Convincing More Patients to Get Help

Practical Communication Skills from the Trenches
Author: Gyl A. Kasewurm, Au.D.

According to the National Institute of Health (NIH) sensory hearing loss is one of the most common chronic medical conditions among older adults, affecting approximately one in three people between the ages of 65 and 74 and nearly half of those over the age of 75. Since all but profound sensory losses cannot be corrected with surgery or medication, the only way that we can “help” more patients with sensory hearing loss is by convincing them to purchase hearing aids.

The concept of “selling” hearing technology to our patients isn’t always a comfortable one, which is not surprising since audiologists aren’t typically taught this in their coursework. And yet, learning how to “sell” hearing technology to our patients is probably one of the most important things we do, given that most of our patients have sensory hearing loss. Convincing patients to commit to better hearing is actually not about “selling” something. It’s about getting acquainted with a patient, learning their hearing needs and then agreeing on a solution that best suits those needs. Consider the consequences of not convincing a patient to obtain help - social isolation, deterioration in their quality of life, and a possible increase in the likelihood of developing dementia. From this perspective, it seems it is not only our professional responsibility to “sell” our solutions, but also an overwhelming reason to take the necessary steps to make certain we are very good at it.

I have heard colleagues express concern that they don’t want to seem “pushy” when it comes to recommending hearing aids. It’s been my experience that one doesn’t have to be pushy to win over a patient’s confidence and to get them to embrace the recommendation to purchase hearing aids. If hearing aids are an essential part of the solution, and for most people they are, and if we are able to give enough convincing evidence to support the recommendation, then hearing aids should seem like a logical outcome to the patient. This process doesn’t necessarily need to entail being overbearing or pushy but it does necessitate devising a consistent presentation that is concise and persuasive. It has been my experience that this type of presentation will not be achieved without considerable effort and practice on the part of the professional.

Current and prospective patients are bombarded with countless messages regarding hearing aids which may cause them to be a bit skeptical of the recommendation to purchase hearing aids. However, it’s my belief that if we truly believe what we are proposing is the “best” solution for the patient; they will be likely to believe it too.

The first step in any patient consultation should begin by sitting down and asking probing questions in an attempt to determine what caused the patient to make the appointment. I find it helpful to take some time to learn what motivated the patient before I test their hearing. A new patient has likely heard about you and your organization from other patients or their physicians. They have probably seen many of your marketing materials, but it is important to determine what caused them to make the appointment “today”. This discussion will serve as a foundation for discussing the patient’s hearing problems and presenting the most appropriate solutions for those problems. Asking effective questions and taking the time to really listen and evaluate the answers is a skill that develops with time and experience. Gathering background information about a patient before completing the hearing evaluation can produce a more effective and appropriate solution to their specific lifestyle and problems. When a patient feels the professional understands their individual needs and the solution they are looking for, they will be more likely to accept the recommendation and take action.

I have found that it is possible to gain a patient’s commitment to better hearing even before evaluating their hearing. For instance, after spending time discussing a patient’s hearing problem and how it is affecting their life, you might say, “Mrs. Jones you indicated that you are having difficulty hearing your grandchildren and you no longer enjoy going out socially because you can’t enjoy conversations. If I can help you hear better in those situations, is that the help you are looking for today?” Discovering a patient’s motivation for making an appointment is a key element in convincing them to take the necessary step of investing in better hearing.

I once heard a presenter report, “The first thing you say is what the patient will remember.” With that thought in mind, I recalled myself explaining test results and saying, “Your low frequencies are normal but you have a moderate loss in the high frequencies.” This helped me make sense of the reason some patients return home and report to their spouse or loved ones that their hearing is normal. There is something to be said for hearing what you want to hear. It may be helpful to begin the explanation of a patient’s test results by focusing on the problem areas and sharing the abnormal areas of the audiogram first and not emphasizing which frequencies if any are still within the normal range.

As a professional, it is easy to feel like we need to do all the talking, when really it’s more important to listen and ask questions. Being a good listener is not easy. Too often we want to spend our time going into way too much detail regarding the parts of the ear and the specifics of the audiogram instead of concentrating on what the patient is more interested in which is the solution to their problem. It is easy to anticipate what we think a patient is going to say and then to jump in with a solution before a patient is ready to accept it. Start by giving a brief summary of the audiometric test results and the recommended solution and then allow the patient time to digest the information. While a moment of silence may seem like an hour, it’s critical to wait for the patient to respond. Remember you are talking to a person who probably knows little if anything about how the ear works and truthfully, probably doesn’t really care. Most patients just want to know the cause of their problem and what can be done about it. Keep the explanation concise and to the point and elaborate only if the patient requests a more detailed account. The beginning of the presentation is a critical time in the convincing process and it’s essential not to lose the patient’s attention because you spend too much time presenting test results. Convince today and educate tomorrow.

