Special Section: Empowering Patients in Medical Settings
Getting medical care is stressful for everyone, but it is particularly challenging for people who are hard of hearing. Emergency departments and hospitals are often busy, crowded places with poor sound insulation. Alarms beep, patients and staff call out, and multiple conversations are often happening at the same time. Stress abounds. Foreign accents and the use of unfamiliar medical jargon make speech understanding even more difficult for these patients.
Research has confirmed that hospitals are difficult listening situations. For example, a study of the emergency department of a leading U.S. hospital found an average background noise level of 60-69 dB (HL), and similar levels have been found in ICUs and operating rooms (J Acoust Soc Am. 2007 Apr;121(4):1996). Another study of hospitalized patients presented speech at a normal conversational tone, then superimposed hospital noise at the typical local ambient level (Res Nurs Health. 2013 Jun;36(3):228). With superimposed noise, all patients showed decrements in hearing, but those with hearing loss fared the worst.
Poor communication is always unfortunate, but in health care settings, it can be lethal. Good communication between clinicians and patients has been repeatedly linked to better health care outcomes and better quality and safety (CMAJ. 1995 May 1;152(9):1423; MJ Open. 2013 Jan 3;3(1). pii: e001570). For example, patients who cannot communicate are unable to provide good medical histories of their problem to health care providers, so they may be misdiagnosed. Those who can't hear verbal instructions may not understand changes in their medication regime. Most importantly and fundamentally, people who are unable to communicate cannot fully participate in their care.
Law and public policy recognize this problem. The Americans with Disabilities Act requires that hospitals provide “Effective Communication” to patients who are deaf and hard of hearing (ADA, 2014). This includes offering an array of auxiliary aids and services.
Unfortunately, many health care providers just don't get it. In my discussions with clinicians and health care administrators across the country, no one has said that his or her staff are trained to recognize hearing loss or use good communication strategies. There is pitifully little institutional capacity to provide simple solutions such as non-customized amplifiers that could help patients participate in their care. This institutional ignorance is particularly insidious given the high number of elderly patients who are hospitalized.
This ignorance is inexcusable, but patients must be prepared for the difficulties of hearing and understanding in health care settings. They should be ready to advocate for themselves, in as much as they are able.
That's where you, the audiologist, come in. Be sure to read a related article (on p. 32 in this issue), where two experts provide strategies for audiologists to facilitate effective communication between patients and health care providers in different medical situations. In an era when audiologists are working to show their value added, what better way to show that value than by providing guidance that will help patients with hearing loss live better?