Being a hearing care professional is a very social job. The entire process—from diagnosing a hearing loss to fitting the perfect pair of hearing aids for a person found to have hearing problems—hinges on communication. Dispensing professionals need to know the kinds of situations in which their patients have difficulty hearing, patients need to understand the impact that their level of hearing loss has on their quality of life, and both need to have a good dialogue to ensure that the patient is hearing to the best of his or her ability with the new hearing aids—and that the patient understands how to care for the new technology. Because of all the verbal give-and-take required to be a successful hearing health professional, it is important that your communication skills be up to par.

The hearing care professional who will be most successful at getting patients to try hearing aids is the one who asks probing questions, listens attentively, and communicates clearly. Paying attention to these strategies will establish your concern for the patient's well-being and enable you to build a strong rapport with him or her.

COMMUNICATION PRIMER

According to MindTools,¹ an organization that provides career-enhancing insights to various kinds of professionals, there are eight components of the communication process:

1. The source, or the person communicating the message;
2. The message the source wants to communicate;
3. Encoding, or the process of the source transmitting the communication;
4. The channel, or the way the message is conveyed—through verbal conversations, such as face-to-face meetings or phone calls, or written correspondence like e-mail and reports;
5. Decoding, or the process of the receiver gaining understanding from the message;
6. The receiver, the target of the source's message;
7. Feedback, the receiver's reaction to the message; and
8. Context, the situation in which the message is delivered.

Problems can occur at any of these eight places on the communication chain. For example, a patient may not focus on the message properly if the context of the conversation taking place occurs in the same week as her spouse's funeral. Or reading (decoding) a small-print handout may be challenging for an elderly patient with poor vision. "To be an effective communicator and to get your point across without misunderstanding and confusion, your goal should be to lessen the frequency of these problems at each stage of this process with clear, concise, accurate, well-planned communications," MindTools recommends.

For example, when you are talking to the patient about his or her hearing loss, lengthy sentences will be hard to follow.¹ This may be particularly true for a person who has just received confirmation of hearing loss. He or she may be focusing a great deal of mental effort on figuring out the best way to cope with the information, rather than moving forward as you are.

Offering too much information too fast can cause problems when discussing hearing aid options. In the emotionally charged context of someone hearing from a professional that he or she has hearing loss, discussing too many hearing aid options can be especially overwhelming. Present a limited number of amplification choices with payment options and go slowly when it comes to explaining the differences.

Cultural barriers also can hinder the process. Obviously, if your practice is in an area where there are many patients for whom English is not a first language, you will want someone on staff who can serve as a translator—or encourage these patients to bring friends or family members—so they will be more comfortable speaking in their native language.

SHARE IMPORTANT INFORMATION

Though communication should be clear, concise, and empathetic, don't forget to discuss financing options with the patient. Sharing information about a hearing aid financing plan that allows for modest monthly payments, for example, builds upon the rapport you have established with the patient thus far. For elderly patients on fixed budgets or others with no immediate access to thousands of dollars in cash, this piece of information may be just what's needed to finalize the decision to buy hearing aids, because a financing program offers a more manageable way to purchase much-needed amplification.

To illustrate the advantage of using such a financing option, take the cost of the hearing aids your patient has agreed to purchase and write down the amount of each monthly payment for the duration of the financing. Answer honestly any questions the patient has and provide him or her with a financing company brochure for further information.

There are several steps you can take during hearing aid presentations to ensure you are communicating properly^2,3:

• Focus on the most important points first. This will help to keep the conversation on track and make the hearing problem and its technological remedy easier for the patient to understand.
• Prepare in advance what you want to say. You will be better able to keep the patient engaged and trusting in your opinions if you are not constantly fishing for words.
• Don't make assumptions about your patients' knowledge when it comes to hearing loss and hearing aids. The danger of making this kind of assumption is that a patient may miss out on critical information needed to make an enlightened decision about whether to get hearing aids. Also, assume that patients have read any literature you've mailed out or provided in the waiting room. Repeat the most important information during your presentation to each patient.
• Anticipate potential questions and have easy-to-understand answers for them. A perfect example of this is to be ready to discuss your hearing aid financing program if a patient expresses concern about the cost of hearing aids. For instance, you could say, "I understand your concern about paying the entire cost of your hearing aids upfront. Fortunately, we do offer hearing aid financing plans so payments can be spread out over a period of time. Let me tell you more about the plans we offer, and how much your payments would be with each one."
• Use a compelling anecdote. Patients will be more likely to understand how hearing aids can help them if you tell them a story about another patient's triumph over communication challenges with the introduction of amplification.

If you alter your hearing care presentation dramatically based on this article, be sure to practice your new protocol.² Schedule role-playing with the staff so everyone is on board with your desire to improve communication in your practice.

