Bridging Healthcare Gaps with Cultural Sensitivity feat. Dr. Kristina English

Dr. Kristina English, a trailblazer in the field of educational audiology, joins us to share her inspiring journey from the bustling districts of Los Angeles to the halls of Central Michigan University. What challenges did she face while managing hearing aid systems for 120 children? And how did those experiences shape her innovative approach to audiology education? Dive into her story as we uncover the evolution of her career and how she developed a pioneering course in counseling for audiologists. Her insights promise to redefine patient-practitioner communication by emphasizing empathy and understanding.

Unlock the secrets to effective communication as we explore the often-overlooked emotional dynamics in audiology. Dr. English takes us through the transformative journey of teaching students to distinguish between thinking and feeling responses, enhancing their ability to genuinely connect with patients. By dissecting real-world projects and assessments, we uncover how crucial emotional intelligence is to successful treatment outcomes. Beyond the science, this engaging narrative underscores the importance of truly listening and responding to patient needs, paving the way for more meaningful interactions in the field.

In a world that increasingly values cultural humility, Dr. English shares her personal efforts to bridge the gap in healthcare disparities. Learn about her scholarship initiative aimed at fostering cultural sensitivity and the inspiring work of young professionals like Sydney Teach, who are shaping the future with their fresh perspectives. As we wrap up our conversation, we reflect on the power of genuine relationships and the importance of being present in patient interactions. Our heartfelt thanks go to Dr. English for her invaluable contributions, and we eagerly anticipate future collaborations.

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Chapters

• 0:19 Evolution of Educational Audiology Practice
• 6:07 Connecting Through Empathy and Understanding
• 14:43 Cultural Humility in Professional Relationships
• 22:12 Effective Patient-Provider Communication and Relationships
• 31:52 Professional Gratitude and Appreciation

Transcript

Blaise Delfino:

You're tuned into the Hearing Matters podcast, the show that discusses hearing technology, best practices, and a global epidemic, hearing loss. Before we kick this episode off, a special thank you to our partners, Sycle, built for the entire hearing care practice. Redux, the best dryer hands down. CaptionCall by Sorenson, life is calling. CareCredit, here today to help more people hear tomorrow. Fader Plugs, the world's first custom adjustable earplug.

Welcome back to another episode of the Hearing Matters podcast. I'm founder and host Blaise Delfino. As a friendly reminder, this podcast is separate from my work at Starkey.

Dr. Douglas L. Beck:

This is Dr. Douglas Beck with Hearing Matters podcast. Today we're interviewing Dr. Kristina English, PhD, and Dr. English is a native of Los Angeles and she got her bachelor's, master's, and PhD from San Diego State University. She specialized at that point in educational audiology, but her first job was in counseling at Central Michigan University. Kristina, welcome. I'm so glad you're here.

Dr. Kristina English:

Thank you. I'll clarify a little bit about my journey because it's been a little bit on the loop to loop side of things, but when I was working as an educational audiologist, first of all, a fabulous job, so much fun. Served 120 kiddos in 10 different districts and constantly driving around, not really bonding. "Let me fix your thing. Here's the replacements, and is everything okay? Good. I have to go."

Dr. Douglas L. Beck:

Yeah.

Dr. Kristina English:

I missed that. In fact, I realized I was developing, at least internally, a perception of being a hearing aid cop or an FM cop. I thought something's missing here, but I didn't have time to think it through.

Dr. Douglas L. Beck:

Well, but the thing is something like 60% of all hearing aids and hearing aid systems in the school systems are malfunctioning at any given moment, right?

Dr. Kristina English:

Exactly. There's the training too. You're really adding to the job description there of SLPs who see those students on a regular basis and they'll do the listening check. They had never done one before I got hired, so they didn't know what the Ling sounds were. I mean, it's amazing.

Dr. Douglas L. Beck:

Sure.

Dr. Kristina English:

A long time ago, but still it was really building from the ground up because they never had an educational audiologist before. In fact, I remember reading an article in an old ASHA magazine about the ASHA Conference where a group of ed auds got together and started the organization for the EAA.

