"Doing good is good for buisness."

In January of this year I was fortunate enough to hear Richard Branson speak at a conference. Mr. Branson spoke with passion about his businesses but specifically about his belief that “doing good is good for business”. This statement is probably understood by most business owners but intent does not always translate into decision making that is consistent with this message. This statement that seems so simple gave me cause to pause and consider what I do in clinical practice that specifically meets this standard.

Certainly how we treat each other becomes a vehicle for doing good but more importantly why we treat each other the way we do becomes a core basis for doing good. Simply put, our motivations outweigh our apparent actions. One needs to really care about their patient in order to always make decisions and communicate direction that is in the patient’s best interest. In the clinical Audiology practice the Audiologist needs to be ethical in their approach putting the patient’s health and well being first but also advising the patient in a manner that is in their best interest. An example of this would be that when an Audiologist notes a possible noise induced hearing loss combined with a history of working in noise that the advice given would be that of Workplace Safety claim initiation as opposed to prescribing a hearing aid that incurs cost to the patient. The same would be true for Veterans with hearing loss being correctly directed. The Audiologist needs to pursue funding routes on the patient’s behalf whenever possible (and there really are several). My personal approach is that there should never be a patient that requires amplification that is turned away due to an apparent inability to afford better hearing.   Making decisions that are in the best interest of the patient even when it is inconvenient to the business is indeed good for business.

My clinic was established 19 years ago and we really were starting from scratch, trying to find a foothold in the community, trying to establish identity and thereby attracting patients.  I remember being acutely aware of every time the phone rang or a potential patient walked in the door. My mind was constantly calculating and recalculating the financial viability of each day and each week. At that time we were able to bill under OHIP (our version of socialized medicine) as well as other insurances but the real income for my company came from hearing aid sales. I can remember many a time when I would discuss a hearing loss with a patient that had come to me for hearing help fully expecting to purchase a hearing aid only to realize that they might actually qualify for complete funding under workplace safety or veterans affairs or a number of other programs. I can remember vividly the ethical debate that took place in my head knowing that we really needed the income now but that the right thing to do would be directing the patient to apply for funding that they themselves had no idea they were eligible for. I can liken this to that cartoon visual of a good angel on one shoulder with a harp and a bad angel on the other shoulder with a pitch fork trying to influence the head in the middle. I can say with certainty that each and every time it was the bad angel that was eradicated and poofed off while the good angel won out. Not easy decisions given the circumstances but these are the inconvenient decisions that allow one to build a positive business reputation with solidity. Looking out for a patient’s best interest should always come first. As an Audiologist, we are also often the first to see signs of retrocochlear pathology (fancy words for a possible acoustic neuroma or schwanoma, which in turn are fancy words for a form of benign tumor that affects the hearing). While red flags may pop up during testing in strong fashion at times often the red flags may be limited or minimal. Here is another example of keeping the patients health and well being a primary focus as opposed to choosing the route that makes the business money in the short run.

The approach of doing good while inconvenient tends to work itself out in the long run. Patients come back after being medically cleared with a renewed faith in the clinic knowing their best interest will be kept in mind, those that finally get their funding through Workplace Safety or D.V.A. or other agencies become patients for life, grateful for the efforts made on their behalf. These patients not only represent themselves but each individual represents hundreds of others, and sometimes more, and these patients become a great referral source through word of mouth.

In business we know that there is no referral source as effective as word of mouth. Word of mouth however is a two edged sword. If one has a bad experience word of mouth can have a negative connotation. My contention is that positive word of mouth brings patients to your door that have foundational confidence in the clinic prior to ever arriving. Confidence is a transferable commodity. When I hear a good friend speak in glowing terms of a business or individual, I find myself being implanted with the beginning of confidence in that business or individual. Whether that confidence grows or diminishes has a lot to do with what I might encounter on a personal level.

