Final Word | October 2017 Hearing Review By Dennis Van Vliet, AuD Earlier this year at a professional meeting, I ran into researcher and sensory aid developer Harry Levitt. We had an enjoyable, if not professionally-related conversation. We were observing that, with aging, there are inevitable lifestyle and health consequences for all of us. He mentioned that as a young teen he was introduced to Shakespeare’s “The Seven Ages of Man.” At that age, Harry was amused by the monologue describing the different stages of life. In our recent conversation, he pointed out that, as he is living these all-too-true life stages, he has been struck by the remarkable accuracy of Shakespeare’s description of the different ages. Harry admits to be approaching the sixth age with the associated inconvenient infirmities of an aging body. He appreciated our discussion enough that he gave me an illustrated copy of a manuscript which is part of the play As You Like It. © Jasa | Dreamstime As I read through the booklet, I could not help but compare Shakespeare’s seven stages, not to life...but to our profession. “At first the infant…” Undoubtedly, the hard-working professionals at military hospitals in the late 1940s and early 1950s were not helpless infants, but working without the foundational research that they provided us and the tools and resources we have today. Their efforts must have taken a great deal of patience and ingenuity. “and then whining schoolboy...” The late 1950s, into the 1960s, brought tireless efforts at research, identification, and rehabilitation, but was missing full participation in the complete rehabilitation process without the delivery of hearing aids. (There was some whining, as I well remember the climate in the mid-1970s.) “And then the lover…” The early 1980s brought a far different era, where hearing aid professionals and audiologists could, together, provide products as well as services. Since the hearing aid dispensing landscape had been formed by our professional hearing aid dispenser ancestors, the audiologists followed the model, and loved it. “Then a soldier, Full of strange oaths...Jealous in honor, sudden and quick in quarrel.” The late 1980s brought lively disputes about diagnostic protocols, fitting formulae, and pronouncements of superiority over one’s competition in research, academia, and practice. The North and the South (hemispheres) fought many noble battles, though neither were considered rebels, only pioneers. “And then the justice…” Then emerged in the 1990s the judges and judged, with arguments over wide dynamic range compression and linear processing; analog and digital. The shootout at the input-output corral where the primary conclusion out of the VA report was that hearing aids work. This we knew, but it was good to have data to back us up! “The sixth age shifts into the lean and slippered…” Maturing in the 2000s, the professions moved on with continuing arguments about measured verification, and manufacturer-driven versus clinician-driven protocols. A few of us persisted reflecting on how it used to be, when a good green micro screwdriver was the most important infrastructure we could have. “last scene of all, that ends this strange eventful history…” Are Shakespeare’s words true for a profession? We can’t help but wonder; without change, are we facing the end of an age or the beginning of a new and exciting professional approach? I am reminded of the landscape in the late 1980s and early 1990s when Health Maintenance Organizations (HMOs) came into larger markets where many of us were quite content to be allowed to see patients who wanted to come to us, and bill Medicare and other third-party payers at will. The HMOs upset the marketplace and chose who they would do business with, pushing many of us away and limiting our ability to earn an honest living. Patient loyalty often melted away when the financial support of the third-party payer was removed. We had to adapt and find new ways to appeal to prospective patients. Today, we are facing a similar threat. Consumers, following contemporary, established patterns of knowledge gathering and shopping, look to online searches and alternate sourcing of goods and services when faced with a spendy purchase. This has taken its toll on traditional brick-and-mortar retail stores, and we may be next. I don’t pretend to know if that will be necessary in your market. It may be that the traditional bundled service model for hearing aids will work fine, but I doubt that the traditional approach is a good long-term strategy. Once again, we will need to adapt. We may need to focus on what we do well that cannot be obtained online or through a quick over-the-counter transaction. In today’s digital world, any product or service that can be replicated and commoditized will be replicated and commoditized. Custom-fitted products and unique service offerings, such as a concierge approach that is more convenient for the consumer, may be a good start. The Final Word? Change is largely upon us and adaptation will be the key for survival. My approach will be to determine what I can provide that isn’t readily available and I will put my efforts toward proving that I can fill that void in the market. Citation for this article: Van Vliet D. The seven ages of hearing care. Hearing Review. 2017;24(10):50.