Old habits die hard

5 common assumptions you might be making when recommending hearing technology.

Okay, be honest. What are your first impressions when you see the images and descriptors below?

“I live alone.”
“I’m here to replace my hearing aids.”

You may have thought, older woman who lives alone, doesn’t look tech savvy, and probably on a tight budget.

What about the gentleman in the second image? He has hearing aids and is just looking for the equivalent in newer technology, this will be a quick consultation.  

Within the first few minutes of an interaction it is easy to form an opinion and/or even have an idea of how the appointment will go. What we don’t know, we tend to assume.

It’s sometimes easier and faster to assume what someone needs and can handle rather than ask them, especially if you are running behind in your schedule. These assumptions can sometimes lead to missed opportunities. Mental shortcuts, also known as heuristics, can be a favorable. However, when these heuristics are influenced by cognitive biases, they can be unfavorable.

What is a cognitive bias and why does it matter?

A cognitive bias is a systematic error in thinking that occurs when individuals are processing information that they have or lack, which then affects the decisions and judgements they make.1  

A systematic review that looked at the association of cognitive biases with medical decisions found that physicians who exhibited anchoring and information bias were more likely to make diagnostic errors. These biases could also be associated with therapeutic or management errors.2  

This is not exclusive to physicians. There is a growing body of evidence that demonstrates allied health professionals are susceptible to a range of biases when making diagnostic and treatment decisions.3    

Think about hearing aid recommendations. There are different types of cognitive biases that can impact audiological rehabilitation options. Let’s have a look.

5 common assumptions to avoid

  1. They live alone so a basic aid will do.

    Confirmation bias is the tendency to accept evidence in support of your own view, while neglecting evidence that may contradict it.

    Patients may come in and claim “I don’t need all the features” or “I don’t need much because I live alone in quiet”. It’s easy to fall into the assumption that if one lives alone, they don’t need to have the finest sound processing features as their environment is quiet and there is no one to speak with.

    We are quick to grab on to that one piece of information and roll with it. We may then miss the fact that the patient has also said “it can be lonely living alone.”

    One could argue that because they live alone, we should be encouraging them to go out and keep social and mental well-being top of mind. So, why not equip them with the tools to foster their social and mental well-being?

    Some may not want to address connectivity (more on this in our next assumption) due to age, but when one lives alone connectivity can be so important for mental health. Having been forced to rely on technology these last two years, being able to have your hearing aids connected to your phone or tablet has helped so many individuals connect with their family and friends via a video call. 

  2. They aren’t tech savvy.

    What led you to this assumption?… Their age?… The fact they are using an old phone you don’t recognize?

    I do believe you can teach an old dog new tricks. I will admit that some will require more time and patience, but the benefit they will get from the advancements in technology will be worth it.

    I once saw a 96 year-old gentleman for his first hearing test and set of hearing aids. He had poor mobility, but the sweetest demeanor. I will be the first to admit that I made a quick judgment that I would fit something simple and easy to insert and remove.

    Connectivity was not something I was going to introduce for this first-time user. Boy, was I wrong.

    After a long and slow journey from the seat in the waiting room to our testing booth and then to our consultation room, this 96 year-old client pulled out his iPad, opened up YouTube, and asked me to direct him to instructional videos on hearing aids that he could watch before being fit in two weeks.

    He was successfully fit with premium hearing aids and utilized all the wireless accessories he could get his hands on. I am not saying every patient will be like this, but what I would like to do is challenge your biases.

  3. Their current aids are still working, they don’t need a new set.

    We have all been in this situation when a patient comes in for their annual hearing test and their aids are five years old and functional. Perhaps you personally are the type that will not replace an electronic device until it breaks and you decide this patient is likely to feel the same − or you may think you are doing them a service by saving them some money.

    You can see how an emotional bias can lead to an assumption, which may be a missed opportunity for your patient.

    Our lives can change at a moment’s notice and so can our needs. Although the patient has come in for a routine check, there is value in conducting a quick case history to see what their current needs and aspirations are. There is a possibility that their new needs could benefit from new technology.

    This is when trial devices come in handy. It could result in the patient reporting their current aids are just fine, but there is also the possibility the patient hears better and is able to do so much more with new devices.

    It is our duty as clinicians to provide the patients with all the solutions so that they can make an informed decision for the best possible outcome.

  4. Higher technology is not worth it/they can’t afford it.

    Again, we are making a quick assumption for the patient that the higher technology that comes with a higher price tag is not worth it. Ultimately, it is up to the patient to decide what they can and cannot afford.

    The patient may put a higher value on a feature or functionality than you yourself. For them, it may be worth paying for higher level technology.  If you don’t present all the options, you may be allowing your cognitive biases influence your patient care.

  5. Roger™ is only for severe to profound patients or Roger is too complicated.

    Roger is more than a solution for only severe to profound hearing loss. When we base our decision to present Roger only when we have a severe to profound audiogram, we may be falling victim to anchoring bias, where we rely too heavily on the first piece of information we gather.

    In this case the audiogram is serving as an anchoring fact. It’s important to remember that the audiogram is just one piece of the hearing picture.

    If your patient continues to have difficulty hearing in dynamic and noisy situations, Roger is a great solution to help reduce listening effort and improve the signal-to-noise ratio.  In fact, more than half of Roger fittings are with audiograms presenting mild to moderate hearing loss.4

    What about your patients with hearing loss who do not, or do, have a severe to profound loss and who are also currently employed?  Conducting a workplace case history can help shine a spotlight on an area your patient has been having difficulty in and may not have connected the dots with their hearing loss. Roger’s adaptive nature and ability to connect to multiple microphones makes it a great solution for your working patients.

    There is also the trend to shy away from Roger because there is the perception that it’s ‘too complicated’. Anything new can seem daunting. If a clinician has a personal bias that the system is too complicated, they may not even introduce the solution.

    What may initially seem complicated to you may not be for your patient. As hearing care professionals, we act as the gatekeeper to hearing solutions so why would we keep one gate open and not the other?

We cannot change what we are not aware of, and once we are aware, we cannot help but change.”  
– Sheryl Sandberg, American business executive and philanthropist

The first step to change – be conscious of your biases

It can be easy to fall into a cruise control mode. We’ve driven this path many times. Patient X comes in with hearing loss configuration A so they likely will need hearing aid B.

Every patient’s clinical journey is different; it could be a quick and smooth drive, or there could be potholes, sharp turns, and pit stops along the way. You can’t drive each solution the same while in cruise control because every patient will have different needs throughout different points in their life − you still need to pay attention and control the direction.

Being conscious of the various biases that can influence your treatment plans is a great first step to quality hearing healthcare.


References

  1. Cherry, K. (2020). What is Cognitive Bias? Verywell Mind. https://www.verywellmind.com/what-is-a-cognitive-bias-2794963, accessed February 24, 2022.
  2. Saposnik, G., Redelmeier, D.,  & Tobler, P.N. (2016). Cognitive biases associated with medical decisions: a systematic review. BMC Medical Informatics and Decision Making,16:128. DOI: 10.1186/s12911-016-0377-1. 
  3. Featherston, R., Downie, L.E., Vogel, A., & Galvin, K.L. (2020). Decision making biases in the allied health profession: A systematic scoping review. PLoS ONE, 15(10): e0240716. DOI: 10.1371/journal.pone.0240716.
  4. Senn, M., Baney, L. (2018). An analysis of programs Roger Pen distribution across hearing loss – Phonak Target Fitting Data.

We invite you to learn more about Roger technology here.

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