I recently had a discussion with my almost 16 year old son regarding good business practice. My son was selling one of his electric guitars to a friend at school in order to use his profits to help him go on a “Serve” trip (this is a youth mission trip). This guitar needed to be re-strung but my son felt like the cost of doing this would take away from his profit margin given that the buyer was more than happy to take this instrument the way it was. My intent was to try to get my child to understand that doing good is good for business. I am hopeful that my child will learn this lesson as he took this guitar to school today to show it to the buyer.

It takes a consistent approach of doing good that is culturally implanted in your clinic from the front office staff to the clinical staff that allows for optimal business growth from a strong foundation.

It is certainly empowering to hear The Richard Branson’s of the world with such tremendous resources both fiscal and human speak of the ability to facilitate change. I must say that while it is exciting to hear someone like this speak it can also make the rest of us feel, well, a little insignificant. I personally have had to come to understand that my “world” is the one I come in contact with and the one that I influence and while this may be a much smaller “world” it is one in which my actions can have a significant effect in and on. Richard Branson’s “world” by definition may be much larger but one he too has influence and an effect on.

In the field of better hearing our clinic supports the “Starkey Hearing Foundation” with a goal of providing amplification for children around the world. It really is an amazing organization. Bill Austin, the visionary founder of Starkey, has converted his life vision into his mission helping children around the world find better hearing, often for the first time. It is really exciting watching colleagues from around the country giving of their time and money working on these missions where in ten days to two weeks they can literally give thousands of children the gift of hearing. The stories are tremendous and moving and motivational. The web site for the Starkey Hearing Foundation has amazing video and pictures from these missions that all can find inspirational. At our Clinic we have a drop box much like the eyeglass program that we are familiar with for donated hearing aids to be used for the purpose of being refurbished or for parts that will be used for these children. As a company, we do what we can to help those that are unable to find the funds for amplification, we try to work with the service clubs in the area as well as agencies such as “The Canadian Hearing Society.”  We try to do what we can through the donation of time, service and in some cases technology in order to make better hearing accessible to all. “Doing good is good for business”!

Starkey Hearing Foundation

www.sotheworldmayhear.org/

Cheap Hearing

I hear the same advertising you do and am just as confused and curious as you might be. Can you really buy hearing aids for under $500 dollars each with everything but the kitchen sink thrown in without additional cost?  There always has been a lot of unknown when it comes to hearing aid purchase but it seems like we are becoming more confused as opposed to more informed. I blame advertising for this confusion. While we are able to gather great volumes of information in today's society, it may be that good information is getting harder to uncover. The astute observer will understand that the intent of advertising is to bring people into your place of business so as to make more money. As a consumer I can attest to becoming more and more cynical when it comes to what appears to be too good to be true. We see the slick late night infomercials that seem too good to be true and often are, we have the telemarketers calling our homes at the most inconvenient times trying to sell us something we don't want.  Is it any wonder that we do not trust what we hear. Advertising can  bring out  distrust in the consumer.  No one wants to be taken advantage of in the market place and so the tactic of advertising has changed over the years to  present the special offer in probable terms.The "deal" has become a major marketing tool.

When it comes to better hearing there can be a great deal of confusion for the consumer. In recent years the locally owned clinic has given way in large part to the chains that are corporately owned and run. The recent trend is for hearing aid companies to be the corporate owners of these stores and clinics. The idea is that this allows them a direct connection to the consumer for their products. Companies that in some cases have fallen out of favour with the Audiologists have decided to force the issue by owning the companies that bring the product to the consumer. It is with this structure that  the "amazing deal" has come to be. Hearing aids started off discounted, warranties were increased, batteries and services were offered at no cost with purchase. The consumer however is now a much more educated one and so "the deal" had to get even better. Now we have hearing aids advertised under $500.00 or recently a company has come out that offers them under $200.00 .  As an Audiologist even I have to say wow! Is that really possible?

