Final Word | February 2017 Hearing Review

During the holidays, we completed our move from Los Angeles, near my wife Alison Grimes’ work at the UCLA Audiology Department to my childhood home in Yorba Linda, Calif. Yorba Linda is 50 miles from the UCLA medical center. More than 10 years ago, when Alison took the job at UCLA, it made sense to move from Yorba Linda to Los Angeles so that she could be closer to work. Now that we are looking at retirement sometime in the next 5 to 10 years, it makes sense for us to settle into our permanent home for the next stage of our lives.

Commuting in the greater Los Angeles area can be a challenge. There are tricks and strategies that sometimes help, but the commute is often difficult and time-consuming. UCLA offers a van pool that is worth the effort so that someone else can drive. Alison was fortunate enough to obtain a seat in a daily van pool as soon as we moved. The practicalities of daily life, however, will make it necessary to drive occasionally. The freeway system in Los Angeles and Orange counties has High Occupancy Vehicle (HOV) lanes for cars with more than one occupant, or for cars with California DMV-issued stickers allowing single drivers in the lane which is typically less crowded than the rest of the freeway. It turns out that currently there is only one automobile manufacturer with sufficient range for our needs and fuel economy standards to qualify for the HOV sticker. For that reason only, we purchased a Tesla model S electric vehicle. The Tesla is a well-designed and nicely appointed sedan. It has a steering wheel, four wheels, and many of the same accessories one might expect from any modern vehicle. Beyond that, the Tesla is quite unique, and much of the knowledge about driving internal combustion cars does not transfer to the electric vehicle.

We learned quite a bit about the car when we took a test drive several weeks before we purchased it. When we took delivery, the process included a 20-minute PowerPoint-style lecture from the dealership. We were told to call with any questions, and sent on our way when the lecture was over. For the next 2 weeks, it was necessary to call with questions at least once a day. To say the least, we did not get sufficient training to allow us the freedom to drive this mobile computer around confidently.

I could not help but make a comparison to our training of new hearing aid users when we deliver products that the patient very likely has a little prior knowledge to apply to their purchase. We joke about the patients who return a week after delivery and exclaim that we never told them about some essential direction that we probably repeated three times, in addition to the written material stowed in the bag they brought back with them from the appointment. I have a little more sympathy for them now.

As the “new normal” becomes less personal face-to-face service in many aspects of our lives, we will need to determine how to best prepare our patients for success. The fact is that today’s hearing aids, as sophisticated as they are, still have the fundamental requirements that hearing aid users have dealt with for decades. Batteries need to be changed or charged, the hearing aids have to be inspected and maintained to prevent plugging of microphone and receiver ports, and the device controls need to be set properly for appropriate use. Until hearing aid design progresses to eliminate these requirements, we are going to be an essential part of the equation for hearing aids, PSAPs, or over-the-counter devices.

The question is how will we provide the service, and set up a system where the patient feels that they are receiving appropriate value for the money they invest in us? It’s fair to assume that some patients won’t need much help from us as device design improves. It is also a reality that many people will continue to need a great deal of support.

There are service models in operation today that are part of daily life for many of us. There are also disruptive elements that challenge these service models. Cable TV became commonplace several decades ago. Because the available packages have become wasteful and expensive, internet services are starting to erode the market because traditional cable does not provide the perceived value it should. Whatever system we adopt to help with selection, fitting and maintenance of hearing aids will need to provide good value—and be nimble enough to adapt to the inevitable competitive market forces that will undoubtedly evolve.

The Final Word? If you were waiting for a brilliant paragraph with the solution to the problem I’ve outlined, you’ll be disappointed. I have some ideas on how we might change things. My ideas might work in some markets, and not in others. I also think we will see some good ideas evolve. Those ideas that survive will provide good value and effective and ethical treatment. In this time of broadly divided beliefs about fiscal and political approaches to problems that face us as a nation, coming up with some good ideas to provide hearing care may seem inconsequential. However, for those who are personally challenged by hearing impairment on a daily basis, it is a top priority for them. Those are the people we are here for.

Dennis Van Vliet, AuDCitation for this article: Van Vliet D. Paving the road to patient success when the “new normal” is LESS face-to-face service. Hearing Review. 2017;24(2):50.

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