Hearing Aids, Masks, and Telemedicine

October is known for many things – Hallowe’en, pink ribbons, pumpkin-spice-everything – but it’s not as well known as National Audiology Awareness Month, intended to remind us “how important [our] hearing is to [our] daily life, along with encouraging hearing screenings and hearing protection.”

True confession – I (and plenty of my peers, if they are honest!) spent a little too much time a little too close to the speaker stacks in the late 20th century, which, along with a mild congenital hearing deficit, left me pretty darn deaf by my mid-30s. For my 36th birthday, after I’d recklessly agreed to an impossible work deadline because I misheard “seven” as “eleven,” I got – Hearing aids! Miracles of miniature engineering that fit snugly inside my ear canals so you’d never know. There are even models these days that can be connected to Bluetooth, though I’m not sure I’m ready for hearing more voices in my head.

But here’s the thing. Even as good as the engineering is, I still rely on lip reading. As I have cheerfully (maybe recklessly) informed my staff in each position I’ve held, “If I can’t see you, I probably can’t hear you.” One-on-one and small group meetings and conversations (in the absence of intrusive background noise) are fine. Bigger group meetings – around a boardroom table or in a ballroom – are more difficult.

Zoom, however, is fantastic! Wow, what an ideal environment for even the mildly hearing impaired. Unless someone is rude enough to be off camera, I can see everyone! All at once! I can discreetly adjust the volume for softer or louder voices! I don’t have to annoy myself or my meeting-mates with frequent requests to repeat what they’ve said! From that standpoint, the past year-and-a-half has been incredibly liberating, removing a layer of exhausting stress in my work I hardly knew was there.

Masks, however, are devastating. They save lives but for the hard of hearing, they are a kind of social death. I suspect even people with no measurable hearing loss may struggle to understand what is said from behind a mask – especially in healthcare encounters. If you’ve been to see – in person – any clinician since March 2020, you’ll know what I mean. They are triple-layered in masks (plural), face shields, and goggles, rendering any reading of expressions let alone lips impossible.

Telemedicine, however, is fantastic! Wow, again, a near-ideal environment for even the mildly hearing impaired. Or mobility impaired. Or immunity impaired. Or transportation deficient. I say “near-ideal” because there are some downsides to all the upsides: It’s not great for the broadband deficient or technology impaired, which comprise too many patients in great need of access to care. And if the clinician is also somewhat technology impaired or just uncomfortable, the encounter can become unsatisfactory pretty fast.

Like if I can’t see your face because you are backlit by a sunny window. Or your camera somehow must be on a tall stick because I can only see the top of your head, or in a dish because I can only see the underside of your chin (or worse, up your nose), or so poorly focused I’m not sure what I’m seeing at all. Or maybe the tech is flawless but you are so fidgety and nervous or distracted or unprepared that I feel like two cents waiting for change instead of a valued and cared-for human being.

A year and some ago, healthcare clinicians across all settings and all disciplines suffered the whiplash of having to migrate to telemedicine virtually overnight. A year and some later, we are all still learning how to maximize the many benefits of this new environment. Like any other form of patient encounter, telemedicine is a skill – there are specific techniques that can be learned and utilized to put patients at ease, establish rapport, perform examinations and assessments, and create an emotionally and physically safe space to achieve excellent outcomes of care. But, also like any other form of patient encounter, it requires learning, skills, and practice.

Next month, in honor of National Hospice and Palliative Care month, we’ll be releasing a new course, “Telemedicine Skills for Clinicians.” The course is self-paced, abundant with “clinical pearls” for enhancing telemedicine patient and family visits for any discipline in any setting, along with practical information on billing, documentation, and compliance. Video excerpts from our very successful “Telemedicine Now! And How!” open forums from the spring of 2020 provide personal insights and “pro-tips” from skilled clinicians, including Michael Fratkin, MD, Resolution Care; Michael Rabow, MD, FAAHPM, UCSF; Dana Lustbader, MD, FAAHPM, ProHealth New York; Brook Calton, MD, MHS, UCSF; Judy Long, Chaplain, UCSF; Claritza Rios, MD, Emergency Medicine, CA. And, completion earns 4 CE/CME hours – all for only $79. In November, we’re offering a 15% discount to individuals and 20% discount to group registrations of 5 or more.

Yes, there’s a lot of “free stuff” out there on telemedicine, but this course is one-stop shopping for learning the skills, mastering the technology, getting paid, and following the rules. Invest in yourself and your telemedicine patients – hard of hearing or not!

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