The reality is that Audiologists do have access to every product on the market and we each have to understand what they do and how they meet the needs of our patient. Just like a Physician has to choose the most effective prescription for what ails you the Audiologist must choose what is best for the patient. When it comes to hearing aids the reality of cost should be considered by the prescriber. Typically every product line will have a basic version of the product, mid range versions of the product and then the best possible version of this product as well. There is a certain level of government regulation of hearing aids relative to cost given that there is a government granting system for hearing aids that offers $500.00 per ear in grant money towards the cost of hearing aids  for the  eligible patient. A key point to keep in mind is that if you use the government grant to purchase a sub- par (Cheap) hearing aid you will not be eligible for the grant again for five years and will be stuck with that technology.  Every hearing aid is available to every Audiologist and the factory costs will be standardized so it is not so much the cost of the product that you might shop for but the additional costs that may not be advertised that you must be discerning about.

So how does one purchase a hearing aid for $200.00 or $500.00? The reality is that this is not really a possibility. You might walk in the door expecting this to be the cost per ear and yet leave having spent considerably more. How does this happen? The cost of the hearing aid may be advertised but the dispensing fees may not, or the extended warranties, or the service plans , or the contractual obligation to purchase your next set of hearing aids in a given time frame from the same clinic. The patient ends up with their heads spinning and leave having spent far more that they intended.

The phrase you get what you pay for is often applicable in these cases. So here is what you should ask and look for when considering purchase of a hearing aid.  Once you have come to understand that you do need a hearing aid and have heard from the Audiologist what product they suggest and why, here is what you need.

1) An itemized quote for the product prescribed with a break down and separation of factory cost and other fees. There should be a dispensing fee and in some cases other fees.

2) a clear explanation of why this hearing aid has been chosen for you and what your other choices may be.

3) Upon purchase you must be given a minimum 30 day trial period by virtue of documentation. Some Clinics offer longer trial periods. You need to ask if there will be a return fee if you are not happy or satisfied with your hearing aid.

5) It would be appropriate to ask if the Clinic would reassess your hearing each year and readjust the programming on the hearing aid to accommodate any changes that might occur.

The purchase of a hearing aid is only a small step on the journey to better hearing, it is a decision that one needs to be informed about and comfortable with. It is the prerogative of the consumer to shop with a cynical eye , to be discerning, and to make well informed decisions. If you have any questions regarding this topic or other topics that I have written about please feel free to contact me at  info@earcompany.ca 

Sanjeev Sukumaran Au.D.

Audiologist

Smart or Dumb

One of the many facets of my job is to see children for Central Auditory Processing evaluations, typically these are children or adults that struggle with staying on task, focus or task completion. These are individuals who often find language based learning challenging, that misunderstand and misinterpret. One of the first comments I make to these individuals is that these differences in learning style have nothing to do with how smart you are. Unfortunately those that do not fit into the normative learning model often question their intellectual ability, in reality these individuals can often be the brightest and the best but they, themselves, do not know it.  I wrote an article earlier on attention deficit disorder with this very theme. It is one thing to make this bold statement regarding intellect but it is another to get one to buy into their own giftedness. Here is a story  that I love to tell regarding a spectacular example of the gifted child that was made to feel stupid.

I saw this child many years ago as a  ten year old. This little girl was adopted early in life. In those days the parents that were adopting had little to no access to family history  so these parents knew very little about the special needs that might arise for their daughter.  At ten this little girl could not read at all, not even a little. This child was unable to do any of the required work for her age and grade. The situation was so dire that the school was moving towards putting her in a "life skills" class. This type of a class is for those deemed of low intellectual ability. The idea is to equip a child through  the classroom to be able to deal with the basics of function in society. As we talked about our testing process and why we were looking at the Auditory Processing Ability our conversation finally came to the point where the Mom finally blurted out "but she is not dumb". This was really the crux of the matter. the message being conveyed through the school and the professionals that this girl was dealing with was that she was intellectually, significantly limited.

