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.

The First Five (You only have one chance to make a first impression)

When you walk into a clinic of any sort that you have never been to before what do you expect, what do you wish for, what matters most? In those first five minutes of your appointment what can make the most difference to you relative to your reasons for being in that clinic. When you walk in do you want to be given reading materials about the clinic, a video to watch about the process or procedure you are there for etc. Would you like to have your first five minutes be information based?

I would like to share my approach to the first five minutes That I spend with my patient and why.

When ever I walk into a new Doctors office I wonder what they are like, will they be friendly, approachable and interactive, or will they be clinical and detached. My first five mins. as a patient is often spent sizing up who I am with and I tend to make that decision fairly quickly. Because of my own awareness of how I view my first five mins. in a clinical space I have come up with a purposeful approach to the first five mins. in my office.

The first few moments in my office are typically affected by my four second rule. The four second rule states that:

“no one can enter the premises of The Ear Company and spend more than 4 seconds without being greeted in a friendly manner and given direction as to their next steps” as an addendum to this ruling the patient is to be treated in a “hospitable” manner offered tea or coffee or water or some of our ever existent snacks. Understand that I am being a bit silly in stating this reality in this manner but this is an important element of patient engagement. Once the patient has filled out their paperwork and are waiting for their appointment I would typically find a moment to step into the waiting room area and have a short introductory conversation and inform them that there may be a short wait if we are not yet ready for them. Sometimes this turns into a longer conversation about topics we share in common.

When I bring the patient into my testing and assessment area I consider those first few minutes to be the most important time I spend with them. The first few minutes we spend in becoming comfortable with one another getting to know each other. The confidence my patient develops in me has so much to do with that time of dialogue. In these few minutes we are in the “get to know each other phase” where we find commonalities and begin to develop a relationship. It is in this time that the patient begins to tell me their story. One of the key discussion points at this time is why they have come as revealed through their own words. This casual time of taking a case history tells the clinician much about the motivating factors of the patient and how much self realization is inherent. It is through this interactive process that the patient identifies the challenges they face.  I always tell my patients that I can really only help help them with the problems they themselves are aware of but sometimes they need help in talking through their own understandings.

There are all kinds of programs that are provided to offices like mine to have a third party standardized  use of the first five minutes where the patient watches a video or is given material to read while waiting for their appointment etc. . While this approach many be useful to some in communicating their intended message my thinking on this is very different. I believe that those first five minutes are an opportunity to make an impression with intent. I compare this to meeting someone socially or going on a first date. The first five minutes should be spent in getting to know each other and getting a sense of each other. It is our need to have some kind of commonality with each other that often drive those initial conversations. We are far more comfortable with each other when we find something that we have in common.   The saying that we have only one chance to make a first impression is ultimately true and needs to be something that we think about and keep at the top of mind.

Diplomas or Worms?

As an audiologist I have three degrees a Bachelors , a Masters and  Doctorate but what is interesting is that the paper with the most power hanging on my walls are pictures. When I first graduated and started working as an audiologist I was proud to put on my white lab coat over my formal shirt and tie attire. As a young man I felt like I really needed my diploma on the wall to convince my patients that I was qualified to see them. In some ways this might have been my own insecurities coming forward. I honestly had to pinch myself in those early days knowing that people actually came to see me as the expert in my field. The lessons I started to learn however moved me slowly in a different direction. I started to learn that the white lab coat actually scared little children as they related the coat to pain incurred through needles etc. . I learned that my ability to learn to listen to my patients and my ability to communicate valid applicable pertinent knowledge to them instilled far more confidence in them than the multiple diplomas on the wall. 

I was in private practice when my wife and I had our first child and I was definitely the ultimate proud father. In my private practice I had a beautiful new office and I started to put on the walls and on my desk pictures of my son. As the years went by my wife and I added to our family with five more boys, six in total, we had six sons in ten years. As you might imagine my collection of pictures grew. As a father I wanted those pictures of my family in my office to remind me of how blessed I was as well as to sit back and imagine what in the world that child might have been thinking. My wife loves taking pictures and she gifted me with many pictures of my boys simply living their lives which found their way onto my wall, there are pictures of the boys on the ski hill, on the beach, snuggling with Dad, eating snow, eating worms ( this is one of the favourites of other children)and the list goes on. 

