Question
What can I do to ensure my patients understand the results and recommendations? I provide them with a copy of their audiogram and walk them through it, but it doesn't seem to be enough.
Answer
Many audiologists have asked themselves this very question, and it's not surprising if you look to the research behind patient counseling.
Margolis (2004) reviewed this topic and found that in a typical counseling session:
- 50% of the information is forgotten immediately
- 25% is remembered incorrectly
- Only 25% is accurately retained
Martin et al. (1990) surveyed patients at 2 days and 2 weeks post an audiological evaluation, and found only 46% could accurately describe their degree of hearing loss, and none could define the word audiogram. I think that most would agree that we need patients to understand their hearing, but do not really care whether they can interpret our X's and O's. Yet, why do we frequently spend so much time teaching the audiogram? I encourage audiologists to actually put away the audiogram and focus on conveying the information that you need the patient to remember as well as address the specific concerns that brought them to your office. And these are often not the same things! Of course, the audiogram can certainly be used effectively in a counseling session, but it needs to be in a format that is patient-friendly (i.e. colorful, clearly worded, with the familiar sounds displayed).
Here are some additional tips I provided in an article published in the ADA publication Audiology Practices entitled Strategies for Effective Counseling (Urban, 2010).
- Organize your counseling session. When we are in a learning situation, we tend to remember best what was presented first, and second best what was presented last (Primacy and Recency Effects). So, organize your counseling so that the first thing you discuss is what you most want patients to remember correctly;summarize this at the end of your session.
- Keep the information simple and specific.
- Use repetition to reinforce main points.
- Limit the use of jargon.
- Address the patient's needs by listening, instead of only sticking to a pre-planned agenda.
- Deal with denial. Margolis (2004) found that denial adversely affects a patient's ability to remember important information. If a patient is in denial, be prepared to simplify the information and to 'plant the seed' of hearing loss for when they are ready to move to the next stage instead of going in to too much detail.
- Emphasize important points. If something is important, show it!
- Break the counseling into topics, and check for comprehension before moving on to the next section (i.e. First I would like to review the results of today's tests, then I would like to discuss how they may effect you on a daily basis, and finally I would like to talk about some recommendations that I have for you).
- Provide a colorful, customized counseling summary for them to take home.
Thanks for your question.
References
Margolis, R.H. (2004). Informational counseling in health professions: What do patients remember? Retrieved on February 21, 2011, from www.audiologyincorporated.com
Martin, E., Krueger, S., & Bernstein, M. (1990). Diagnostic information transfer to hearing-impaired adult. Texas Journal of Audiology and Speech Pathology, 16(2), 29-33.
Urban, B. (2010). Strategies for effective counseling. Audiology Practices, 2(3), 26 - 30.
Brian Urban, Au.D. is the President and co-founder of CounselEAR: Audiologist's Online Report Writer and owner of Advanced Hearing and Balance Center in Evanston, Illinois. He can be contacted at brian.urban@CounselEAR.com or at 888-516-4281. You may also learn more about CounselEar at the CounselEar web channel on AudiologyOnline.