Dr. Douglas L. Beck:

Sure.

Dr. Kristina English:

Fred Berg was the guy to contact. I think I was number 18 on the membership list. I was totally invested in that. When we moved, I was finishing my Ph.D. all the way through this, and it was in education/special education and I was thinking about life span learning and what do people, when they experience hearing loss, how does that impact the quality of their life in learning? That's all I was thinking about. I was kind of looking for what's the next thing, because I was working on a grant, which was running out of funding, and I called Gerry Church who you know well.

Dr. Douglas L. Beck:

Yes.

Dr. Kristina English:

It was asking him, so there's this movement afoot to develop an aud program, but it's taking it's time. In the meantime, people are really keen about a distance learning idea.

Dr. Douglas L. Beck:

Yeah.

Dr. Kristina English:

In my reading from a journals about distance learning, they were all focusing on Central Michigan. I was so surprised at their reputation. I asked him, "Say, is audiology doing that?" He said, "Mot yet. You're a little premature, but we do have an opening for a faculty member." I said, "I do have a fresh PhD."

Dr. Douglas L. Beck:

That's fantastic.

Dr. Kristina English:

It really was. They interviewed me on the phone initially before they flew me in and they were saying, "We have a pediatrics course that's advanced, can you teach that?" "Absolutely." "We have a course in sign language." "I can do that." I can't remember the other one now. Then they said, "And also counseling," and I said, "Absolutely." In my head I thought, because how hard can that be?

Dr. Douglas L. Beck:

It can be hard. It can be hard.

Dr. Kristina English:

I'd never taken a counseling course in my life.

Dr. Douglas L. Beck:

Oh my goodness. You stepped in without any background.

Dr. Kristina English:

Exactly. I told them that in all full disclosure and they said, "Well, no one has." For our knowledge, it was the first counseling course offered.

Dr. Douglas L. Beck:

I think it was. I think it was. I spoke there a couple of times because Gerry had invited me and I was just so amazed and surprised at the support that they had at CMU. It was incredible.

Dr. Kristina English:

Oh, it was amazing. I remember one of those visits, actually, I was in the back of the room.

Dr. Douglas L. Beck:

Oh, that was you with the tomatoes and everything. It's interesting because when I was studying counseling, I had Derek Sanders and we were using a lot of books from the sixties, seventies, eighties. When I started my doctoral education, one of the most meaningful classes I ever took was Carl Crandell from University of Florida teaching counseling.

Dr. Kristina English:

That's right. Was that within your AD then?

Dr. Douglas L. Beck:

Yeah, it was, yeah.

Dr. Kristina English:

Carl and I was constantly in touch with him, "What are you doing? How are we doing things," that kind of thing. It was such a remarkable experience. There was only one textbook available, and it was edited chapters by John Greer Clark and Fred Martin.

Dr. Douglas L. Beck:

Yep.

Dr. Kristina English:

It was one of those things where people just say, I'll write about adolescence. It was like putting populations or issues under a microscope, and it was a good start. It gave me week by week something for students to read.

Dr. Douglas L. Beck:

Sure.

Dr. Kristina English:

I literally would go to the library and get a trolley of books to bring back with me and catch up and think, "What is this really?" What it really was, was I would say a game changer, at least in my mind, if not professionally or to the profession, but it was, we are not inert. We are not uninfluential. We can either make or break an appointment or a time together with the patient if we're missing things. How do we focus on ourselves and the interaction that's going on?

Dr. Douglas L. Beck:

Well, that's so important and so brilliant, and I applaud you for taking this on because when I heard Carl is teaching this, I was amazed at what I didn't know, truly.

Dr. Kristina English:

I'd have to admit, I kept reflecting back on my master's degree and thinking this never was discussed, ever. I would kind of learn this mantra, well, a new patient comes in, let's say you see four in a day. One will probably follow up in your recommendations. I thought that's a pretty bad hit rate.

