Welcome everyone to the webinar on how to design an effective case history questionnaire. We're so glad you could be here today to learn more about the importance of an effective case history and how it can benefit your patients and your business. Your moderators for today are me, Keri Peterson, IHS Education Administrator. And me, Fran Vincent, IHS Marketing Manager. Our expert presenter today is Dr. Deborah Wall. Deborah earned her Master of Science in Audiology from Wayne State University. Residing in Michigan, she was the Assistant Regional Director for a large dispensing organization, but she longed to return to a less hectic pace of life and move closer to her family. In the summer of 2003, she took over her own private dispensing practice, AudioAid RX of Midland, Michigan. Deborah is also an instructor for the International Hearing Society's Audio Pressology Program. We're very excited to have Deborah as our presenter today. But before we get started, just a few housekeeping items. Please note that we are recording today's presentation so that we may offer it on demand through the IHS website in the future. This webinar is available for one continuing education credit through the International Hearing Society. You can find out more about receiving continuing education credit at our website at IHSinfo.org. Click on the webinar banner on the home page or choose webinars from the professional development menu on the left side of the page. There you'll find the CE quiz and information on how to submit it to IHS for credit. Also on the webinar page at the IHS site, you'll find a note-taking guide to help you gather the information you'll need for the CE quiz. If you haven't already downloaded it, feel free to do so now. As a special bonus, everyone who completes the 60-minute webinar and submits a CE quiz with the CE quiz fee will be sent a special download with a case history template to use in your practice. Tomorrow you will receive an email with a link to a survey on this webinar. It is brief and your feedback will help us create valuable content for you moving forward. Today we'll be covering the following topics along with Q&A within a 60-minute presentation. Learning how an effective case history can ultimately generate more referrals. Gaining an understanding of how the case history can allow greater ease of getting patients to accept amplification. The importance of the case history to help create a plan for effective modes of communication to mirror lifestyle. At the end, we'll move on to a Q&A session. You can send us a question for Debra at any time by entering your question in the question box on your webinar dashboard, usually located to the right of your webinar screen. We'll take as many as we can in the time we have available. Now I'm going to turn it over to Debra, who will guide you through today's presentation. Hello, everyone. I'm so glad all of you could attend because this is just an exciting webinar about a case history. I've always thought the case history is an important tool in all of our practices because it's the initial meeting of your patient. Generally, people start off with the case history. I mean, you may have a different protocol in your office, but I've always done that because I think it's a good starting point to create a bond with your patient that you're going to take through the process from testing case history to ultimately hopefully fitting with amplification. A couple of reasons why a complete case history is so important. Sometimes we get into the day-to-day routine of just filling the blanks, this and that, and we kind of need to step back once in a while and really analyze why are we asking these questions. What is the purpose of it? Because if we do that every once in a while, we can get a better understanding how the case history can give you invaluable information to use with your patient and also to create a stronger practice through continued referrals from outside sources. But the first thing that I wanted to talk about is with why a complete case history is the word who. How does that apply to this particular subject? You know, we have a person and we're starting our case history. We want to kind of figure out what we're going to do, and based on that question, we need to figure out or look who's in front of you. Is it a child in front of you? Is it an adult? Is it a veteran? Is it someone there for workman's comp? Is it a senior? The broadcast is now starting. All attendees are in listen-only mode. So we want to start off why a complete case history. I might be repeating myself, but I just got a little glitch with my headphones. But who's in front of you when you start your case history? Is it a child, an adult, a veteran, someone there possibly for a workman's comp case, a senior, is it a nervous Nelly or an eager engineer? So you want to figure out who's in front of you because based on who's in front of you, you're going to pick the appropriate case history to use. For instance, most of you are probably in the practice of using an adult-slash-senior case history because that's going to probably be your biggest patient load of the people that you encounter on a daily basis. But just some other case histories that go in conjunction with this particular one is if you had someone that maybe needed some evaluation done for military purposes. And if that were the case, the case history is going to involve more questions revolving around noise exposure, tinnitus with dates of onset of tinnitus, severity of tinnitus, any instances that may have happened when they were in the military. And if you're like a lot of people in this field, you're seeing more and more military-driven people coming in because the VA