What Audiologists Need to Know About Primary Care Physicians



Author: Brian Taylor, Au.D., Bob Tysoe, and John Bakke, M.D.

Physicians represent some of the most rigorously trained professionals in the world. Physicians trained in the United States complete four years of medical school after receiving their undergraduate degree. To become primary care physicians (PCPs), medical school graduates then undertake at least another three years of residency training in accredited primary care programs, such as family medicine, pediatrics or internal medicine.

PCPs comprise the largest group of physicians with more than 200,000 licensed in the U.S. A primary care physician is usually the first medical practitioner contacted by a patient, due to factors such as ease of communication, accessible location, familiarity, and increasingly, issues of cost and managed care requirements. For care that requires a sub-specialist (including audiology), the PCP is usually the one who refers the patient. Thus, primary care physicians are a prime audience to educate patients about the negative consequences of untreated hearing loss.

The primary care physician acts on behalf of the patient to collaborate with referral specialists and other sub-specialties such as audiology. Additionally, PCPs coordinate the care given by various organizations such as hospitals or rehabilitation clinics, act as a comprehensive repository for the patient’s records, and provide long-term management of chronic conditions.

Because primary care physicians are expected to juggle so many patient-centered activities they are extremely busy and their time must always be respected. This is especially apparent in today’s Affordable Care Act environment where PCPs are required to conduct wellness checks and other screenings on a growing segment of the aging population.

Given the time constraints and priorities of PCPs, it is imperative that audiologists always respect both their time demands and how physicians digest information. Physicians are highly trained in the scientific method. This means that you must support your statements with data from peer-reviewed, outcomes-based research, when available. Opinion articles written by authorities in their field of expertise and published in journals with a history of integrity, such as JAMA, British Medical Journal, New England Journal of Medicine, and Annals of Internal Medicine are sufficient enough to be trusted because, in part, they are usually well referenced in medical literature.

It is advisable to provide patient-care-oriented articles at monthly intervals so that the primary care physician is not overwhelmed due to time challenges. Providing multiple articles so that the evidence is cumulative and informative may result in changes in the physician’s referral behavior and, possibly, their treatment regimens as well. Weinstein and Taylor (2015) recently developed a physician toolkit that is designed to educate PCPs as well as other medical professionals about age-related hearing loss, its consequences and treatment options. The toolkit can be assessed on-line; click here.

When developing a communication strategy for primary care physicians and their staffs, be mindful of the quality of the data you will communicate and the image you are projecting. It is helpful that you address each of the questions below and have a plan for how you will address each one with the physician that you are meeting. These questions are modified from a recent JAMA paper by Choudhry, et al (2014).

Questions PCPs frequently ask when making a referral to an audiologist:
  • Does the audiologist have enough expertise with the problem for which the patient requires consultation?
  • Do other physicians also refer their patients to this audiologist?
  • Is the audiologist affiliated with a well-respected institution where the patient will receive outstanding care?
  • Can the patient be scheduled for an appointment in a reasonable time frame?
  • Does the audiologist accept the patient’s insurance and what are the expected out-of-pocket costs?
  • Does the audiologist have genuine concern for the well-being of his or her patients?
  • What is the quality of the audiologist’s support staff?
  • Will the audiologist provide high quality continuous care and support?
  • How well does the audiologist communicate with the referring physician?
  • Are the audiologist’s premises easy to locate and access?
Primary care physicians can be very approachable and respectful of your expertise if you are mindful of all of the items listed above. Considering the growing geriatric population, who often present the PCP with one or more chronic conditions associated with hearing loss, it is critical for audiologists to intervene in the care of these patients so that they may experience better communication and a higher quality of life. Armed with succinct, evidence-based and ethical information, audiologists are sure to form strong bonds with PCPs based on mutual respect and trust. These pointers will help get you there.    
Bob Tysoe is an independent consultant residing in Portland, OR who has more than 30 years of experience working with patients. He can be contacted at robert.tysoe@netzero.net.

John N. Bakke, M.D., MBA has practiced for more than thirty years in primary care and has extensive experience in medical group administration. His career includes leadership positions in academic, private fee-for-service and capitated/integrated care environments. He serves as Senior Consultant for Zolo Healthcare Solutions where he has worked to help launch Accountable Care Organizations in New England, Middle Atlantic and Southeastern states.

Brian Taylor, Au.D. is the Editor of Audiology Practices.

References
Choudrey, A. (2014) Selecting a specialist: Adding Evidence to the Clinical Practice of Making Referrals. JAMA. 312, 18, 1861-62.

Weinstein, B. & Taylor, B. (2015). Hearing Healthcare Toolkit for Use in Primary and Geriatric Care. Accessed 2/6/15 from Unitron.com. .