Dr. Douglas L. Beck:

That's terrible.

Dr. Kristina English:

Then I began to realize it's because I was not connecting with that person at all and no one had emphasized why that was important. Counseling is all about that.

Dr. Douglas L. Beck:

Counseling is all about that.

Dr. Kristina English:

"Where are you at? What do I not know? What do you want me to know?" Accept everything you hear as real without having to say, "You shouldn't feel that way," that kind of dismissal. All of that is so subtle and yet, if no one's telling you this is the reason why things are not working well, you don't change. I started to test on this. I really felt that if this field was going to advance, it needed evidence to indicate it was important. All I had available to me was the students in front of me. Bless their hearts. This was actually the first distance ed course that Central Michigan taught with Vanderbilt.

Dr. Douglas L. Beck:

Right.

Dr. Kristina English:

Me and Gus Mueller were the only ones with our courses ready so we got them going. Beforehand I got some permission to move forward on a project that had been refining. This was the final landing of it, was to first of all identify off the top of my head is piece of cake, you could do it too. What are four things that people say that you might've missed? One of them I remember vividly was, "My family says my child was born deaf because I worked till the last week of pregnancy." Well, do we spout the statistics on that or do we talk to this mom with a broken heart?

Dr. Douglas L. Beck:

So important, right? As soon as you said that, I want to jump in and say, "No, that didn't happen," but what you're saying is accept them for what they're telling you, listen to them, and don't respond. You need to think.

Dr. Kristina English:

And wait. Maybe she is asking that, but maybe she's not.

Dr. Douglas L. Beck:

Right.

Dr. Kristina English:

Maybe she's seen herself as extremely guilty, which is like what moms and dads do anyway, but I would kind of go there now. Another one was, "The kids at school are making fun of my son because he uses that FM thing," and you could go into the signal-to-noise ratio benefits and all the rest of it, but this is her kid who is being bullied or at least victimized or let's work with that. Let's find some help and support on that. One of the most common ones that came up in my background was, "I couldn't possibly wear hearing aids because my boss will think I'm not competent." There's so much to unpack there, but I just would want to lather on the reassurances and not empower that person to own their problem and find their way. Carl Rogers talked so much about trusting the capability of the person in front of you if you give them the space to grow into it. That was the project that I developed.

I had four statements altogether, found three professional, like a social worker, counselor, and a psychologist to say, "On a scale of one to five, would you rate these comments as," and I thought the most simple thing that I've been working with the students was to use either your thinking mind or your feeling mind. Also, what about the person you're talking to? What are they doing? You're going to have a communication mismatch and completely miss each other.

Dr. Douglas L. Beck:

Absolutely. Absolutely.

Dr. Kristina English:

They looked at those four and they said, "These are definitely feeling mind comments." I had the proposal, that part approved, and then I had divided the class in half to do a pre-test and then a post-test.

Dr. Douglas L. Beck:

Right.

Dr. Kristina English:

Then only the other half did only the post-test. Also, Gus agreed to give me his roster list and let me pick out another 32 people.

Dr. Douglas L. Beck:

Wow.

Dr. Kristina English:

They had no idea about what this project was about. My hypothesis was, if no one tells you of the risk of a communication mismatch, you're going to put on your audiology science hat and talk to the wrong point.

Dr. Douglas L. Beck:

Yeah.

Dr. Kristina English:

Sure enough, the students completely missed it according to the ratings from my professional psychologists.

Dr. Douglas L. Beck:

Of course,

Dr. Kristina English:

Afterwards they got it. It was like from a one to five scale, they were at 1.6, now they're 3.4.

Dr. Douglas L. Beck:

Yeah.

Dr. Kristina English:

My thought was, well, they had the pre-test experience to bias them, but that was the same effect we got from the kiddos who never knew we were doing it.

Dr. Douglas L. Beck:

Sure. Sure.

Dr. Kristina English:

Gus's class of course, because they didn't touch the topic at all, they were all at the 1.5. I said, "Yay, teaching makes a difference. This is a learnable."