has really started dispensing a lot of instruments and people are calling up and needing tests and so on. So that's something you want to think about as far as a case history when you're focusing on that type of clientele. The other possible person that might be sitting in front of you might be a child. If you're doing a child, most of you probably are, but if you are, the case history is going to evolve around different types of questioning such as pregnancy questions, the onset of the hearing loss, any learning disabilities the child may have. And usually I find with children one of the most important focuses of the case history is to find the cause of the hearing loss, whether it was congenital or acquired. And also there's going to be a lot of information needed for educational purposes. Rule of thumb, when I encounter a child, I don't specialize in children and I can do it, but I usually refer them to more of a person that's had more experience in the pediatric world. And then another case history you might be focusing on is someone that comes in for a workman's comp case. And if that's the case, then you're going to probably focus on some information based on their accident that caused them to be put on workman's comp, symptoms related to that. If you have a person that's coming in maybe that's gotten in an accident and is applying for workman's comp, you probably are going to want to have a little light bulb go off in your brain thinking, oh, I wonder if this person is going to be a malingerer, are they going to try to budge a hearing loss severity and so on. So these are all things that you would probably notice or you want to keep an eye on when you look at who's in front of you. Based on who's, you're going to take the case history to that particular bit of information. Now under what, this is an important question, and I know a lot of you have probably attended other seminars. What brings you in? What brings you in today, Ms. Nervous Nelly, or eager engineer? Because by asking this question, you can determine maybe what part of the case history you need to devote a little bit more time with. If you have an eager engineer, you probably are going to stick to the facts a little bit more. I don't mean to pick on engineers, but they tend to be a little bit more direct and analytical versus some, maybe a little nervous Nelly, as I call her, who's a little bit nervous and kind of doesn't know why she's there. She's a little bit scared and she's just more of an introvert. That particular person, you're probably going to focus more on making them feel comfortable. That's one thing I didn't talk about yet. What I like to do as soon as I start working with the case history and have the person in front of me is that 60-second bond. I really believe the 60-second bond can just set the tone of the whole afternoon or the whole process of who you're working with. It can build confidence. It can destroy confidence. That 60-second bond, you really want to kind of figure out what the approach you're going to use with that person. Whether it's going to be just the facts, stick to the facts, or have facts with feelings. That's something you develop over time. It's almost like a sixth sense. You kind of feel that person's energy if you want to get metaphysical about it. You kind of know where you need to go. By knowing what brings the person in, as I said, you can help decide, maybe I need to spend a little bit more time with this or a little bit less time with that. You can budget your time accordingly, case by case. Maybe they would say, I'm here because I can't hear. My wife says I can't hear. Then you're going to want to make sure the wife's right there to help complete the case history. Or I need a test for work. You might think, oh, okay, I'm going to whip through this, because probably the person's normal. They just need an annual test or something. I need a test for a VA, for VA purposes. That reason for coming in, you know you're going to focus on those questions we talked about, about dates of onset of tinnitus and so on. Or if they say, you know, I want to try new amplification. If they say that, then you know, okay, they kind of have that in their mind already, so you can budget your time based on that piece of information that you got from the what. And, you know, was there a pivotal moment that caused you to come in? Oh, you know, I was at my granddaughter's dance recital, and I couldn't hear a thing, and I was so upset because her little voice. Or, you know, I got this new babe and my new girlfriend, and she keeps saying something I can't hear, and I need to hear everything she's saying, because I'm thinking she wants to take it to the next level. You know, it's just little things. You want to know the pivotal moment. What made them maybe possibly come in? Now, under the question of where, is where are you going with this particular person? Are you going to possibly fit them with amplification? Are they going to be a medical referral? Well, let's say they came in, and under the what, they says, well, I'm here because what brought me in is I woke up today, and I couldn't hear in one ear. The where is where are you going with this patient's going to be. They're going to go directly to the doctor. Do not pass go with a sudden loss like that. So by knowing the what brings them in, it helps you with where you're taking them in the process. Or what brought me in was I need a test for work, and as I said, okay, well maybe we just need to do a screening on this person. Now, the next thing is, I'm going to switch these words around a little bit, is how. How are you going to get to your ultimate goal, such as amplification, and if you've established that through the