I find the provision of patient centered care to be a misnomer. Instead I often see audiologist centered delivery where the entire approach is based upon what the audiologist thinks the patient needs rather than what the patient truly wants and desires from the process. In the course of my work, I have the opportunity to review a great deal of testing and documentation. I get the opportunity to talk with audiologists and audiology students from all over the country. One thing I sadly see, time and time again, is a myopic focus on two things: the basic audiogram and hearing aid candidacy. We believe every patient complaint and audiologic problem can be solved by just retesting an individual’s hearing and throwing hearing aids on their ears.
Despite insurmountable evidence, I see little to no focus on the whole patient; their overall communication abilities, desires, needs and quality of life. Our case histories are typically problem focused, at best, and centered solely on the ears as they relate to hearing and hearing loss. There is little interest in co-morbidities, medications, and social and family history and their potential influence on the patient and their long and short term satisfaction and outcomes. There is inconsistent use of the standardized and validated hearing, vestibular and tinnitus inventories that allow us to truly measure the patient’s subjective views on the impact of their symptoms.
There is also inconsistent use of screening tools for cognition, auditory processing, falls risk, postural blood pressure, speech/language, and development, despite the fact that many scopes of practice allow for this and many audiologists market the importance and value of this information in patient outcomes. These tools help guide a larger understanding of the individual and their needs. This information helps audiologists to improve the patient’s overall communication and quality of life, not merely their acoustic hearing sensitivity.
Finally, and, in my opinion, most importantly, our care plans are obsessed with the basic audiogram and amplification. If the outcome is not a hearing aid, the recommendations typically end with “see you next year for another hearing test” (even though there is no evidence to support the need to test hearing annually). The patient reports a hearing loss or a communication difficulty and, if they have normal hearing, we send them away with nothing and again tell them to come back “if it gets worse”. They report tinnitus, we ignore it or believe that the hearing aid alone will solve the issue, even without further evaluation or treatment. We never mention ear protection and hearing loss prevention despite reports of noise exposure. We do not do implants, so implants are not on the table as an option. We do not discuss cerumen abatement options just lament how hard it is to get out. Also, sadly, despite the fact that audiology, as a profession, was borne out of rehabilitation, rarely mention communication strategies or auditory rehabilitation or training.
I know what some of you will say: “I do these things, I just don’t write it down” or “I do not have time” or “Patients will not pay for this”. First, if it is not documented, it did not happen. Period. Second, lack of time is an excuse for inaction. I can help you monetize the time. Finally, there is zero evidence that consumers will not pay for this level of care. I see a small cadre of audiologists providing this care and collecting privately for it every day without incident. They also have no trouble filling their schedule.
A renewed focus on the evidence and the standardized tools and assessments we have at our disposal will assist each of us in developing truly patient centered, comprehensive audiologic and vestibular care plan. This type and level of care can be easily operationalized, monetized and marketed and will allow us to differentiate ourselves, our practices and our profession from the disruptive forces in our marketplace.
Like the Army, let’s be all that we can be. Let’s show the world what audiology means and why it is essential.