Dr. Douglas L. Beck:

Yes, it does. Yes it does.

Dr. Kristina English:

"Let's move forward on it." That gave me the confidence as a scholar to say, I'm not the first one by any means to measure things in counseling but it had not been much done in audiology, if ever. Luterman talked about it of course.

Dr. Douglas L. Beck:

I was going to say, yeah, David Luterman from Boston talked about these things and his books were all brilliant.

Dr. Kristina English:

Yes.

Dr. Douglas L. Beck:

I think he had three different books, and mostly he focused on nurseries and very, very little kiddos and counseling the families.

Dr. Kristina English:

And families, yes, exactly, parents, but no science, which is where we start. You start with the anecdotes and you thinking, "Oh, this is heartbreaking. What are we going to do now," that kind of thing. I always go back to him. He's got the words of wisdom. Let me tell you real quickly, I saw him once at a conference when I was just recently graduated with my master's. The program was, this was in California, not very interesting. I was kind of bored walking around. Then I see a room with standing room only, and I look at my program and it's David Luterman. "Oh, I remember that name." I honestly thought there was an aura or halo around the man. Everyone was just like on the edge of their seats.

Dr. Douglas L. Beck:

Absolutely.

Dr. Kristina English:

It's like this hungry, let me feed me, please.

Dr. Douglas L. Beck:

Yeah, he was absolutely a stunning speaker because he was so plain and so relatable and so compassionate. He oozed empathy.

Dr. Kristina English:

Yeah.

Dr. Douglas L. Beck:

I mean, he didn't try to make you feel like you were important. The fact that you're talking to him, you're already important and he would get that. David, oh my gosh, I worked with him on one or two interviews 20, 25 years ago.

Dr. Kristina English:

Mm-hmm.

Dr. Douglas L. Beck:

Every time I walked away thinking of the world differently, I mean seriously, he was like Dr. Phil. He would listen to you for a minute or two and it was like, boom, "Did you consider," blah, blah, blah and the whole world comes into focus I think when you're listening to Luterman.

Dr. Kristina English:

Exactly.

Dr. Douglas L. Beck:

I was very impressed with him and I always enjoyed hanging out with him. You mentioned Carl Rogers, and I wonder if you can relate that for us to Elmo from Sesame Street and congruence.

Dr. Kristina English:

Oh, I'd be happy to. It took me a while to get the pieces put together because I was so intrigued when Elmo, the Muppet, posted very innocuous social media posts to say, "Elmo wants to check on everybody. How are you doing?" Initially people were like, "Oh, fine," but then it got really dark.

Dr. Douglas L. Beck:

Yes, it did.

Dr. Kristina English:

People were saying, "I'm not doing so good." One person said, "I'm close to being homeless Elmo, I may have to move in with Oscar the Grouch." I mean they were trying to be light, but yikes, you don't say that without some reality behind it.

Dr. Douglas L. Beck:

Yeah, I mean this elicits some very dark and very deep and very wonderful feelings as well.

Dr. Kristina English:

Exactly.

Dr. Douglas L. Beck:

It's digging pretty deep. Why do you think that is? Why does Elmo do that with adults?

Dr. Kristina English:

I don't know. First of all, Sesame Street's so adorable anyway, but Elmo is particular, he's so innocent and he totally accepts you who you are, like Carl Rogers would want you to do. He loves you.

Dr. Douglas L. Beck:

Yeah.

Dr. Kristina English:

It's absolutely so sweet. Then there was this analysis that always caught my eye, the headlines, psychologists were saying he was channeling Carl Rogers. "Oh, that's so cool," so I read that and they were talking about empathy and unconditional positive regard, or some people call it warm acceptance. I thought that's when the penny fell for me. I thought you didn't mention congruence. Well, why not? Carl Rogers has always said, "Congruence means that you are authentically real with a person that you're with and what you feel and think is what you are projecting, and that's what the person perceives." I thought this is in complete contradiction to our issues that we've been talking about in the last four or five years with regard to implicit bias.

