Are Professionals Over Medicalising Sensorineural Hearing Loss To Justify a Business Model?
Geoffrey Cooling
Providing Strategic Communications & Business Channel Modelling Services
Yup, that's a genuine question, I know some people will be spluttering their chosen form of beverage all over their computer screens right now, but it is a question we need to explore. I want to qualify exactly what I mean here, I mean the treatment of sensorineural hearing loss.
Quite a lot of things have been happening within the wider hearing care world over the last few years to widen choice and access for consumers. Much of it is now coming to a head with the introduction of interesting products and the approaching culmination of the OTC saga.
The announcement of an executive order by President Biden has stirred up some outrage within professional circles. The main point of irritation is the pointing of fingers at hearing care professionals as responsible for the high price of hearing aids. The go to response of the profession is to blame the manufacturers.
I asked someone "Are you saying professionals don't make a healthy mark-up?" They agreed that they do, but they put the work in. You know that's relatively true for many in the profession now. It hasn't been the case in the past.
Accepted best practice hearing care has been around for a lot longer than I have been qualified. However, it is probably only in the last two years that REMs have become common-place across the profession.
Yes there are many who have done them for a long time, but they were in the minority. The idea that REMs are crucial for a good fit only appears to have dawned on the bulk of the profession because high profile people were communicating it to consumers.
So the idea that the profession has had the consumer's best interest at heart for years is laughable at best. The profession has stated that fact many times, but it was like all the best lies, uttered to keep us warm at night. Similar to the concept of charging double for two hearing aids, it's hardly twice the work is it?
Anyway, let's forget the past, let's focus on the question in the title of this article. The thrust of the argument is that the profession is central to the process because it is a medical device. More than that, because of the possible medical issues involved with hearing loss, the profession is crucial to the process.
I do believe that the profession is crucial to the testing process, that in some cases, a hearing loss is indicative of far deeper and nefarious issues. Having said that, the bulk of sensorineural hearing losses are just that, simple age related, genetically predicated or noise induced.
After the person in front of us has been found to have simple sensorineural hearing loss, why should we remain involved? Is modern technology not capable of treating sensorineural hearing loss without our intervention? While the answer at this minute, may be a qualified possibly, in the future, will that change?
I steep myself in technology, not just related to this industry, but also aligned audio industries and medical fields. I can honestly say that the time is rapidly approaching when unaccompanied technology can offer everything we do.
We offer our products and services in the way that suits us. There is a growing cohort of consumers who don't find it attractive. We have always known that there is a large cohort of consumers with hearing loss who don't find our business model attractive, yet we have never changed it.
We justify that intransigence with the statement that this is healthcare and we as professionals treat the problems in the best way possible. But is it really? After the testing process, is the treatment of hearing loss with a hearing device truly healthcare? We have certainly made it so, but does it need to be?
I hear many professionals state that their customers are basically too stupid to manage their devices moving forward. Okay, they don't say too stupid, but that is what they mean. As the proportion of hearing aid users that are too stupid to manage reduces as the demographics change, will that still be a justification?
As augmented audio becomes mainstream in consumers lives and they become more familiar with the customisation of audio to match their needs, do you think their reliance on us for treatment could wane? Anyway, back to the question, is the treatment of sensorineural hearing loss such a complex thing that we as professionals can be the only people to do it right?
Are we relying on the medical card to justify a business model that suits no one but us? I think we should all reflect on that question, I think we should really all reflect on what our USP is as a profession. The justifications for our business model that we use right now are paper thin. The only real thing that we do after the diagnosis and communication needs assessment that can not be replicated is REMs. That won't last for long.
Yes, we genuinely help and support people moving forward to manage their hearing aids and to get the best from them. But the proportion of people who need that will continue to reduce moving forward, so why should they be locked into services they don't want delivered in a way they aren't interested in?
