History intakes and patient interviews can be a complex, but enjoyable process. In the first article on this topic, “What Patients Say: Patient-Centered Interview,” audiologists and student clinicians were encouraged to invite and listen to each patient’s story about their feelings and the impact of their hearing loss (Wilson, 2015). We must ask the right questions, actively listen to the responses, and carefully document the comments to understand the patient’s presenting complaints and concerns about hearing difficulties.
Audiologists must comprehend each patient’s story to carefully, thoroughly, and competently assess, treat, and care for the individual. Comments from patients and their family members were presented, in their own words, describing hearing difficulties, experiences, and feelings about their hearing loss (Wilson, 2015).
Patients continued to share their heartfelt opinions and descriptions about their experiences with their hearing aids and related technology. Clinicians are encouraged to carefully listen and accurately document the patient’s comments, concerns, and issues. Britton (2005) reminds us that listening is not a passive activity, but a learned behavior that requires skill and practice. According to Nitzky (2016), “we…must be fully engaged, fully focused on the patient during the time they are with us.”
We want our patients to hear better and easier, with less effort. But sometimes our best intentions and efforts cannot be met, as evidenced by these comments.
- “Hearing aids are okay, but I wouldn’t say they are the best thing I ever owned.”
- “Hearing aids are good, but not good enough.”
- “Not perfect, but doable.”
- “It’s an adjustment.”
- Hearing aids “have their own personality.”
- “I have a love–hate relationship with my hearing aids.”
- “Started out really good, but now a little disappointing.”
Typically, when a patient returns to the clinic for follow-up visits and hearing aid checks, we ask how he or she has been hearing with the devices. Their comments can be comical or disappointing. Sometimes, the patient’s goal with amplification use may not be realistic. When asked, “What would you like your hearing aids to do?” a patient commented, “Iron and fly me to the moon.”
- “I was hoping to hear rats pee on cotton.”
- “I guess it’s about as good as it can be.”
- “When I get them in, I didn’t hear what I wanted to hear.”
- “Not like night and day.”
We want the sound quality to be natural and comfortable, but sometimes we are not able to achieve that goal.
- “They speak like Limoges China; I need Fiesta Ware!”
- “Listening hard doesn’t help; words don’t really clear up.”
- The right hearing aid “fizzles like a carbonated drink.”
- “I am still struggling with the strangeness of sound.”
- “I feel like there’s a bucket over my head. It’s still hard to describe, but maybe it sounds tinny or like a cracker wrapped in paper.”
- “Like a microphone right at the fringe of squealing.”
We encourage our patients to wear the devices consistently to acclimate to new sounds and to become accustomed to the devices. Many patients take our suggestion to heart and form a bond with the hearing aids.
- “You form your little support system. My Volvo and my hearing aids are right up there.”
- “I love my hearing aids. I try so hard to be so good to them.”
- After wearing the hearing aids in the shower, the patient said, “I am so sorry I did this to you.”
Our primary goal for the patient is use of and satisfaction with the hearing aid. We want the patient to benefit from the use of amplification. It can be gratifying when they give us a positive report about their hearing aid use.
- “I am just tickled pink.”
- “My wife has commented that I listen a lot better.”
- “These things help me a lot, but my hearing is not perfect.”
- “You fixed me up real good; really turned the juice up.”
- “I could hear a pin drop with these.”
- “It’s like night and day.”
- “Pretty close to 10.”
- “I feel like a new person.”
Sometimes, the patient does not perceive benefit from hearing devices until the individual removes the hearing aids.
- “I can tell when I don’t have them in.”
- “I can tell when I take them off, it’s more silent.”
- “The world is dead without them.”
New hearing aid users can be surprised when they realize the impact of their hearing loss. Often, they are not aware of sounds they could not hear.
- “One of the nicest things; I can hear the birds.”
- “I had no idea my phone makes a noise when you take a picture.”
- “I heard the clock ticking; has it always been that loud?”
- “I hear grass flutter.”
- Hearing clothes rustle; “a really big surprise.”
Patients frequently complain environmental sounds and ambient, background noises are too loud or noticeable.
- “I find myself paying attention to the noise more than the people talking just trying to figure out what that sound is.”
- “I heard the ice machine; like a hailstorm inside a car.”
- “The rain on the windshield sounds like rocks hitting the windshield.”
- “When I first got my hearing aids, the tires on the pavement sounded like a meteor coming in.”
- “There’s a crackling sound, like stiff paper wadded up.”
- “I can hear them crack an egg in the kitchen.”
As patients become more accustomed to amplified sound and have more experience with hearing devices, they are able to make judgments about the hearing aid fitting, including sound quality.
- “I think I need a tune-up.”
- “They work, almost too well; a little too shrill, treble.”
- “Left hearing aid is not pulling its full weight; right hearing aid is pulling more; is left hearing aid along for the ride?”
- “The left hearing aid is getting some age on it.”
- Low battery tone “sounds like a whale moaning or dying.”
Patients offer unusual descriptions about their hearing devices. They also make comments about their ability to manipulate the hearing devices and physical comfort.
- “I’ve been challenged on this installation.” (inserting receivers with domes)
- “Umbrellas” (domes) “keep falling off in my ear.”
- “My leash keeps falling out.” (sports lock)
- “These are right-handed domes and I am left handed.”
- “At the end of the day, I’m so relieved they’re out. It’s like taking your bra off.”
- “The left hearing aid battery drawer is a little flippy floppy.”
Focused attention and active listening are paramount to establishing an interpersonal relationship with each patient. People want to be understood, validated, and appreciated. When one truly listens to the person, we demonstrate compassion, respect, and understanding (Ciardello and Janssen, 2011).
We must listen to the patient for important information. Clinicians should apply attentive listening skills to learn the patient’s story, and personal attributions, beliefs, and feelings (Fortin et al, 2012). According to Nitzky (2016), “we need to understand their priorities, lifestyle, goals, and values.” Many patients explicitly and eloquently describe their experiences, their communication struggles, and their objectives (Wilson, 2015). We must value the patient’s input and feelings, and we should trust what the patient shares with us (Wilson, 2015). “Trust is one of the most powerful forms of motivation and inspiration. People want to be trusted” (Covey and Merrill, 2006).
According to Draper and Goyne (2017), “if patients feel understood, it builds an atmosphere of trust and collaboration.” We must establish an effective working relationship with the patient, characterized by honesty and integrity. We want the patient to trust us and believe in our sincere desire to help. “Simply put, trust means confidence. When you trust people, you have confidence in them—in their integrity and in their abilities” (Covey and Merrill, 2006). We can positively contribute to the patient’s well-being and quality of life. Our ultimate goal for hearing rehabilitation could be summarized by a patient’s description of his hearing aids; “they make life a whole lot nicer.”