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Hearing Loss and Misunderstandings

Henn, Patrick MB, BCh, BAO; Tuathaigh, Colm O. PhD; Smith, Simon BSc, MSc

doi: 10.1097/01.HJ.0000525528.48808.3f
Editorial

Dr. Henn is a lecturer in medical education at the School of Medicine at University College Cork, Ireland, where Mr. Smith is the director of communications and Dr. Tuathaigh is a lecturer.

Hearing health professionals have a key role in making old age less hazardous for patients who are ill and seeking medical help. Older people are more likely to have chronic diseases, physical or psychological decline, and regular contact with a range of health professionals in hospitals and medical facilities. They may also have hearing loss—a disability associated with older patients—that may contribute to suboptimal medical treatment.

Unfortunately, older people also are at increased risk of medication errors, some so serious as to require casualty department evaluation or inpatient admission. Premature readmission of elderly patients is common and costly. One in five Medicare beneficiaries is readmitted within 30 days, costing more than $26 billion per year (JAMA Intern Med. 2014;174[7]:1095 http://bit.ly/2uD3L55). A 2014 study reported cognitive status to be an overriding factor that correlates with health literacy, physical health, and depression in older adults; however, participants with hearing impairment were excluded from this study (Health Serv Res. 2014;49[4]:1249 http://bit.ly/2uCNixy). Researchers working with the Vanderbilt Inpatient Cohort Study found that about half of the elderly patients in their study experienced discharge medication errors (BMC Health Serv Res. 2014;14:10 http://bit.ly/2uCORvq; Mayo Clin Proc. 2014;89[8]:1042 http://bit.ly/2uCEdVT). Hearing-impaired patients were also excluded from this study.

To date, there remains a lack of well-developed research on hearing-impaired patients’ understanding of medical consultations, investigations, and treatments of health conditions unrelated to their hearing loss (Ann Fam Med. 2008;6[5]:441 http://bit.ly/2uD8XWz). Professionals may be unwise to assume that patients have an accurate understanding of their care. Patients (including practicing physicians) are reluctant to question their treating clinician. While written materials may adequately supplement a clinical interview, the quality of these materials has been questioned. Furthermore, one-third of older adults in England reported problems in reading and understanding written health information (BMJ. 2012;344:e1602 http://bit.ly/2vNpqG5).

As medical educators, we wondered if it was possible to train our students differently to reduce medication errors when managing elderly patients. To answer this, we had to disentangle hearing impairment from other possible factors like cognitive decline. We embarked on a study involving a large number of young, intelligent, assertive, and hearing-impaired adults.

This may be the first qualitative investigation of words commonly misheard by hearing-impaired patients at clinical consultations in a primary care or hospital setting (J Patient Saf. 2017 http://bit.ly/2uCJ5u4). We also looked at contextual factors that contributed to miscommunication and medical errors. Fifty-nine percent of the respondents said they have misheard a physician/nurse in a hospital; 60 percent identified these in relation to consultation content; 33 percent misheard words; 21 percent misinterpreted statements like diagnosis and medication details; 22 percent indicated physician/nurse-patient communication failures; and 19 percent noted failures to initiate/maintain eye contact and wearing surgical masks while speaking, preventing patients from lip reading. Concerning common words that were misheard or misinterpreted, 23 percent identified phonological similarity such as similar sounding words and numbers, while seven percent noted discrimination of unvoiced consonants. Similar findings emerged in community clinics.

Our findings underscore the need to identify hearing-impaired patients and augment communication with visual aids and other strategies like lip reading.

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