THE POWER OF LISTENING

Your ability to speak effectively will enable you to establish rapport with patients and educate them on how hearing loss can be helped with hearing aids. But another important part of communication is the ability to listen. Listening carefully to which situations pose hearing challenges for patients, for example, can help you to determine what kinds of features would be helpful in their hearing aids. Communicating to patients that you have listened to their stories and concerns lets them know that you care enough to get to the bottom of their hearing problems and that you understand their situations fully so that you will come up with the best solution possible for them.

The strategy of active listening enables you to meet the need to understand each patient completely. According to an article by Perkins and Fogarty⁴ of the University of Florida, you can show you are actively listening by:

• Asking good questions in a way that encourages truthful responses;
• Listening nonjudgmentally;
• Paraphrasing what the patient says; and
• Empathizing with the patient's situation.

When you ask questions based on what the patient has said, you should never do so in a negative or accusatory tone. Your questions should serve to clarify meanings; uncover the patient's thoughts, feelings, and needs; encourage elaboration and discovery; and enable you to gather more information.⁴ Sticking to questions along these lines, as well as refraining from being judgmental, keeps the patient open to communicating with you.

Paraphrasing is simply restating what the patient has told you to confirm your understanding.⁴ For example, if the patient tells you of a restaurant dinner during which she was embarrassed by responding inappropriately to a question, you could say, "It seems like you've experienced trouble hearing in a noisy environtment. Hearing aids can help with this problem." By doing this, you are validating your patient's concerns and conveying that you are capable of solving the problem.

Empathizing requires you to set aside your own feelings about the negative impact of hearing loss without amplification and focus on the years of difficulty the patient has had before coming to you. You must essentially see through the eyes of your patients in order to understand their deepest concerns and help them effectively solve their communication problems.⁴

To facilitate your ability to gather information by asking questions, there are some behaviors to avoid.⁵ Do not:

• Pretend you understand everything they're feeling. Instead, admit it when you don't understand a statement and ask the patient to clarify.
• Avoid understating a patient's problem—he or she may feel you are trivializing it.

BODY LANGUAGE POINTERS

While actively listening gives you the information you need to tailor the information you want to share in a way that will be meaningful to each patient, you want to be sure that the impact of your words is not hindered by your body language. If your words and expressions are incongruent, the patient may decide you are not being sincere and ultimately not trust you to solve her hearing problem.

Author Mary Kassian⁶ recommends several strategies for reaching conversation partners positively with body language:

• Smile. "Wearing a warm smile is like hanging out a welcome sign," Kassian observes. "It invites people to relate to you."⁶
• Affirm. Nod your head and make affirmative vocal sounds to indicate that you understand what your patient is saying, and to encourage him or her to continue.
• Lean toward the patient. Leaning slightly forward sends a message that you want to hear what the patient has to say. But be careful not to lean too far, which could suggest aggression.
• Unlock posture. Your posture is closed if you cross your arms, close your hands, hold an arm across your chest, clasp your hands together, or cross your legs away from the patient. These mannerisms indicate that you are "defensive, guarded, or closed to interacting," according to Kassian. Instead, keep your posture open to communicate openness.
• Make eye contact. Make eye contact with your patient to show respect and attention. "It communicates, ‘Right now, I am more interested in you than anything else!' " Kassian concludes A good rule of thumb is to make eye contact for 1 to 10 seconds at a time—more while listening than while talking, Kassian suggests. This keeps the eye contact from getting awkward or uncomfortable.

An appointment to assess and treat hearing loss requires good communication. The practitioner should encourage patients to tell their stories, listen attentively, and ask for clarification as needed, clearly conveying information about technological solutions and payment options and ensuring that they are happy with their new hearing aids. Heeding this communication checklist results in putting patients at ease—and reaching more of them with the amplification products they need.

REFERENCES

1. MindTools. Introduction: Why you need to get your message across. Available at: www.mindtools.com/CommSkll/CommunicationIntro.htm. Accessed July 5, 2007.
2. Abrams R. Powerful presentations. Available at: www.inc.com/articles/2001/05/22582.html. Accessed July 5, 2007.
3. Fripp P. Short and sweet: Mastering quick presentations. Available at: www.inc.com/articles/2000/05/18605.html. Accessed July 5, 2007.
4. Perkins DF, Fogarty K. Active listening: A communication tool. Available at: edis.ifas.ufl.edu/HE361. Accessed July 9, 2007.
5. Analytic Technologies. Active listening. Available at: www.analytictech.com/mb119/reflecti.htm. Accessed July 9, 2007.
6. Kassian, M. Connect with body language. Available at: christianwomentoday.com/womenmen/bodylanguage.html. Accessed July 9, 2007.

Danielle Campbell-Angah is a freelance writer for CareCredit and former editor of an audiology publication. She can be reached at .