Portal de Periódicos da CAPES

The good, the bad, and the ugly

2007; Lippincott Williams & Wilkins; Volume: 60; Issue: 1 Linguagem: Inglês

10.1097/01.hj.0000324493.59315.11

2333-6218

Robert L. Martin,

Figure: Robert L. MartinI believe our profession is the greatest job on earth. There are times you and I have the opportunity—the great pleasure—to do “magic.” We improve the lives of people dramatically. But our profession is often stressful and exhausting. If you want to enjoy a long career in this field, you had best be prepared to deal with burn out and other job-related problems. You need to have a life outside the profession and you need to look after your physical, emotional, and mental health. Let's take a look at some aspects of this job—the good, the bad, and the ugly. PEOPLE DIE I've known “David” for many years. He is deaf in one ear and has a profound mixed loss in the other ear. He and I swap stories about our boys, who are the same age. David's son came with him to the office several times. He wanted to show off his football jersey. Well, I saw David the other day and he looked at me with troubled eyes and said, “I lost my boy last month.” I was too stunned to speak. I just sat there and cried. I knew the boy had been sick, but I never thought it was life threatening. There was nothing I could do for David except be there as a friend to him. While this was an unusual case, since David's son was so young, death is all too common among our patients and their spouses. If you've been in this profession for a while, you've had the experience of seeing a patient on Friday who died the next week. It's just the nature of the patient population we deal with most of the time, an inherent aspect of our job. But that doesn't make it any easier to bear. PATIENTS MAY BE BEYOND OUR HELP The other day, I saw “Joan,” a 39-year-old lady who had been treated with an ototoxic medication for tuberculosis. She had 20-dB thresholds from 125 to 500 Hz and no hearing in the higher frequencies. Her word understanding was zero bilaterally. Joan was highly motivated to hear better, and I wanted to help her— yet there was nothing I could do for her. This type of patient represents one of the major frustrations of our profession—people we cannot help with amplification. Fortunately, many are candidates for cochlear implantation, and we should urge them to pursue that alternative. PEOPLE CHANGE For 25 years I've been looking after “Dorothy,” who has severe conductive hearing loss in one ear and no hearing in the other. She loved me and praised me. I was always her “saint,” the greatest doctor in the world. Then last year her mental and emotional state deteriorated markedly; she is now difficult to work with. Nothing pleases her. The fun and loving Dorothy I knew is gone. This is another stressful aspect of this job. You get to know many patients so well they are like family. But, the last few years of their lives may bring huge problems to everyone associated with them. AVOIDING PROFESSIONAL MISTAKES As a profession, I believe we need to do a better job of policing ourselves. Most of our patients love us, but this can change. We should not take their trust and approval for granted, especially when we are doing invasive procedures that have a potential to do harm, e.g., taking impressions. If issues arise that are beyond our scope of practice, we should refer them to an appropriate professional. The practice of medicine changed when lawsuits became common. Defensive medicine is now the norm. If we are not careful, “defensive hearing aid fitting” could become a reality and we could lose the professional freedoms we now enjoy. Patients trust us to care for their hearing and ears. We must respond with competence and caring. FEEDBACK IS FOREVER Feedback is one of the ugly parts of this job. It's been around since the hearing aid was invented and, despite huge strides being made with modern anti-feedback circuitry, it continues to plague us. When people talk about hell, they refer to fire and brimstone. I think they have it wrong. If you want to describe incessant torture, “feedback” is more painful. I could get used to fire. But feedback? PEOPLE ARE PEOPLE Human nature varies from one extreme to the other. Humans can be very loving and supportive and they can be unreasonably demanding and uncooperative. It is a joy to work with happy, reasonable people. But some days, it seems like only the demanding, unhappy, irrational ones make it to the office. On those days, you have to shift into self-protect mode, put on your “happy” professional face, and be super-polite. Finally, and most importantly, we need to remember that we are people too—precious people who need and deserve to be treated just as well as we treat our patients. You are your practice's greatest asset, so treat yourself accordingly—with love and support. You deserve it.