People know "Stuff"

As a child, I have vivid memory of Dr. Shepard, my family doctor. The good doctor lived in a large two story white house in a nice area of town and had his office on a portion of the main floor. My parents took me to see the doctor for regular checkups and then awaited his findings and directives. 

If  I had abdominal pain and the doctor  decided that I needed my appendix removed simply by palpating the area where the appendix would be located, my parents would accepted the diagnosis without question and the surgery was scheduled. If the doctor looked in my throat and decided I needed my tonsills removed a similar process was followed. The point being that medical science was considered knowledge out of reach for the common man. Our physicians held the keys to our health and we as patients accepted diagnosis and the process for remediation without question. Our family doctors, as a result, were held in high regard due to this position of necessary prominence in our lives.

As a young child my family decided that I would be a doctor, actually I was to be a pediatric orthopedist. That, by the way, is entirely another blog. At the age of  ten,  my parents purchased a whole set Encyclopedia Britannica. In addition to the adult version of the Encyclopedia was a children's version as well as a set of medical Encyclopedias. The expectation was that I was to read them all. This too is probably another entire blog. The Encyclopedias being accessible was for me the unravelling of the mysteries of medical science and was typical of how we learned of the unknown, we read it in a book or Encyclopedia, as it was in this case.

Today we live in a world where knowledge and information flows so much more freely. We do know a lot more than we did when I was a child. So much about medical science has become common knowledge because of the growth in television and other media but specifically the internet. We all have the opportunity to learn about virtually any subject in a very short time. I typically know what ails me and what I want done for me and prescribed for me, before I get to my doctor's office. I know what type of diagnostics I require simply by understanding the disorder or pathology I might have. If the doctor suggests I have something particularly wrong with me that I did not suspect, the first thing I do is a search on that disorder and learn all I can about it. If a family member is diagnosed with something sinister I will educate myself on that disorder and be available to make sure the correct decisions are made by the specialists as well as decisions that I am comfortable with.

The point is that as an Audiologist, I have to be aware of this reality and understand that my job is one that has components that are evaluative and diagnostic however what has become the greatest part of what I do is educate. Most of my patients now know "stuff" about hearing, balance and disorders in both areas. Most of my patients also have some idea of what they do and do not want to do about their hearing or balance issue. What each of us as consumers of health care want more that anything else is knowledge. We want knowledge that allows us to make decisions about ourselves for ourselves. Decisions that WE make are done with a lot more confidence in the outcomes than decisions that others make for us.

So practicing as a Doctor of Audiology has a significant component of being an educator  as well as a Clinician. One must consider that people know "Stuff" and that can not be denied. My job is to make sure that people know the right "stuff" when it comes to their well being.

The Power of the Human Touch

What is necessary or unnecessary when it comes to evaluation and diagnosis?   The initial interview portion of each assessment, taking patient history, hearing about what symptoms they have is a powerful tool. Listening to the parent of a child describe their concerns and why is a piece of knowledge that can not be overlooked. 

The truth is that I can usually be fairly accurate is judging the nature and severity of disorder or even the presence or absence of disorder just through the case history or interview process. I might not have had this ability right out of school but there is consistencies that you learn along the way over time. Really listening to the patient and their families is a skill but asking the right questions is also a skill that one needs to develop in order to facilitate good clinical analysis. The truth is that your family doctor can often assess your needs based on symptoms. So the question becomes, why bother with the hands on component of assessment?

I have a cousin who is rather brilliant and as a result was predestined for medical school out of undergrad. This student was brilliant and capable when it came to the book work but when it came time for his first clinical placement something happened. This young man came to the realization that he found it exceedingly difficult to make a personal touch based connection with those he did not know.  He simply could not touch those with whom he was unfamiliar.   Biomedical engineering was a much better fit for this individual.

The reason I bring this up is because we as humans need that personal connection in order to develop confidence in the process of assessment. One needs the Doctor of Audiology to look in their ears when assessing their hearing. One needs the Medical Doctor to look in their throat when assessing their sore throat. I was told by a medical Doctor some time ago that indeed they were taught in medical school the necessity of touch in the process of evaluation.

We look for personal connection with those that "take care of us". Certainly "touch" has power but so has the way we "touch" each other through personal communication, by listening to each other, by finding out about who the patient is. There is amazing power conveyed through "touch".

Motivation to Listen and Hear

The way you listen to others becomes the way they speak to you.  If you demonstrate how interested you are in what others say, others will say more to you. Ninety percent of all communication is non-verbal so your listening of others says more to them than anything you can say.

If others believe that you're not listening to them, they won't listen to you. It's called the Law of Reciprocation. Think of your most recent encounter with someone you believed wasn't listening to you. Think about your feelings of irritation and annoyance. Or if this person is an important part of your life, think about the anxiety or doubt that not being heard by this person caused you. 

Here's what I know about humans: if we feel we're not being heard by someone else, we see it as our fault. We question our ability to communicate effectively. We focus on what we did wrong even if nothing is wrong. We take the other person's lack of interest as an indictment on ourselves. 

