Editor's Message: Communication Breakdowns in the Clinic Are Cause for Concern: What Audiologists Can Do

Author: Brian Taylor, Au.D.

For individuals aged 60 and older spending time at the doctor’s office is a common occurrence. And, considering the prevalence of hearing loss in older people, it’s not too surprising hearing loss gets in the way of effective communication between the older individual and their healthcare provider during this routine encounter. A recent study, published online by JAMA-Otolaryngology, indicates communication breakdowns that result from hearing loss in older people might be more common and debilitating than realized.

Here’s more on that study: A group of researchers at University College Cork, Ireland, led by Vikki Cudmore, interviewed 100 adults between the ages of 60 and 80-plus years. Fifty-seven individuals reported hearing loss, and, as expected, the individuals over aged 80 had a much higher rate of self-reported hearing impairment. Almost half of the group (43%) reported they misheard a physician or nurse during a primary care or hospital visit. Interestingly, the frequency of mishearing did not vary according to the age group. It seems all adults over the age of 60 have some difficulties following verbal communications in the busy doctor’s office.

As part of the study, respondents were asked to elaborate on the context of their miscommunications with physicians and nurses. Some patients explained why they misheard their healthcare providers, and their reasons fell into one of five categories. Descriptions of illnesses or instructions tripped up 36 percent of people, and 29 percent said they missed words or full sentences for no particular reason. People talking too fast, too many people talking at once and similar issues were cited by 27 percent of people. Pronunciation or similar-sounding words were an issue to 10 percent of people. Others reported intentionally not listening to their providers and some blamed the setting or the physician or nurse for not speaking clearly.

The urgency for physicians and other healthcare professionals to shore up their ability to communicate with older individuals was reflected in an accompanying commentary to this research. Heather Weinreich, MD of Johns Hopkins University wrote that physicians need to be improve their communication style with older patients, and intervene in other ways to help patients hear well during their interactions. One intervention cited by Weinreich was the use of temporary amplification devices.

“On a global scale, supporting legislation for hearing coverage, opening doors to alternative hearing devices and pushing for standardization of technology like personal sound amplification amplifiers are methods (of improving communication)” Weinreich writes. “There are potential immediate short-term and long-term impacts of miscommunication with patients. We need more research into the medical errors and costs caused by hearing loss and to examine methods to provide effective communication so as to deliver high-quality patient-centered care,” Weinreich concluded.

As audiologists continue to grapple with changes in device regulations, the research of Cudmore and her colleagues in Ireland could be a springboard to building stronger relationships with the physician community by providing low-cost, non-custom amplification devices that can be used during physician/nurse appointments with patients in the hospital or clinic. One example of this type of interventional service can be found at the University of Pittsburgh Medical Center and the work of audiologist, Lori Zitelli and her colleagues, while another can be found at Johns Hopkins University under the leadership of research audiologists like Nick Reed and Jon Suen.

Wherever you practice, the clarion call of audiologists needs to be to go out into your community, identify at-risk populations and provide resources to all parties affected by these communication breakdowns. This could be educational in nature, such as communication tips for physicians and nurses, or situational in nature through the provision of low cost off-the-shelf non-custom amplifiers. Interventional services such as these are needed more than ever.