Here is the interesting phenomenon. What I have found over the years is that when patients walk into my office/testing room the conversation often turns to family. When children come into the room it is so apparent that they are drawn to the pictures on the wall as their eyes take it all in and as they glance around there is an effect on young and old alike. I can visibly observe these people relax. This observation actually is one that I even see in prelingual toddlers and babies. I can see them drawn to the pictures on the wall. Many of the conversations I have with these young children are about the boy eating the worm or the boy at the beach or the boy on the ski slope etc. . 

It is my contention that in our human interactions and in the early stages of relationship we all search for commonality, there is comfort in knowing that the person we are with is somewhat like us. We probe and delve until we find that thing that gives us some degree of comfort before we start to trust the person we are with. When we become comfortable with the professional we are talking to and we begin to relate to them we are more likely to take in their words with confidence. As an audiologist I too want to know the person I am with and have that same sense of connectedness with them as they seek in me. 

When I learned to combine the ability to listen to my patients, relate to my patients, find commonality with my patients our clinical relationship was vastly improved. The knowledge and information I share is taken in by them with greater confidence and trust and as a result their outcomes improved. My patients end up leaving having somewhat enjoyed their time in office and are willing to tell others about their good experience. 

My lab coat and diplomas told my patients that we were different my pictures tell them that we are the same.

Sudden Hearing Loss

A common discussion point with patients is often whether loss of hearing or loss of vision is the poorer fate in life. Speaking in the theoretical is one thing but actually going through it is another. There is a condition in which in the blink of an eye you can go from perfectly normal hearing to a sudden and profound loss of hearing, typically in one ear. The effect this sudden change in a perception has a major impact on ones psyche. What might have been considered to be the better option to blindness can quickly be recognized for what it is. Here is a little information on this disorder.

Sudden Sensorineural Hearing Loss (SSHL) sometimes called sudden onset hearing loss is a condition on which one has a reduction in hearing typically in one ear that occurs suddenly and with significant impact on inner ear function. The cause of this disorder is sometime unknown (idiopathic). It is suggested that some possible causes are infectious diseases, head trauma, vascular issues such as insufficiency, and the list goes on. In most cases it is difficult or impossible to know what the specific cause of the sudden loss was.

Correct diagnosis and treatment of this disorder immediately is of ultimate importance. The typical first diagnosis for this condition is that this is an ear infection and antibiotics are prescribed however this approach is one that does not address the real issue. It is important to see an audiologist immediately to document and verify the nature of the loss. Once diagnosed correctly a typical approach is the prescription of corticosteroids either taken orally or sometimes injected intratympanically (through the ear drum), recovery can be spontaneous but also may be aided through intervention occurring primarily in the first two weeks after onset.  The audiologists should be included in monitoring the recovery.

https://www.nidcd.nih.gov/health/sudden-deafness

http://american-hearing.org/disorders/sudden-hearing-loss/

http://www.masseyeandear.org/for-patients/patient-guide/patient-education/diseases-and-conditions/sudden-deafness

Just Check it.

As the New Year is upon us many of us see this as an opportunity to start afresh on various fronts. A common theme is taking better care of ourselves from the perspective of our health. Often we vow to loose weight, eat better, exercise more and simply be on top of our health. When it comes to our hearing health it is often forgotten amongst the many things we consider important. We remember to visit our Dentist or Optometrist annually and consider that our vision and dental health is an important part of our well being yet we may not categorically put our hearing health on the same level. We are happy to have our eyes checked even when we are certain that they are good and we understand the importance of monitoring our dental health but when it comes to our hearing we often wait until we have a significant problem before we visit the audiologist. In many cases we wait far past the optimum time for excellent and positive intervention. I have seen people ignore their hearing health for years all the while having reversible pathology that would have best been dealt with early, simply because they were afraid they would need a hearing aid. Baseline hearing testing, much like regular check ups and screenings for many of our other senses and health indicators are simply a good idea. As a whole we are far more likely to be informed and in control of our own destiny when it comes to our health than ever before.

There is no need to hide from  knowledge regarding your hearing health, knowing what is going on is simply just that, knowledge. What one does with the knowledge they have is really up to them. This is the message that I often share with that family member that comes in complaining that another will not get their hearing checked primarily because they fear that that they have a problem.

This year I am making it my goal to communicate the need for baseline hearing testing. The concept that each person should know how well they hear is one that I intend to propagate with a question and a directive. The question,” How’s your hearing?” The directive, “Just check it.” Just a part of that new years theme of making sure we are taking the best care of ourselves that we can.