It is common practice today to use computers to record patient notes. While it’s tempting to stare at the computer while explaining test results, it’s very important to keep your eyes on the patient if you want them to feel that you are really interested in their problem.

Do not become discouraged or alarmed if a patient objects before, during, or after you recommend hearing aids. In fact, we should expect objections. Objections are nothing more than statements, comments, requests for information, or inaccurate assumptions by the patient which need clarification. While our educational backgrounds may not prepare us how to deal with objections, there are four common ones that we probably hear every day if we work with patients that have sensory hearing loss so it would be an outstanding idea to be prepared for these protests.

The most frequent objections include:

“My hearing isn’t bad enough” - The patient called to make an appointment, took time out of their schedule, drove to the office, endured a test in a sound proof booth, relayed many situations in which they experience difficulty and were even embarrassed not being able to hear well and yet their objection is their hearing isn’t bad enough to get help. Really? Perhaps what the patient is actually saying is that they are not convinced that they should spend the money and time to get hearing aids. In this situation, think back to the case history and the original reason the patient made the appointment. For instance, “You mentioned that you didn’t hear your wife calling you when she fell down the stairs, Mr. Jones. I am sure that you wouldn’t want to risk that ever happening again and the hearing aids will certainly help you hear your wife better if her safety is ever in jeopardy again.”

“I want to think about it.”- In this situation, you may have not answered all of the patient’s questions and there must be more objections lingering in their mind. Perhaps you could say, “Mr. Jones, obviously I would like you to get the help you need. Is there some information that I can give you today that would help you make your decision?” or on a lighter note, “You told me you have noticed this problem for the past five years and you are eighty five years old. How much longer would you like to think about it?”

“I can’t afford it” – This may or may not be a legitimate objection. However, don’t take this objection at face value. Many of us can recall at least one patient who didn’t look like they could afford help and said they couldn’t afford help only to discover the person was a multi-millionaire. Or the patient who said they couldn’t afford help and then went to a less qualified competitor who did convince them to purchase aids. I sometimes use the statement, “I wouldn’t want to let finances get in the way of you being able to hear better. If you don’t have any resources, there is a Foundation I can write to for help.” This may flush out whether the patient is truly unable to bear the expense or whether they just don’t want to spend the money. Offering financing options is also a good way to deal with this objection.

Most of us have been the recipient of what happens when we assume what a patient can or cannot afford. Never judge what you think a person is capable of investing in better hearing. Present the options that you believe are the most appropriate for the patient’s loss and lifestyle and then let them be the judge of what they can or cannot afford.

A man who had been a long time patient of mine made an appointment to firmly tell me he was never buying anything from me again. He explained he was 84 years old and he and his wife had spent tens of thousands of dollars on hearing aids. While they weren’t dissatisfied, their money was running out and they simply could not spend any more money with me.

No more than a month later we were holding an upgrade event and I noticed this patient’s name on the list. I couldn’t help but think what a waste of time that appointment would be. The man attended the event, listened to the presentation, purchased new technology for himself, and then referred his wife to get new aids because he was hearing so much better!

Yet another example of why one should never judge a person’s ability to pay for things they value.

“I need to talk with my spouse” – This may be the only legitimate objection. Most patients won’t make a purchase decision of such magnitude without discussing it with their spouse. However, the spouse probably knew of the appointment and in fact, even encouraged the visit. In this scenario, the first option is to suggest that the spouse accompany the patient when the appointment is made. I have read that patients are 80% more likely to take action when an influencer comes to the appointment with them. If the patient comes alone, you may say, “I have identified a significant hearing problem in our testing, Mr. Jones. Obviously this is affecting communication between you and your spouse so I would like to make another appointment when your spouse can accompany you so we can discuss this problem together.” Or you could also inquire as to whether the spouse knew of the appointment and if he or she has ever complained about their hearing problem and then ask, “Wouldn’t your spouse want you to get the help you need?”

“Hearing aids don’t work” – Most of us have heard patients talk of the “friend” who has aids that sit in a drawer. In this case, it is best not to try to disprove why the friend doesn’t like his or her aids but rather to say, “It is true that there are patients who don’t wear their hearing aids, but in your situation….” Don’t spend a great deal of time trying to disprove a claim that you know nothing about but rather spend your time on the issues that make your patient an excellent candidate for help.

