No One Owns You

Having spent some time in the United States for my education and having worked in a few different settings there I can tell you that there are some rather apparent differences in the way health care is delivered. If you have ever driven through the states you will have seen billboards advertising a variety of health care including emergency rooms. I remember seeing a sign that had a digital readout advertising the wait time at an emergency room. My Mother-in-law was a nurse and at one point my wife and I visited her in Texas where she was working. When I walked into the hospital lobby I felt like I was in a high end hotel like the Ritz Carlton. The décor and amenities were mind-boggling. I wanted a place to get a work out in while I was there and was able to use the Hospital gym that rivaled any health club I had been to. While this is obviously not the case in every hospital it does point out a stark difference in how health care is delivered. Health care in the U.S. is a business and the services of that business are marketed to increase the revenues of that business. These businesses strive to set themselves apart from each other in hopes of having potential patients utilize their services.

Canadian health care is a very different scenario. In Ontario we don’t really make choices in health care. We find a Doctor if we can and all referrals to specialists and hospitals are made by that Doctor and we comply. Now that’s not to say we don’t have great health care because the reality is that we have some amazing health care and hospitals, it is simply to say that we don’t shop for our health care. We rightfully understand that if we don’t like our current physician for any reason well that’s likely not going to be something we can change given the process involved. In the U.S. if you don’t like your Doctor or want another opinion you simply make that change. 

The practice of audiology and hearing care that is non physician based is very different than health care covered through our universal healthcare system, however we are so conditioned by Universal health care that we often conflate the two and really think of one as having the same limitations as the other. The reality is that because you have started with or been going to a particular clinic or dispensary for hearing assessment or for the provision and care of hearing aids there is nothing that binds you to that clinic or dispensary.

I often seen people that come to me with pre-existing WSIB (workers comp) cases thinking that they can't change the clinic they have been going to even if they are dissatisfied or unhappy with the care they have been receiving. The reality is that everyone has the ability to use that coverage as they choose. I often hear my patients tell me of family members or friends that have hearing aids they struggle with but don’t think or know that they have the option of going somewhere else for their care.

A common practice in audiology and hearing aid dispensing clinics is to sell the practice when moving to retirement or on to something else. Much of the clinic value is really the patients, so it is really the patients that come with the clinic that are being sold. This always makes me cringe as I look at this from the perspective of the patient. No one owns the patient. The patient chooses where they want to go and have the free will and ability do so. This is not the same thing as the medical system that we are used to.

The point becomes that as a consumer of health care in this context even here in Canada you have choices that you can and  should exercise in getting the best care that you can relative to your hearing. You deserve to be confident and satisfied with the care you are receiving. You should feel like your expectations are exceeded rather than simply met or perhaps not even that. No one owns you or your file or your care.

Turkey Days and Hearing Problems

While I have written on this subject before it is worth discussing again. So what is the correlation with turkeys and hearing problems? Well specifically at this time of year our neighbours  to the south (neighbors for them) celebrate Thanksgiving sometimes referred to as Turkey day, a day in which families get together to watch football share time together and have a meal built around the thanksgiving turkey. We as Canadians but earlier in the year.  This is a time in which we spend a fair amount of time functioning in a group setting. This is a time of conversation sometimes random or at least with rather varied  subject matter. If your family is anything like my family several conversations can be taking place at the same time around the dinner table and they can be just about anything. While this is what we call relaxing it can actually be a fairly frenetic time of conversation. As one turkey day ends it is only a few weeks away from another turkey day, Christmas. Especially this year with American Thanksgiving only a month away from Christmas, four weeks, it is going to be like the party doesn't stop. There are going to be family get togethers, parties with friends , office parties, church events and many more opportunities for times of heightened social interaction. While this time of year can be nightmarish for natural introverts it can also be a very difficult time for those that have become introverts due to their hearing loss and the complexity it brings to communication.
Those with hearing loss we know have extreme difficulty functioning in background noise. The noise of multiple talkers makes it difficult to impossible for the hearing impaired to understand speech effectively. Things may indeed be loud enough but not clear enough. This a common difficulty for the hearing impaired and often one of the early signs of hearing impairment. In a background of noise we find ourselves using our eyes more and more, watching peoples faces to help ourselves to understand what is being said.
For the hearing impaired the holiday season spanning from one day of turkey eating to another can be frustrating , challenging , daunting and exhausting given the difficulty presented by the communication environment. It can be so difficult at times to communicate that the hearing impaired individual chooses to avoid what would have otherwise been a time that would have been a highlight of the year.
For those family members, friends, co-workers, and acquaintances that are spending time with the hearing impaired during the holiday season being aware and considerate of the difficulty that is faced would be so appreciated by the hearing impaired individual. When we are aware of someones difficulty and it matters to us we are then able to do some things to make communication easier and more enjoyable for someone that otherwise will be left out feeling disconnected.
So what do we do? We can reduce the background noise. We may have the football game on at Thanksgiving as a family tradition but perhaps we can have it on with the volume turned down or off especially if we are having other conversations going on at the same time. We can make an effort to confirm engagement by addressing and including the hearing impaired individual and verifying that they are included and following the conversation with subtle questions that allow you to actively fill in the missing parts. The best strategy however is to schedule some one on one time with those you care about that have a hearing loss. Spending some one on one time in a quiet environment with the hearing impaired individual will allow them optimum functionality and allow for a much more enjoyable experience. The reality is that hearing impaired or not, just taking the time to spend some quality one on one time with those that matter is time well spent.
So this Turkey season think about whats important and who is important. Give the gift of your time to those that matter.