Dr. Douglas L. Beck:

Yes.

Dr. Kristina English:

You are not contending or honestly addressing your biases, regardless of it's often been race-based, but often ethnicity or race, if you don't, you're holding something back, even though you're trying your hardest to be polite and professional and all the rest, that person can tell right away.

Dr. Douglas L. Beck:

Yeah.

Dr. Kristina English:

Then you don't have that trust that you were hoping to establish because you only have a few minutes to do so.

Dr. Douglas L. Beck:

A lot of these implicit biases, which I agree entirely, the more you examine yourself, the more you're going to discover you do have them. This ties in and perhaps pivots on cultural issues and humility. Can you speak on that for a few moments? Yeah. Because in particular, humility.

Dr. Kristina English:

Well, in fact, humility is, starting off, I have to report back on my growing up in a Catholic school, and that was kind of a thing, you're not that important people, those nuns made sure you understood.

Dr. Douglas L. Beck:

Then they hit you on the knuckles.

Dr. Kristina English:

I was just trying to remember did that actually happen or was it with my brothers who often got in trouble?

Dr. Douglas L. Beck:

Well, yeah, it was certainly with your brothers.

Dr. Kristina English:

Yeah, I think.

Dr. Douglas L. Beck:

Yeah.

Dr. Kristina English:

Even in high school, I have to say it was bad.

Dr. Douglas L. Beck:

Yeah.

Dr. Kristina English:

Anyway, there was a notion of, you need to know how you not stand in the world in terms of quality, but just you're not that much better than anybody else. If you think you are, that's a sin, they would say. It certainly is a barrier to interpersonal relationships.

Dr. Douglas L. Beck:

Yeah.

Dr. Kristina English:

I was trying to think of some benign examples to not offend people so uncomfortable with race conversations. I had a memory of when I was about seven, some cousins of mine from another state on the east coast came to the west coast. They were older, they could rent a car and they would go to Disneyland for the day, but they'd spend the night at our house. We had never heard such racist language in my house ever.

Dr. Douglas L. Beck:

Oh my goodness.

Dr. Kristina English:

It was horrifying. My brothers and I are like, "Dad, do something. These are your family people." They were just, without any filter. They were so used to it. My dad dragged them out and said at one point, very quickly on, "No more. There are small kids in the house. We never use those words," not even to think about what they do in terms of hurting. He told me later as a grownup about this, and he said, "One more time, and you're out of here." They were appalled and mad-

Dr. Douglas L. Beck:

To be called out?

Dr. Kristina English:

... because this is how they were raised. They didn't see that as a problem. That's interesting. They were condoned for it where they grew up. The next night they moved out and they found a motel, but I thought, yay for dad.

Dr. Douglas L. Beck:

Yeah.

Dr. Kristina English:

I thought, here's the bias part, because I'm seven and immediately imprinted upon this experience, my feelings even to this day is, people from that state are jerks. I mean, I just immediately figured they were awful and so mean and insensitive. Now that's not true, but I have to think about it when I find out, "You're from there? Oh, okay." Pay attention. Notice how you're reacting. It was an old thing. It was a one-and-off thing,

Dr. Douglas L. Beck:

Yeah. There's a lot of truth to that. I grew up in New York City and we had neighborhoods and we had particularly boys, I mean, we're the worst. You would say stupid things with your stupid friends and you don't grow up knowing how offensive you are. It takes a little while because boys mature much slower than girls. Full brain myelination is not until 23, 24, 25 and boys mature at about age 60, 63, something like that. The thing is that you grew up in that environment where people say stupid things and you have stupid friends who say stupid things and okay, that's how you grew up, that's where you were, but you're not there anymore. You're an adult. It's very important to start to understand that this type of language and labeling and implicit bias and the cultural biases that you bring to these discussions, these are not okay. If you're going to get by in the bigger world, you have to accept people for who they are.