what and the where, how you're going to get through that is careful questioning in the case history about their difficulties that are occurring right now. Later on, we're going to talk about rating of hearing category. We're going to do a lot of focusing on that. So how you're going to get there is kind of the vehicle based on those first couple of questions, who, what, where, and so on. Is it a medical referral? So how you're going to get there is just refer them to a doctor. And then finally, when. I threw this in because people say, when do you think the amplification process starts? Or really, when does the oral rehabilitation process start? And I always believe it starts at the case history, because that's when you get to know the person's problems. You're developing a program for them. So the whole process starts in this case history with specific questions that you're going to be asking your patient. But you're really writing a story about your patient, chapter one, chapter two. And then obviously the end is going to be a solution to the possible problem that brought them in, either fitting them with amplification, a medical referral. Another thing is you want to, writing the story is to complete the stories, enroll them in some sort of oral rehabilitation program, and so on. But now picking the appropriate case history of the patient, we kind of touched upon that. Once again, the pediatric, adult, military, or compensation. And all this information you can get right up front when you find out when or why they're there, because then, once again, you can devote the time that's needed. Because if you're all like me, time is always a valuable commodity, and you want to use it very effectively. And that's one of the reasons why I'm very, when I first meet a person, I like to immediately know what I need to do, where I'm going to go, how I'm going to get there, what this person needs, and so on. Just some general information we all know that we need is their name, obviously, their address, their email, birth date, insurance, and so on. And the other thing that I wanted to make sure is that one of the things is we want to, nowadays we want to make sure we put possible web address, because web addresses can be very instrumental in helping people get names and information where you can do some marketing through the web. So that's an important thing that you might want to include in your case history. But more on general information is you want to get the name of the person's doctor. And we're going to talk about this a little bit more in depth, because this, to me, is the first step in starting a referral program that you can use in conjunction with your case history, is getting every person that comes in that you're going to be testing. You want to make sure you get their physician's name, and you want to send a copy of the hearing results to the physician with a letter. Because by doing this, it's going to really promote a lot of professionalism, and it's going to put you in the front-runner of that physician, because it possibly may lead you to obtain more referrals from that particular physician. So that is a really, really key important thing, is with all people, make sure you get the physician's name and ask them if you can send them a copy of the results. And by doing that, as I said, you're going to promote a lot of professionalism within your practice, plus it's going to give you more and more confidence with your patient, because they know that this is a medical situation and you want to involve their primary care physician. Now, with the physician referral program, based on the case history, a lot of you probably have done some research or some seminars, attended them on physician referral programs. But I really believe that one thing is the case history starts a program that you can start in your particular area just by gathering doctors' names of your patients. And by sending a follow-up letter with every person you do. Now, in the beginning it can seem overwhelming, but once you get in the mode of it, it's very quick and it's very effective. A lot of times what we'll do here at our office is the office manager, whoever gets the paperwork together, will have the envelope type for the doctor's name and address, so then the professional just has to write the letter, make a copy of the test, and it's all set to go. And it creates a communication that you can actively pursue with the physician. And based on that, then what you can do is actively get into possible some lunch-and-learns. I know a lot of you probably, as I said, have gone to maybe some seminars on physician referral programs and they've talked about lunch-and-learns. But if you start with the case history and start a relationship through a mutual patient, once you do contact that doctor, you have a common point of interest, which is their patient so it's just going to get you in the door easily, or a little bit more easier if you do it with that in mind. Once you do a lunch-and-learn, and basically a lunch-and-learn is you take a lunch in and you talk about a subject. Some people will take lunch in and just get to know the doctors, or they'll take lunch in and discuss something, something new, whether it's a new hearing aid or talk about digital hearing aids. I find a lot of times when I would go to my lunch-and-learn, the doctors would have questions about specific hearing aids, they've read somewhere, or this person had this, and they're very, very curious because they want to know because it involves their patient. Once you do that, you just keep the process going on by keeping them full of candy and cupcakes and cookies and all those good things, and the cycle begins. I think we all