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ViewPoint: What's ethical? Who decides?

Katz, K. Ray

doi: 10.1097/01.HJ.0000293015.63628.a3

In the midst of all the soul-searching taking place in hearing healthcare circles regarding ethical practice, a practitioner argues that adhering to a few simple rules can ensure a dispenser a clear conscience.

K. Ray Katz, BC-HIS, has been a dispenser for more than 26 years, before which he was a special investigator in Europe and Asia for Army Counterintelligence. He owned a multi-office business in Arizona where he has also been chairman of the state licensing board and the state hearing aid society. Mr. Katz currently has an office in Benson, AZ, and may be reached at 520/762-0086 or by e-mail at

Editor's note In the past year, an initiative by the American Academy of Audiology has led to an increased focus on ethical practice. Ethics is a complex subject about which there is ample room for differences of opinion. Following is one perspective, offered by a hearing professional who has been in practice for 26 years. The Journal welcomes other opinions on the issue.

I recently received an e-mail from Audiology Online and The Hearing Journal asking me to fill out a survey related to our profession. No surprise. Everyone is doing surveys. How else would we know if we are above or below average? Gee, what would happen if I was below average and didn't know it? I won't even discuss being above average. That's for someone else to worry about.

Anyway, this survey had a bunch of questions relating to ethics. Most of us in hearing healthcare think of ourselves as being ethical in our dealings with our patients. The few who don't think they are treating their patients ethically are probably right. But what about the rest of us? What is ethical, and who is to judge if our conduct is ethical or not?

Most states have laws governing how we should treat our patients and all states have consumer fraud laws, so the really bad ethical violations are written down for us to avoid. That's just in case our parents didn't teach us the difference between right and wrong when we were growing up or we slept through the ethics class in college.

Traditional hearing aid dispensers have always practiced in a retail or business environment and have generally followed certain rules: (1) Do the best you can for your patients. (2) Make a profit so you can feed your family and live a good life. (3) Stay ahead of the competition. (4) Reap whatever rewards legitimately come your way.

Audiologists have had a somewhat harder time of it since they were trained first, last, and always to serve their patients to the best of their abilities. Nothing wrong with that! But, very likely they were not told that they had to make a profit or that making a profit is a good thing. “Do no harm” and “Make a good profit” are not mutually exclusive commandments! Most physicians have figured that one out.

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What I've been leading up to is that it appears to these old eyes of mine that dispensing audiologists are being told that many of the things they do every day are unethical and unprofessional. I'm talking specifically about accepting the various “perks” offered by manufacturers. A professional who buys equipment from a manufacturer with a written or implied quid pro quo or who accepts trips or the like is being told he or she is unethical.

This line of reasoning can be extended to condemn many other common activities as unethical, including taking advantage of quantity discounts, doing co-op advertising, joining a buying group, accepting open house support, and attending free seminars sponsored by a manufacturer.

Remember the first two rules I listed above for hearing aid specialists: Help your patient to the best of your ability and make a profit. I would argue that these two are inseparable and interdependent. You can't—and shouldn't—do one without the other.

Making a profit without helping your patients is unethical. Fortunately for consumers, you won't be in business very long if that's how you operate.

However, I would argue, helping your patients without making a profit is just as unethical since, again, you won't be around long enough to help the people who need you.

In a competitive marketplace and at a time when we are fitting fewer instruments than we used to, a smart businessperson/professional who wants to help as many patients as possible will take advantage of every appropriate opportunity to reduce costs, improve services, and increase sales.

What, I ask, is unethical about trying to purchase instruments at the best possible price so you may pass the savings along to your patients? What is wrong with using co-op advertising so you can afford to reach more hearing-impaired people with your message of better hearing? What is unprofessional about taking seminars that enhance your ability to help your patients, even if the courses are part of a manufacturer-sponsored weekend at a lovely resort? And, what is wrong with a hearing professional reaping some personal rewards from all of this? Not a thing!

Most of us are not saints, but neither are we the sinners that some would have us believe.

What seems to have some people worried is that audiology, whose origins are in the non-profit world, has become part of the business world, where a professional gets paid in money as well as in the satisfaction that comes from making a difference in people's lives.

The rules of the free marketplace apply as strongly to hearing aid manufacturers as they do to hearing professionals. All manufacturers want to sell us more instruments. To do so they have invested millions of dollars so that their products are competitive with the other brands.

As a result of this competition among manufacturers, we can fit a patient with quality instruments from any one of a dozen or more companies without compromising the quality of the fit. In this environment, it's simply foolish for a practitioner to say, “I want to fit my patient with a hearing aid that is as good as any other. But, so that no one can accuse me of a conflict of interest, I want to pay the full single unit price and I don't want any perks.”

It's foolish and it's unnecessary as well. If you are honestly trying to fit all your patients with amplification appropriate to their needs and if you are charging prices that are fair and meet your need to have a successful business, I contend that it doesn't matter what arrangements you have with manufacturers—provided they are legal.

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For those in the hearing healthcare community who are concerned about the ethics of the rest of us, I would suggest that they turn their attention, not to legitimate business arrangements between dispensers/audiologists and manufacturers, but to what I consider the blatant violation of consumer fraud laws, specifically the misleading advertising of product discounts.

How often have you seen your competitors (not you, of course) advertising hearing aids at 20% to 40% or some large dollar amount off manufacturer's suggested retail price (MSRP)? Have you ever thought, “Wow! ABC Hearing Center must be making a fortune if they normally sell aids at MSRP”? Or, more likely, you say to yourself, “That sure is misleading because I know that ABC doesn't normally sell aids at MSRP.”

The fact is, this ad is at best misleading and at worst fraudulent if ABC advertises a discount from MSRP and fails to acknowledge in its ad that it does not normally sell hearing aids at MSRP.

Also, consider the message about hearing aids this type of ad sends to consumers. It will cause consumers to view hearing aids as no different from any other expensive electronic gadget. And, just as with the zero percent interest car ads, prospective purchasers will simply wait for the next big sale before getting help for their hearing loss.

My soapbox is getting a little soft now, so it must be time to step down and let someone else put in his or her 2 cents' worth. But, here's my take-home message on ethics: Serve your patients to the best of your ability, make a profit, never say anything derogatory about your competitors that you can't prove, and go to bed at night with a clear conscience. If you can do that, your ethics are in pretty good shape!

© 2003 Lippincott Williams & Wilkins, Inc.