You and I can have an enlightened discussion about how this is so important, but it doesn't mean that we do it all the time. I mean, I certainly sometimes screw up, and I know everybody screws up sometimes, but there are lessons that we should be learning in this. When we're talking with patients, we have to be particularly aware of these things because we're the doctor.

Dr. Kristina English:

Mm-hmm.

Dr. Douglas L. Beck:

If the doctor screws up the personal relationship, the professional relationship ain't going to happen.

Dr. Kristina English:

In fact, the research is heavy with regard to the racial disparities.

Dr. Douglas L. Beck:

Yeah.

Dr. Kristina English:

They call it discordant dyads. The clinician of whatever stripe is white and the patient is not, there's tension and there's distrust. The patient typically gets less care to begin with, less time, more interruptions, less medications. There are studies that would show pediatricians who don't know that they're being tested for this, they will take a quick look at a case, these are all children with appendicitis and all the rest of it, and what are you going to do with this? They would say, "I'm going to recommend," blah, blah, blah. With a bio, it would be race, age, gender, and maybe who knows what else, other conditions. What they found out afterwards was when the race was black, they were recommending less pain relief every single time. They did not know it, of course not. Well, you were asking about cultural humility and humility in general, and this is all part of a piece.

Dr. Douglas L. Beck:

You mentioned in passing that these biases have been addressed in the American Medical Association, and they still are. Just as early as late as last week, there was a study in the JAMA, the Journal of the American Medical Association, looking at the disparities in pediatrics in particular of people of lower socioeconomic means and people of other races, seeing doctors, physicians in particular. They found exactly what you're speaking about, that this still exists.

Dr. Kristina English:

Mm-hmm.

Dr. Douglas L. Beck:

I don't know, are we ever going to get to a point where we have pragmatic equity where people are actually accepting each other for who they are without bringing all the baggage with them?

Dr. Kristina English:

I can only hope that within our field we can do so. I don't know about how to manage the rest of the world. Country's kind of tense right now,

Dr. Douglas L. Beck:

Yeah.

Dr. Kristina English:

I'm really that interested in it that I don't think I've ever told you about this, but last November or so, I woke up and said to myself, "I'm no longer directly influencing students anymore and I miss that." I thought, how can I influence students? Then the next morning I woke up and realized I can sponsor a scholarship that's about cultural humility in the clinical setting. AI kind of flew it by people on the University of Akron's development. Well first of all, the chair of the department, he said, "Why would I say no to money? Of course, go ahead." Then the development people, because it's definitely part of their mission, it is a diverse neighborhood, diverse part of the state, and they're working hard. I'm really happy to say that a student was awarded it a three weeks ago. She wrote an essay and the charge was summarize, don't write an epistle about it, but summarize within a, I think a thousand words, what do we know about racial inequity in healthcare and the causes of it? What can an audiologist do to be a change agent in their clinical setting?

Dr. Douglas L. Beck:

I love it.

Dr. Kristina English:

She brought tears to my eyes. She nailed it. You know what? I was kind of concerned in asking, "Are you guys able to confirm whether AI wrote this?" They said, "We can't do anything about it." This was a human voice.

Dr. Douglas L. Beck:

Right.

Dr. Kristina English:

I mean, her heart was there and I was just so delighted to meet her. Kudos to Sydney Teach, I'll give her a shout-out for that.

Dr. Douglas L. Beck:

I'll tell you, and you know this, of course, anytime you put something in the public arena, you're going to upset half the people who read it and the other half are going to think that you're wonderful. It's very difficult, particularly as a very young person, because obviously she's in college, right? It's difficult to put your thoughts and feelings out there because no matter what you say or feel, you will be criticized. It's terrifically unfortunate. We've lost that north star where we build each other up and we try to find the good in people. I don't mean to make that a social commentary, but for young professionals to say, "This is a problem in our society." People will look at them and say, "You're 22, you haven't been out there." It's a fair observation and it's a well-thought through point about where we are as a society and what we might do to try to make a better society.

