“What did you say, doctor?” - Cape Cod Healthcare

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Published on April 13, 2021

“What did you say, doctor?”

“What did you say, doctor?”

The Hearing Loss Association of America estimates that 20 percent of the people living in this country have hearing loss. By the age of 65, it affects one in three people, and that number goes up as the population ages.

It’s a problem that is only going to get worse. The number of people with hearing loss is expected to nearly double by 2060, according to researchers at Johns Hopkins University.

Hearing loss is associated with accelerated cognitive decline and poorer physical functioning. It causes people to withdraw from activities and other people. The result is isolation and loneliness, which is thought to have as much of a negative impact on health as obesity or smoking.

“There’s a saying that people who are blind are cut off from the world and people who are deaf are cut off from other people,” said otolaryngologist Ross Johnston, MD, at Cape Cod Ear, Nose and Throat Specialists in Hyannis.

“One of the big things in terms of losing hearing and aging is people start to isolate. It’s not fun for them to be at gatherings. They get tired of asking people to repeat, so they learn to stand off in corners. They learn to smile and nod and hope for the best.”

Problems In A Healthcare Setting

Social isolation and loneliness are serious issues, but a recent study published in JAMA Otolaryngology – Head & Neck Surgery showed an even more ominous problem. In a survey of 100 patients age 50 and older, 43 reported mishearing a doctor or nurse in a healthcare setting. Even people who can hear well don’t always understand what their doctor is saying, but those with a hearing loss face a larger challenge.

“It’s well documented that people come away from a physician encounter understanding half of it,” Dr. Johnston said. “If there was a bad diagnosis or bad news, even less of the information is absorbed, because the mind can’t process it.”

The key to good patient care is good communication, he said, but that is especially important with those with hearing loss. Doctors need to recognize when their patients don’t comprehend what is being said. He also suggested that doctors not use a lot of medical jargon and repeat and write down all important information, like the diagnosis and medication instructions. It’s very helpful to have a spouse or other family member present to be a second set of ears.

“When I talk to patients and their spouses, we talk about communication etiquette,” he said, which includes:

  • Make sure you are in the same room with the person.
  • Make sure the person is looking at you when you are talking.“Even though they’re not truly reading lips, their brain knows what an ‘s’ looks like versus a ‘w’ or other sound,” Dr. Johnston said.

You don’t necessarily have to speak louder to someone with a hearing loss, but exaggerating mouth movements to enunciate words is helpful, too, because it offers more clues.

Dr. Johnston also advises his patients with hearing loss to make sure every doctor they see is aware of the problem. That is good advice for patients who do know that they have hearing loss, but a lot of people don’t recognize the problem or are in denial, he said. In that case, it becomes more important for family members to speak up for them.

Hearing Aides Can Help

A hearing aid can help, but they often don’t give patients the exact results they are looking for, according to Dr. Johnston. A hearing aid boosts the signal better but can’t distinguish between the scratching of a fork on a plate and the people talking around you.

Hearing aids often lose their effectiveness in the very environments that people need them the most, like a loud restaurant, a party, or Thanksgiving with the family, he said. “If there is too much background noise, you still can’t follow conversations.”

The times when hearing aids are most effective are during one-on-one conversations in a quiet room or car, so they can be very helpful, he said.

For those who can’t afford hearing aids, Dr. Johnston recommends over the counter amplifiers like a Pocketalker, which can be found on Amazon.com for $130 to $140. The device looks like a Walkman so it is very portable. Users plug in an earpiece and then place the microphone next to the thing they want to hear amplified.

A lot of churches, theaters and auditoriums also have closed looped systems for the hearing impaired where they can get a headphone and the sound is transmitted wirelessly. People with hearing loss should always ask if these services are available.

Hope is also on the horizon for other options. Last August, Congress and the president approved the Over-the-Counter Hearing Act. It gives the Food and Drug Administration three years to create an over-the-counter hearing aid category with safety rules for the devices.

“When patients would come in and need something to amplify reading, we didn’t have anything,” said Phelan-Stiles. She did some research and found a company that makes disposable magnifiers and they were willing to add the Cape Cod Healthcare logo.

While staff can make copies of some information using a larger print for visually-impaired patients, there are some documents that cannot be reproduced in that format. That is where the magnifier can be of help.

“Sometimes a small investment can help so much,” said Phelan-Stiles.

Patients can take the magnifiers home with them but the pocket-talkers remain at the hospital.

These two devices are just the tip of the iceberg of assistive devices that are available to hearing-impaired, deaf, visually-impaired and blind patients at Cape Cod Hospital and Falmouth Hospital, she said.

For deaf or hearing impaired:

  • American Sign Language Interpreter
  • American Sign Language (ASL) using fingers, gestures and facial expressions to communicate
  • iPads on a pole or stand to use for interpretation
  • Video relay for placing phone calls (those with hearing disabilities can communicate by phone using American Sign Language through video equipment.)
  • CART (Communication Access Real-time Translation) translating verbal communication into text using a stenotype machine, notebook computer and real-time software. Phelan-Stiles says this system is used very rarely
  • Certified deaf interpreters, deaf interpreters who have specialized training

Changes in nursing care plans also assist in the care of patients with these challenges.

“When I started at Cape Cod Healthcare, there were two sections to address these disabilities,” said Phelan-Stiles. “There was a section to check off deaf/hard-of-hearing and then legally blind, that was it.

“The nurses needed more help and advice, mainly with our visually-impaired patients. I got a team together to look at all aspects of disabilities including mobility, visual, auditory and others.”

The result was new care plans that prompt questions about the details of a patient’s disability such as are they hard-of-hearing and if so, is it in both ears, right ear or left ear. It includes a section to list the aids they need to communicate.

If they are blind, there are check-offs that indicate if they are deaf and blind, legally blind, partially blind and their level of impairment. Nurses can post signage in their room to indicate they are blind or have limited vision and include other information that is necessary on the care plan.

Staff and Phelan-Stiles are always looking for ways to improve care for patients with disabilities.

“It’s important to do anything we can to help our patients communicate and, in turn, we provide better care,” said Phelan-Styles.