About Patient Visit Expectations and Practices

Audiologists and Hearing Aid Dispensers
1

How does a patient’s fitting tweaks get documented by the practitioner.
Suppose I go five time in a year, and each time based on my complaints, and possibly some short testing, tweaks are made. Sometimes they are made to large swatches of frequencies.
Sometimes only a few bands are touched. Some adjustments were larger than others - and some fixes were made via the software “fix” prompts.
One round of adjustments involved changes to a few of the MODES.
Some adjustments also were to address how beep tones, and buttons behaved.
While most involved the all important sound processing.
As I said, some adjustment were made directly in the gain/frequency table, and others were done by varying sliders in several categories of behavior within modes.

Then I come back for a sixth time, explaining that in some ways the results were better after the FOURTH visit, and one thing I liked from even earlier, and some problems now exist since I have been there, but some things are better.

Is the practitioner able to decipher based on notes made, what the positive and negative tweaks were? DO PRACTITIONERS ACTUALLY MAKE DETAILED ENOUGH NOTES to ACCURATELY ROLL BACK SPECIFICS ? If so, how are those notes made - in how fine a resolution? I mean, just noting “globally lowered high frequencies” is not specific enough to revert back. If changes were made in multiple screens, it will be very time consuming to check each saved session to see exactly HOW they varied. That kind of comparison I think even I would be too lazy to do. I wonder if it being the pro’s expertise and native language if they would have an effective way to retrace each and every one of their steps in each session.
From my limited experience with this kind of thing… from reading the pro’s body language … the impression I got was that it was just guestimates and that also, that possibly under X circumstances probably would have done Y changes. But this suggests that either the full potential of all possibilities was not considered previously or could be overlooked in resetting now.
As I question this, it is with the expectation of one of two possible replies:
A: Good question - and in fact we have a very detailed table of changes that we complete with each and every patient visitor, that table is permanently saved and has charts that are required to be filled in tailored to the specific software, and which include, not just the main insertion gain tables, but also every mode and every custom parameter, so we have the ability to overlay those changes, and analyze retroactively exactly what worked and what was less desirable. This is why it pays to come to a pro!

B: Well things are very fluid and infinitely changeable. At each junction, the practitioner will try to do the best possible fitting based on all the data available in the patient’s history, the patient’s feedback then and now, and the practitioner’s own immense insight built over countless hours of training and practice.

IF your answer is A - then please show me, send me, or PM me, examples of those charts you refer to, it would mean a lot, and not only help me in my own record keeping, but go a long way in establishing my trust and value in the industry.

IF your answer is B - then may I suggest you might be interested in hiring me to write your ad copy, customer out-reach, and in general handle all your PR, since I am probably a cut above what you are currently getting, and I certainly can help train your crew to make your clients feel that they are treated better (even if they are not!). :rofl:

2

In Phonak Target software each time the aids are connected, changes made and saved that is a session. Target keeps records of these sessions. At any time the fitter can revert the aids to any of these sessions.and see the changes. There is also an area in Target the notes can be saved and retrieved at any time.

I can not say how the other hearing aid brands do this but I bet they do similar.

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It is because as a Target DIYer, that I can relate to the complexity of reconciling notes with roll backs. Yes, one can revert back to an prior session but that could end up throwing out the baby with the bath water! So then the patient will either have to re-visit to try to restore the unintended reverted change or just do without, and wonder why. I would want the PRO to have a much more detailed and sophisticated management schema to address this. Wouldn’t you?

4

Raudrive gave you the answer - so now you’d just need to write your ad copy to say something like, “If you liked your hearing aid settings 2 sessions ago, KNOW that they are safely stored in your audi’s software!” LOL.

Seriously, I am walking in YOUR shoes! I LOVE to get in and see my audi! We not only get things done that needed doing (refinements, additional features/programs, hey, even set up a new pair of aids or Roger mics!), but we just thoroughly enjoy each other’s company.

Yes, she has all my previous settings, and we have definitely gone back to prior settings. PLUS - and just as important for your copywriting promo - she can copy/paste the settings from older Phonak aids onto my new purchases. That saves HOURS of back 'n forth and follow-on visits.