CEO and Chief MoreThanEars-ologist @ Soundfair | PhD in person-centred service design | Clinician committed to amplifying lived experience | Fast moving leader who paints outside the lines (on purpose)
3ygreat convo starter Geoffrey Cooling. Given that many of the consequences of SNHL are psychosocial and often behavioural, people are needed to address these consequences. I am excited to see that tech and devices is evolving such that the device-focus will likely be relieved of audiologists and similar professionals, allowing them to address the daily concerns more thoroughly and appropriately. The reality is though, this will not suit many people currently in the profession and a lot of upskilling/unlearning will be needed.
Professional NED and Managing Director at Bingarra Scale-Up Solutions
3yYou pose some interesting questions here Geoffrey Cooling . I think it's both under AND over medicalised. Many, probably most, people just need to hear. It's not complcated. Some need excellent diagnostics, either to try and understand why their hearing aids are not effective, or to identify the cause. Certainly in Australia the prevailing model doesn't generally accommodate that. As you know, I still hold that the model of Goldstein and Stsphens covers it all if used properly. But perhaps the wakeup call will come with the rise of therapeutics
Senior Audiologist at NHS
3yHearing care is hearing therapy not just a hearing aid device Who independantly verifies the quality of the aids that programmed up by the consumer. How do we know that the aid is tuned best for the patient. It could be easy to blame the loss rather than the aid as the aid is not a cure. I would argue that all people need to see a trained specialist for great advice. Would you fix your own car. Boiler, tv ? Whos going to educate the family to use better communication tactics? In the UK working age people can get free roger pens if it will help at work. Whos going to make that access to work referral if there are no audiologists. You could write down all the information an audiologist knows but 1. Would the patient read the manual. 2. Would they understand it. Reduction of the dynamic range of hearing for example. I have no concerns about otc aids etc. Its a entry level hearing aid for people who cannot afford to see a specialist. I would argue the case that governments should make audiologists more accessable. I spent about 40 mins the other day explaining the balancing act of gain vs feedback vs ear mould size vs ear mould confort. Would this sort of chat occur with otc prescription method?
Principal and Chief Solutionist for Audiology Resources, Inc.
3yThank you Geoff for clearly communicating the realities of the situation in which we find our profession. Healthcare, science and technology have merged and the by-product is finally reaching our profession (although, for me, "finally" means over a decade ago). Most fail to acknowledge that consumer electronics companies and new entrants in the space have valid product and delivery offerings (because we never evaluated them ourselves). I know that consumers are long over our bundled price, inaccessible care delivery options, and the lack of value many often provide. I know that, while many now claim to do REM, most do it as a cursory task and rarely fit to target (if we are going to fit to patient comfort, why could the patient not have done that themselves?, I digress). Many still do not provide research evidence based, patient centric EVALUATION and TREATMENT BEYOND the hardware. Many fail to recognize and acknowledge that every consumer does not have a $3000 problem and does not want to come to your brick and mortar office Monday through Friday, 8-5. For a profession intent on "hearing" we do an overall crappy job truly listening to consumers and their needs and desires. I have data to substantiate everything I listed above. Here is what I know: 1) The risks of non-treatment of hearing loss are greater than the risks of gold standard treatment (which the majority still do not provide), 2) Many consumers can and will successfully evaluate and fit themselves with amplification, 3) WE need to allow consumers to captain their own hearing journey and we need to be present, in a helpful, patient centric, non-judgmental way (and for a fee), in our role as their navigator, 4) we need to educate ourselves on emerging technologies and delivery models before we judge them, 5) we need to get off of our pedestal because we do not have the data to support many of our claims and begin the gather data illustrating our value, 6) we need to rethink and re-imagine our evaluation, care, rehabilitation, pricing, and delivery models, and 7) if we do #1-#6 audiology and individual practices will thrive!
Senior Audiology Consultant for Audioscan - Member Board of Directors for AUDNET Hearing Group
3yI would like to take the bait and respond to Geoff's question. https://lnkd.in/guTzgd9