Patient Engagement

Moving Beyond the Individual on the Path to Person-Centered Care

Given that the job of a healthcare professional is to care for patients, it would follow that those who choose to become clinicians are inherently compassionate. However, the care we provide is not always as compassionate as we hope. I have been a private practice audiologist for many years. After completing my PhD studies, I returned to practice thinking that I could practice in a true person-centered way; my patients would be happy and the outcome of care would be great. Although I do think of myself as better prepared to combine my technical skills and knowledge with compassion, I still find the situation within which I work to be sub-optimal and sometimes challenging to be as person-centered and compassionate as I wish to be.

Audiologists specialize in identifying, diagnosing, treating and monitoring auditory and vestibular disorders. Hearing is critical in the development of speech and language in children, communicating with others, and social inclusion. We are just now learning of the implications of hearing health for memory and cognition as we age. Like those who pursue any other health profession, audiology students pursue their dream to become caring providers who hope to improve the health of their patients. The person-centered aspirations for the profession are not limited to audiology students; practicing audiologists explicitly endorse person-centered care and could tell stories of person-centered moments in their practice.

However, recent changes in the audiology landscape have impacted hearing healthcare practices and are detrimental to how audiologists and audiology as a profession is perceived by patients, other health professionals, the public, and even the profession’s own members.

Audiology has been prevented from reaching its full person-centered potential through an interplay between personal, professional, social, and system factors, for example: the stigma attached to hearing loss and hearing aids, the professional identity of a healthcare provider and desire to treat patients, the main treatment option for hearing loss being a consumer product (i.e. hearing aid), the rapid advancement in hearing technologies and technological innovations, and the defunding of hearing health care services from universal healthcare benefits.

Healthcare professionals are often more concerned with clinical outcomes, which may, at times, oppose patients’ goals and opinions. Untreated hearing impairment can contribute to adverse effects that go beyond communication difficulties and hearing aids are the most viable and common intervention for treating age-related hearing loss. However, due to the stigma attached to hearing loss and hearing aids and other negative perceptions and attitudes toward hearing loss and hearing aids, hearing aids are not always a desirable treatment option. As health care professionals, audiologists want to treat the hearing loss to improve communication and mitigate the negative impacts that untreated hearing loss could have on a person’s quality of life. However, in a person-centered encounter, where patients’ views are important in setting goals for their care, patients may decide not to pursue professional recommendations and leave the hearing loss untreated. Staying true to tenets of person-centered care requires the audiologist to respect the patient’s wishes despite the awareness of the possible mental, social, and emotional consequences of untreated hearing loss.

In 2001, the Ontario Health Insurance Plan (OHIP) reduced audiological service coverage significantly. The coverage has become limited to hearing tests and only to clinics that have an on-site otolaryngologist. In response to the defunding of hearing care services, corporate multi-site practices started offering non-technological hearing care services for “free,” relying on revenue from hearing device sales. This change has impacted audiology services at multiple levels; contributing to devaluation of audiological services and instead focusing on the sale of hearing devices and challenging survival of small private practices in a competitive sale-oriented climate. Consequently, hearing clinics have been relying on hearing aid sales and thus challenge person-centered orientations of clinicians who are facing increasingly narrower career options.

While the aging population is increasing the demand for audiological services, more and more hospitals have shuttered their audiology departments. The growing demand and shrinking services have resulted in an upsurge of chain and multi-site hearing aid clinics and thus the competitive climate has increased small practice buyouts by big corporations. With the changing culture of practice in audiology, it is not surprising to see the focus of the profession has been gradually shifted and is increasingly perceived to be focused on dispensing of hearing devices rather than providing a breadth of hearing care services.

Cultivating compassion requires looking beyond individuals and what they ought to learn and do, and drawing attention to the broader healthcare context. Considering compassion a personal attribute or behaviour and person-centered care as a way of practice for clinicians places the onus on individual clinicians to be compassionate and practice in a person-centered way, without taking into account the role of the technical, institutional, social, and political challenges inherent in complex systems of practice. It also limits person-centered care mainly to the individual visits or care processes provided by individual clinicians.

While developing person-centered skills and attributes may be necessary in practicing in a person-centered way, it will not automatically optimize person-centered care. We need to explore the capacity of systems of practice for person-centered care, and increase awareness of technical, social, and institutional challenges in instilling person-centered care. We need to understand how individuals influence the systems and how systems influence individuals. Only by moving beyond the focus on the individual clinician may we help the profession of audiology foster true and genuine person-centeredness. Given the importance of hearing health to other aspects of health and well-being, the overall system cannot afford to ignore these issues any longer if it wishes to be person-centered.

About the author

Dr. Laya Poost-Foroosh

“Critical Social Approaches to Supporting Person-Centered Care in Audiology” …

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