0:14 thanks for joining us today my name is
0:17 Dr Dusty jessen and I am an audiologist
0:19 in a private practice ear nose and
0:22 throat clinic in the Denver area and I'm
0:24 also the founder of cut to the chase
0:26 communication which is a company
0:29 specializing in oral Rehabilitation
0:32 products and services for hearing care
0:34 providers I have a financial
0:37 relationship with Asha for this
0:39 presentation in the form of a speaker
0:41 honorarium and I also have a financial
0:44 relationship as the owner of cut to the
0:46 chase communication because we provide
0:48 products and services related to the
0:51 content of this presentation and I have
0:53 no non-financial relationships to
0:55 disclose so the purpose of this
0:59 presentation is to dig into what oral
1:02 rehabilitation really is and why it is
1:05 so very important in a private practice
1:08 setting and then we'll really get into
1:10 how we can make oral Rehabilitation work
1:14 in a private practice setting so let's
1:16 start by defining oral
1:19 Rehabilitation Montano and Spitzer
1:21 define oral rehab as a person centered
1:24 approach to assessment and management of
1:26 hearing loss that encourages the
1:28 creation of a therapeutic environment
1:31 conducive to a shared decision process
1:34 which is necessary to explore and reduce
1:36 the impact of hearing loss on
1:38 communication activities and
1:42 participations is kind of a mouthful in
1:46 2007 Dr Arthur booy defined oral rehab
1:49 as the reduction of hearing loss induced
1:52 deficits of function activity
1:55 participation and quality of life
1:58 through sensory management instruction
2:01 perceptual training and counseling so he
2:03 took it a step forward to explain the
2:05 components that should be incorporated
2:09 in an oral rehab program but really oral
2:12 rehab is just the comprehensive services
2:15 that we as Hearing Care Providers give
2:17 to our patients or offer to our patients
2:19 and so it can include all of the
2:22 following components calair implants
2:24 hearing aids auditory training group
2:27 sessions patient centered care assistive
2:30 listening devices counseling education
2:33 speech reading communication strategies
2:35 all of that is Incorporated in oral
2:37 Rehabilitation that is what a
2:40 comprehensive oral rehab program should
2:42 include unfortunately in private
2:44 practice we're faced with certain
2:48 challenges that leave us to um use a
2:53 more technocentric model of oral rehab
2:55 rather than a clinician centered model
2:58 of oral rehab so in this figure you can
3:01 see the model that's very commonly used
3:03 and the technology being the hearing
3:06 aids and the Wireless accessories is the
3:08 focus of this model and then the
3:11 arguably possibly more important
3:14 components of education and resources
3:16 communication strategies are kind of
3:19 tucked in as afterthoughts so I would
3:22 like to propose a different model and
3:24 this is a model that puts the clinician
3:26 at the Forefront so as you can see at
3:29 the base of this model the clinician is
3:32 Prov providing education resources
3:34 communication strategies and group
3:38 classes and this needs to be provided to
3:40 every single patient that comes to us
3:43 because if they're seeking our services
3:45 that means they're experiencing some
3:47 perceived difficulty and so we need to
3:50 be addressing those difficulties whether
3:52 or not they need hearing aids or want
3:55 hearing aids and then the next step in
3:57 this model is to provide audibility for
4:00 those patients who need it who have in
4:02 loss and that can be provided in the
4:04 form of hearing aids assistive listening
4:08 devices or personal sound amplifiers and
4:10 then there are some patients who need to
4:12 go a step further where hearing aids and
4:14 the education is not quite enough for
4:16 them and that's when we get into the
4:19 auditory training so there are two forms
4:21 of auditory training the first is
4:24 computerized auditory training and that
4:26 is nice for a busy Clinic situation
4:28 because the patient typically does
4:31 computerized train training on their own
4:33 at home but there are those patients who
4:36 need a more one-on-one approach and so
4:38 clinician directed auditory training
4:40 serves that
4:43 purpose so why is it so important that
4:45 we as private practice practice
4:48 clinicians are providing oral rehab for
4:51 every single patient well first of all
4:53 hearing aids just can't do it all for
4:55 patients who have deficits in spectral
4:58 and temporal resolution and also for our
5:01 aging popul who are experien
5:03 experiencing age related cognitive
5:06 changes in their working memory and
