“You really listen to me”: Life as a doctor with a hearing lossBMJ 2004; 329 doi: https://doi.org/10.1136/bmj.329.7468.s128 (Published 25 September 2004) Cite this as: BMJ 2004;329:s128
Clare Redstone recently developed a hearing impairment and found that the single most helpful step was getting in touch with other health professionals with hearing loss. Here she shares her experiences and gives some tips for both hearing and hearing impaired colleagues
I've had tinnitus since my student years. My initial audiogram showed such a slight hearing loss that it didn't seem to be an issue. I don't remember receiving any advice that I should have it repeated occasionally. But about three years ago I realised I was saying “Pardon?” far too often. Friends would burst into laughter while I sat with a vague smile on my face, not having heard the joke. I joined the ranks of fuddy-duddies complaining of too much background music on television. A word with our practice nurse, one audiogram later, and I realised that my high frequencies were shot to bits. That was frightening. Was I safe to practise? And what about the future?
Experts were on hand to fit hearing aids, but none knew how to use a stethoscope with them. I spent many anxious hours trawling the web and discovered it can be done. But it was only on meeting a couple of other deaf doctors recently that I realised we don't need to stress about auscultation—they pointed out it's only a small part of our job. I wish I'd met them three years ago. So, the most helpful tip I can give is to make contact with other “deaf doctors.”
Talking of “deaf doctors,” although the phrase neatly rolls off the tongue, I'll refer to “HPHLs” from now on—“health professionals with hearing loss”—to encompass all health professions and a wide variety of hearing impairment.
Like a rainbow
We HPHLs are a heterogeneous bunch, and our disabilities may not affect us all in the same ways. Think of a rainbow: I've lost my violets and blues, the high frequencies but my reds, the low frequencies, are intact. A colleague has lost her low frequencies. Heart and lung sounds fall in the low frequencies, so she uses an amplified stethoscope and I don't. On the other hand, she can hear perfectly with hearing aids, and I'm in the more usual situation of having to employ additional hearing strategies, especially in noisy environments. Like a rainbow, I fade when the sun goes down. I make use of lip reading, and watching expression and body language. So I may not hear as well in poor light or if I'm tired.
Box 1: Tips
Tips for HPHLs
Find other HPHLs—and anyone else with hearing loss
Don't get stressed out about stethoscopes: auscultation is only a small part of our work and likely to be perfectly possible
Remember some easy communication strategies (box 2)
Be open about your hearing loss
Enlist support—others with hearing loss, other HPHLs, hearing therapist, audiologist, occupational health, colleagues
Tips for friends and colleagues
With today's technology, more of us can practice safely than ever before. Please encourage and support us, particularly in the early stages when it's new for us too.
Remember some easy communication strategies (box 2)
Hearing loss can be like working in a foreign language. If I miss a word, I can often work it out from context. It takes a lot of concentration. It's not selective hearing: I truly did not hear you ask me to cover for you yesterday. I thought you were saying good night.
Coping with hearing loss
Over the past three years, I've been learning how to live with hearing loss. I haven't come to terms with it yet, but it's getting better. My greatest fears are for the future. Will I become more isolated? Should I be preparing for a career change? My audiology physician says no to the latter. Deterioration is unpredictable but probably slow, and developing technology may well keep pace.
But I struggle with the isolation. Because it can be difficult to hear in a group, I withdraw. I am learning to be open about my hearing loss, so my friends and colleagues know to make that little extra effort to include me. Most people are happy to help. For example, I started a new job recently, told my new colleagues I'm deaf, and circulated a leaflet of strategies. Their positive response boosts my confidence in other situations. The strategies are simple and they work (boxes 1 and 2, and picture).
Others with hearing loss
It helps to meet other people with hearing loss. I attend lip reading classes where I hear new information and gain from others' experience. I learn from our teacher as she models hearing strategies. When a classmate tells me how he asked someone to speak a bit more slowly, I try it too. Organisations such as the RNID and Hearing Concern are rich sources of information including advice about equipment, legislation, and funding.
There are plenty of us around, not to mention our predecessor, Helen Taussig, paediatric cardiologist of Blalock-Taussig fame (the pioneering operation for Fallot's tetralogy1). Helen demonstrated that practising (and training) with hearing loss is possible.
Box 2 Communication strategies
If you have a hearing impairment
Manipulate the environment: Choose quiet surroundings wherever possible
Face the person you are conversing with
Don't be too far apart
Keep plenty of light on the speaker's face
Explain you have a hearing impairment
Watch for clues from lip movements, facial expression, gestures
Don't be afraid to ask the speaker to repeat themselves
Thank the speaker for their help
If you are speaking with someone who has a hearing impairment
Attract the listener's attention
Ensure the listener knows the topic
Speak clearly but not too slowly
Do not shout
Keep hands away from your face
Don't be afraid to repeat yourself
Rephrase anything that has been misunderstood
I eventually found the Association of Medical Professionals with Hearing Loss website and NOISE mailing list to be indispensable. Members are quick to share from wide-ranging experience.
