A 62-year-old man comes to the emergency department with his wife due to back pain. He has had no recent falls or injuries. Medical history includes hypertension and hypercholesterolemia. As the physician is trying to obtain additional history, the patient becomes embarrassed and says that he is having trouble understanding because he has hearing loss, and his hearing aid batteries died a few minutes ago. In addition to closing the door, muting the TV, and turning off nonessential medical equipment to decrease ambient noise, which of the following strategies is the best next step to improve communication with this patient?

Question

A 62-year-old man comes to the emergency department with his wife due to back pain.  He has had no recent falls or injuries.  Medical history includes hypertension and hypercholesterolemia.  As the physician is trying to obtain additional history, the patient becomes embarrassed and says that he is having trouble understanding because he has hearing loss, and his hearing aid batteries died a few minutes ago.  In addition to closing the door, muting the TV, and turning off nonessential medical equipment to decrease ambient noise, which of the following strategies is the best next step to improve communication with this patient?

Quizplus · Accepted Answer

Hearing loss is common, impacting almost 20% of US adults; the prevalence increases with age. Hearing loss is associated with increased rates of misdiagnosis, longer lengths of hospitalizations, and increased readmission rates. As such, physicians should employ strategies to improve communication, which include: Hearing loss patients are heterogeneous with varying needs. Physicians should ask open-ended questions such as, "What is the best way for me to communicate with you?" and frequently ask for feedback to ensure that communication is effective. In addition, physicians should document successful strategies to improve future encounters. (Choice B) Although this patient has hearing loss, he is able to verbally communicate effectively with the physician and does not need to write. The physician (rather than the patient) may use written communication if this is in line with the patient's preferences. In general, writing is not preferred because nuances can be lost, intentions misinterpreted, or information left out for the sake of brevity. (Choice C) Obtaining history from the wife or next of kin is appropriate if the patient is incapacitated (eg, comatose state). Attempts to communicate directly with the patient are always preferred. (Choice D) Speaking loudly into one ear may be helpful for some patients with unilateral hearing loss. However, this should only be done after confirming this aligns with the patient's preferences and asking which ear is best for hearing (ie, the better-hearing ear). (Choice E) Optimal care of patients with hearing loss who use sign language requires trained interpreters. However, many patients with hearing loss do not use sign language; this assumption can lead to delays in care and embarrassment for the patient. Educational objective: Hearing loss can impair communication, resulting in adverse health outcomes. Strategies to improve communication include minimizing background noise, facing the patient directly, and speaking clearly at a normal pace. __________ References: Improving communication with patients with a hearing impairment. (http://www.ncbi.nlm.nih.gov/pubmed/23840079)

A 62-Year-Old Man Comes to the Emergency Department with His