5:08 their speed of processing hearing aids
5:11 cannot address those issues on their own
5:14 and from a business standpoint hearing
5:16 aids are really starting to be seen as
5:18 commodity items hearing aids can be
5:21 purchased at big box stores like Costco
5:23 they can be purchased from online
5:26 retailers from storefront retailers and
5:28 so the patients have a lot of options
5:30 when it comes to purchasing hearing aids
5:33 and so there's a growing need as
5:35 professionals to set ourselves apart
5:38 from those commodity options and also
5:40 oral rehab really brings the
5:42 professional back to the Forefront
5:46 because we're focusing on service versus
5:48 technology so it's so very
5:51 important now most Private Practice
5:54 audiologists do understand how important
5:56 oral rehab is to our to our practices
5:59 and to our patients however we do face
6:02 unique challenges that may not be faced
6:05 in other settings so this um flowchart
6:08 here gives you an idea of the challenges
6:11 that I face on a regular basis these are
6:15 the tasks that I have to complete in my
6:17 practice on a daily
6:20 basis I know that each audiologists may
6:22 have a different organization in their
6:24 practice but this is what I face on a
6:26 regular basis so I am responsible for
6:29 the Diagnostics in the form of the
6:32 diagnostics for the ENT as well as
6:35 diagnostics for hearing aid evaluations
6:37 I'm responsible for the treatment the
6:39 oral reab and the provision of hearing
6:41 aids I'm also responsible for office
6:44 tasks like going through the mail going
6:46 through our emails returning phone calls
6:49 going through invoices and I'm also
6:51 responsible for trainings both the
6:54 manufacturer trainings that I receive as
6:56 well as trainings that I give to our
6:59 staff on various topics and finally I'm
7:01 responsible for the marketing so I have
7:03 to put out social media posts and I'm
7:05 also responsible for all community
7:07 outreach so I have a lot on my plate
7:10 Private Practice audiologists have a lot
7:12 on our plates and so sometimes it's hard
7:14 to fit in the oral Rehabilitation that
7:18 we know is so important and sometimes
7:21 that leads us to treating our patients
7:23 in a way that we're not so proud of so
7:24 I'm going to give you an example of a
7:28 not so proud moment this patient was a
7:30 67-year-old male
7:33 he had a mild sloping to severe sensory
7:36 neural hearing loss above 2,000 Herz he
7:39 had no self-perceived difficulty he
7:41 didn't feel like he had any hearing
7:44 trouble at all and he believed that his
7:46 difficulties were exclusively the
7:48 problem of his wife who always talked to
7:51 him from another room and mumbled and on
7:54 and on so he agreed to a trial with
7:57 hearing aids just to Plate his spouse so
8:00 that she would leave him alone so here
8:02 is our not so proud process that we use
8:05 for this patient because of a scheduling
8:08 mistake this patient was scheduled for a
8:11 hearing aid evaluation appointment for
8:15 just 45 minutes and this really cut down
8:17 on our time with this patient so we had
8:20 to rush through this visit so this was
8:22 the process that we followed we gave him
8:24 one intake questionnaire which was our
8:27 hearing Health assessment and this
8:29 questionnaire just asked Basics about
8:32 ear history and hearing health for
8:34 Diagnostics we only had time for a
8:37 screening audiogram versus a diagnostic
8:40 audiogram our plan was simply a trial
8:42 with hearing aids because that's what
8:45 the patient come in came in expecting
8:47 and so we went ahead and followed his
8:49 expectations and fit him with hearing
8:53 aids that very day and the result of all
8:55 of this was that he returned 3 days
8:57 later and returned the hearing aids for
8:59 credit it was kind of an awkward
9:01 situation really kind of a waste of time
9:05 on his part and ours so what did I learn
9:07 from this well number one I learned that
9:10 patient centered care does not mean
9:13 patient dictated care so just because
9:15 the patient came in with certain
9:17 expectations didn't mean that I
9:20 necessarily had to meet his expectations
9:22 so I learned that we can't cut Corners I
9:25 really needed to be the professional in
9:28 that situation and I needed to come in
9:30 and tell him my expectations let him
9:32 know how the process was going to work
9:34 so that he could make a decision of
9:35 whether we were the right practice for
9:38 him or not and perhaps this would have
9:41 been a good situation for a referral out
9:43 to someone else he was looking for more
9:46 of a retail experience and we are don't
