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Behavioral economists tell us the act of paying more than a few hundred dollars for something can be a painful experience. Brain scans suggest the experience of purchasing an expensive item that we may not want, but need, elicits the same pain centers in the cortex as when you hold your hand over a flame. Hearing aids, of course, are not Gucci purses or a Rolex watch – they certainly fit the definition of an out-of-pocket purchase that most people do not want, but one many certainly need.

When we end the HAE appointment by focusing on the details of the hearing aids and their out-of-pocket cost, we are playing into the hands of those experts who say we are making the buying experience painful. Although we need to be direct and straightforward about the cost of hearing aids, there might be creative ways to use the findings of behavioral economists to lessen the pain.

One way to lessen the pain of the out-of-pocket buying experience of the hearing aid purchase is to end the appointment with a discussion of the specific communication goals and expectations of the patient. The process works like this:

  1. During the HAE, the patient, their communication partner (who should be involved in the appointment) and the clinician create a series of specific communication goals. As clinicians know, these goals look something like this:
  • To talk on the phone with my grandkids
  • To enjoy my favorite TV program with my wife
  • To participate in conversations at my favorite restaurant
  1. Generating a list of communication goals, most would agree, is an essential part of the HAE process. These goals, along with audiological variables and other crucial details are used in the hearing aid selection process, which occurs toward the end of the HAE. After an agreement has been made on the price and technology of hearing aids, there is an opportunity to re-visit the goals that were established earlier in the appointment. Clinicians can start this dialogue by saying the following to the patient, “Now that we’ve agreed on the technology level (and price) that is most suitable for you, let’s start the process of addressing your communication goals today.”
  2. Refer to the communication goals you’ve written down and ask the patient to complete the following:
  • Rate their ability to communication in the unaided condition using a 1 to 5 scale. (5 is communicating with ease nearly 100% of the time)
  • Next, ask the patient to tell you where on the 1 to 5 scale they expect to be after they have been wearing hearing aids for about a month. (This is marked with an “E” on the figure below).
  • Now, it is time for the clinician to chime in by marking on the form with a check mark where the clinician realistically targets as improvement. If the clinician and patient are not in the same box, it is an opportunity to discuss realistic expectations.
  • After a brief discussion about the importance of aligning expectations, the clinician concludes the appointment by talking about how the patient, communication partner and clinician need to work together over the course of the first 30 days or so to ensure that goals are being met.
  1. This tactic at the end of the appointment is intended to put the focus on the goal planning process and how all parties must work together to improve communication, rather than placing too much attention on hearing aid technology being the sole cure-all for communication problems. In other words, the focus of treatment planning and goal setting needs to be on how the patient is communicating, not on how the hearing aids are working. Hearing aids are a means to an end.
  2. At some point during the first 30 or so days of hearing aid use, the clinician, patient and communication partner can return to the treatment goals and monitor progress relative to previously established expectations. This is indicated by the “I” on the form below.

Figure. Patient Expectations Worksheet

For more information on tools used for implementing patient communication treatment, please contact your regional manager.