Can you hear me?

The scenario

Paul, newly-qualified optometrist

“I’m a newly-qualified optometrist with two years’ experience. I have recently moved from a resident position in a large setting to a much smaller practice that has a broader and more diverse patient base. As I see more patients with different needs, I’m finding myself positively challenged. As I seek to further my skillset, would you have any tips and advice for providing an eye exam to someone with hearing loss and/or limited hearing?”

The advice

Cirta Tooth, specialist optometrist

There are a wide range of simple and effective things that optometrists can do to support people with hearing loss who attend for an eye examination. First and foremost, I would recommend that you try and put yourself in their shoes. Research shows that patients with hearing loss are anxious about presenting for an eye examination because it’s quite common that there are misunderstandings, or even misdiagnoses.

They have often had a negative experience with a healthcare professional previously and as a result are anxious, so your number one priority is to put them at ease. This can be as simple as a smile on your face.

Booking

In terms of making an appointment, face-to-face booking is much better than telephone booking for this patient group. However, whatever way a patient who is hard of hearing chooses to book, you should make sure that you send confirmation of the booking in writing. This means that any potential misunderstanding should be avoided. Over the phone, I would recommend reading the booking back to them. In person, I would recommend writing the booking details down on a piece of paper and giving it to them.

When you are making the booking, be sure that you tell the patient that you will make a note on their record that they have a hearing impairment, and ask them what their preferred way of communicating is - this varies quite a lot. Assure them that you will write it in their notes so that when they come in next time you know how to approach them. That will make them feel much more comfortable straightaway.

When a patient who has hearing loss arrives in practice for an appointment, try and make sure that you approach them – they may not see or hear you. Consider where you sit them to wait before the eye examination. They should ideally be able to see the receptionist but also, if possible, the optometrist coming out of their room, so they are not excluded from the scene.

They have often had a negative experience with a healthcare professional previously and as a result are anxious, so your number one priority is to put them at ease. This can be as simple as a smile on your face

The testing room

40% of patients over the age of 50 have hearing loss. This rises to 71% of patients over the age of 70. Therefore, one of the first questions I ask my patients is ‘What is your hearing like?’. In doing so, I explain that it’s important that I can communicate well with them because I care about them as a person as well as their eyes. I have found that this helps put patients with hearing loss at ease and helps to make them feel that someone is taking them seriously.

In the testing room, you want to make sure that your room is set up so that the person can see your face clearly. This means thinking about where your light source is. Similarly, make sure that your hair and hands are not obstructing your face. This is important for the projection of your voice, as well as your facial expressions, which account for more than half of your language.

I also ask if they prefer a high pitch, low pitch, fast pace, slow pace, etc and I try to mimic their accent as these are all things that will help them hear you better.

Finally, before I begin the test, I try to give them a way out. I will let them know that from time to time I may talk to them as I am making notes, or continue discussing something as I walk around the room. I stress that these are bad habits of mine and that they should call me out or tap on the table whenever I do this. They will then feel more comfortable saying something when they can’t hear or understand me.

For each test I do, I make sure that I have explained everything before I put the patient in front of a piece of equipment. Once they have a machine in front of them, they will not be able to see my face and therefore communication can be increasingly difficult.

Think about how you can continue to communicate once the lights are off too. You could agree for them to tap knees or give a thumbs up and down when using the trial frame, for example.

Throughout the consultation, for this group of people, it’s important to use short phrases and not too much jargon. Have the patient repeat back to you what you have said and ask them if they have understood what you have said.

Also be sure to slow your pace of speech as they will take longer to process what you have said.

Many of us will raise our voice when talking to someone with hearing loss. However, when we talk loudly our facial expressions can become angry, so you should try to make sure that when raising your voice, you do this with a smile on your face.

Be sure not to assume that if a patient wears a hearing aid then they can hear you. It is rare for someone who wears a hearing aid to hear perfectly

Hearing and dementia

Many patients with age-related hearing loss may also have dementia. They therefore often bring another person into the testing room with them. I would encourage everyone in this situation to bring another person into the testing room with them. However, in these situations, be careful not to talk to the carer; always talk to the patient.

There is a tendency to begin talking to the person doing the translating. To ensure I avoid this, at the very beginning of the consultation I address the patient and tell them that it’s great and helpful that they have brought a friend, but that I am going to assume that the friend can hear me well. I will turn to the friend to check and confirm my assumption, before turning back and assuring them that I will therefore speak to them directly during the examination. This ensures that I keep the patient at the centre of the communication.

Spotting the signs

The vast majority of hearing loss that optometrists will come across in practice is age-related.

A clue that you could look out for to help you spot patients with hearing loss is hearing aids. However, be sure not to assume that if a patient wears a hearing aid then they can hear you. It is rare for someone who wears a hearing aid to hear perfectly. You should also not assume that just because they only wear one, they only need one. They could be completely deaf in the other ear.

Unfortunately, most people who have hearing loss do not wear hearing aids. They are a clue but do not necessarily tell you the full story.

When patients appear to have hearing impairment, I have found it useful to ask which ear is their best ear because it helps me to know where to best position myself in the room.

Listening to your patient is important. If you don’t know if a patient has hearing loss and don’t want to ask them directly, listen out for clues, such as you asking them a question and them answering another question. They may also ask you to repeat yourself or may lean in when you are talking to hear what you are saying.

If the practice has any leaflets available that are relevant, you can share them, but be sure to explain and circle the bits that are appropriate to them so that it doesn’t cause any concern

After the test

If after the test there are any findings of interest, while you will have explained these to the patient at the time, it is good to put things in writing too. If the practice has any leaflets available that are relevant, you can share them, but be sure to explain and circle the bits that are appropriate to them so that it doesn’t cause any concern.

• As told to Emily McCormick