UK Health Professionals with Hearing Loss
NOISE is international, but most members are in the United States. I had difficulty finding information specific to the United Kingdom. The BMJ Careers chronic illness matching scheme (bmjcareers.com/chill) only goes so far, so a colleague and I have developed a website for UK health professionals with hearing loss. The site includes UK information such as how to fund and try out equipment. We want to develop the network we wish we'd had three years ago so UK HPHLs is a resource for each other, at all stages in our careers. Visit us at www.hphl.org.uk and please get in touch.
There's more to deafness than hearing aids. I knew other equipment might help but felt bewildered by the vast array available. I was grappling with the social impact of hearing loss and my fears for the future. At the end of my tether one day, I asked to see a hearing therapist and at last found someone who would listen to me and acknowledge that it is difficult coming to terms with new disabilities. She encouraged me to tell people about my hearing loss and to use hearing strategies. I wondered about lip reading classes, and she gave me information and talked about the added benefits of meeting others with hearing loss.
Hearing therapists know about other equipment to help in and out of the home and at work. Sometimes it's available to take on a “test drive.” Two months with a radio microphone transmitting to my hearing aids were a joy. Conversation in noisy environments was much easier. In lectures, the directional mike meant I could hear questions and comments from the audience as well as the speakers (more about gadgets below).
Occupational health can be a source of advice and practical support, but experience appears variable. A colleague told me: “It took 18 months before I stopped feeling a second-rate doctor” after an uninformed occupational health physician implied she would never be as good as a hearing doctor. They should have read Amanda Kvalsvig's excellent article.2 In contrast Rhianwen Stiff, who has a visual impairment, found her occupational health doctor invaluable and advises that we ask to be referred to someone who does have experience if necessary.3
All the bells and whistles
Okay, so the bells in my head are here to stay, but whistles can be silenced. Hearing aids today are far advanced on the chorus line greeting us in the dayroom of yesteryear. If your aid whistles, go back and keep on going back. Hearing aids can take a bit of getting used to4 but are well worth it. The sooner you get one, the easier the transition.
The RNID and Hearing Concern have fact sheets about hearing aids and information about NHS and private provision. Excellent digital hearing aids that help most patterns of hearing loss are becoming more widely available from the NHS, but the most sophisticated aids must be bought privately.
Hearing aids do not usually restore normal hearing, thus the need for other gadgets. There is an abundance of equipment that vibrates, flashes, and amplifies. Infrared, radio waves, and magnetic fields dance around our heads. My pager vibrates when the phone or doorbell ring, and my pillow shakes if the smoke alarms go off. The T switch in my hearing aids is invaluable for telephones and the radio mike (which I mentioned previously) is an example of the many assisted listening devices available. Simple amplifiers are available that clip on any telephone. Text messaging needs no specialised equipment.
Whether for work, home, or out and about, there's probably a suitable gadget. Find them on the web (see Further information), swap ideas with others, ask audiologists and hearing therapists, and go to road shows and local agencies for demonstrations.
Funding and legislation
You can find advice about funding, the Disability Discrimination Act, jobs and training in a recent Career Focus article.3 The GMC requires any doctor whose health might put patients at risk to follow advice from an occupational health department. Occupational health may also be your ally in obtaining “reasonable adjustments,” such as equipment.
The Access to Work scheme helps fund work related costs. Communication support and equipment can be very expensive. Provision may be variable, so it pays to persist and get advice from others who've been through the system. Social Services can supply some equipment to help in your home.
With a low frequency loss, you will need amplification. A wide assortment of electronic stethoscopes is available, to use with or without hearing aids, some even with visual display. Just like being a student again, it takes practice and time to become accustomed to your new stethoscope.
Some people use a stethoscope in one ear and a hearing aid in the other. Having behind-the-ear aids, I can slip my ear moulds out and my stethoscope in. Judicious use of toupee tape prevents the aids taking a tumble. I aim to have an electronic stethoscope I can use with hearing aids, and this can be done in many ways. Read Cope with Scopes,5 and speak to some other HPHLs. Borrow theirs to try out or buy others on trial.
Our website: UK Health Professionals with Hearing Loss—www.hphl.org.uk
Association of Medical Professionals with Hearing Loss—www.amphl.org
NOISE mailing list: link from AMPHL
Deaf Professionals Network—www.deafprofessionals.com
A lesson from lip reading class. “Repair strategies” are what you use before resorting to “Pardon?” When you think you have the gist, reflect. “You're talking about what triggers your pain...?” Respond positively to what you do hear. “It happens when you exercise...?” These strategies are close relations to active listening skills. How do I know this strategy works and that I am still in the right job? When someone says to: “Thank you, doctor. You really listen to me.”⇓
Many thanks to Lisa Shaw and the other health professionals with hearing loss who have encouraged me and shared their experience and advice.