need to learn on the process that drug reps use because it's pretty much the same system. You just constantly stay in contact. This program does not happen overnight. It takes a while, but these letters with the case history are just little stepping stones to create the foundation for a very professional relationship going forward. It takes ten minutes out of each person you see. What you'll do is you'll start seeing a pattern where, oh, it seems like everybody's going to this doctor, or everybody's going to that doctor. Once again, it takes you back to time management. You know, hey, I need to focus on these certain doctors. That's what I have found. A lot of my patients see a group of certain doctors and they're really focused on them. I think you need to find the doctors that are very receptive to you because not all of them are going to be. You need to find the ones that are and really develop a strong relationship. This all goes back to the case history, just getting that information from your patient and starting that letter. Under the case history, under medical information. In the old days, nobody really took a lot of the supplements that they take now. When you're doing a case history, it's really important to list their medications and their supplements and all that good information because, as you know, a lot of medications can cause hearing loss, but a lot of them can cause dizziness. This is information you want to know, so when they come in, a lot of times they'll bring in a list of the medications and you can just make a copy and throw it in their file. You definitely want to know if they're on Coumadin. If some of you do cerumen management, Coumadin is definitely something you want to know if they're on because, as you know, it's a blood-thinning medication. If you do cerumen management, you want to be aware of that because if you nip their ear, you might have a bleeder and you might have a problem. Things like that, it's important to ask because of that reason. The other couple of things you want to find out is if they're diabetic. Along with the diabetes, if they are diabetic, it can affect their hearing, so you might want to put that person on a yearly schedule of hearing evaluations. Also, back to the cerumen management, if they're diabetic, as you all know, you have to be extremely careful. If you cause some sort of sore, wound, or laceration, they have trouble healing. These questions we just don't ask because we want to take up time. There's a reason why we ask them. Radiation treatment, have they been under radiation treatment in the last six months or so? Chemotherapy, have they had it in the last six months? That's an important question because if a person is under chemotherapy, not all... In fact, I'm not a specialist on this subject, but a lot of times chemotherapy doesn't affect the hearing. Some do, some don't. You want to know that information because if it does affect the hearing, it may not affect it when they're taking it, it may be later on or may be a couple of months down the road. You want to know that because you want to be proactive. If they get amplification and then all of a sudden they come in and say, well, I'm just not hearing like I used to, these hearing aids are terrible, then the little light bulb is going to go off and you're going to say, oh, you know what, that person was under chemo, I wonder if their hearing has changed. Give you a heads up to prevent any problems going forward. Some people do come in and if you know in advance they've had some TMJ problems, you know that possible fit issues or they may have pain issues with their jaw and so on, you've all had patients like that. If you know that in advance, once again, you're going to be on the offense because I am definitely an offense football player versus defense because I like to be prepared as much as I can. If you have all this information, then you know going forward you might have some issues with it. Then, we have the stroke, heart disease, kidney disease, and so on. All these things you want to ask. One thing about kidney disease, if they do have kidney disease, you want to keep an eye on their thresholds because the kidney disease and hearing loss can go in conjunction, too. All those things are extremely important. Sorry to keep jumping around here. Then, finally, dizziness. So many people have dizziness that it's really important when it shows that they do have dizziness to really question them. Is it dizziness? When they get up too fast? Or is it vertical, where they're like crawling, where it's just the room is spinning? Two different things. If it's a vertical issue, then that's a doctor referral. If it's a dizziness where, oh, I get up too fast or this or that, now that's a totally different thing. So, you want to really question them when you get to that part of the case history. More medical questions. Have you had your hearing tested previously? You want that information. You want to find out when. Most importantly, you want to know the outcome of that test and the action they may have taken. Because if they say, oh, my hearing was normal, I had it tested a year ago, then you probably are preparing, well, they probably have normal hearing and so on. But if they say, oh, well, I had a hearing loss and I decided not to get hearing aids because they wanted this much money and I just can't afford that, that's a two-part question. Because they've told you, kind of in a roundabout way, they know they need hearing aids, but they can't afford hearing aids. It's not that they can't afford them, but they don't want to pay or they can't afford maybe the most expensive one. So it gives you information that you can guide yourself around and kind of have