25th Anniversary For The Ear Company

25 years. Wow! When I was young I used to think that 25 years would be an eternity but that eternity seems to have blasted by at warp speed. It was 25 years ago this month that Peterborough Audiology Inc. came into existence. When I was in graduate school I used to envision what I thought my professional career would be like. I thought that what I wanted as a professional was primarily linked to monetary gain. As a young man in school I don’t think I really understood the effect my personal impact in my profession could have and how important it could be. I always envisioned private practice but really didn’t know what that would be like and how to go about doing it right. When I sit with Mary Girard my office manager from the start and reminisce about those early days it is hard to imagine that we actually survived. This month as I look back on the last 25 years I feel so blessed. I feel honoured to have encountered so many wonderful people along the way, I feel humbled by the way peoples lives have been changed because of the function of our clinic. I have learned that I love the people I get to meet and want to get to know them and be personally involved in their hearing health. I have learned that I don’t prefer administration. I have learned that excellence in one location for me is preferable to owning and operating a chain of clinics from behind an office desk. The fact that my clinic is in a place like Peterborough is also an unforeseen benefit. This town is a large small town where we want to know each other and are willing to take the time to do so. This has been a town where my clinic isn’t just a business but is a part of a community. 25 years and enough mistakes made to have a good idea of the better way to do things. When I consider what I reflect on when thinking back on these 25 years it is the many individuals, characters and their stories and experiences that I cling to. My life is enriched because of these people. 25 year of amazing people is something worth celebrating. I look back and smile at the experiences and interactions but also feel sadness for those that have passed away. With all the ups and downs what a wonderful 25 years it has been for “Peterborough Audiology”, “The Ear Company”. I love that along with my staff we can be proud of what we are what we have done and what we continue to do.

Hearing Loss and End of Life

The ability to hear is always important but perhaps takes on added importance in those last days of life. As audiologists, we are often asked to help our patients hear better during those last days by assuring that their hearing aids are adequate and functional, as well as we are sometimes asked to provide personal listening devices.

There is the suggestion that hearing is the last sense to go before death and there is growing evidence of this possibility. In the article “Signs of Death” written by William Lamers M.D. for the Hospice Foundation of America he states that, “Caregivers, family, and physicians should always act as if the dying person is aware of what is going on and is able to hear and understand voices. In fact, hearing is one of the last senses to lapse before death.” 

“The Institute of Medicine (IOM) released Dying in America, a major consensus report on improving the quality and availability of services for people nearing the end of their lives. Core components of quality end-of-life care included:

• Frequent assessment of the patient's physical, emotional, social, and spiritual well-being.
• Management of emotional distress.
• Counseling of patient and family.
• Attention to the patient's social and cultural context and social needs.
• Attention to the patient's spiritual and religious needs.

These all require communication with the patient which is seriously affected by the reality that in North America one in three people over 65 are hearing impaired. “

References:

(bit.ly/IOM-Dying http://bit.ly/IOM-Dying)

The Hearing Journal: January 2015 - Volume 68 - Issue 1 - p 18,19,22

doi: 10.1097/01.HJ.0000459739.71381.16

Cover Story

https://hospicefoundation.org/Hospice-Care/Signs-of-Approaching-Death

Reaching Out

Just had lunch with these three beautiful, intelligent, special women. I was invited to join them as they got together do discuss, support and share with one another as well as to further develop a true friendship that has taken ahold. I was humbled in their presence partaking in the generosity of their hearts. While all three are people I consider friends our paths crossed when they each at different times became my patients. Each of these women has been and are on their hearing journey that has led them to the decision for cochlear implantation. While the paths that led each of them have been different there has also been a commonality amongst them. These are strong, determined, intelligent people that have a will to succeed, they are positive thinking fighters, fighting for better hearing.

