Effective communication has been shown to improve patient outcomes and satisfaction in a number of studies( Scand J Caring Sci 2006;20: 143-150 http://onlinelibrary.wiley.com/doi/10.1111/j.1471-6712.2006.00420.x/abstract;jsessionid=562AF753E0839394B72815566761E3DE.f02t04; J Eval Clin Pract 2010;16:560-568 http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2753.2009.01160.x/abstract). Hearing loss is a very common diagnosis in the general population that also happens to be invisible to many. As we all know, it can cause significant barriers to successful communication.
Working as an audiologist in a busy medical facility, I often find that my patients are other medical professionals—physicians, physician assistants, nurse practitioners, nurses, clinical medical assistants, and transcriptionists, among other medical staff members.
Although the challenges that hearing loss poses for these professionals are common to most of my patients, this group of healthcare providers presents some unique communication issues.
Medical professionals must accurately hear their patients and coworkers in a variety of environments where inaccuracy can result in devastating outcomes. In addition, many of these professionals routinely use a stethoscope and must diagnose medical problems based on what they hear.
As a result, making proper recommendations for patients who work in medical fields is not only important for their daily function, but also vital for their communication with colleagues and patients. The Americans with Disabilities Act (ADA) of 1990 http://www.ada.gov/pubs/ada.htm governs the accessibility and accommodations that employers and educators are required to provide to employees and students with disabilities of all kinds.
In that vein, The Hearing Journal published an article about the legal case brought by Michael Argenyi, a medical student with hearing loss, against Creighton University in Omaha, NE (April 2013 issue, p. 12 http://journals.lww.com/thehearingjournal/Fulltext/2013/04000/Legal_Case_Casts_Light_on_Accessibility_Issues_in.7.aspx). Mr. Argenyi asked for Communications Access Realtime Transcription (CART) and interpreter services; however, his repeated requests were denied by the university.
In September 2013, a jury in federal court concluded that Creighton University discriminated against Mr. Argenyi and must provide reasonable accommodations. Then, in December 2013, a judge made the final ruling that interpreters and CART must be provided at no charge to Mr. Argenyi, who had previously paid for interpreter services himself.
Communication Strategies and Accommodations Utilized by Health Care Providers with Hearing Loss: A Pilot Study
Trotter AR, Matt SB, Wojnar D
Am J Audiol
Alanna R. Trotter, Susan B. Matt, and Danuta Wojnar conducted a pilot project investigating the impact of hearing loss on the work of professionals in a number of different medical fields, particularly on the communication strategies and accommodations they used.
The authors developed a 28-point survey that included basic demographic information and items specific to hearing loss, such as age, gender, work environment, years of experience in the medical profession, hours of direct patient care, and onset of hearing loss, as well as questions about accommodations and communication strategies.
Subjects were recruited in the digests and Facebook page of the Association of Medical Professionals with Hearing Losses (AMPHL). The survey was completed by 32 healthcare professionals—11 registered nurses, six medical doctors/doctors of osteopathic medicine, four doctors of veterinary medicine, four nurse practitioners/advanced practice registered nurses/masters of science in nursing, two pharmacists, and one in each of the following professions: audiologist, medical assistant, echo/ultrasound technician, radiation therapy technician, and dietitian.
Of the participants, 25 were woman, and more participants were in the 40- to 49-year-old age group than in any other age group.
In terms of additional characteristics related to work environment and hearing loss:
- Eleven participants worked at hospitals, six participants worked in private clinics, and the remaining professionals worked in other settings.
- Nineteen respondents reported onset of hearing loss at birth or early childhood, and the remaining participants had progressive loss.
- Assistive communication modes included hearing aids (21 participants), cochlear implants (10 participants), captioning (13 participants), and American Sign Language (ASL; seven participants).
- Twenty respondents used amplified stethoscopes; the Cardionics E-Scope was most popular (12 participants). Of note, all respondents who had cochlear implants used the Cardionics E-Scope, and several participants used the Steth-O-Mate adapter tips on Littman stethoscopes.
TENSION WITH EMPLOYERS
The healthcare providers differed as to whether they told their patients about their hearing loss. Nineteen professionals reported sometimes sharing that fact, while only three participants said they always told patients. Two respondents reported never divulging their hearing loss to patients.
The decision to share the presence of hearing loss was based on several factors, including the need for repetition from the patient; use of assistive technology, such as an amplified stethoscope or frequency modulation (FM) system; and the development of a rapport with a patient who has hearing loss, participants said.
Many of the respondents reported difficulty in their relationships with employers, colleagues, or staff; 17 said they received no special accommodations because of their hearing loss, while several were granted a decreased patient load, amplified or other special type of telephone, or other assistive technologies, such as interpreter services, CART, or note takers.
On the other hand, most of the healthcare providers reported satisfaction with the accommodations in their work environments—19 participants—while nine said they were not satisfied. Communication strategies used by the respondents included working face-to-face with people, moving closer to patients, asking for repetition, repeating what they heard, and using visual displays, such as e-mail or other written communication.
The healthcare professionals made a variety of recommendations for additional resources, including improved education about the ADA, the use of clear face masks, a better technology interface with hearing aids and cochlear implants, and more affordable hearing aids and assistive devices.
TROUBLE FINDING AN AUDIOLOGIST
This study reported communication approaches and accommodations used by a small number of medical professionals in a variety of work settings. The respondents described using the same strategies that are recommended by most clinical audiologists for all patients with hearing loss.
It's interesting that 15 of 29 participants reported difficulty finding an audiologist who could help them with work-related priorities, including the need for an appropriate stethoscope. It is important for audiologists working with medical professionals who have hearing loss to identify internal and local resources for them and to develop strategies that will help the providers be successful in their own work environments. The Association of Medical Professionals with Hearing Losses website https://amphl.org/ is a very good starting point for medical professionals to find support and information about particular tools, such as specialized stethoscopes.
One suggestion from an audiology practice where many patients work in medical professions is to develop a list of mentors or peers with whom the professionals can collaborate and share ideas.
I recommend that patients who have difficulty hearing with their stethoscope work with an expert who can help them identify particular heart, lung, and other body sounds through the stethoscope, and verify that what the professional hears and reports is accurate. Some amplified stethoscopes, such as the Cardionics E-Scope, can be used as a teaching/learning tool, allowing the teacher to hear what the student (in this case, a medical professional with hearing loss) is hearing via headphones.
Accommodations that use visual displays and the Bluetooth/wireless capabilities of hearing aids and cochlear implants will likely become more readily available in stethoscopes and medical communication in the future, allowing more seamless transition between work and nonwork environments for medical professionals with hearing loss.