Don’t take the patient’s first objection as a final, “No”. Figuring out another way to answer a patient’s concerns and resuming dialogue on the hearing loss after being told “No” will ultimately make you a better professional. It is not rude to persist; it is simply not giving up before providing the patient a second chance to accept the recommendation to obtain amplification. Make a second attempt to determine what is actually holding the patient back and return to the reasons the patient made the appointment in the first place – missing important information at work, feeling left out of conversations with loved ones, avoiding social situations, etc. I would never recommend pushing or manipulating a patient into taking action. You may get them to move forward in the short run but in the long run, the patient may return the aids or let them sit in a drawer. Remember, a patient’s “No” might be definite for now, but sooner or later, they will need to reconsider doing something about their hearing problem if they want to live a productive life. Also, don’t take it personally when a patient objects to your recommendation. They simply may not be ready to action. Objections are inevitable and an integral part of learning how to convince more patients to take action in the way of amplification.

The very first step in improving the ability to convince more patients to get help is to track appointment outcomes. Many of us “think” we help more patients than we actually do. Most practice management software tracks appointment outcomes. If not, start a spreadsheet and record how many patients you see who are candidates for amplification and then compare that number to the ones you actually convince to purchase it. This should include new patients as well as current patients who could benefit from new technology. It’s also important to have a written definition of who is a candidate to keep tracking consistent. This process can determine your “help rate” or the number of patients that you see that need hearing aids as compared to the number of patients that actually purchase hearing aids. These tracking results may be surprising and will illustrate how successful you are at actually “helping” your patients!

People who have lived with hearing loss may have a difficult time understanding what it will be like to hear well again. Too often, we tell patients what they should do, but we don’t show them what it would be like to hear better. Demonstrating the latest technology and showing a patient how it can improve the ability to hear conversational speech can be a very effective way to convince a patient to take action. An effective demonstration needs to be quick and efficient. Have the hearing aids close by with fresh batteries so that the illustration doesn’t disrupt the presentation and take a lot of additional time.

Our effectiveness as audiologists is directly influenced by how many patients we convince to take our advice. I have always believed that promoting better hearing is like religion – if you believe it, it won’t be difficult to get your patients to believe it, too. It’s easy for patients to sense insincerity and that will definitely make them leave without getting assistance for their problem. Work on developing an honest, effective presentation that will be convincing and comfortable for you as the professional! The satisfaction of being able to help more patients by convincing them to take action now and not waiting will be well worth the additional effort.    
Learn Your Line

Scripts can be useful tools for crafting a cohesive and polished message to be used during consultations with patients. Audiologists can use scripts like actors use them: You never see actors reading from a script during a performance, but all actors practice their part using a scripted dialogue. Here is a script derived from a presentation by Phil Jones, international sales trainer.

Mr. Smith, you came in today for help understanding your grandchildren and at your board meetings.

I am a doctor of Audiology with ___ years of experience in hearing healthcare and have worked with over 6500 patients. Second, our lab is staffed with two assistants who are able to take care of your needs if you should walk in for service. You can come in whenever we are open to have your hearing aids cleaned and checked. In fact, that is one of the things most of our patients rave about. We also include batteries for the life of the hearing aids which is an average of five years. For most people, this adds up to a savings of hundreds of dollars per year. If you have questions about your hearing aids, don’t ever hesitate to call or come in. The entire staff is committed to helping you hear better.

Based on your speech in noise test scores and your ability to understand speech, I am recommending ______________. (if a person has poor speech in noise results, I start by saying, “Based upon the difficulties you are having understanding in noise, you should get the best technology you can). In my ____ years as an audiologist the technology has never been better. Mr. Smith, the technology I am recommending is designed to boost your grandchildren’s soft voices while maintaining comfortable volume levels during (fill in situations patient mentioned during interview). I have fit _____ patients with these hearing aids last month and they have commented how much easier it is to hear and understand other people, even in noisy situations.

We have gone over what is included with your hearing aid purchase. I have explained why ______ is the right choice for you. Your investment for the hearing aids is $_____.

The next step is to schedule a fitting appointment in two weeks. During this appointment my assistant will explain how to clean and care for the hearing aids and then I will program them to your specific hearing needs. I would recommend that we go ahead and make that appointment. Is that agreeable with you Mr. Smith?    
Dr. Gyl Kasewurm is owner of Professional Hearing Services in St. Joseph, MI. Dr. Gyl is passionate about hearing healthcare. She, her husband and the staff at Professional Hearing Services participate in health programs in their community, they have donated Induction Loop Systems to several buildings in the St. Joseph, MI area and have traveled to under-developed areas of the world to deliver the gift of hearing.