9:48 we don't want to provide that we are
9:49 wanting to provide an oral
9:52 Rehabilitation experience so maybe he
9:54 would have been happier at a retail
9:58 store or a big box store so luckily as
10:00 clinicians we learn from mistakes and so
10:03 I'm going to take you through a proud
10:05 process and this is the process that we
10:07 now use with every single one of our
10:09 patients that come in it's our
10:11 comprehensive oral Rehabilitation
10:13 process so this patient was a
10:16 65-year-old female she had a mild
10:18 sloping to moderate sensory neural
10:21 hearing loss above 1,000 Hertz and only
10:24 mild self-perceived difficulty as you'll
10:27 see in a moment here she was not at all
10:30 excited about getting hearing aid AIDS
10:32 her spouse however was very excited
10:35 about her getting hearing aids he was a
10:38 university Professor very techsavvy he'd
10:40 been doing lots of research about
10:42 hearing aids and he knew all the latest
10:45 and greatest on the devices he was also
10:48 a very fast speaker and we knew that
10:50 because he was there with us and it was
10:53 great to have him at this appointment
10:55 and he truly was the main motivation for
10:58 this visit she wasn't really interested
10:59 in hearing aids but he was is very
11:03 interested in having some help for her
11:06 so here's our proud model or the proud
11:09 plan that we use with every patient now
11:12 it starts with the initial or the name
11:14 of this initial appointment so if you'll
11:16 remember back to our not so proud
11:20 process we scheduled a hearing aid
11:22 evaluation well this time we have
11:24 changed the name of that initial
11:28 appointment to a communication needs
11:29 assessment or a
11:32 CNA and we've scheduled this appointment
11:35 for 90 minutes Dr Robert swedo was
11:39 calling for this change clear back in
11:41 2007 and I'm hoping that I can help him
11:43 to get it to start catching on in
11:45 clinics because a communication needs
11:48 assessment really more accurately
11:50 describes what we're assessing and what
11:53 we're hoping to help these patients with
11:55 and from a business standpoint it's
11:57 going to set your practice apart right
12:00 from the get-go because chances are that
12:03 not many other clinics are scheduling
12:06 communication needs assessments but
12:08 they're instead scheduling hearing aid
12:11 evaluations or hearing aid trials so
12:13 when a patient calls your office to
12:15 schedule an appointment and you schedule
12:17 them a communication needs assessment
12:18 they're going to be impressed that
12:20 you're looking at more than just selling
12:23 them hearing aids so the first part of
12:26 our assessment process are the in intake
12:28 questionnaires and the first three question
12:29 question
12:31 are given to the patient prior to the
12:34 appointment we actually have them on our
12:36 website and so the patient can download
12:39 them and fill them out from home or they
12:40 can fill them out in the waiting room
12:42 before their appointment the three
12:44 questionnaires are our basic intake
12:46 questionnaire which gets basic patient
12:49 information our hearing Health
12:51 assessment which we used with our first
12:54 case it just takes in information about
12:56 ear and hearing Health family history of
12:58 hearing loss that sort of thing and then
13:01 the Paka which we'll go over
13:04 next so the Paka is the personal
13:08 assessment of communication abilities
13:11 and this form can be downloaded at the
13:14 website at the bottom of this form at er tr.com
13:15 tr.com slaka
13:17 slaka
13:20 paca I like to use closed set
13:22 questionnaires like this in the
13:24 beginning because it gets patients
13:26 thinking about different communication
13:29 environments and it encourages them them
13:31 to rate their level of difficulty in
13:34 these different environments so it gives
13:35 them a lot of ideas without having to
13:38 think too hard and I always have the
13:41 patient fill out this form as well as
13:44 their spouse if the spouse is with them
13:46 and as you'll see in a second here the
13:49 spouse had very different responses and
13:51 so that gives us a good basis for some
13:54 more in-depth counseling so in this case
13:56 the patient was reporting moderate
13:59 difficulty in large groups concerts and
14:03 movies places of worship and in the car
14:06 and only slight or no difficulty in all
14:09 other situations but as you'll see from
14:12 this next slide her spouse her husband
14:14 had a very different view of her
14:17 difficulties he perceives her having
14:19 much more difficulty than she perceives
14:22 her having himself and this is very
14:23 common for the spouse to be more
