Portal de Periódicos da CAPES

What's luck got to do with it?

2003; Lippincott Williams & Wilkins; Volume: 56; Issue: 6 Linguagem: Inglês

10.1097/01.hj.0000294056.06034.ea

2333-6218

Robert L. Martin,

Figure: Robert L. MartinWe like to say this business is half science and half art. But when Lady Luck is in town, science and art go out the window and she calls the shots. Luck can be good or bad, but in either case it is a powerful immutable force of nature—one you have to learn to live with if you want to survive in this field. My patient Julia is an example of good luck. She came in this morning to get a pair of BTE hearing aids. Her hearing is off the chart at 2000 Hz and above. The earmolds fit perfectly and the feedback-control software eliminated feedback. The first fit algorithm did a good job also; I only had to increase the gain in the lower frequencies. Julia got all excited, saying, “I can hear! I can hear!” You might say this wasn't luck. It was the result of years of practice and a pair of excellent power BTEs. To be sure, practice and good hearing aids help. But when the earmolds are perfect, the fitting comes together quickly, and the results are better than predicted, Lady Luck has lent a hand. She's also involved in John's case, only on the other side. I've seen John twelve times for unanticipated hearing aid repairs. He is, understandably, very unhappy about the situation, and he lets us know how he feels. Many of my other patients wear the same model as John and have few problems. He just seems to be a victim of bad luck—and lots of it! I don't understand some aspects of luck. For example, why is it that a few unfortunate patients have major problems with feedback while many others wearing the same model with the same gain and the same vent do not experience feedback? Or, why do many patients encounter no difficulty wearing very mild-gain CIC hearing aids with large vents, while a small percentage of people have irresolvable feedback. Why does luck—whether good or bad—seem to follow some hearing aid wearers, regardless of the make and model that they wear? Some people wear the same pair of hearing aids 10 or 12 years without a single problem. These people scare me when they walk in the door because they'll expect their next set of hearing aids to work the same. CREATE GOOD LUCK I really don't know how to answer some of the questions I've raised. Maybe there are no answers, except to say that Lady Luck is capricious by nature. Nevertheless, I do believe there are ways you can attract good luck and avoid bad. Let's talk about some of these. If you want good luck, you have to anticipate it. Look for it. Work to make it happen. When you drive to the store, you are not going to get lucky and find a parking place right by the front door if you never look for it. Luck changes continuously, so you never know when it is your turn to be lucky. Branch Rickey, a famous baseball executive of yesteryear, said, “Luck is the residue of design.” In other words, while you can't guarantee yourself good luck, it's more likely to come your way if you plan what you do with care. One important example in hearing care has to do with taking care to develop good patient relations. If your patients respect your professional knowledge and skills, they are more likely to listen to you and trust you. That can improve their luck and yours. For example, if you repeatedly warn patients that hearing aids are delicate items that need to be treated with care, they will likely heed your advice and take good care of their hearing aids. And, even if they do need repairs, patients will understand that this is normal and not bad luck or a sign of a defective product. If you do your best with a patient and the fitting keeps failing anyway, don't endlessly repeat the process. Find a different approach: different models, different plastics, different retention points, different zones of amplification, etc. When I have a streak of bad luck, I'll laugh and say, “Life is like baseball—three strikes and you're out, and I just struck out.” I then tell the patient about a different type of hearing aid fitting. AVOID MEGA-DISASTERS Every so often, various circumstances come together in such a way as to create mega-bad or mega-good luck. Off-shore sailors talk about the once-in-a-decade combination of wind and ocean swell that creates a “perfect storm” swamping every boat in its path. “Perfect storms” can happen in the hearing aid business if we are not careful and if we fail to follow our own well-thought-out standard operating procedures. Let me give you two examples. A patient and his wife were going to celebrate their golden wedding anniversary on a cruise. I rushed the fitting and set the output way too high. He stubbornly wore his “wonderful and expensive” new hearing aids during the dances and other musical events on the ship. The sound of the trumpet almost took his head off. When he returned and complained about the fitting, I thought he was going to have a heart attack. I've never seen a more frustrated and angry man. In the other case, a physician brought his mother to see me and I fitted her with hearing aids. I rushed the follow-up visits, believing the doctor was in a hurry. I did not do UCL testing. Only years later did I learn the sad truth. The MD's mom never wore her hearing aids, and here's why. She had a noisy parrot that she loved. Both the patient and her son, the doctor, assumed that nothing could be done with the hearing aids to reduce the loud parrot noise. Ironically, a simple change in the AGC setting would have solved the problem. There is an important lesson in these stories. Whether it's in the ocean or in the field of hearing aids, disasters are often the product of a chain of events. And a unique sequence of events can combine to make a very big disaster. When someone wants you to rush a fitting, beware! Doing so might be the first step on a path to disaster. Second, be very hesitant about deviating from your standard practice protocol. You've developed this protocol for good reasons and, if you have designed it well, it has proven its value over the years. As the cases of the man on the cruise and the woman with the parrot so clearly illustrate, you should always do follow-up tests to make sure that the amplification is adequate but not excessive. Don't get me wrong. I'm not saying you should never speed up the manufacturing or fitting process. What I am saying is, “Stick to your standard operating procedures. Always check, test, and retest fittings/patients.” A small oversight can cause a fitting to “crash.” We are many years away from the day when computers will handle every aspect of fitting hearing aids. There are still thousands of people and product issues that a successful hearing aid practitioner needs to master. SOME LAST IDEAS Whenever I am unable to satisfy a patient and he or she returns the hearing aids for credit, I carefully write myself notes, including instructions on what to do and not to do. For example, I'll write, “Next time, cut off the helix, make sure the aid goes in and out very easily.” Or, “Double-check feedback. This patient hates feedback!” It may take years, but more often than not, the patient returns. And when that happens, it helps to have precise notes. One last thought. In our business, disasters can happen because the patient gives us a set of rules. For example, a person who needs high gain/output may refuse to wear a BTE. I've found it helpful to tell such people, “Before we can make the hearing aids you want, I need to do an experiment. It's difficult to predict how much gain you need at 500–1000 Hz, so I want to give you a temporary fitting, a BTE fitting, just to see how much sound you need. You will only wear this aid for a week or two.” When a patient wears a loaner BTE hearing aid for a couple of weeks and it works great—he hears well and there is no feedback—the positive experience often overcomes the person's bias against behind-the-ear instruments. Loaner fittings also give us a great opportunity to educate other family member. Here's why that can help. If the patient continues to reject BTEs and you fit him with a custom product that gives him problems, the family members who observed his success with the BTE will remind him that you, the professional, recommended different hearing aids. Robert L. Martin, PhD, has been in private practice in the San Diego area for 28 years. He holds a doctorate in audiology from the University of Tennessee and was formerly on the faculty of San Diego State University. Correspondence to Dr. Martin at 7750 University Avenue, La Mesa, CA 91941.