your plan of action already set in your head where you're going to go with this. So that's invaluable information. Or yes, I had a hearing test five years ago, and yes, I got hearing aids and I hate them and I've never worn them. It opens the door, oh, okay, well, let's find out why you didn't like them and so on. And based on that, prevent possible problems going forward. And then we have, we want to ask their better ear, and we know we want the better ear and that's for testing purposes. And also, it gives you another heads up if they possibly had a sudden loss where they woke up and their hearing was just gone. You know, it never ceases to amaze me. I'll test people that they'll have an asymmetrical hearing loss and I'll say, well, how long has that one ear been that low? Oh, I don't know, I woke up one day and it was just like that. And they never bothered going to the doctor or having it checked because, you know, when a person has a sudden loss, it's time is not the friend. They need to get to the doctor, ASAP. And rule of thumb, if I have a person with a sudden loss, I immediately pick up the phone and call an ENT. And if I can't get them in, I'll even send them to emergency because the sooner they can get treatment, usually through steroids, there's a possibility that that hearing could come up to a certain degree. So sudden losses need to be dealt with quickly and swiftly. You know, I don't like to say to a person, well, you're going to have to call your family doctor and make an appointment. You know what? Are they going to wait six months to get in for an appointment? You need to be their advocate. Get them in somewhere so they can get some treatment. And then drainage, that's a no-brainer. If their ear is draining, you're not going to touch them. You want to send them to the doctor. They have pain, discomfort, fullness. If they have fullness, you know, you can do a, if you do tympanometry, that can maybe indicate some sort of middle ear problem or so on. Okay. More medical ideology, sudden loss, we kind of kicked that to the curb here. I mean, I just can't stress, you need to get that person in ASAP to some sort of medical treatment if you're going to help them regain any of the hearing they possibly have lost. And then excess noise exposure, you want to find out these, get these questions answered because, you know, if they've been exposed to a lot of noise, such as hunting, I don't know, lawn mower, things of that sort, you want to know that information. Plus, you want the information to be told because then you can counsel them on hearing protection going forward. And you know, for instance, if they're a musician, then you can counsel them about maybe noise, their musician earplugs. So it's another revenue of something that you want to look in and possibly help your patient with. And then we want to definitely find out if they've had any form of ear surgery because, you know, you want that information before you go in there and start examining the ear canal. So, you know, look in their ear and say, why is there a big hole in their head? So you're kind of prepared for things that you may be seeing. Now, tinnitus is, maybe it's just in my world, it seems like it's gained popularity, and I think a lot of it is because I do work with a lot of veterans, is so many people have it, and it's just not military. And I'm seeing it more and more, especially in our young population because of iPods and so on, which is another subject. But you want to ask them, is it present? How long have you had it? Which year do you have it in? Well, let's say they say, well, I've had tinnitus, and oh, I woke up yesterday and I had it in my one ear and my hearing was gone. Once again, that's a red flag where, oh, that needs to be addressed with the doctor. So you want to find out how long they've had it, which year, and, you know, these questions are major questions that are always asked when you're dealing with the military, but you do want to know someone that's not connected with the military or even hasn't been exposed to excessive noise because all this information is useful one way or the other. How annoying is it from zero to ten? You want to find out how annoying is it because based on that information, then maybe they need some counseling on it. If it's zero, then who cares? Zero being, I don't even have it. Ten being, oh, it's sometimes unbearable. Then you know that maybe this person is there for a test, but maybe they need to look into some possible tinnitus retraining programs, which are different clinics offer, or you need to look into possible hearing aid. I know there's one hearing aid that I don't really work with that you can use in conjunction with tinnitus, and it's got a mask or some sort of system built into for very positive results about it. So you want to know where they're at with that. You also want to know, because they're going to ask you a lot of times, you know, if I get hearing aids, is this going to make it worse? But if you have a heads up on how bad it is, you can kind of be prepared for that. Finally, when I was getting my AUD, I had to take certain classes, and one of them was a class on tinnitus, and I just said, you know, I know everything. I don't know why they're making me take this stupid class, but I learned some very important simple things from taking that class that made it worth every time I went and logged on and did my tests and all the work I had to do, because one thing that I learned from that class, and to date I have not met anybody else that, it's usually new information, and that is when a person has extreme tinnitus, you want to be careful fitting them with a certain model hearing aid. They discourage people with