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Often, audiologists who are good clinicians, though not realizing it, have teaching potential. Understanding how to prepare a talk and gaining experience in doing it has helped many audiologists to lose the dread of speaking and to begin teaching as a way of becoming a resource to the medical community and opening new referral channels.
Present your cases, not products.
There is nothing that demonstrates your thorough knowledge and understanding of audiology better than showing how you apply it to improve the life of an actual patient in a measurable way. In presenting a CASE, you will champion the PROCESS of audiology, not the PRODUCT of hearing aids.
The healing arts professions use this approach. And while many use a product as part of the process, their clinicians are careful not to allow the product to define their profession: oral and maxillofacial surgeons use titanium dental implants, plastic surgeons use breast implants, orthopedic surgeons use titanium hip replacements, and orthodontists use braces. Listen to a lecture by any of these clinicians and you’ll hear a discussion of the patient, her reason for presenting herself for care, and the process the clinician applied in the plan for rehabilitation. These presentations flow naturally, are easily given and fun to listen to, because after all, the subject matter is a case personally worked through by the presenter.
For audiologists there are at least two problems with product-feature presentations. Any enthusiastic discussion of a brand or technology of product has the tendency to reward the product for solving the patient’s problem, instead of casting the audiologist as the solution. Secondly, it is human nature to find out what products are believed to be best, and then search Google to buy them for less.
In the practice of audiology, your process should be the emphasis.
When you present a case rather than a product, your audience sees you in action. They hear your organized thought process, feel your confidence, and know your personality. A presentation made by you about one or two of your cases gives you the opportunity to demonstrate your competency, establish your name as a brand and create word-of-mouth referrals for you as an audiologist.
For whom should you prepare your presentation?
People who refer patients are one of two personality types: “Connectors” or “Market Mavens,” terms coined by Malcolm Gladwell in his bestseller The Tipping Point. Connectors have a gift of knowing people. They have the impulse of collecting acquaintances. They are members of many worlds. They broadcast to their contacts. They have a truly extraordinary knack for making friends and acquaintances. There are a handful of connectors sprinkled among every walk of life.
Mavens are information specialists. They brag. They help. They have a desire to be of service and influence. They are data banks of information. They can be obsessed with how to get the best deal on a can of oil, but they don’t stop there. They will tell everyone how they got that deal, and they want to tell you about it too. Connectors and Mavens are necessary for word of mouth. “Word of mouth is not me telling you about a new restaurant with great food, and you telling a friend, and that friend telling a friend,” says Gladwell. “Word of mouth begins when somewhere along the chain someone tells a connector or a maven.”
There are several reasons you prepare and make presentations. Presenting your work is an exercise that sharpens your clinical skills. When you organize and articulate case work you build competency and confidence. Secondly, making presentations to educate and inform is a character trait of leadership. Leaders are respected, called upon, and trusted. Leaders feel that it is their responsibility to give back to the medical community and the community at large. A third reason to make case presentations is that it causes you to be known by the Connectors and Mavens. Presenting cases well will cause your name to be a brand equal to the term “audiologist.”
Your case presentations should be made to the physician, and more importantly, to the staff. Recently my wife was diagnosed with rheumatoid arthritis. Two of her friends are RNs, and my wife asked each of them if they knew a rheumatologist. Without prompting, both recommended the same specialist. A good lesson here: recommendations from medical staff are as important as a recommendation from a physician.
The internal medicine specialist is the primary care physician to the geriatric population, and a busy office will see 40 to 60 patients today. Orthopedic surgeons see mostly 60- to 90- year old women with osteoporosis. Pediatricians will be the first to know of speech and hearing problems with a child and are the first to give hope to a grieving parent. Oral and maxillofacial surgeons treat diseases and deformities in the facial and oral region; they work with the team-approach, which usually includes an audiologist. Hospitals utilize in-service training for staff, who are largely Mavens and Connectors. Neurologists help patients with nervous system disorders including cranial nerves and sensory functions. If you are an audiologist in solo practice, it is understood you may not choose to make a case presentation to the competing otolaryngologists, but there are not enough Tuesdays in a year to see every group that would accept your offer for a case presentation.
While there may be many ways to format a case for presentation, I like the format physicians use. After all, physicians will recognize the format they learned in medical school and your use of it will reflect well on you. The format is called SOAP notes. The letters S-O-A-P stand for SUBJECTIVE, OBJECTIVE, ASSESSMENT and PLAN. A final step, which follows the P, is another (P) for PROGRESS.
The SOAP note is written to: (1) Improve communication among all those caring for the patient, (2) to display the assessment, problems and plans in an organized format to facilitate the care of the patient, and (3) for use in record review and quality control.
The four parts of a SOAP note are:
1. SUBJECTIVE —The initial portion of the SOAP note format consists of subjective observations. These are symptoms the patient verbally expresses or as stated by a significant other. These subjective observations include the patient's descriptions of pain or discomfort, the presence of nausea or dizziness and a multitude of other descriptions of dysfunction, discomfort or illness the patient describes. The audiologist will include how the communication problem is affecting the patient’s career, social life, leisure and family life.