In this group Tammy was the first to take on this challenge and as her hearing changed she dove in with both feet determined to do better, to be better, to excel. There was going to be no stopping this woman from regaining her ability to use hearing as a part of her life. Tammy was such a success with her implant because of her attitude and hard work as well as her intellect.

Ann was such a similar soul capable and brilliant. Someone who simply had found ways that might seem improbable to navigate the hearing world with a significant hearing impairment. Ann’s stories of strategies for compensating for her loss still make me laugh at the creativity with which she managed life never hiding from her loss but facing it in a bold way. The beauty of this story is that when Ann was considering a Cochlear implant it was Tammy who was such a wonderful and powerful influence in helping Ann to take on this challenge. Interestingly both these individuals have enjoyed great and measureable success with their implants.

Tamara the third individual in this group is another brilliant young woman that amazes me with her accomplishments inspite of her significant hearing impairment that has been a part of her life from birth. From the time I met her I was amazed by her apparent ability to function so “normally” knowing the degree of her loss. I have come to appreciate the tenacity with which this woman approaches life taking on challenges head on not willing to accept the unacceptable. At this meeting both Tammy and Ann were meeting with Tamara to encourage and support her as she had also just had the surgery for a cochlear implant and are going to continue to support her as she follows in their footsteps on this journey to hear.

It was with such joy that I spent my lunch talking with these friends feeling encouraged in my own journey as they shared their experiences. The lessons for me were not necessarily simply about Cochlear implantation but were about life and the goodness of the human soul. The message to me was about being willing to support each other even as total strangers taking the chance to become meaningful friends. Watching these women I have learned about determination, about overcoming about digging deep but most of all about reaching out.

24 Years Of Thanks

Thanksgiving is one of those holidays that has always been a meaningful one in our household. As many of you know, my wife and I have six boys that range in age from 12 to 22. While this holiday is about the Turkey and all the fixings more importantly it is about gratitude and taking stock of our blessings and how fortunate we are. One of our specific family traditions that takes place right before saying grace is that we go around our table with each person present required to share what they are thankful for. We have one simple stipulation that the only thing that can’t be used in Thanksgiving is gratitude for family as we consider that a given. This tradition is one that my boys often groan about but they still expect that it is something that will always take place at Thanksgiving.

I thought I would take this time to share my thoughts of thanks relative to my clinic. October is actually the month that I opened my doors to this clinic in 1993, 24 years later I am amazed at how little I knew about life and people and business way back then. I am so thankful for the clinic that is my home through the week and the patients that have become my family. There are so many patients that have been with me from the beginning or at least from those early days. It is such warmth that I feel when I get to spend time with those that have been with me on this journey. Along this way I have been blessed to have met so many people with so may stories and experiences. I love what I do because of whom I get to do it for. I have also been blessed with a staff that cares for my patients deeply and personally.  From our humble beginnings our clinic has grown. It is rare to go out into the community and not run into a patient or a patient’s family member. I love this.

So while our rule at home for things we are thankful for excludes family I am breaking that rule at work and expressing thanks for the amazing people that have been through the doors of our clinic in the last 24 years.

Comedy Of Errors

“Why does my hearing loss make it so hard to get the punch line in jokes ”? This is a common question that I have heard quite often from my patients. Well there is a reasonable explanation that is related to the hearing loss. You see there are several factors that affect how we understand involved in the telling of a joke. Now I am no expert on comedy but there are a few things that I think we can all see readily that affect whether we think something strikes us as funny or not. So the main body or the set up of the joke may be easy enough to follow as it seems to make sense and the words connect almost in story telling fashion however the punch line is meant to take us by surprise, it is supposed to be unexpected and not easily predicted. Some comics would deliver the punch line in a quieter voice or almost under their breath perhaps a mumble. This delivery style is with purpose and adds to the humor. Sometimes it is not only delivered more softly than normal conversation but also a little bit quicker in order to keep the listener off balance. The point is that all of these elements of joke telling can make it very difficult for the listener that has a hearing loss to follow and hear/understand the punch line. The hearing impaired listener may just laugh along whether they get the joke or not and hope that they are laughing in the right place.

For those that do not have a hearing loss but do spend time with those that do perhaps this is something that was not understood. The hearing impaired often feel less than fully capable in certain situations and may prefer not to be in that position where they struggle. No one wants to be viewed as someone that doesn’t “get it”. So the next time you want to go out with your significant other , family member, friend, or coworker etc.  that has a hearing loss perhaps it may be best to avoid the comedy clubs.