14:26 frustrated with someone's hearing with
14:27 their their partner's hearing loss than
14:29 the patient themselves because they're
14:31 the ones having to repeat themselves and
14:34 speak louder and and so it's important
14:36 to get this information from the spouse
14:37 so you can see that all of his responses
14:40 are shifted to the right showing that he
14:43 is rating her difficulty much
14:46 higher and then the final step of this
14:48 assessment process actually happens in
14:52 person so those first three assessment
14:55 forms were completed before I even met
14:58 the patient so I have a wealth of
15:01 information before even having the
15:03 patient step foot in my office and
15:05 that's great because the name of the
15:08 game in private practice is efficiency
15:10 and we are trying to fit a lot of
15:12 information into a short amount of time
15:14 so the more that we can do with our
15:16 patients outside of the actual office
15:20 visit is really helpful but the coce or
15:22 the client oriented scale of improvement
15:24 is something that I feel needs to be
15:26 completed with the patient because it
15:28 takes a little more prompting and
15:30 discussion this is where the patient
15:34 actually identifies his or her most
15:37 difficult communication situations I
15:39 like for them to choose their top three
15:42 and we rate them the Cozy can be
15:44 downloaded at no charge from the website
15:47 at the bottom of this
15:50 slide and then after we've intake taken
15:52 in all of that information and we'll
15:54 come back to the cozine a little bit
15:57 here it's important to create our plan
15:59 but first of course we do our
16:01 Diagnostics and so in a typical
16:03 situation like this we do a diagnostic
16:07 audiogram we do a quick sin testing and
16:09 mcl's and ucls and this gives me basic
16:12 audibility information the patients's
16:14 ability to process speech in the
16:16 presence of background noise as well as
16:20 any loudness sensitivities so only 45
16:21 minutes into our appointment I feel like
16:23 I've got a really great and
16:26 comprehensive view of this patient's
16:29 hearing and communication needs so we'll
16:32 move on to our plan the first step of
16:35 our plan is education and then we get
16:38 into a little more specific personalized
16:40 plans for each individual patient and
16:43 this is where we go back to the proposed
16:45 model that we discussed earlier so this
16:47 is where we start with the education
16:50 resources communication strategies and
16:52 then we work our way up the model
16:54 through audibility and then possibly
16:57 auditory training and the most important
16:59 part of this is that this
17:02 model cannot happen without the
17:04 clinician so this really is a
17:07 professional clinician centered model
17:10 and it shows that we cannot be helping
17:11 our patients our patients problems
17:13 cannot be fixed without the professional
17:15 there with them they can't just go
17:17 online and purchase some hearing aids
17:19 and think that everything is going to be
17:22 okay so that's why this model following
17:25 this model in your plan is so
17:28 important so the education starts with
17:30 providing the patient with some
17:32 important information now education is
17:35 something that I feel should be kept
17:39 very simple because the patients are
17:41 overwhelmed sometimes with all of the
17:42 information that we're giving them at
17:45 this initial appointment especially if
17:47 we're talking to them about hearing aids
17:49 as well they are just overwhelmed by the
17:51 care and use of the hearing aids how to
17:53 change the batteries all of the
17:55 technical aspects and so the other parts
17:57 of the education that are probably more
17:59 important sometimes times get you know
18:01 pushed to the back of their mind and
18:03 they forget them so the three aspects
18:06 that I really try to focus on with my
18:10 patients are realistic expectations the
18:12 importance of communication partner
18:15 involvement and communication strategies
18:17 for this particular patient we use the
18:19 five keys to communication success
18:21 handbook but there are lots of
18:23 educational resources available out
18:25 there you just want to make sure that
18:28 they really are um short and to the
18:31 point and fun for the patient to read
18:33 and so the way that I assign this
18:35 education is I give them the handbook on
18:37 the way out the door of their first
18:38 appointment but I don't give it to them
18:41 as an afterthought it's really important
18:44 the way that we assign this information
18:45 to our patients because if we give it to