It’s this kind of service, experience, and partnering that has always prompted me to buy my aids at a clinic where I develop a long-term relationship with my audi. O’course my audiogram proves I’m no run-of-the-mill lazy listener. I have serious cinderblocks. The fact that I do SO well with my Phonak Lumity Life 312 aids + the Roger On iN mic for streaming is proof that my audi and I are on the same page. I’m blessed to have found her.

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Well no as the Audiologist can add notes to any sessions and go back to ANY sessions saved, you don’t lose anything as long as it’s saved to the database.

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Yes, you are blessed to have found her, and I would add, that she is lucky to have you as a patient.

My reason for posting my question was that after dozen or more years, seeing various AuD and other fitters, peek and pore unconfidently through past sessions, and my occasional need to return just to have a feature accidently turned off, restored, or other uncertainty, redirected back at me, to provide feedback in, because of their lack of clarity… I have begin my DIYness. And now for the past few months have been exploring how best to document the many changes that might be made, some little some large.

I find that even if I had the patience and took care and time to document every little thing I changed, later it might be less than crystal clear, or lead to a lack of confidence that perhaps I forgot something.

SO - I know that this is a valid issue. I would think that very experienced pros have a better handle on it, but with all the variations in software, there is a good idea somewhere in my query that there be a global way to track changes. Kind of the way markup changes can be documented in shared editing environments. Mine was not a flipant - though I try to add humor when possible, the greatest truths are said in …what?

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7

Database, good term.
Yes, databases have fields.
But the notes is just a note field that then must refer to changes made elsewhere.
Due to the many screens, modes, sub modes, devices, etc…
failure can come by oversight, or lack of verbal clarity, haste, interruption…

Frankly I wonder how often and how thoroughly do practitioners make notes.
How many have decided that notes are probably not too valuable, as many patients won’t come back soon, and things change, or that patients complaints may oftentimes be somewhat vague or incoherent. Perhaps the patient is not able to articulate issues well. I say this because often I have seen patients leave, and the AuD, is quick to close the program to meet with ME! And this too would happen, as I was leaving!!

Then we would have to be detectives 3 months later, when next I visited.

So yes, a database has fields and I would be interested in seeing a display of all those fields, listed on the left, with vertical columns of say previous six dates, and in the cells appear the settings for that date. The cells would auto populate based on the changes made. What you think ?

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TOTALLY agree with your sentiment. If our audis bumble through these fixes, and we are NOT a DIYer, I’ve been advovating for YEARS now that the industry needs a dedicated side business - a Geek Squad - to manage the aids, connections and accessories of multiple makers’ devices. They don’t have to be JUST Phonak or Oticon conversant, so they could help truly anyone out there who has aids and wonders how to optimize them for hearing, streaming, LIVING in our noisy world.

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9

My Dealer insists that customers wield the power.
I would think dealers have more clout.
But for sure if customers spoke up… things would change sooner.
Yet from replies seen here, on this forum, my outspoken nature is not too well appreciated.

Anyway - to better serve patients, fitting programs, in which the data already exists - should have a HISTORY SCREEN. That screen will display the collection of all changes either in absolute or delta values, changes to any options in each mode. All options to be displayed on the left, with values recorded in the cell intersecting with the dates across the top. A chart.
It could be broken into multiple screens, like global/gain/modes/devices.

This would automate record keeping of all changes, and greatly facilitate serving patients much more reliably and efficiently.

But my question - asked what system is in place currently.
Is there no system ensuring 100% reliability? If so this is an emergency!
If there is a system, would someone please post screen shots here of how it is reliably documented?
Thank you in advance for this!

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10

I haven’t been following your posts here, but just tune it out if some folks don’t agree. That is why we have an open and LIVELY board here! :grinning:

I hope you can tap into the DIY knowledge here, cuz I kinda think you can get back to previous settings. However, sometimes you change a frequency range here … then add a program there… So you’d want to have your “history” organized by the area being changed versus the date of the office visit. Almost like a spreadsheet where you can sort by TOPIC/AREA and then find all the changes made there since the purchase date of your aids.

I never stop dreaming about what may be some day! I’ve dreamed of waterproof aids … prob’ly not happening in my lifetime, and streaming conversations directly to my ears (yep, I’d give the Roger mic credit where it’s due), and better aids so I comprehend speech better (yep, I vote for my Phonak Lumity Life 312s).

