A Patient’s Journey: Interview with John Greer Clark, PhD
Douglas L. Beck, AuD, spoke with Dr. Clark about the stages of a patient’s journey, breaking difficult news, building motivation when there is none, avoiding clinical behaviors that lead to poorer clinical dynamics, improving patient information retention, moving beyond the technological fix in hearing loss treatment, and more.
Academy: Good morning, John! Congratulations on the new book!
Clark: Hi, Doug. Thanks.
Academy: If you’ve got a few moments, I’d like to chat about the content of the book (2014) co-authored by you and Kristina M. English, titled Counseling-Infused Audiologic Care.
Clark: Sure thing.
Academy: Okay, so let’s start with…what motivated you to write another book on counseling?
Clark: Good question! Well, as you recall, Fred Martin and I published a counseling book in 1994 that was an edited book with multiple authors. This evolved into the 2004 book with Kris English as an author…and then, in 2014, it was just about time to rethink and rewrite and re-publish…the result of which is Counseling-Infused Audiologic Care.
Some audiologists may believe they cannot serve as counselors because counseling is considered (erroneously) outside their scope of practice. Clearly, psychotherapy is not within or scope. However, audiologists do counsel patients and it’s within our scope of practice when we’re talking about both informational counseling and, equally important, personal support counseling. Unfortunately, as with many health professionals, audiologists limit their counseling to information transfer. To address the emotional impact of the oftentimes difficult news that we present, and to enhance patient motivation and commitment requisite to hearing treatment success, we need to be able to listen effectively and to respond in ways that acknowledges patient fears, bolsters motivation and develops self-confidence in the face of change. The counseling we provide should be infused into all that we do. It is not an add-on service.
Academy: And let me jump in for a moment and note that our traditional adherence to “content-only” issues is likely a significant contributing factor with respect to why so many cochlear implant and hearing aid patients think of us a sales people!
Clark: I agree with you. When the person with hearing loss buys or acquires hearing aids without professional services and counseling beyond simple informational counseling, the product becomes the focus of the process and the person providing it becomes a salesperson. We do indeed provide products, but the product is not likely to be as successful as it might be if we fail to properly infuse counseling-based audiologic care into the activity.
Academy: So, John, if we consider that each patient is on his or her own journey, which is not necessarily a predictable, step-by-step, straight-line process…what is it we can and should do to influence or motivate patients appropriately?
Clark: When patients come to see us, there are often many emotional and personal experiences which the patient has been living with as a result of hearing loss. To help patients, we need to know a lot more than what our testing can tell us. It is not really our role to motivate our patients. As all of us know, when we need to do something that we don’t really want to do, motivation to take action usually has to come from within ourselves. We need to be able to guide our patients through a bit of introspection so they can realize better the full impact of hearing loss on their lives and on the lives of those around them. This is a far more powerful motivator than when we tell patients which speech sounds they are missing based on their audiometric profile. And we have a variety of tools to guide us in this introspective exploration with patients. A large-scale survey, conducted by Paul Pietrzyk when he was a student at the University of Cincinnati, found that more than 60 percent of audiologists used self-assessment measures less than 25 percent of the time. One of the features of the text is that it outlines how we can use self-assessments to help springboard patients toward actions that should be taken – whether it’s an adult reluctant to purchase hearing aids, or a pre-teen who no longer wants to wear hearing aids.
Academy: As a profession, we certainly don’t make full use of the tools we have available. Which assessment tools would you recommend?
Clark: This is a question that comes up often. Of course, there are a whole variety of assessment tools available. I’ll mention a few, but it won’t be an exhaustive list, and these might not be the very best tools for each individual and each situation! So, that said, I like the Hearing Handicap Inventory for Adults/Elderly (HHIA/HHIE) and the companion communication partner versions. We detail the “Screener” versions in the book and they’re very quick and efficient. Schow and Nerbonne’s (1982) Self-Assessment of Communication is another excellent tool for exploring the impact of hearing loss and is available in a computerized self-scoring version. I also like the assessment tool by Preminger and Meeks (2012) called The Hearing Impairment Impact—Significant Other Profile. It is one of the few tools that actually explore the effect of a person’s hearing loss on the life of that person’s communication partner.
Academy: And can you tell me your thoughts on the Client-Oriented Scale of Improvement (COSI, by the National Acoustics Laboratory)?
Clark: Yes. The COSI is an excellent tool to help define and set goals, and to define, clarify and adjust realistic expectations for those goals, although it’s not specifically designed to explore the emotional impact of hearing loss on individuals. It works very well in tandem with the others.
Academy: John, one section of the book that rang true for me was in one of the early chapters addressing the stages of grief associated with hearing loss. Can you please comment on that?
Clark: In the book we said, “When a diagnosis of hearing loss is given, life as envisioned for the years ahead is changed forever, and clearly not for the better.” For many of us who are diagnosing hearing loss, the process becomes relatively routine. But for the parent of a child with hearing loss, or the older patient with hearing loss, there’s loss, there’s grief, and there are changes. The many stages of grief certainly do not follow a set pattern and can frequently be revisited. But we do have to demonstrate our acceptance of patients and the stage of grief they may be in. Grieving is normal. We also need to recognize when a patient needs professional help with grieving and we explore this in the book.
Academy: That’s great. Thanks, John. I’m very appreciative of your time and I absolutely enjoyed the book. Congratulations to you and Dr. English on a wonderful and comprehensive text!
Clark: Thanks, Doug.
John Greer Clark, AuD, is an associate professor of audiology at the University of Cincinnati and co-author of Counseling-Infused Audiologic Care.
Douglas L. Beck, AuD, Board Certified in Audiology, is the Web content editor for the American Academy of Audiology.
Also of Interest
Counseling-Infused Audiologic Care CEU Program