Dr. Kristina English:

Mm-hmm.

Dr. Douglas L. Beck:

Again, I don't want to be political, but that whole love it or leave it thing that used to be in the sixties, I was a big time hippie in the sixties and I was also in the United States Air Force. To say that is so disingenuous because the point wasn't love it or leave it. The point was love it and make it better. The fact that you want to make it better doesn't mean it's bad. It means we have new knowledge, we have more information. We could probably do a better job if we start to think of things from a more egalitarian viewpoint.

Dr. Kristina English:

Mm-hmm.

Dr. Douglas L. Beck:

I think that these are very, very important discussions.

Dr. Kristina English:

Mm-hmm.

Dr. Douglas L. Beck:

If you don't discuss it, you don't participate in the change.

Dr. Kristina English:

Exactly. You might dismiss and maybe even hurt other people even with attitudes. You know how it says to make us a more perfect union, we're not perfect yet so I always kind cling to that. There's always that opportunity. I was a hippie as well, and my husband was in the Navy and we just saw eye to eye on everything there. He loved his country deeply, just like you did in the Air Force, but there were problems there too.

Dr. Douglas L. Beck:

Kris, before I let you go, I wonder when you're talking about humility and you're talking about implicit bias, we have to establish relationships with patients. Some of those are therapeutic and some of them are harmonious. I wonder if you can give me the key points on each of those. What would you say defines a therapeutic relationship, a harmonious relationship, and when is the right time for that?

Dr. Kristina English:

Patients can tell almost instantly whether you care and whether you are paying attention. Even if you're shaking their hand and making eye contact, they can tell if you're distracted and thinking about what you need to do next.

Dr. Douglas L. Beck:

Right.

Dr. Kristina English:

It's just a moment of just we are together in this moment in space and let's get to know each other a little bit and truly listen to their issues. Person centeredness, of course has been the focus for Ida Institute and they taught us so much about how to do that. Even interestingly, I was just watching something that was posted, what open-ended questions would look like. Even that wasn't very perfect because the audiologist would ask questions, the patient would answer, but she was typing constantly. I know you have to type eventually, but can you listen? Then they call it signposting to say, "Now I need a minute. Let me put my thoughts down." The patient absolutely understands that, but you could see that there was like, "I don't know if you're actually listening to me."

Dr. Douglas L. Beck:

I'm so glad you said that. I was at a medical appointment yesterday, the day before. What happened was the physician walks into the room and he introduces a young lady who was in the room as well, and he said, "She's going to be my note taker." I've never experienced that before, but it was brilliant. He and I were face to face, eye to eye. He's asking me a lot more depth than I've seen in many, many decades in a medical office.

Dr. Kristina English:

My goodness. Yeah.

Dr. Douglas L. Beck:

It was great. The young lady was there typing every word. I started to think, well that's really cool because now they have everything I've said, everything he said. So medical legally, I think that's terrifically solid. Then I wondered, well, why don't we just hit record like we're recording this on Zoom and put that in the file?

Dr. Kristina English:

You're reminding me of my mother's doctor's appointment. She really needed several people on a team and they always had a recorder, they had a handheld thing because it was complicated. Whatever she was telling one doctor, needed to be heard by the other doctor, not just the summary, Reader's Digest version of it.

Dr. Douglas L. Beck:

Yeah.

Dr. Kristina English:

I am surprised that they would pay someone else.

Dr. Douglas L. Beck:

I was surprised and delighted because he and I were able to really focus. I'm sorry, I didn't mean to interrupt you, but therapeutic relationships and harmonious relationships.

Dr. Kristina English:

Mm-hmm. I would also really lean into shared decision-making.

Dr. Douglas L. Beck:

Yeah.