As for your dealer saying we customers have more clout? I’m not sure I agree. MANY of us stumble into a clinic or hearing aid store not even knowing if we need one let alone which one, and then exert clout over that device being FORCED to meet our needs and lifestyle choices. Hearing is nuanced. It’s not like getting your eyes examined and then buying a stylish pair of glasses. Our whole hearing package is vastly more complicated with all the accessories and scenarios in which we need to hear.

Hope others will weigh in with some solutions for you!

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11

Bravo Bluejay!
I have a number of threads urging users to call the manufacturer.
I could probably dig them up and copy links to the key posts onto this thread…if you need.

My experience is that the majority of gear designers, are not end users, or at least not very robust and particular end users. While the majority of senior based hearing aid industry users are not mucho gear savvy or sophisticated. This results in large numbers of insecure/confused/afraid to make waves/low confident users in the hands of not fully respectful and challenged designers who it seems often feel we should be thankful for the morsal of incremental improved performance that does not fully perform as common sense would expect.

Probably the manufacturer’s strengths are in the physics and fabrication realms, but the user interfaces - which can only be truly evaluated in the field when robustly used and fully pushed to perform is where consumer feedback is essential, and that is where it seems we are failing ourselves.

it seems we need help not only in hearing but also in SPEAKING!

Over a dozen years, I have on several occasions been involved when Hearing Aid practitioners called manufacturers… who invariably were USELESS providing meaningful reasoning for how and why my old hearing aid phone app worked, and even some aid features worked. It can take a long time to get through to anyone of importance, and business owners, cannot afford that! However, there must be yearly symposiums/conventions/trade meetings where leaders of design meet dispensing leaders. This is where communication must occur and for that to happen the end users need to speak up at every opportunity.

Consider that if the tech cloudy and unsophisticated instrument user is not qualified or able to articulate issues and the tech savvy, critical thinking experienced user is content in shrugging our shoulders and accepting what is hard to change - then how can anyone expect improvement?

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I keep fairly detailed notes on any changes I make, but not a detailed table. Degree of detail is going to vary by provider, but I doubt any keep the sort of table you describe.

But also, what are you doing that your note-keeping needs to be so complicated to identify what changes did what? When a patient comes in and we make, for example, five specific changes to address a couple of issues, and then they come back later saying, “since those changes I’m experiencing this X thing” it is not really the case that I have no idea which of those five changes are causing the new thing–I know which one is doing it and I just turn that one back.

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13

My details, as a DIYer, are probably both more detailed and more often.
I can experiment. And when a repeatable situation comes up… for example a TV show, or a recording, I can at my leisure - revisit the experience, with my system and software.

But my suggestion of a TABLE is based on seeing various situations in which several small adjustments were made. Across multiple screens, and sometimes tweaking different modes in different ways and where memory failed! Pros either have a “typical” response in cases like that, or they make each adjustment based on evaluating a variety of factors. If it is a typical adjustment, then that is NOT going to be a perfect adjustment for most patients. If it an intricate customized adjustment, then it cannot possibly be remembered, and if "notes’ hand keyed in, are the only record, it is only a matter of time before either adjustment gets paraphrased, or a detail is left undocumented. Simply too time consuming and human error will creep in.

Considering all the complex factors the software computes… it should be Childs play to compile all adjustments into an easy to evaluate and reference chart.

What’s the objection? Everyone should be happy - UNLESS - now that am forced to think about it, I guess some less competent operators, would probably NOT want clear cut evidence of bad decisions to be documented. But it is something that many professionals must live with these days.

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14

My take on this, by self programming, is there is enough space to record as much, or as little, as you want when saving a new session. All notes (in Target) can be viewed as a list, with dates.

I have each of my 6 pairs set up as different “clients”, using the model, as the name. I also saved a backup from my 1st properly programmed pair. I used to enter “his” Audiogram on creation of all, but now just do a feedback/real ear, followed by an Audiogram direct. I find it interesting that every Audiogram Direct is different. I guess this relates to:

  1. Differing tubing (Thin, Thick, RIC)
  2. Differing fitting (full moulds, slim tips, domes)
  3. Differing Type (Bolero, Audeo, Naida)
    I believe these Audiogram Direct readings o some way towards the lack of REM, as the hearing tests are done with the actual fitting.

None of the above was done with the UK NHS, they did first fit, and out the door. I insisted on moulds though, as they said I’d be fine with vented domes! On my final visit, I asked for tweaks to help speech recognition. She changed the tubing and asked if that was better!!