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2. OBJECTIVE —The next part of the format is the objective observation. These objective observations include symptoms that can actually be measured, seen, heard, touched, felt, or smelled. Included in objective observations are vital signs such as temperature, pulse, respiration, skin color, swelling and the results of diagnostic tests. The audiologist will be able to discuss and explain the validity and accuracy of several diagnostic tests used in the science of audiology.
3. ASSESSMENT —Assessment follows the objective observations. Assessment is the diagnosis of the patient's condition. In some cases the diagnosis may be clear, such as a contusion. With some conditions, an assessment may not be clear and could include several diagnosis possibilities. In the specialty of audiology, a clear identification of the condition can usually be made: sensorineural, conductive, or mixed loss.
4. PLAN —The last part of the SOAP note is the plan. The plan may include laboratory and/or radiological tests ordered for the patient, medications ordered, treatments performed (e.g., minor surgery procedure), patient referrals (sending patient to a specialist), patient disposition (e.g., home care, bed rest, short-term, long-term disability, days excused from work, admission to hospital), patient directions and follow-up directions for the patient. The audiologist’s plan will discuss the specific prescription of hearing instruments, the reasons for the selection and adaptation, supported by the assessment.
The SOAP Note should briefly express the following: (1) Date and purpose of the visit. The patient’s symptoms and complaints. (2) The current physical exam. What is the patient's age, height, weight, temperature, pulse, blood pressure, visual acuity, hearing acuity, etc.? (3) New lab data and results of studies, reports, assessments. (4) The current formulation and plan for the patient.
4. PROGRESS —The format is completed with a discussion of the patient’s progress. For an audiologist this can be a dramatic and memorable part of the presentation. There are many ways to show degree of improvement, and your goal is to communicate the contrast between the patient’s understanding ability aided compared to unaided. You may use aided vs. unaided word list scores, Speech-In-Noise (SIN) testing, Live Speech Mapping, etc. Perhaps nothing communicates better than video taped clips of pre- and post- tests conducted by the patient.
Some physicians, and audiologists, are better at documenting cases than others. Excellence in this area is a habit that is achieved by discipline and practice. A photograph of the patient should be taken and used to help the audience relate to the case as a real person whose life has been improved by audiology. Documentation should be meticulously followed with each patient. Follow-up visits should always be documented with appropriate SOAP notes. Eventually, all of your charts will be complete for medical case presentation, giving you the ability to select cases relevant to the physician specialty to which you will be presenting.
Communication is the transfer of emotion. It is about getting others to adopt your point of view. These are your cases and you should know them better than anyone on earth. So if you believe in what you’ve done, sell it as hard as you can and get what you came for. Your audience will thank you for it in referrals.
Take a look at web sites from periodontist, orthodontists, dermatologists or plastic surgeons, to name just a few. These clinicians effectively show their cases on their sites to display their skill and their patient’s PROGRESS. They don’t give patient’s names and they do follow all HIPAA requirements. The point is, audiologists can show their work with integrity on par with any of the “ists.” So leverage your work today for more work tomorrow.
Study clubs are multi-disciplinary groups of physicians that meet monthly. The purpose is education and fellowship. These are not intended for CEU credits. Each month a member is responsible for presenting an interesting case to the group. In our city, I know of two groups that include audiologists. If you are a connector, find a group to join, or start one.
Eat and Learns are held on a workday in a physicians office with the lunch and program provided by the guest speaker. You or an outgoing staff member make a call to the receptionist at a selected physician office: “Hello, this is Mindy with Dr. Johnson’s AUDIOLOGY office. I’m calling to see if I could set up a time for an Eat-And-Learn for Dr. Johnson to do for your staff to present a couple of AUDIOLOGY cases?
Know in advance that physician staffs enjoy eat-and-learn events. They don’t like it when a rep or another physician treats their physician to a lunch away, because it leaves them out. An offer for a lunch means they get to have fellowship with their coworkers, their boss, save lunch money and learn something at the same time. At least 50 percent of a referral is influenced by the staff. Because when the staff likes you, has met your personality, has seen samples of your work, they are Mavens and Connectors with the power to reach for your referral pad when the physician says, “I want to refer Mrs. Smith out for audiology testing.
Many of our clients schedule case presentations 50 weeks out of the year and this constitutes their total marketing program, with overwhelming success. Consider making this tool a part of your strategy, too.
James W. Wilson is general partner of The Wilson Group, a marketing firm located in Fort Worth, TX. He works with healthcare practices nationwide. Wilson is the author of The Consumers Guide to Hearing Aids, The Five Steps to Better Hearing, The Consumer’s Guide to Hormone Replacement Therapy, The Consumer’s Guide to Cosmetic Surgery, May I Help You?... telephone training for reception staff, and other practice-building resources. The firm's web site is www.jameswwilson.com and the author can be contacted at jimww@jameswwilson.com.
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