Picture this: A young, driven audiologist walking down the hallway of a clinic when he hears something that makes him stop in his tracks. A voice coming from an open door of an exam room. The words causing his brow to furrow. His head cocked; mouth opened slightly. Confusion.
“Your hearing isn’t that bad. Don’t bother spending money on hearing aids,” said an anonymous primary care physician.
As a young (new), driven (passionate) audiologist, I was surprised at how often I heard other healthcare providers say that same phrase in some form or fashion. I’m sure many of you have as well. As the audiologist in the clinic, I was the expert on hearing loss and hearing aids. I used to allow myself to only feel annoyance and frustration when I would overhear comments like I shared — that was until I had a revelation:
They. Did. Not. Have. Enough. Information. To have an opinion on the topic of hearing loss!
I saw that revelation as an opportunity to inform other medical professionals and at the same time, make it very clear that I was their expert about hearing loss and hearing aids. I deserved to be viewed as a valuable member of the patient’s team. Here’s how I moved forward with achieving that goal.
Why should a hearing care provider be aware of a patient’s medical support team?
One aspect of being part of a medical support team is that you will often make certain decisions about a person’s healthcare as a group. Each member of that team has a voice in what he/she thinks should be included in the management plan for that patient.
It is unreasonable to expect every healthcare provider to stay up-to-date with research that is unrelated to what he/she does on a daily basis. Because of this, there can be a feeling among other healthcare providers that hearing loss is just a benign inevitability of getting older.
Why should hearing care providers be a part of that team?
There are two reasons:
- As the hearing care provider, you have a deep understanding of the auditory system and the effects of an untreated hearing loss.
- Because of the amount of time you spend with your patients and the frequency you see them, you also have a unique perspective on their health and well-being. What you are able to contribute to the team is valuable, and it is important that you have a voice as well.
What are some of the steps to take to be part of a patient’s medical support team?
The first step is to identify what other healthcare providers your patient has an ongoing relationship with. We know that hearing loss has been linked to cardiovascular disease, diabetes, chronic kidney disease, Alzheimer’s and dementia, depressive symptoms and higher risk of hospitalization and injury due to falls.1
Your patient’s primary care provider will be on the list along with one or several specialty providers (otolaryngologist, cardiologist, endocrinologist, nephrologist, oncologist, neuropsychologist, psychologist, social worker, physical therapist, speech language pathologist, etc.).
After identifying all of the other team members, the next step would be to make contact with each of them. While this could be a phone call or an email, I would recommend making a more personal connection. Schedule a time to meet with them in person and have a discussion about yourself, as well as hearing loss, balance, hearing aids and the services you are able to provide.
You will want to have a plan for what you will be talking about at this meeting. You could simply talk about good communication strategies when it comes to interacting with someone with a hearing loss. You could go one step further and have a discussion about forging a relationship going forward to collaborate on patient care. You should clearly state what kind of information and communication you need from them. Ask them what they need from you.
It is also important to know who you are talking to and what type of information may be important to them. Also, think about the most effective way to share that information with them. For example, you may want to share how an untreated hearing loss can lead to ineffective communication.
If you are talking with a PCP, you may discuss how a person’s hearing is essential for them to be able to understand and make informed decisions about their healthcare. You could offer them strategies, like using a pocket talker during appointments (and then refer for a hearing test, of course!). If you were having that same conversation with someone in administration, you may talk about how people with an untreated hearing loss report poorer communication from their healthcare providers and how that can lead to poorer patient outcomes and lower satisfaction ratings.2
What could a medical support team look like for a patient?
A medical support team may look different from person to person. For some, it could be as simple as promising to always send reports to a patient’s PCP. As mentioned before, you spend a lot of time with your patients. This could allow you to gain some important information from the patient, such as performing a cognitive screening much more frequently and therefore, subtle changes could be noticed sooner.
Having an established medical support team would allow you to know exactly who you should send those screening results to and also keeps the line of communication back to you open.
For those with a more complex medical history, there may be more involved. When I was a pediatric audiologist, I almost lost count of how many medical support teams I was a member of. Children who were suffering from vestibular problems saw audiology, ENT, physical therapy and the gait lab.
That entire group of providers would then meet monthly to review the cases from the month and all test results, discuss recommendations and then compile those recommendations to be communicated to the family. We also had a cranio-facial anomalies clinic where children cycled through audiology, ENT, plastic surgery, speech therapy and social work. All of those healthcare providers also met and agreed upon a plan for each patient moving forward.
When I was seeing adults in clinic, I created a team of providers who worked together for those suffering from bothersome tinnitus. I would meet with the licensed clinical social worker and primary care provider for each of my tinnitus patients so everyone was on the same page.
Whom should you talk to about being on their medical support team?
I mentioned earlier about the idea of performing cognitive screenings. There has been and continues to be a lot of research investigating the potential link between hearing loss and cognitive decline.3-7 If nothing else, hearing loss and cognitive decline can both impact communication and can also display similar behaviors.
Why shouldn’t you be looking at both areas? A validated screening tool such as the Montreal Cognitive Assessment (MoCA) can be particularly useful for detecting mild cognitive impairment. That could be extremely valuable information for that person’s healthcare provider to have, especially if family support is lacking.
