Looking beyond hearing

While improved communication is the primary goal that we all share, we must each be alert for detractors to well-being beyond hearing loss that may threaten patient welfare.

We see each of our patients for only a small sliver of their lives.

Unless we use one of the many hearing loss impact self-assessment tools (and most of us do not1), we may have only a vague impression of the struggles hearing loss may present.

And we are rarely privy to insights that might reveal the extent of the ongoing communication struggles that many of our patients contend with on a daily basis even after they have successfully adapted to the latest hearing aid technologies we may have equipped them with.

Looking beyond hearing

But beyond these hearing related issues, unless we heighten our vigilance, we may fail to recognize life altering or even life-threatening conditions that our patients may be living with. The sixth component or the seven components of person-centered care in audiologic practice2 calls on each of us to maintain a continued vigil for the safety and well-being of those we serve both within the clinic and within our patient’s broader life context.

Threats to well-being may include child or elder abuse2, bullying2,3,4, a threatened self-concept5, suicide ideation2,5, cognitive decline2,4.5,6, or eroding intimacy with loved ones2,5. Unfortunately, when we do recognize any of these or other perils of life, many of us may feel uncomfortable broaching these topics.

As advocated by the No Wrong Door Mental Health Charter, all health care venues should be able to serve as a portal to the wide variety of patient needs so that a range of services are accessible from multiple points of entry.

To do this, hearing care professionals need to be vigilant for patient needs, ready to broach what some may view as difficult conversations with patients and prepared to make appropriate referrals.

Our role as audiologists

Like many professional codes of ethics, the code of ethics of the American Academy of Audiology, Part 1, Rule 2b, states that “Individuals shall use available resources, including referrals to other specialists…”

It is unfortunate that the Academy’s scope of practice suggests a limit to our ability to identify referral needs by stating that, “Audiologists may perform speech or language screening, or other screening measures for the purpose of initial identification and referral of persons with other communication disorders.”

Clearly this statement needs to be updated to encourage screening measures for the purpose of initial identification and referral of persons with disorders or circumstances that may impact treatment plans or patient welfare. Indeed, we do this when we provide visual or situational screenings to guide our reporting of suspected child or elder abuse as mandated by state law.

There are a variety of areas that necessitate a broaching of what may be termed as difficult or uncomfortable conversations. We ask patients to undergo difficult tasks every day when we recommend the use of hearing aids to those who may still feel uncomfortable with their use.

We owe it to our patients to similarly be willing to go into uncomfortable territory. We owe it to ourselves to prepare for what needs to be said when we suspect a patient may be grappling with a threat to well-being.  Many of this blog’s references as well as the links for further exploration may be useful in this preparation.

For further exploration on this topic you may want to check the International Journal of Audiology article Heightening our vigilance toward patient well-being and the ABA Tier 1 text, Counseling-Infused Audiologic Care.

You can also read more in the IJA special supplement dedicated to well-being topics.


  1. Clark, J.G., Huff, C. & Earl, B.R. (2017). Clinical practice report card: Are we meeting best practice standards for adult hearing rehabilitation. Audiology Today, 17 (11): 14-25.
  2. Clark, J.G. & English, K.M. (2019). Counseling-Infused Audiologic Care, 3rd Inkus Press/Amazon.com.
  3. Squires, M. Spangler, C., Johnson C., & English K. (2013). Bullying is a safety and health issue: How pediatric audiologists can help. Audiology Today, 25(5), 18-26.
  4. Clark, J.G. & English, K.M. (2019). Broaching Difficult Conversations: Recommendations for audiologists. Audiology Today. 19(4). https://www.audiology.org/audiology-today-julyaugust-2019/broaching-difficult-conversations-recommendations-audiologists
  5. Clark, J.G., English, K.M. & Montano, J.J. (2020). Heightening our vigilance towards patient well-being. International Journal of Audiology, DOI:10.1080/14992027.2020.1834632. https://doi.org/10.1080/14992027.2020.1834632
  1. Clark, J.G. (2018). Difficult conversations: Screening for Dementia. Retrieved from http://advancingaudcounseling.com/?p=1577, accessed June 17, 2021.