A new patient recently came into our office for a hearing technology consult. She’s a longtime hearing aid user in her 80s and she knew exactly what she wanted: hearing aids connecting directly to an iPhone. I was somewhat surprised by this and celebrated her savvy tech awareness—not to mention her coolness.
Direct to iPhone—instead of requiring an additional Bluetooth bridge or streaming device to send an audio signal from the cell phone to the hearing aids—is a technology some hearing aid manufacturers have offered for a while and others recently introduced. We suspect it will soon be a standard offering across manufacturers.
In getting to know this patient a bit more and taking into consideration her audiometric results, I started to suspect she might benefit more from a different manufacturer and model. I counseled her as such, but somewhat gently as she insisted upon direct to iPhone. We went ahead with her preferred order and scheduled the fitting. At the fitting appointment, I learned a crucial bit of information—she didn’t even have an iPhone!
In a previous blog post, my business partner, speech-language pathologist Jody Vaynshtok, wrote about the holistic care of patients with hearing loss. One of the main questions she asks in framing the discussion was, “What are the patient’s overall communication needs, and how can an SLP work alongside an audiologist to address those needs?”
As she wrote, SLPs can support audiologists in identifying key communication difficulties the patient continues to experience at home, work or social settings. These insights enable audiologists to adjust or add technologies and tailor recommendations for environmental and workplace accommodations.
Now, I want to take this discussion one step further. Exactly why would I, as an audiologist, need support in identifying those communication needs? Isn’t that already a part of selecting hearing-assistive technology? And how can I identify those communication difficulties and address them with newer technologies that best fit the patient’s needs?
In a small private practice like ours, co-owned by an audiologist and SLP, we can co-manage and co-treat patients with hearing loss. Ideally, each hearing aid/hearing technology patient meets with Jody for an aural rehab consult, and then I get her support in identifying key communication concerns. I also benefit from Jody’s perspective about auditory training to complement any hearing technology fitting. Most facilities are not set up like this. Instead, it’s usually the audiologist’s singular role to blend the science of hearing-assistive technology with the art of needs assessment. In the case of the patient whose story I shared earlier, I rushed the consult myself and let technology trump the evaluation of her needs.
Audiologists are taught in school to keep hearing technology consults patient-centered and communication needs-focused. However, in the real world, external factors influence the consult. Patients often place emphasis on:
- Budget/insurance coverage
- Insistence upon features
- Cosmetic preferences
- Expectations of benefits
A patient’s options—and, therefore, successful meeting of their communication needs—might be affected by their available budget. Likewise, patients who insist upon specific features or very discreet hearing instruments sometimes limit themselves. And when it comes to expectations, many first-time users think hearing aids are analogous to corrective eyeglass lenses, so managing expectations can take up quite a bit of time in the initial consult.
Our goal as audiologists involves balancing the patient’s concerns and wants with their actual communication needs. So how do we get to the core concern(s) and where do we get the time to do so if co-consult with an SLP isn’t available? At our practice, we have come up with a few solutions to efficiently and effectively drive shared decision-making in hearing technology consults:
- Be transparent in financing. From the beginning, we try our best to make pricing the lowest-level concern, as we do not want options to be severely limited due to budget. Patients benefit when we present them with clear pricing and helpful options, such as interest-free payment plans, consideration of outside health care financing plans, or referral to a third-party provider or state vocational rehab program.
- Set goals together. Come up with a “treatment plan” that is goal-driven. The Client Oriented Scale of Improvement (COSI)—the subject of a recent ASHA Leader column—provides a goal-focused structure to guide options for management.
- Quantify. Use other self-report measurements to quantify the patient’s needs and further guide management. Such self-reports can also be used as pre- versus post-fitting data for validation.
- Take it home! The clinic is not the patient’s world. Let patients experience hearing technology by taking it for a “test drive” to a special event, out to dinner or at home, where they can use the listening device in real life with family and friends. Involving loved ones alleviates some of the unknowns of using the device. Extended out-of-office demos also help reframe the discussion about benefit versus expectations, ease of use and meeting defined needs and goals.
There are so many exciting options for hearing technology right now and new releases are coming. (In a future post we plan to cover our practice’s adventures in introducing specific hearing aid accessories and assistive listening devices to patients and their families.) As trends continue for hearing aids to directly connect to smartphones—and smart homes—and become wearable devices for health monitoring, patients and audiologists have more and more options to navigate.
When the communication needs of the patient are thoroughly identified, they take the front seat of the technology consult, both initially and over time as the patient’s needs change.
As for our new hearing aid patient, she went to the Apple store the very next day, purchased an iPhone and excitedly brought it with her to her follow-up appointment. A follow-up appointment made with the caveat that we explore her other communication needs as well as the coolest new apps!