Also, think of those patients whose other healthcare interventions could have a direct negative impact on their hearing or balance. A simple example could be a person who will be receiving a treatment for cancer that involves an ototoxic medication. You should be involved in an ototoxic monitoring capacity and have communication with their appropriate provider.
For patients suffering from bothersome tinnitus, some of them are also taking antidepressant and/or antianxiety medications. Some research has suggested that these types of medications can reduce neural plasticity and make it more difficult for people to habituate to their tinnitus.8 Obviously, the decision about what medications are used for a person is that of the prescribing provider. However, you are absolutely in the right to communicate with that provider in the event an alternative, equally effective intervention could be used.
How do you talk to your patient about being included on the team?
This conversation will most likely be handled differently depending on the situation. For someone who will be receiving a potentially ototoxic treatment, the reason for your involvement is pretty clear.
On the other hand, other conversations may be trickier to navigate. When discussing the idea of cognition, it is important you are considerate of that person’s feelings. Perhaps they cared for a parent that suffered from dementia and the idea of going through that personally is very scary for them. Be empathetic that some people may want to know more or less information than others. It should be up to them. If you are performing cognitive screenings, before immediately telling someone the results of that screening, ask them how much information they would like to know.
What are the benefits for a patient that HCPs are part of their medical support team?
If someone has a hearing loss, it will always be a positive thing for them to have someone who will advocate that their healthcare providers support effective communication during any and all interactions. Your suggestions to their healthcare providers about utilizing text appointment reminders, providing written instructions, supporting the recommendation for hearing aids, how to appropriately use an ALD, such as a Phonak PartnerMic, to not talk with their back turned, etc., will only improve the overall healthcare experience. Being able to effectively communicate with their healthcare providers makes it much more likely they will understand and comply with any instructions.
How does this fit into patient-centered care?
The Picker Institute has identified eight areas that are important to create a positive patient experience.9 These are known as Picker’s Eight Principles of Person-Centered Care. A medical support team can definitely have an impact on at least two of these areas: coordination and integration of care and continuity and transition of care.
When people feel that their healthcare is well coordinated, they feel less vulnerable and powerless in the face of illness. When people feel that there is a continuity in the healthcare, there is less confusion about what they need to do and what their management plan is. And the best part? With you involved, they’ll be able to hear what’s going on!
I may have felt frustrated at first when I felt like other medical providers were over stepping. Rather than letting that negative energy fester, I channeled it into action. I went to the administration of the hospital I was working for and explained to them why audiology should have more visibility in the clinic.
After getting buy-in at that level, I met with every primary care and specialty provider in the system to explain why they should be thinking about the hearing and balance of their patients. The collaborations occurred naturally from there.
Next time you hear another healthcare provider say something like, “Your hearing isn’t that bad,” don’t allow it to discourage you. See that as an opportunity to share your passion about helping those with hearing and balance problems. Recruit that person to be a part of your team. It will only benefit your shared patient.
We invite you to read a previous blog article that discusses the impact of hearing loss on other health conditions.
1 Vercammen, C., Ferguson, M., Kramer, S.E., et al. (2020). Well-Hearing is Well-Being. Hearing Review, 27(3), 18-22.
2Mick, P., Foley, D. M., & Lin, F. R. (2014). Hearing loss is associated with poorer ratings of patient-physician communication and healthcare quality. Journal of the American Geriatrics Society, 62(11), 2207–2209. https://doi.org/10.1111/jgs.13113
3Loughrey, D. G., Kelly, M. E., Kelley, G. A., Brennan, S., & Lawlor, B. A. (2018). Association of Age-Related Hearing Loss With Cognitive Function, Cognitive Impairment, and Dementia: A Systematic Review and Meta-analysis. JAMA otolaryngology– head & neck surgery, 144(2), 115–126. https://doi.org/10.1001/jamaoto.2017.2513
4Deal JA, Betz J, Yaffe K, et al. Hearing Impairment and Incident Dementia and Cognitive Decline in Older Adults: The Health ABC Study. J Gerontol A Biol Sci Med Sci. 2017;72(5):703‐709. doi:10.1093/gerona/glw069
5Lin, F. R., Metter, E. J., O’Brien, R. J., Resnick, S. M., Zonderman, A. B., & Ferrucci, L. (2011). Hearing loss and incident dementia. Archives of neurology, 68(2), 214-220.
6Amieva H, Ouvrard C, Giulioli C, Meillon C, Rullier L, Dartigues JF. Self-Reported Hearing Loss, Hearing Aids, and Cognitive Decline in Elderly Adults: A 25-Year Study. J Am Geriatr Soc. 2015;63(10):2099‐2104. doi:10.1111/jgs.13649
7Sarant J, Harris D, Busby P, et al. The Effect of Hearing Aid Use on Cognition in Older Adults: Can We Delay Decline or Even Improve Cognitive Function?. J Clin Med. 2020;9(1):254. Published 2020 Jan 17. doi:10.3390/jcm9010254
8Fornaro M, Martino M. Tinnitus psychopharmacology: A comprehensive review of its pathomechanisms and management. Neuropsychiatr Dis Treat. 2010;6:209‐218. Published 2010 Jun 24. doi:10.2147/ndt.s10361
9Ogden, K., Barr, J. & Greenfield, D. Determining requirements for patient-centred care: a participatory concept mapping study. BMC Health Serv Res 17, 780 (2017). https://doi.org/10.1186/s12913-017-2741-y