Dr. Kristina English:

A lot of times people think they do. I happen to see a video from Ida Institute that they never used because they were told that this particular, you know how they would bring film and watch how people would work? They were told that this was a good example, but it was remarkably not patient centered or person centered especially. I even wrote them down to make sure that I've got this right. The patient kept saying, "I'm not really sure I need this. It's my daughter's decision in kind of moving me forward to this." She just went forward and fit the hearing aids on anyway, and that was that. Then she came back for the checkup afterwards and she was mentioning things and the audiologist would just shut her down to say, "You'll need to wear these more often than you're wearing them." Instead of asking, "How are things going? What's holding you back? How can we work out some plans? Do you want to test some situations?" She would say, "It's normal to not like the sound of your voice, but you get used to it." That's not very helpful.

Dr. Douglas L. Beck:

We used to say that in World War II, not that I was in World War II.

Dr. Kristina English:

Yeah.

Dr. Douglas L. Beck:

That is not particularly effective counseling. You're not listening to the patient.

Dr. Kristina English:

Mm-hmm.

Dr. Douglas L. Beck:

I mean, right off the bat you have an answer and you're going to tell them how it's going to get better and blah, blah, blah.

Dr. Kristina English:

Yeah. Yeah.

Dr. Douglas L. Beck:

I think the lesson from this podcast is you need to take into context and validate her concern, not solve it.

Dr. Kristina English:

Or the idea of shared decision making is a back and forth. Example, one of the ones was she said, "You'll realize that what you thought was people mumbling," and she used the air quotes, "is really your hearing impairment." That's not very helpful either. What I would've thought was immediately start out by saying, "Would you like to test what your perceptions are? Would you take some notes when you think that people are mumbling and watch out for background noise and take a listen to that and see if that's loud or soft? Are you close or far?" I mean all the variables that we know might be the reasons why it sounds like it, and then you could modify the variables.

Dr. Douglas L. Beck:

Yeah.

Dr. Kristina English:

Get away from the noise, get closer and fix the lighting and so on.

Dr. Douglas L. Beck:

Sure.

Dr. Kristina English:

Help her be part of the problem solving. The question would be, "Would you be interested in trying it that way?" Most people that I know would say, "That's worth a shot. Who knows?"

Dr. Douglas L. Beck:

Yeah. Yeah of course.

Dr. Kristina English:

That would clarify some things for me.

Dr. Douglas L. Beck:

Particularly if you have that harmonious relationship first, because now we are comfortable with each other as a human.

Dr. Kristina English:

Yes. Yeah, exactly. The last one she was saying is, "You'll always have problems in noise and you'll have to get used to it. It's unavoidable." I was thinking here, I would say, "Right now we're in this very quiet room and we're doing quite well, but I haven't really heard yet about what noises are bothering you situation wise. Could you keep some notes and get back to me on that. You're providing me some information and we can share the solution-solving."

Dr. Douglas L. Beck:

Yeah, that's that's great. That's great.

Dr. Kristina English:

It's just partnership rather than expert, basically adult child is what you're kind of treating that person as.

Dr. Douglas L. Beck:

Yeah, this is to a large degree why I often use the COSI, the Client Oriented Scale of Intervention because I could take their words and make that the area that I was going to focus on. You could ask them, "Where are you having the most difficulty? What's great for you? What's difficult for you?" You take their words and their scenes that they've described, and you can use that as your targets for treatment and management.

Dr. Kristina English:

I was thinking about what else to do next and I thought, well, I don't know except talking to you, started to get the ball rolling in my brain to at least invite your listeners who want to be trying out the same thing, to talk to their alma mater's or their local programs or their state organization to say it's not a big deal in the great scheme of things, but it could make a big difference one person at a time, but maybe multiply it accordingly.

Dr. Douglas L. Beck:

All right, well listen, I am going to leave it there this time and I am so appreciative of your time. Dr. English, it's a joy and a delight to speak to you. I thank you for your contributions to the profession and for your friendship. Wonderful afternoon and thank you so much.

Dr. Kristina English:

Thank you so much. I appreciate working with you. Take care.

Dr. Douglas L. Beck:

Take care, bye-bye.

Dr. Kristina English:

You bet. Bye-bye.