When Mom had made her assertion I asked her to tell me more and what I heard next blew me away. Mom revealed to me that she could take this little girl shopping with her and she could fill up her cart and this ten year old could calculate in her head what her groceries would cost her with tax. I could have fallen off my chair at this point. I agreed that indeed there was potentially much more to this girl than she was showing at school. After a long conversation with Mom we set out to find out what was going on. Upon further investigation it was found that this girl was off the charts brilliant when it came to mathematical thinking and off the charts in the opposite direction when it came to language based learning. So the question became what to do with this child? Was this girl a genius or was she "dumb" so to speak. My commentary is that she was obviously very bright. The problem at school was that even math had become language based at that age. This girl was given what she needed at school and began to flourish. When this child got to high school she was the annual winner of a province wide math competition each year that she entered and was taking University math while in high school and yet she was always a lousy reader.

This brilliant young woman had sadly spent her early years in life thinking that she was less intelligent than her peers and had started to give up her willingness to learn. In the end this child was far superior to the rest of her peers  but didn't know it. The point is that we are all individuals with strengths and weaknesses but we are all taught the exact same way. Some traditional learners can thrive in this environment but others that potentially are the brightest and the best sometimes never have the opportunity to feel intelligent.

Overwhelmed By Personality

As an audiologist, I have opportunity to meet folks from young to old, from all walks of life with disorders and differences. Really, it could be anyone that walks in my door. What I know as a strength and what is rewarding is reaching the otherwise unreachable connecting with people that might be difficult to connect with, having relationships with those that seem to be impossible to relate to. It is not because I feel I have something to offer them but it is because I know they have something to offer me.

The other day I was tasked with testing a 14 year old girl with cerebral palsy.  This girl was sent to me to do audiometric brain stem response evaluation (this is an objective neurologically evoked response that allows hearing threshold testing in infants and the difficult to test). The reason for the referral from another clinic was that they could not get results with traditional evaluation. This young woman was accompanied by her mother at the time of evaluation. From the moment this young lady arrived in my office, it was obvious that her ability to communicate with language was quite impaired, most of her vocalizations were sounds without apparent distinguishable content. Even with the absence of understandable vocalization, it was soon realized that we could communicate. I ended up having a conversation with this child that we both understood. As we started to understand each other, I understood with certainty that I could indeed do subjective testing and that this girl knew exactly what I required of her in order to accomplish this task. We ended up getting results that others had failed to get in her 14 years of life because we were able to communicate and understand each other because we had developed a relationship. There is a very strong clinical implication in this story as to the importance of connecting with and understanding each patient that walks in my door but there is a much stronger implication that I would like to share.

During our visit together I was profoundly impacted by the strength of this child's personality and how she made me feel. I am not talking about how it made me feel dealing with the sadness of a handicapped child but I am talking about the nonverbal communication of joy and happiness. Sometimes we see what we want to see in life and transfer feelings from within but this was different. This young woman had such a beautiful, magnetic personality with strenght and joy that could not be misunderstood. While her body limited her ability to communicate physically, she had learned to communicate with subtleties that were now very powerful. I went in to my office overcome with emotion having come to conclude that I was the one who had gained much from this encounter, that I was the one that had been given a gift that day.

How much more of a responsibility do those of us have to make others feel with our words and our actions. We that are fortunate enough to have been born without handicap have an even greater set of tools with which to engage those around us. It is so difficult to put into words the effect of that particular encounter on my life  but it is definitely indelible and unforgettable and undeniable. I could not help but be drawn in by this child, it was she who connected with me not the other way around.

The Power of Sincerity

In life, there are often anecdotal experiences that lead one to the knowledge of inherent truths, sometimes validated by research and other times validated through common sense consideration. There is much I have learned from my patients over the years. I learned very early in my career that my patients required an authenticity to my approach. This group of people wanted me to be sincere and honest, with the reward being loyalty , trust and friendship. I have known in my heart that sincerity is a very powerful human characteristic, recently one of my patients validated this viewpoint through a wonderful personal experience.

