If the hearing health care field is serious about reaching the 80% of consumers who have a hearing loss and refuse to address their physical disability, then the way professionals counsel potential clients/patients has to change. What’s needed is a dedication to making people take ownership of their hearing problems. In order to accomplish this, however, the traditional relationship between the professional and patient needs to undergo a transformation. And, if this is to happen, hearing care professionals will need to access two personal qualities: curiosity and courage.

It’s 1983. A patient reluctantly walks into your office for a free hearing screening. His wife had scheduled an appointment to see you. You complete the hearing screening and recommend that hearing aids would be of great benefit to him. You discuss the latest hearing aid technology in great detail. During your presentation to the patient, you elaborate on the marvelous automatic features of the new completely in-the-ear (ITE) devices. He is curious about the technology and says he needs to think about it. He says he really likes you, and he thinks you are quite intelligent. He thanks you for your time as he leaves your office. Although it would have been nice to dispense hearing aids to this patient, at least you were able to educate him on his hearing loss and his amplification options. You believe that, when he is truly ready to try hearing aids in a year or two (after all, your test says he needs them now), the ever-improving technology will significantly help him.

It’s 2003. A patient reluctantly walks into your office for a free hearing screening. His wife had scheduled an appointment to see you. You complete the hearing screening and recommend that hearing aids would be of great benefit to him. You discuss the latest hearing aid technology in great detail. During your presentation to the patient, you elaborate on the marvelous automatic features of the new completely-in-the-canal (CIC) digital devices. You even offer him a free 3-year supply of batteries. He is curious about the technology and says he needs to think about it. He says he really likes you, and he thinks you are quite intelligent. He thanks you for your time as he leaves your office. Although it would have been nice to dispense hearing aids to this patient, at least you were able to educate him on his hearing loss and his amplification options. You believe that, when he is truly ready to try hearing aids in a year or two (after all, your test says he needs them now), the ever-improving technology will significantly help him.

In the movie Groundhog Day, a weatherman, played by actor Bill Murray, is doomed to endlessly relive the same day before he decides he must change. He is in control and totally rational while he relives each day. However, until he decides to change his attitude and outlook in a profoundly deep manner, he is unable escape his time warp. Is it time for hearing care professionals to do the same?

Presently, the hearing industry is reaching slightly more than 20% of the hearing-impaired population.¹ Michelle Fusco of Sonus Corp has estimated that over 50% of the patients who visit hearing care offices looking for hearing help fail to get it. These people are leaving these offices without being moved to the ownership of their communication problem. A high percentage of patients fail to get the hearing help they need for several years. Consequently, the hearing industry as a whole has reported flat growth for the past several years.² Hearing instrument technology, concurrently, continues to evolve at a breathtaking pace. Why isn’t anything changing?

Reluctant Patient + Ever-Improving Technology + Professional = Outcome

This equation summarizes the current state of the industry. A successful hearing aid fitting involves all three parts of the equation. We believe the first two parts of the equation are static; they are essentially constants. Only the third part, the professional, can vary.

In other words, if the hearing care industry is to change in any substantive way, it is up to the hearing care professional to do the changing.

Reluctant Patients
Many patients you see during your career will be reluctant to accept their hearing impairment or take action to improve their ability to hear. The simple fact is that it is quite normal and expected for patients to be reluctant about the use of hearing aids. This fact cuts across age, gender, and income brackets. Reluctant patients visit hearing care offices looking for hope and help in overcoming their communication difficulties. In many cases, these reluctant patients leave without accepting fairly clear recommendations for the remediation of their hearing problems.

Hearing care professionals have traditionally felt it important to convince patients of the need for help by scientifically proving the existence of their hearing impairment (eg, via an audiogram, etc). While this information is intellectually persuasive, it seldom motivates or encourages the reluctant patient to accept and act upon the hearing care professional’s recommendations. One fact seems clear: Patients will continue to accept their hearing impairment and delay action to improve their ability to hear.

Ever-Improving Technology and Its Lack of Persuasive Appeal
Hearing aid technology has never been better. Hearing aid technology will continue to improve. What is the hearing care professional to make of these two statements?

