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Physician Insight Series

MN health care news

Patient-physician communication

Don't let hearing loss get in the way

By Scott Benson, MD

From Minnesota Healthcare News

Achieving the best medical care depends in great part on proper communication between you and your physician. If your doctor understands your medical concerns and your symptoms, he or she can offer the best treatment options. And if you understand your physician’s diagnosis and recommendations, you’re more likely to follow his or her suggestions accurately, have better follow-up, undergo fewer unnecessary diagnostic tests, achieve better health care outcomes, and be more satisfied with your overall health care.

This is true for all patients, but sometimes can be harder to achieve for
people with hearing impairment. A hearing loss presents a challenge to effective communication. Hearing impairment may make it necessary for
you to plan ahead, change your style of communication, and spend a little
more time at your appointment. But the improved medical care you can obtain by doing so will be well worth it.

Be honest

Physicians can help you better if they know about your hearing loss. Don’t be afraid or embarrassed to say that you don’t hear well. It takes
an average of up to seven years for a person with a hearing loss to decide to seek help for this condition, often at the instigation of the
person’s spouse. (“Honey, you don’t listen to me anymore.”) If you suspect you have a hearing loss but haven’t had it diagnosed officially,
please tell your physician. Physicians try to be alert to signals that
you might be having trouble hearing, but it is easier for everyone if
you are open and honest about your condition.

Self-test

If you are uncertain whether you have a hearing loss, here are some
questions to ask yourself. Do you:

  • Ask people to repeat themselves?
  • Feel confused when people are talking?
  • Refrain from asking questions?
  • Sometimes think you respond to your physician’s comments inappropriately?
  • Turn your head to listen?
  • Have a history of exposure to loud or constant noise?
  • Have ringing in an ear?

If you answered “yes” to any of these questions, you may have a hearing loss. Ask your physician to check your hearing. There may be medical reasons for your hearing loss that can be corrected, such as an ear infection. Obesity, smoking, and some medications can also lead to hearing loss.

In women under 50, taking ibuprofen or acetaminophen two or more days a week has been linked to an increased risk of hearing loss. Other drugs associated with hearing loss include certain antibiotics and chemotherapy medications, aspirin in large doses, and certain diuretics. If your physician rules out medical conditions for your hearing loss, you may want to see an ear, nose, and throat specialist or an audiologist for a complete hearing evaluation.

If you are deaf

If you have a hearing loss, either partial or complete, you may have to spend more time communicating with your physicians and other health care professionals. Here are some suggestions that have worked well for my patients who have hearing loss. Ask your physician to:

Establish effective office policies. Your physician should document your hearing loss on your chart and make sure that frontline staff knows when you are coming to the clinic. The physician should remind his or her nurse to greet you face-to-face instead of calling your name in the waiting room.

Get your attention. Ask the physician to tap you on the arm or shoulder and then make eye contact before starting to speak. That way, you do not miss words at the beginning of the discussion. Also ask your physician to acquaint you with the topic of the conversation and to avoid changing the subject without first telling you.

Speak clearly. If you have partial hearing loss, ask your physician to speak loudly and slowly, and to avoid using sentences that are too complex. If you hear better out of one ear than the other, make sure you are positioned so your “good” ear is facing the physician. Ask your physician to pause between sentences and wait to make sure you have understood what has been said.

Keep his or her face visible. As you know, part of the hearing process is watching the speaker’s facial expression and lip movements. Ask your physician to keep his or her hands away from his or her face while talking and to refrain from chewing gum. Even a mustache or beard can interfere with your visualization. If you need a procedure, make sure you understand everything before you move to the procedure room; it is difficult to have a conversation with a physician whose face is covered up by a mask. Many exam rooms today are equipped with computers for physicians to enter medical information as they work, but often this puts the physician’s back to you. Make sure your physician talks directly to you before turning to the computer.

Write it down. Physicians may have to write down more information than usual, including information about your illness, course of treatment, and medications. Bringing an erasable whiteboard may be helpful. You also might want to bring a family member or friend to the appointment with you to write down what the doctor says. If your physician sends a prescription to your pharmacy electronically, ask for a written note so you know what medication to pick up.

Ask questions, repeat comments. If your physician asks you questions during the conversation, you are more likely to understand. If you are puzzled by something he or she says, ask to have it repeated or stated in a different way.

Use visual aids. Don’t be afraid to ask to see an anatomy chart or the Internet during an exam. Having a physician point to something on paper or a screen can be clearer than verbally trying to convey a complicated medical term.

Minimize noise, maximize light. Ask your physician to turn off any noise that may interfere with your ability to hear. It helps if the room has curtains and carpets to soften noise levels. Also, make sure the room is well lit, with light shining on your physician’s face so you can see his or her expression clearly.

Use outside services. Some physicians may use teletypewriter (TTY) options available on the computer. You might also ask for a sign language interpreter. It is better to avoid using family or children to fill this role, particularly when discussing highly sensitive topics or when you are under stress.

Don’t ignore emotion. Emotional and psychological issues, especially depression and anxiety, can be associated with hearing loss. Be sure to address these issues with your physician if they are a concern.

Removing communication barriers

It is common for people with hearing impairments to have more difficulty comprehending speech when they are tired or ill. If you cannot hear well or are deaf, it can be to your advantage to ask for help with communication during your medical appointments in order to obtain complete, accurate information and avoid misunderstandings.

As physicians, we want to provide the best medical care to all of our patients. You can help us remove any barriers to access and communication with you by being open about your hearing loss and letting us know how we can make your visit more effective.

Scott Benson, MD, is a board-certified family medicine physician and
practices at Apple Valley Medical Center.

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