The story that is told is one that took place many years ago. This woman with adult children had been seeing a particular ears nose and throat specialist for some time and had developed a familiar but professional patient doctor relationship. The woman was a smoker and the physician had been advising her to quit for some time. It came to the point that at every appointment this topic of conversation would inevitably arise. The patient would listen and return home unfazed and with no motivation or intention to stop smoking. While the advice was politely received it really did go in one ear and out the other. One day the patient arrived at the doctor's office for an appointment and found that the physician was somewhat distracted and disturbed. It turned out that this doctor's sister in-law had only the day before been diagnosed with terminal lung cancer. True to form, at this visit the doctor again brought up the topic of smoking and the health concerns that he had for the patient. On this occasion it was a heartfelt and personal plea that was rendered to the patient to stop smoking. The woman went home like any other day not giving a great deal of thought to the possibility of quiting smoking. The very next day without a great deal of thought she left her cigarettes at home and never smoked again. When I questioned her about it she really did not have a rational explanation for what came over her other than the power of the sincere plea brought on by personal tragedy.

As I thought about this message delivered to me through a personal experience I couldn't help but relate that experience to my own professional life. One has to be true to their beliefs speaking truth from the heart in order to really be heard. If we, as professionals, are not convicted of the message we deliver, our patients will not reward us with trust and loyalty. At this point in her story I turned to my patient and suggested to her that I sincerely hoped she would go to the mall and buy me a wonderful Christmas present. I suppose my request was not all that sincere since she did not really feel compelled to do so.

The art of conversation.....lost, or just changed?

lol....ttyl..... bff....g2g...nvm....is this how we converse today? Indeed in vast portions of society this is the language of choice. The question becomes what does this do to our ability to really understand one another and effectively communicate? I do not dispense of  this form of communication as irrelevant, it is obvious that is is here to stay and evolve as a communication mode.

In the professional context as an Audiologist I have reason to be concerned with the way in which we communicate specifically with the hearing impaired. The generation caught in the middle of this clipped short formed communication style as opposed to the more elongated, developed, elegant conversation of an era fading away are the Baby Boomers.  The Baby Boomers do communicate on the information highway  but also value social conversation that develops over time. These folks still take part in group social activity that revolves around communication and conversation.

The hearing impaired individual requires multiple cues to really understand speech. There is a necessary need for redundancy and reiteration of subject and content to enable optimal understanding for the hearing impaired individual. In addition to auditory redundancy is a need for further redundancy linked to visual cuing as well. We find communication optimized when we can both hear and see the individual with whom we are conversing.

No matter what our generational style of communication it is probably true that taking the time to have a slow conversation that develops over time on a face to face basis can be a rewarding and relaxing process. Sitting down and having a coffee with a friend or colleague can lead one to have a clearer understanding of that person. It is far more likely that we will misunderstand a quick comment or assertion than one that is introduced, developed, and completed as a thought.  Should it not be our intent to make every effort to be clearly understood?  

Misson Impossible

Years ago when I was in graduate school I was fortunate enough to have access to what was cutting edge technology.  The school had a partnership with research facilities second to none and as a result we were able to see technology long before it went to market.  At one point a well known research facility came to the school and placed in the middle of the table a literal black box, perhaps 12”x 10”.  The scientists were rather excited to tell us this was a prototype of a digital sound processor.  These scientists were very hopeful that one day they could miniaturize this prototype to fit as a pack on one’s waist with a wire that would go to the ear attached to a mold to hear with.  This was eons ago in the world of technology.

A few weeks ago I was at an innovation summit for another unveiling of a digital sound processor.  The processor was so tiny it could fit into one’s ear canal with very little visibility.  More impressively this miniature processor, designed for hearing loss, was able to receive a wireless signal from one’s television or other audio device with no other wires, cables or other attachments. These hearing devices are now miniature wireless custom ear phones.  More impressively they have an iPod like remote - soon to be released with a touch screen - that allows one to connect via blue tooth to the telephone but also allows the other party to hear you through the custom devise in your ear, all hands free and hidden away,  primarily invisible to the casual observer.  This technology, that at one time seemed only imaginable in fiction, now exists in reality.

Mission impossible has now become possible.  What the next ‘black box’ prototype will be capable of one can only imagine.