The follow-up examination and documenting success

I have three questions for you: In The Wizard of Oz, what did the Scarecrow need? Remember your answer, as we will discuss it later. Next question: When you see a patient for a follow-up visit, do you work from a checklist or do you talk with the patient to see what needs to be done? Last question: Other than hearing aids, what “proof” do your patients have to show them they were successfully fitted? We often get in the habit of fixing the problem that brings the patient into the office, such as a plugged hearing aid. It is all too easy to ask, “How's everything working?” hear “Fine” in response, and then say, “Okay, see you in 6 months.” But, as professionals, we are responsible for doing what the patient needs, whether or not the patient articulates those needs. It is our duty to check each patient's ears, hearing, and hearing aids periodically. These checks need not take much time; most can be done quickly. And, at the 1-year follow-up visit, I believe we should give the patient documentation showing that the person has been successfully fitted. More about this later. CHECKLISTS We are often swamped at work and have patients lined up waiting to see us. This puts us under enormous pressure to see patients as quickly as possible. Because of this, it helps to use a checklist so we don't forget something important. Here is the list I use for the 1-year follow-up appointment: Make sure there is no wax or debris in the patient's ears. Check the ears for pressure spots created by the instruments. Ensure that the hearing aids are comfortable to wear. Check to see if the patient is using them properly (insertion, volume adjustment, program selection, etc.). Speak with the patient and, if possible with a family member, to find out if the hearing aids are providing the patient with suitable amplification and benefit. Regarding the last point on my checklist, keep in mind what David Hawkins wrote in the Final Word column in the February 2007 HJ about two types of patients we all encounter. One type always says “fine” when you ask them how they are you doing. These folks want to be accommodating and tell you what they think you want to hear even when if they still have serious problems with their hearing. Another group consists of people who are never satisfied with their hearing aids no matter how much benefit they are getting from them. So, when asking patients how well their hearing aids are working, you may need to ask them or their significant others follow-up questions to make sure you are getting the full story. It helps to understand the significance and purpose of the follow-up visit by considering it from a medical point of view. How would you feel if when you went for a physical exam your physician came into the waiting room, walked around and talked to every patient seated there, gave each of you instructions on how to deal with your problems, and then told all of you to go home? Not satisfied, I'll guess. When we go to our physician, we expect him or her to measure our blood pressure, take x-rays, draw blood, and perform other routine procedures to assess the state of our health. If a physician dismissed us without doing any tests we would probably consider the person negligent. THE OTOSCOPIC EXAM Now, let's talk about the basic components of the follow-up appointment, starting with otoscopy. Use a fiber-optic otoscope or a video otoscope and look in the ears for wax and debris. Be especially careful to look in the upper part of the ear under the antihelix ridge for any irritation created by a hearing aid. This area is sensitive and easily irritated. Use the otoscope also to look for debris in the microphone and receiver openings. This procedure takes just a few minutes, but it provides valuable information. Many patients have excessive wax or dry/dead skin in their ears. If we don't manage it properly, it will get into their hearing aids and interfere with their performance. When I clean ears, I always show the patient what I've removed. They usually exclaim something like, “Oh, my gosh, that's awful!” Showing them the wax and talking about it is very effective in making patients take responsibility for keeping their ears clean. LISTEN TO THE HEARING AIDS One of the most important skills we develop from experience is the ability to listen to hearing aids with a listening scope and judge the quality of the amplification. Sound box measurements We need to consider sound box tests from two perspectives—the patient's and the professional's. First, let's consider the patient's point of view. For many years, I used Frye 6500 hearing aid test sets in both my offices. Last year, I upgraded to Frye 7000s, using my old video monitors. Nobody noticed! I then purchased oversized, flat-screen monitors for these new hearing aid test units. My patients were suddenly very impressed. They noticed the colorful lines and asked, “Wow, when did you get the new equipment?” We need to remember that the patient's perspective is very important to the success of a fitting. I recommend that you upgrade your video monitors with oversized flat screens so your patients can easily see the curves. It is money well spent. Now, let's consider the sound box test from the point of view of quality control. I asked George Frye, president of Frye Electronics, what is the most useful test we can do in the sound box. He replied, “You are looking for a test that answers the question, ‘Is the amplification the same or has it deteriorated?’” George recommends that practitioners set hearing aids to the use-gain level and run a sound box test when they fit the aids. The dispenser then places a copy of this test in the patient's file. When the patient returns, George suggests running another use-gain test at the same settings and comparing the two graphs. Doing this reveals quickly if the aid has the same use-gain or whether it has changed and is in need of repair or cleaning. Debris in the microphones or receivers can change the curve substantially. I suggest that you print a copy of the second test so you can give it to the patient. I'll explain why later. THE HEARING TEST It takes time and effort to give a new patient a comprehensive hearing test, since many issues need to be considered. It takes much less time to re-check an existing patient's hearing. In the re-check, we are looking to answer the question, “Is there anything more we can do with the amplification to improve this patient's hearing further?” I have observed that as hearing aid users age they need more sound (gain) and wider band sound (more amplification in the lower frequencies and more in the higher—until this increase reaches the point of being counter productive). They find that “bigger” sound is easier to hear and that it provides more loudness. Older patients have more confidence in their hearing when they listen to “bigger” sound. ASK THE PATIENT More and more businesses, e.g., luxury hotels, auto dealerships, give questionnaires to their customers. The management wants to know how we feel about the quality of the service we received. These businesses also want us to know that our input is important to them. We should do something similar with our patients and their families. I like using a questionnaire such as the COSI that patients fill out both before and after receiving our services and that asks them about their satisfaction with the service they received and the quality of their hearing with the hearing aids. PROOF OF COMPLETION Now, let's get back to the questions I asked at the beginning: What did the Scarecrow in The Wizard of Oz need?” Answer: A brain. And, the Wizard of Oz supplied the “brain” by giving the scarecrow a diploma. When we deal with patients we assume the role of the Wizard. The patient wants some validation that we have done our job and that the hearing aids are working well. Instead of a diploma, we can give them some documents of completion at the end of their follow-up appointment. These can include the printout from the sound box, which offers concrete evidence that their hearing aids are working appropriately. The questionnaires completed before and after treatment provide further proof of the efficacy of the fitting. Questionnaires completed by family members are particularly meaningful, as their viewpoint is often more objective than that of the patient. We can also give patients a document—let's call it a Certificate of Completion—stating that they have been successfully fitted with amplification. IN SUMMARY You would stop going to a physician who did not use appropriate diagnostic tests. Similarly, we need to incorporate routine tests in our follow-up protocol. And, after the follow-up appointment, we should give patients some tangible, official statement attesting to the successful completion of the hearing aid fitting process.

Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.