When the issue of using an FM system came up, apparently the person with hearing loss stated “No, that would not work in my situation because it is too noisy”. So I was asked to come up with some other suggestions.
Ummm, ok, I have a whole bunch of problems with this.
First, I think we need to clarify when we need to listen to our patients and follow the patients lead. At other times we, as audiologists, SLP’s, hearing instrument practitioners or hearing resource teachers need to provide leadership and guidance to our clients with hearing loss. As an Audiologist with hearing loss, I have walked in both sets of shoes, so I would like to offer some suggestions.
First, here is a list of things where the person with hearing loss knows best:
- Ask and find our all the different situations in which the person with hearing loss is having difficulty. List them all and seriously look at how we are going to help overcome those challenges.
- The patient knows and can tell you how it feels to be in a given situation. Don’t be afraid to ask about this. When a patient says ‘I could not hear at my daughter’s wedding” find out how they felt about that. It is good to just let the patient explore their feelings and frustrations.
- Discuss past experiences both good and bad to see what you are up against. For example, find out if the client ever tried an FM system or ever used directional microphones in the past. Likely if something was a failure in the past, find out how much coaching the patient had in how to use the equipment.
In short the patient knows, better than you the clinician, the situations they are having the most difficulty in, and what it feels like to have a hearing loss. But here is what the patient does not necessarily know and where the expertise of the professional is required.
List of Things a Patient with Hearing Loss Does NOT Know;
- Whether or not a hearing aid is even needed.
- What electroacoustic characteristics are needed in the hearing instrument
- What style of hearing instrument is most appropriate. A patient can wish all they want for a tiny hearing aid, but if the loss is too severe, it can’t be done. Period. Yes, many patients have lots of choices of the form factor, but some do not. We need to lead here, not follow.
- What technology for managing noise is needed? For example, if a client has a moderate severe loss and a speech in noise test such as the LiSN-S PGA indicates that an FM system is needed, the hearing health professional NEEDS to communicate this to the client. The client does not know what technology is required. They just know the situations they find challenging.
- How to effectively use the equipment. You cannot simply toss the equipment at the client and hope they figure out how to use it in the difficult listening situations that were identified. Patients need our counseling and coaching here.
Now back to the patient who can’t hear at work. The specific situations at work need to be fully explored. Ideally, you can do this formally with the COSI. Again, the patient understands this so much better and he needs to tell us as much as he can about his challenges if we are going to have any chance of finding solutions. Next we need to explore why he feels that an FM system would not work. He likely does not know how the technology works or how to use it effectively. There are excellent FM counseling tools available for this purpose.
But we have to stop letting patients dictate the wrong things. I have seen in my 20+ years of professional experience numerous patients who are wearing “dirty little secret” tiny aids and are not getting the correct amplification. We need to provide leadership here and work the client towards more appropriate amplification.
Similarly, we must always consider not just the amplification needs but also the hearing in noise needs as they relate to the client’s own personal situation. Will the client need directional microphone technology? Should it be fixed or adaptive directional microphones? Will directional microphone technology be enough or will FM technology be needed? Most patients with moderate severe loss and greater will likely find themselves in situations in which a hearing aid or cochlear implant is not enough.
I agree that we cannot force anyone to take our professional advice. But patients do have a right to make an informed decision. In my opinion, we are obligated as Hearing Health Care Professionals to give the patient all the facts. Too often, when I give talks about directional microphones, FM systems, and other assistive devices, a patient will ask me “How come this is the first time I am hearing about this stuff?”