I now rarely alter gains or MPOs, but do make small adjustments to sliders in Program options. I record these in Target, along with which additional programs, startups, manual switching.

If I mess up, I can do the whole thing from scratch. I’m currently using Lumity Naida L90 SP. I’ll have a quick look at the notes, as they’re currently working really well.
Peter

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15

Just want to clarify -
I am not personally expecting to be continuing making many changes.
However, I tend to immerse myself deeply into something and don’t believe that an occasional tweak here and there is the way to go. I think it is better to explore more, and then retreat selectively or reset completely.
BUT I think that I SHOULD explore a variety of Fitting Rationales. As I am reading how some find this or that one amazing… and changing rationales, I would imagine could then involve reviewing all areas… I dunno. I am not the expert, and don’t need to be. The most important thing is to be able to ask questions, that is the most important factor in problem solving and learning.

Thought you might find this interesting.
Try to export a user from your software - you will get a file which for example with Target is an .export file format. Now open that file in notepad.
I think you will be AMAZED at how much date exists!
Keep scrolling down.
So you see all the data that I ask to appear in a chart form - it exists.
Just needs to be harvested and laid out in one newly designed screen.
Very doable I think.

I will be experimenting with editing this file to duplicate it in modified user name - saved in discreet folders, for re-importing when I want to explore rationales.
Think it will work?

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Me too here. I’ve just looked at the Lumity notes, which have 35+ adjustments. Some of the early ones were increases in G50 gains from 1k upwards, which is where my Tinnitus is. Recently though, it’s much more program options stuff

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Wow. All I can add here is that I need a BRAIN transfer from one of you guys here! I would SO love to have Target, master it, and then have the confidence to make changes and see what their impact would be.

I think I “win” the Cinderblock Ear contest here (oh. boy.) and need SO much compression in my settings that it’s a wonder I do so well with my little 312s, wire and double dome tips.

I’m really impressed and inspired by the amount of knowledge in this thread and the Hearing Forum. Life would be easier if HA makers would help us help ourselves. They want to push the phone apps on us, but not the actual Target software that lies at the heart of things. I get why that is the case, but I think so many of us could benefit from being able to understand how our aids & accessories work and be confident to make changes on our own.

It’s not like we’re disabling the brakes on a Porsche. We can always “revert” to the previous settings and take off in a new direction from there. Wishful thinking! :thinking:

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Hey Bluejay, I am new to the DIY approach. Although I love technology, I was scared to death to “mess” with my hearing aids. I’m about due for new aids so I thought what the heck, if it blows up I’ll just get new aids. Few tweaks (not having a clue to what I’m doing" and wasn’t getting the result I had hoped for. I did a “first fit” and I add the same issues my audi did when I first got my aids. Nope, go back to the original settings. I actually went back quite a few times. Anyway, fast forward a couple of months, I ended up with a few tweaks to my audi’s setting and played with TV streaming. Also swapped out a program. I did lose my initial audiogram (oops!) but no big deal. So I’m due for new aids next year and I plan on telling my audi that I tweaked some settings. I think she will be OK. I will work through her for new aids for the first year and may try a few things in between visits. After a year’s worth of visits I’ll be on my own. Still some things I don’t get so it will be an interesting discussion.

Thanks to tenkan for his work in the DIY world.

Didn’t mean to hijack the thread but thought I’d throw in my two cents.

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19

Dig deep and you will find a lot of info online and on here.
Your audi, can overwrite your mangling with her version and restore those settings.
You can take screen shots of your screens, if nothing else, to compare variations.

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I think maybe I’m just struggling to imagine what you are imagining. I keep adjustment notes in the patient chart, not in target, so it’s not hard at all to flip through different chart notes. And marking down precisely what was done doesn’t take much effort and doesn’t get misinterpretted later. So it’s not that I am objecting to some sort of chart, but rather that I am not understanding the need at this point.

Yes to all of your factors. But also just keep in mind that the definition of a threshold, the sorts of thresholds upon which all prescriptive targets have been developed, is the tone that you can hear 50% of the time on an upwards run when you don’t know when it is going to be presented. Thresholds are a signal detection game in a stochastic system. If you’re running your own in situ it is not going to be that, and your in situ “thresholds” will generally be better than your actual thresholds.

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