will generally last about 5 years—if they take good care of them. However, he cautions them to stay informed of technological improvements because new features on updated models could potentially make a big difference in the quality of hearing a patient may experience. Sometimes, says Sweetow, professionals complain when patients read about hearing aids on the Internet because they feel like experts after gaining a little information on the technology. However, he says, he prefers that patients do some research because it gives him the opportunity to elaborate on some of the more current technology. “CAN't YOU GIVE ME SOMETHING SMALLER?” Like most of her colleagues, Johnson frequently sees patients who ask for the smallest possible hearing aid so the rest of the world won't notice their impairment. In those instances, she asks patients what is the most important benefit they're hoping to get from hearing aids. They usually tell her things such as that they want to hear their grandchildren's voices, be able to enjoy talking with friends, or hear the minister in church. She then asks patients why, if those issues are what matter most to them, they place such a priority on getting small hearing aids that won't be as helpful as the ones she's recommending? Johnson adds, “I tell them that their hearing loss is more noticeable than their hearing aid. I say it slowly and methodically, and they trust me. I tell them I'll do everything I can to keep the device as small as possible, but it has to work to meet their priorities. Then they get it.” Cathy Messina, MA, who owns a solo audiology practice in Baton Rouge, LA, says that occasionally she will give a patient a smaller model than she thinks best if that's the most important thing to the person. But before that, she'll try to talk them out of a smaller one and often she succeeds. Messina advises patients that the smaller ones may not be appropriate for their situation or that they'll have to give up certain features a larger one may offer that could improve their hearing, such as directional microphones or a telecoil. She also counsels them that if their present hearing loss is at the limit of what the smaller model can handle, it may become inadequate if their hearing worsens over time, as it usually does. “Lots of first-time hearing aid users tend to be a little more conscious of the esthetics,” notes Messina. “After patients have worn hearing aids for a while, lots of times you can talk them into using something larger because they've begun to see the benefits.” “HELP! I SWALLOWED MY HEARING AID!” If you work in this field long enough, you'll hear just about everything from your patients, including stories that are downright bizarre or hilarious, depending on your attitude. Here again, employing kindness and good humor can be helpful, practitioners advise. In his practice in Oregon, Bob Klein remembers a couple of experiences with patients that may be hard to top. One gentleman called him to report that he had accidentally eaten his expensive little hearing aid, thinking it was a vitamin pill. Klein calmly advised him to keep a close watch and retrieve it when it came out the other end. Sure enough, 3 days later, the patient brought in his hearing aid in a Baggie and Klein shipped it off to the manufacturer for repair. In another incident around Halloween, a patient mistook her hearing aid for food because it was sitting on a countertop near the candy corn. She began nibbling on it until she noticed there was nothing sweet-tasting about the digital device. She, too, brought it to Klein for repair. Every once in a while, Cathy Messina says she gets a patient who isn't satisfied with any of her answers to the vast number of problems he raises. All the person does is complain, complain, complain, she laments. Her advice? “If all else fails and they don't like your answers, refer them to your competitor!”