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AUGUST 2016 I HEARINGREVIEW.COM 15
student] had not appropriately devoted time
to helping the husband understand my role
in the process. He heard my suggestions for
technology and other options, but he had not
heard me validate his or his wife’s personal
As a reflective-practitioner-in-training,
the student realized that, of course, family
members will have concerns, and they will
want to be included in the appointment. This
realization doesn’t necessarily help us feel
comfortable with the prospect, because there
are still so many unknowns: What if patient
and family perspectives contradict? Can we
help patient and family develop common
ground? What if the family member takes
the lead or even dominates the conversation?
Will we lose control of the appointment?
Wouldn’t it be better to avoid the situation
These are the kind of questions that could
lead audiologists to opt out of “family-cen-
tered” audiologic care, even in light of several
known benefits. Singh et al1 recently published
a position paper regarding the benefits or
why’s of family-centered care: to benefit the
patient, the family, the clinician, the business,
and the relevance and longevity of the profes-
sion. The position paper also offered 10 sug-
gestions on how to implement family-centered
audiologic care. The three they recommend
starting with are:
1) Invite a family member to appoint-
ments and reinforce the reasons why
they should attend;
2) Arrange the physical environment so
that family are comfortably included
rather than being relegated to a seat in
the back of the room;
3) Let the patient and family member know
that input will be sought from both of
them: patient first and then family mem-
ber (Figure 1).
This last suggestion will inform us
whether the patient and family are on the
same page regarding the patient’s hearing
problems. If they both see the situation the
same way—and both are open to our help—
we can move forward. However, when the
parties are not in agreement, we likely find
ourselves in a difficult conversation. Let us
consider a scenario wherein a patient (Mr
Roberts) and his son are present for an
Audiologist: It’s nice to meet you, Mr Roberts.
And you are?
Son: I’m his son, Joseph.
Audiologist: Welcome to you both. Mr Roberts,
I’d like to focus on you first, and then, Joseph, I’m
hoping you will add your thoughts? [Joseph nods;
audiologist turns back to Mr Roberts]. Mr Roberts,
tell me about yourself... [He introduces himself and
talks about his occupation, family, interests, etc]
This is all helpful to know. And now, what brings
you here today?
Mr Roberts: [rolling his eyes] Joe did—he made
this appointment and he also drove me here. He’s
making a big fuss about nothing.
Son: [Leans in, and the audiologist turns his way.]
Audiologist: What’s your take on the situation,
Son: He keeps saying that, but it’s not true. He
is really missing almost everything people say these
Mr Roberts: And yet I’m understanding him
perfectly right now. I’m an old man; it’s normal to
stop listening to every silly word.
We realize we have opened the proverbial
“can of worms,” a concern shared by other
healthcare professionals as well.
is defensive and feels demeaned; the son is
concerned and frustrated. We’ve learned their
conversation has been going on for some time,
and has not been productive.
Our first instinct might be to withdraw
from the uncomfortable situation, bypass the
familial tension, and focus only on the patient.
However, this approach would likely yield only
short-term gains: we might maintain some
efficiency in terms of testing time, but our test
results and recommendations may not help
the patient change his viewpoint. He has taken
a position and, human nature being what it
is, will hold on to it: “Once one has made a
public pronouncement, matters of pride and
consistency push one toward clinging to that
position, no matter how discredited.”
Rather than avoid this difficult conversa-
tion, we can take an extra step and try to help
the patient reframe the situation, ideally from
his son’s point of view. To do so, the conversa-
tional flow needs to change, so the audiologist
seeks a way to help them talk to each other, not
to her (Figure 2).
Figure 2. As the conversation moves forward, the audiologist can attempt to reframe a difficult conversa-
tion item and help the patient and family member(s) build accord and find positive solutions.
Figure 1. Let the patient and family member know that input will be sought from both of them: patient
first, and then family member.
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