18:47 them as an afterthought they're going to
18:50 think of it as an afterthought but if we
18:53 tell them how important this education
18:55 is we tell them that we are going to
18:57 follow up on what they've read at their
18:59 next appointment and we give give it as
19:02 an assignment versus just a suggestion
19:04 then they're more likely to read this
19:06 when they get home and have have this
19:08 information in their brains when they
19:10 get back for their next
19:13 appointment the next step is to plug our
19:16 patients into the local and national
19:18 resources that are available in your
19:21 area and so the local resources will
19:24 include University oral rehab classes
19:27 many universities put on community oral
19:29 rehab classes that the faculty and the
19:32 students put these on at libraries and
19:34 community centers and so it's really
19:36 great to plug our patients into those
19:38 and then the local hearing loss
19:40 associations have chapter meetings
19:43 usually on a monthly basis and so these
19:45 are great because the these allow the
19:47 patient to connect with other people who
19:50 have hearing loss and understand what
19:53 they're going through now I realize that
19:55 depending on your location you may not
19:57 have a university nearby and you may not
20:00 be in a big city that as local um
20:01 monthly hearing loss Association
20:04 meetings but I still encourage you to
20:06 look into these options because you
20:09 might be surprised how far a patient is
20:12 willing to drive to connect with people
20:13 who are understanding what they're going
20:15 through so definitely look into the
20:18 cities in your area and see if they have
20:20 oral rehab classes and hearing loss
20:22 Association meetings happening and then
20:25 on a national level no matter where you
20:27 live you can be plugging your patients
20:30 into the hearing LW Association of
20:33 America um this is a wonderful
20:35 organization the membership to the
20:37 hearing loss Association of America is only
20:38 only
20:43 $35 per year and so it is such a cheap
20:46 easy way to provide our patients with
20:49 awesome education and that membership
20:52 includes the bimonthly hearing loss
20:54 magazine and that is like an oral
20:57 Rehabilitation class in a bright pretty
20:59 shiny magazine that they get in their
21:02 mailbox every other month so it is
21:05 really worth it in this particular case
21:07 my patient was not interested in being
21:09 plugged into the local classes she
21:11 didn't want to go hang out with other
21:13 people with hearing loss although I
21:15 think her husband wanted to but she
21:18 wasn't interested in that she was
21:21 however thrilled with our gift
21:24 membership to the hlaa so in our Clinic
21:27 we purchase a $35 membership for every
21:29 single patient who purchases hearing
21:32 aids through us and she loved
21:35 that okay so now that we have educated
21:39 our patients and we have given them the
21:41 resources that they need if they're
21:44 wanting to plug into a group class or a
21:47 group meeting now it's time to kind of
21:50 bring this into a personalized plan for
21:53 this individual patient based on the
21:55 specific needs that they put forth at
21:59 the very beginning and so we use the co-
22:01 the goals that they put forth on the
22:05 Cozy as our guide for our personalized
22:07 plans we use something called the
22:10 successful communication plan which goes
22:12 along with the five keys to
22:14 communication success handbook that I
22:17 mentioned earlier these plans can be
22:20 downloaded at no charge from the website
22:22 at the bottom of the
22:26 screen and so we choose those use those
22:29 cozy goals we choose three of them and
22:30 we add them to our successful
22:32 communication plan so in this case I'm
22:35 going to go through her goal of hearing
22:37 her husband better around the house so
22:39 as we complete the successful
22:41 communication plan we have to identify
22:43 the challenging situation which in this
22:45 case is around the house and of course
22:47 we need to identify the communication
22:49 Partners involved in this case it's her
22:51 husband and then we're going to take
22:54 them through stepbystep communication
22:57 strategies to help them overcome their
22:59 communication challenges in in this
23:02 environment so this program breaks
23:05 communication strategies down into five
23:08 different components or keys and the
23:11 first key is the environment modifying
23:14 the environment so my patient and her
23:16 husband have agreed to turn off the
23:18 television unless they're actively
23:20 watching it because they both said that
23:22 it's hard to hear each other when the