Hearing care professionals should expect hearing technology to be constantly improving, but this constant improvement in technology alone will not change the state of the industry. Closely examine the advertisements in this issue of HR or any other trade publication. Hearing aids with “100% digital processing” and “adaptive dual microphones” are now routinely offered. Now dust off an old issue of Hearing Instruments or The Hearing Aid Journal. In 1982, for example, the state-of-the-art in hearing aids were “in-the-ear” instruments, “forward facing microphones,” and “wireless” technology. Innovation, flexibility, and value were buzzwords used in advertising to describe the latest technology 20 years ago; innovation, flexibility and value are buzzwords used in advertising to describe the latest technology today.

Clearly, today’s hearing aids are technologically superior to those of two decades ago. It is also true that a higher percentage of patients are more satisfied with a wide range of hearing instrument performance aspects than ever before.1 We can expect the technology to evolve. However, as hearing care professionals, we have to ask ourselves, “Is improved technology alone going to answer the objections of the reluctant patient?”

The Professional
If our profession is going to reach the 80% of hearing-impaired people currently not seeking help, we need to change the way we do business. The following equation might be used to define the hearing professional:

Technical Skills + Interpersonal Skills + Clinical Process = The Hearing Professional

Let’s examine the three variables in this equation.

Technical skills are comprised of the academic experiences and the knowledge gained from continuing education and experience. These skills enable us to measure hearing loss and appropriately program/fit hearing aids.

Interpersonal skills are considered by many to be those “soft” personality traits that make each of us unique at providing service and relating to the patient. Interpersonal skills have traditionally been thought to be largely “hard wired”; you inherit personality traits and these traits do not change. Emerging information challenges this notion. According to Goldman, Boyatzis & McKee³, long-lasting changes in interpersonal skills can be achieved.

The third variable in this equation is the clinical process. Clinical process refers to the tests and procedures performed on patients. An established clinical process is done the same way with every patient. Businesses that emphasize process over talent in the long run are more profitable and effective.⁴

Author Robert E. Quinn⁵ maintains that professionals take control of their daily existence by adhering to four basic organizational values:

1. Staying in control;
2. Looking good;
3. Suppressing negative feelings;
4. Being as rational as possible.

The purpose of these values is to avoid embarrassment or threats that might result in the professional feeling vulnerable or incompetent. When professionals are faced with a situation they cannot handle, they can fall apart. When this occurs, they cover up their distress in front of the patient, and they’re anxious to talk about the incident with their colleagues. Interestingly, these conversations often take the form of bad-mouthing their patients. In the case of the hearing care field, these are the very patients who are dealing with the emotional pain of an untreated hearing loss.

What Needs Changing?
When we, as patients, go to see our physician, dentist, or ophthalmologist for an unscheduled visit, we are usually eager to let that professional know exactly what pain and discomfort we are experiencing. In most cases, patients cannot say enough about whatever malady they are struggling with. The key point to notice is that the flow of information is from the patient to the professional. With hearing care professionals and patients, the opposite is often true: the patient is reluctant to share the personal details of his/her hearing problems, and consequently the flow of information goes from the professional to the patient.

We have been taught that we “know what is best for the patient.” Unfortunately, reluctant patients are not “getting” our message. It is even more unfortunate that hearing care professionals aren’t getting the message either. The answer to reluctance resides in the patient, not in the hearing professional. One cannot tell, advise, or cajole the reluctant patient into understanding and accepting their disability. If telling, advising, or complaining about the patient’s hearing impairment worked consistently, the “nagging” spouse, friends, and loved ones would have succeeded years ago in persuading throngs of people to positively address their disability.

We need to begin addressing the emotional pain that the hearing-impaired patient is experiencing. There are two concepts that will forward the growth of the hearing industry and its ability to help hearing-impaired individuals in this endeavor: curiosity and courage.

Genuine Curiosity that Results in Patient Ownership of the Visit. Well-intentioned hearing care professionals are faced with a dilemma that other health-related professionals are not. In varying degrees, reluctant hearing-impaired individuals are taciturn, evasive, non-cooperative, blaming, oblivious, and even dishonest about their disability. Can you imagine the patient being this way with their physician? Yet, this is an everyday fact of life for the hearing care professional.

