Editor's Message: Clinical Judgments and Patient Centered Care

Author: Brian Taylor, Au.D.

Audiologists agree that a commitment to patient centered care is a valuable part of ethical practice guidelines. Exactly how patient centered care is defined and implemented, however, is subject to considerable debate. A good place to start the discussion of how patient centered care is implemented in the clinic is by examining the process of how clinical judgments are made by providers during a routine hearing aid evaluation. Unlike diagnostic audiometry, which relies on accurate and precise execution of a standardized test battery, the hearing aid evaluation process tends to vary by a remarkable degree across providers. There is no universally accepted approach to conducting a hearing aid evaluation and, given the number of patient variables, the process will probably never by as standardized as the diagnostic hearing assessment. Granted, by its very nature, the process of selecting and fitting hearing aids is inherently messy, fallible and unpredictable. It is more art than science, and rightly so. There are dozens of variables, many completely unrelated to the auditory system that influence the decision-making process. These variables include the individual’s motivation, self-confidence, and financial considerations – factors that cannot be objectively measured very easily.

During any routine hearing aid evaluation process when the patient and provider are determining candidacy for hearing aids, performing a communication needs assessment and making decisions about hearing aid features needed by the patient, several highly subjective judgments are made. These judgments, undoubtedly, are influenced by the experiences, education level and biases of the provider who is conducting the evaluation. Because it is such a subjective process, who is conducting the evaluation often matters more than what tests and procedures the provider is conducting during the appointment.

By taking a page from clinical psychology and using scaling questions that address patient perceptions of their condition and their willingness to treat it, rather than focusing so much attention on the results of the hearing assessment, audiologists can add some scientific rigor to an otherwise highly subjective interaction. As audiologists Carly Meyer and Louise Hickson demonstrate in their new book, Patient and Family Centered Speech Pathology and Audiology, recently published by Theime Press, highly subjective judgments made during the hearing aid evaluation process can be turned into slightly more objective knowledge, which, in turn, can be used to build a stronger emotional bond with patients. At the end of the day, the hearing aid evaluation is indeed a messy, fallible …. human process, but with a few new wrinkles provided by Hickson and Meyer, it also can be a slightly more objective process that remains engaging for the patient.