23:25 TVs on in the background the speaker key
23:27 is for the husband he's the speaker in
23:30 this case and he agrees to speak slower
23:33 he also agrees to go to the same room
23:35 that she's in or call her name before he
23:39 starts talking to her The Listener key
23:42 in this case is for our patient and she
23:44 is taking on the responsibility of
23:47 asking her husband to rephrase versus
23:50 saying what and also to repeat what she
23:52 thought she heard rather than saying
23:55 what because in our initial assessment
23:57 it came out that she says what all the
23:59 time even if he hasn't even finished his
24:01 sentence so we're going back to what we
24:04 learned and discussed in our assessment
24:07 as we fill out this form she also agrees
24:10 to go to the same room as him before she
24:12 starts talking now this is where
24:14 auditory training would come in and
24:16 we'll get to that in a little more
24:19 detail in a second here the technology
24:23 key is the next piece of this puzzle the
24:25 five keys and so the patient was fit
24:28 with hearing aids and she originally
24:30 came in saying that she only needed the
24:32 hearing aids when she goes to church or
24:35 when they go out to eat but after some
24:37 counseling and now she has it written in
24:39 a plan she has agreed to wear her
24:42 hearing aids around the house as well
24:43 because that is one of her top
24:46 challenging situations and then we also
24:48 fit her with a remote microphone and we
24:50 discussed when that might be appropriate
24:52 around the house as well and then the
24:55 fifth key is practice because we know
24:57 that none of these tips are going to
24:59 sink in right away way so we know they
25:01 have to practice these and so we
25:03 assigned them the finger touch before
25:06 talking practice and this just means
25:09 that our patient and her husband have to
25:11 touch fingertips before they start
25:13 talking to to each other around the
25:14 house and this is something that we
25:17 assign to couples often it's kind of a
25:20 fun game that they play and they they
25:22 think it's nice but it really gets them
25:25 in the optimal distance from each other
25:27 and it also makes them be face to face
25:28 before they start talking to to each
25:32 other and so it's it's a great practice
25:34 strategy okay so let's talk about
25:36 auditory training for just a moment
25:39 Arthur broid in
25:43 2007 defined auditory training as formal
25:45 listening activities designed to
25:49 optimize speech perception so auditory
25:51 training can be clinician directed
25:53 meaning the clinician is sitting with
25:55 the patient and going through the
25:58 training exercises and there are
26:00 wonderful clinician directed auditory
26:03 training programs some of the resources
26:06 for those are the hearing Rehabilitation
26:09 foundation and the Ida Institute and
26:12 then the next form of auditory training
26:15 is computerized auditory training and as
26:17 I mentioned earlier this may be a more
26:19 feasible option for the busy Private
26:22 Practice clinician because it can be
26:25 done by the patient at home and doesn't
26:27 have to take up Clinic time a couple of
26:29 options that we use in our clinic and
26:32 that we offer to the patient are the
26:34 lace or the listening and communication
26:37 enhancement program and the rmq which is
26:40 read my quips which is a more of a
26:44 game-based auditory training program so
26:46 some patients will want to do auditory
26:48 training they're very excited about it
26:51 but honestly most feel like they don't
26:53 have time maybe it's not necessary so
26:55 when it comes to auditory training if we
26:57 have patients who we feel would benefit
26:59 from it either because they are
27:02 reporting difficulties in background
27:04 noise or difficulties with comprehension
27:06 or because they have very poor speech
27:08 and noise scores or speech recognition
27:11 scores we need to have some auditory
27:13 training options in our back pocket
27:16 ready to offer these patients and the
27:18 way that we deliver it to our patients
27:20 is very similar in the way that we
27:22 deliver our education it cannot be
27:25 thrown out there as an afterthought like
27:26 oh yeah if you have time maybe you
27:29 should do this program but rather
27:31 something that we recommend highly we
27:33 think it's really going to help them and
27:35 we we give it to them as an assignment
27:37 versus an
27:41 option so the final part of our
27:45 successful plan here is followup now our
27:48 patients have been inundated with
27:50 information information about the
27:52 hearing aids about how to care and use