And here's the real tragedy:  "Most people are not even aware of the pain they're causing others by their level of distraction. They're ignorant of the trauma they're causing by being absent even through they're present."  This is a quote from Mike Lipkin of Environics and motivational speaker. 


I was fortunate enough to hear Mike speak at a conference that I attended. While much of what motivational speakers say might be construed as Universal truths that we all know, sometimes it is valid to hear them again to emphasize the pertinence to the application that we are currently considering. This quotation spoke to me as an Audiologist dealing with people on an everyday basis. I know I need to be friendly I know I need to be personable but this quote said more to me. I could say that my natural personality allowed for this kind of connection to be made with my patients and that was a major reason for the successes that had come my way. The thing is that this approach was unintentional as opposed to being done purposefully or intentionally.

I have found that even listening is allowing for disclosure but also giving a little to get a little. Personal revelation goes a long way into allowing others the confidence to communicate their own personal difficulties. Listening intentionally is something we can do not just on a professional level but also would be wise to add to our everyday interactions.

Think though, of the hearing impaired individual, who tries to listen but is inefficient in doing so because of a hearing loss. If the person being communicated with is unaware of the impairment the effect can be negative. The hearing impaired person that doesn't know they have a hearing loss tries to accommodate or even fake their way through a conversation often leaving the other feeling that they were figuratively not heard when the fact is they were literally not heard. The implications of hearing impairment reach beyond the individual that is impaired to potentially effect all that they come in contact with.

How To Turn Five Minutes Into Ten

Over the years, I have been a clinical supervisor or mentor to nursing students, premed students, Communicative Disorders Assistants, grad students in Speech Pathology or Audiology, Hearing Instrument Specialists or just those interested in the field of Audiology. Typically, these students spend time learning the technicalities of my profession and hopefully much more. I have always felt that there is so much more to clinical competence than just theoretical knowledge.

Years ago, I spent much of my working life consulting to a variety of clinical practices, some Audiology and others, Otolaryngology. I was doing some work, testing for a well known and respected Otolaryngoloist and was finding the pace grueling. I was young and wanted to be as complete in my clinical assessment as possible. 

At some point, I commented to the Physician regarding the number of patients seen per day and the panic I was feeling working at this pace. The Physician shared this piece if advise  with me on that day and it is something I have never forgotten. "Sanj,"  he said  "the key to knowing you have used your time efficiently is to spend five minutes with a person and have them leave feeling like they spent ten". 

The longer I have been in practice, the more profound this statement has seemed to me. What is really being proposed is that the time you spend needs to be efficient and effective. When dealing with patients, I try to connect with them right away, to get to a personal level of rapport immediately. I try to be "present" asking questions, having discussions, sharing with efficiency. To personally connect with your health care provider gives one a feeling of comfort and security as well as trust.

Beyond the clinical, this is a lesson for everyday life and interaction as well. The truth is that we may only have that first minute of interaction with others to leave a lasting impression as well as the beginnings of connection.

96 and Out Of Breath

My wife, an avid blogger, www.livinglovingbreathingboys.com  has finally convinced me to start a blog on Everything Related to Hearing. As a Doctor of Audiology, this could prove to be a discussion of things limited to the field of Audiology, however I would rather choose to share experiences and insights into the human element of what I do for a living.

I have a story I love to tell of a truly life altering encounter I had with a patient many years ago that I hope will set the tone for my blogs to follow. I was working in the office of an Otolaryngologists many years ago and was waiting on my next patient. I had been running a busy schedule and as per usual had reviewed the patient chart quickly to get an idea of what I might expect. The chart proved to have little information that might help me prepare other than to cue me to the fact that my patient was a 96 year old female. I formed in my mind a vision of a hearing impaired little old lady that would soon walk in my door. I began to get annoyed because either the patient was late or going to be a no show and therefore I was not going to make any money during this time slot. These dark thoughts had started to permeate my consciousness when a knock on my door cued me to the arrival of my patient. When my patient arrived she was indeed this 96 year old woman panting and out of breath. I started to panic wondering if my patient was going into cardiac arrest or something just as sinister. As if reading my mind, or the panicked look on my face the lady told me not to worry, she was fine. You see she had been at the gym in the pool swimming laps when she realized she better scoot on over to her appointment with me. This lady had hurried over and in the interest of saving time just run up to the fourth floor on the stairs instead of using the elevator and this was why she was out of breath.

My interest in this woman was peaked at this point and we began the discussion that changed my life. You see she said "when I turned 90 I decided it was time for me to make some changes in my life, I decided to start taking better care of myself and to try new things". At 90 years of age this lady started going to the gym and exploring the world of possibility in front of her. The woman was fascinating and had captured me with the revelations of her life in the last six years. Never having tried it but always wanting to this woman took an art class at 90 and the long story short was that at 96 she had been painting and selling her art for a living with great success.

This encounter in life has spurred a thought that has driven me along the way. You never know what you are capable of if you have never tried. Your talents can go unexplored if you stop exploring the realm of possibility. I was a young adult at that time and have used the knowledge gained in that encounter to propel me to constantly be looking for new things to try and to learn.  That little old lady shook my world as I knew it.