REM (or verification in general) does help solve patient problems and can make the fitting process easier. I’ve had cleint perpetually unsatisfied with long term HA use, measured RECD + Speech Map later and they now have corrected audibility and a happy client. Turns out they had an unusual canal resonance and the fitting software has no way of knowing that. It can also verify what you suspect the issue is when your clients give you subjective feedback. (For oversimplified example, “It sounds tinny” -->REM shows peak at 3kHz, adjust by smoothing it out–>cleint happy VS . “It sounds tinny”–>no REM–>adjust by turning gain down 2khz±->client may still be happy but with reduced benefit at 2kHz and 4khz+) That example also shows how doing a good job might result in happy clients, but doing a good job + REM means they could do even better, however they might not be “happier” as they have no idea what they were missing.
The biggest problem I have with not doing REM is that you have no idea what you are doing, yoru taking an educated guess. You can be doing a perfect job one day and a poor job the next without knowing it. Even adjustments, two steps in one fitting software is different from two steps in another fitting software.
People used the same arguments for not using a fitting algorithms like NAL or DSL when they came out and asked for the same thing, a nice correlation between NAL = Happy. This is a difficult thing to provide however as it doesn’t account for acclimatization, it doesn’t account for if they are doing better but not knowing it, it doesn’t account for them doing better but not likely the sound (because you can surely have both) and it doesn’t account for people not knowing what it should sound like. Their brain is not trained for what it needs to hear and they often don’t like it, at least at first. We have evidence of this as Todd Ricketts presented data on the issues showing that the hearing aid gain settings that patients find most pleasant may not provide them with much, if any, benefit (Ricketts, 2009).
Without doing another lit review at the moment (sorry this adventure has exhausted my daily fill for medline journal searches :P) you’ll have to settle for me quoting the Aazh and Moore (2007) study which showed REM resulted in a batter fit to target and hope that you feel a better fit to target at least is to the clients benefit, after all that’s what the first fit is trying to do anyway…
PS
For the record while most clients stare blankly while doing REM, it can still be a valuable counselling tool as it visualizes what the hearing aid is doing. This can be done with out trying to impress with your fancy machine IMO.
References
Aazh, H., & Moore, B. C. (2007). The value of routine real ear measurement of the gain of digital hearing aids. Journal of the American Academy of Audiology, 18(8), 653-664.
Ricketts TA (2009) OC fittings: Considerations regarding prescriptive methods and function of special hearing aid features. Audiol Online