When it is determined by the audiologist or hearing instrument specialist that the patient has an aidable hearing loss, the professional is faced with the task of proving, convincing, or educating the patient so that the patient has a clear understanding of their need for the professional’s products and services.

The unvarnished truth is that—unless reluctant patients in greater numbers come to a deep and profound understanding of their impairment and become willing to accept their need for hearing care services—patients will not be helped, the hearing industry will not grow, and hearing care professionals will not prosper.

So where does curiosity take its rightful place in the interview of the hearing-impaired patient? There is a great need for hearing care professionals to change the direction of the flow of information. The patient must participate in his/her own hearing health care. However, if the patients’ answers are to change, the questions that hearing professionals ask must also change. This is where genuine curiosity comes in.

So often in the hearing health care field, professionals are consumed with “The Close.” This is not to imply that we’re obsessed with selling products or services; rather, there is a tendency to jump forward to the conclusion before allowing the patient to come to that conclusion for him/herself. In short, we need to see our role as a hearing care professional differently. We need to become more interested in the opening of the patient. Nothing can be closed if it is not opened first. It is a monumental occurrence that the reluctant, frightened, anxious, nervous, angry patient that you regularly see has come to the office in the first place. We need to find out what trigger has finally caused that person to come in after putting off the visit for 7-10 years. There is a great need to move the patient toward ownership of their visit to the clinic, and not allow the patient to delude him/herself by blaming their visit on some external force like their spouse.

If we, as professionals, always do things as we have always done them, we will always get what we have always gotten. It is time to take the ultimate risk for health care professionals…change!

Courage and Risk: Change requires courage and a conscious, intentional willingness to risk. This is not a comfortable arena for the “tried and true” methods of any health care professional. However, relying on the traditional technological answers that the hearing industry provides has led to negligible growth. It is as if this approach is “better than nothing”; why risk the unknown or the unproven when one can stick with more comfortable approaches (even if they don’t work well)?

Real courage is the willingness to live in the questions that always precede growth and advancement. The skills of the true counselor who listens profoundly and asks from that place of true curiosity is the next powerful step forward for the hearing industry. This inevitable next step will be met with resistance by many in the industry, for it represents learning new skills and facing the fear of change and uncertainty.

How Do We Change?
The overwhelming majority of hearing care professionals are already dedicated and caring. This article should not be interpreted as an indictment on their abilities or intentions. Rather, it should taken as a call to action for deep and long-lasting change that lies in the hearts and minds of the majority of hearing care professionals.

Historically, training programs have targeted technical skills. While improving technical skills is a critical area for targeted learning, it is the interpersonal skills and clinical processes that need to be targeted for improvement. As Kris English eloquently stated in a recent article, “We as a profession need to talk about our perception of our role as helpers, or we will burn out from the despair of ineffectiveness.”⁶ In other words, doing the same thing the same way and expecting different results is, according to some, the definition of insanity. We cannot expect the patient or the technology to change. Therefore, as hearing care professionals, we must do the changing.

Are we ready to change? In order to meet the needs of our reluctant patients we all need to be willing to do some changing. Part 2 of this article will provide five effective solutions for improvement.

Brian Taylor (pictured), MA, is director of continuing education at Sonus Corp, Portland, Ore, and Von Hansen is a business and communications consultant and lecturer on hearing health care issues. His office is located in Lebanon, Ore.

References
1. Kochkin S. MarkeTrak VI: The VA and direct mail sales spark growth in hearing aid market. Hearing Review. 2001;8(12):16-24, 63-65.
2. Strom K. The HR 2002 dispenser survey. Hearing Review. 2002;9(6):14-33.
3. Golman D, Boyatzis R, McKee A. Primal Leadership: Realizing the Power of Emotional Intelligence. Boston: Harvard Business School Press; 2002.
4. Gladwell M. The talent myth: Are smart people overrated? The New Yorker. July 22, 2002:28-33.
5. Quinn RE. Change the World: How Ordinary People Can Accomplish Extraordinary Results. San Francisco: Jossey-Boss Press;2000.
6. English K. Are we really helping people hear better? Audiol Today. 2002;14(2):11.

Correspondence can be addressed to Brian Taylor, Sonus Corp, 111 SW Fifth Ave., Ste. 1620, Portland, OR 97204; email: Brian.Taylor@sonus.com.