27:55 the hearing aids um information about
27:57 education the resources we've been
27:59 plugging them in into effective
28:01 communication strategies their brains
28:04 are on overload and we cannot expect
28:07 them to remember all of this on their
28:12 own and really followup is so important
28:15 long-term consistent followup is
28:19 critical for long-term satisfaction and
28:21 success so if we are wanting our
28:24 patients to do really well with their
28:26 treatment to remember what we taught
28:29 them to use their hearing aids to
28:32 recommend us to their friends and family
28:34 members to come back to us for their
28:36 next set of hearing aids or if they're
28:38 having any difficulties we need to make
28:41 sure that a follow-up program is in
28:44 place and follow-up can come in the form
28:47 of phone calls it can come in the form
28:50 of snail mail or traditional paper mail
28:52 and it can come in the form of
28:54 electronic mails or
28:58 emails in our Clinic we have chosen to
29:01 use electronic mail or email as our form
29:04 of followup we find that email is a
29:08 really nice and convenient way to reach
29:12 a lot of patients at once and email is
29:15 also relatively inexpensive there are
29:17 commercially available email programs if
29:18 you're wanting to create your own
29:21 follow-up emails you can use Constant
29:23 Contact or MailChimp and I know there
29:25 are others but those are a couple of
29:27 suggestions and then there are also
29:30 commerci commercially available email
29:32 follow-up programs for audiologists and
29:35 Hearing Care Professionals so we use the
29:38 etip program that goes with the five
29:40 Keys communication program and that's
29:42 what you see on the screen here it
29:45 includes one communication strategy tip
29:48 in this case it's a technology tip and
29:50 then it includes a homework assignment
29:52 for them to help them apply that
29:54 strategy to their own life that week and
29:56 then finally it ends with the hearing
30:00 aid tip also there's a big bold message
30:02 at the end of every email that says
30:04 please return to your hearing care
30:07 provider if you need anything at all so
30:09 if even if the patient doesn't open
30:11 these e tips they at least have to
30:14 delete them and they when they do that
30:16 they are thinking about their hearing
30:19 care provider and so they think hm that
30:20 hearing aid that is sitting in the
30:22 drawer over there probably should be on
30:24 my ear and I probably should contact my
30:27 hearing care provider so we send these
30:30 we send these out to our patients on a
30:32 weekly basis and they receive them for
30:35 an entire year and this really just
30:36 helps to keep us connected to our
30:39 patients for the long run they're also
30:42 very easy for our patients to forward to
30:44 their family and friends because
30:46 sometimes the tips that we're talking
30:48 about are problems that their family
30:51 members do like talking from another
30:53 room or mumbling or talking with a
30:55 napkin near their mouth and so it's kind
30:58 of an easy way for our patients to
31:00 educate their family members about
31:03 fixing these communication issues
31:05 without having to say something to them
31:08 in person so it's it's a nice way to to
31:09 share the education with their family and
31:10 and
31:13 friends so before I conclude here I have
31:17 a question for you what is the most
31:20 annoying word to the family members of
31:21 someone with hearing
31:25 loss and as you'll see on the next slide
31:28 what is the most annoying word to the
31:30 family members of someone with hearing
31:35 loss so it truly is all about focus and
31:39 if we focus on hearing aids and
31:43 Technology we just aren't able to reach
31:46 the patients on a level that makes us
31:49 stand apart from the commodity options
31:51 that are available out there but if we
31:54 focus on communication communication
31:56 breakdowns fixing those breakdowns and
31:59 the communication need needs of our
32:01 patient and their family members we are
32:05 solving a much bigger problem than if
32:08 we're just fixing the problem of hearing
32:10 because we know that hearing loss is
32:13 only one part of communication and so if
32:16 we're really doing our job correctly we
32:19 will be providing a comprehensive oral
32:22 rehabilitation program that addresses
32:24 all of the communication needs that our
32:27 patients come to us with so I hope that
32:29 you'll be able to take this information
32:31 and use the strategies that I've
32:34 provided and some of the tools and the
32:37 websites and implement this in your own
32:39 clinics as soon as you can thank you for