this type of disability to be fit with CICs, because they have found that it can intensify it, because the CIC is so far in the ear, and it's kind of the same scenario, if you plug up your ears and you have it really bad, you can hear it worse, so something to think about. Not in every case, I mean, we don't fit the CICs like we used to, I mean, most people don't, but so these are questions you're going to get when you're asking your patient about the tinnitus, and now you kind of know why it's so important. It's not just, you know, you want to ask them questions. And then hearing history, what experience have you had with hearing aids, and that kind of goes back to, have you ever had your hearing tested, it gives you a heads up on what they think, their experience and so on, and there's one question that I have used, you know, you get a person in, I've had hearing aids, I just hate them, my friends hate them, I don't know why I'm here, my wife made me come, you know, I don't have time to fool around with people like that, they just come in negative, and you know, I need to turn them around quickly, so I will just cut to the chase and ask them, what do you think a hearing aid should do? If they say to me, well, I think a hearing aid should make me hear normal, and I should be able to hear my wife when she's doing the dishes and the TV's on, and the grandkids are screaming, then you know that you're really going to have to spend a lot of time on counseling with this person, and a lot of time explaining limitations, or they're going to end up just like they were with the other hearing aids, they're not going to accept them, so by asking that question, you can get a lot of information on what that person is expecting, because then you can meet halfway with them, tell them what a hearing aid is going to do, and what it's not going to do. As you all know, if you do that with people, right there, they're with you for life, because they recognize that you're really trying to help them, and you're cutting to the chase. I always say, I like to tell people the good, bad, and evil, because I've had people even say, well, are you saying I shouldn't get hearing aids, and I find it amusing, because I've just gone so far to the other extreme by explaining limitations, but I'd rather have a person unhappy, or happy, than be unhappy, because the limitations were not expressed correctly. Other questions, does your hearing loss make it difficult to hear, of course, that's why they're there, difficult with the phone, TV, or the radio, that's a door that, oh, okay, that person has problems with the phone and the TV, they might have to have some ALDs in conjunction with their hearing aids. Do they have difficulty with restaurants, religious settings, theaters, and so on? That is good information, because a lot of churches are getting these loop systems, so you want to get that information at that point, if your church has it, and at the same time, if they do have it, it might be a possible good referral source for you, if you contact the church and tell them that you are an expert with loop systems, and so on. Another referral source that you can get from asking that question, does your hearing loss cause you to feel stressed or tired? These are questions that, and it's an emotional thing, and it's kind of like it's an emotional cleansing if they say, oh, I'm just so tired of not being able to hear. These are valid questions. And then, how would you rate your hearing? One, not affecting my life, ten, severely affecting. Based on the number, it's going to kind of tell you where you need to go to. Do I need to devote a lot of time with limitations, or do I need to know, or do I need to spend a lot of time kind of figuring, or helping them, guide them through the process that, you know, I really do have a hearing loss, getting them out of the denial stage, based on the number they're going to pick. It just gives you an idea of what to focus on in the explanation of the process. And then you can have the spouse rate their hearing, because then you know where their spouse is in the particular situation. The other thing is you want to, maybe it's kind of a modified COSI is to have them give you three listening situations where they would like to hear better and you can jot them down. You put this right in your case history and then you can go back to it after you've fit them with the amplification and it's right there and you can go over those situations and see how they're doing. With lifetime assessment, I find it interesting because this field has just evolved because we have these baby boomers, we just have all these people that have these unbelievable active lifestyles. So when you're counseling or when you're doing your case history, you wanna find out about their lifestyle. What do they do? Are they active? Are they in a lot of background noise? Or do they have a casual lifestyle? Are they occasionally in background noise? Do they have a quiet lifestyle? Is it limited background noise? Is it very quiet where they have rarely or in background noise? You wanna find that information in the case history because that's going to dictate possible technology that you're gonna fit them with. And then another question is what hobbies do they have? You know, do they play cards? Do they line dance? Do they golf? You know, all those questions need to be asked. You know, it's a good bonding question, but also it's information you need to get for their lifestyle assessments so you know what technology to fit them with because that's the name of the game nowadays. It's, you know, it's really we fit lifestyles, not really hearing loss. And then, you know, you might wanna ask them what hobbies have you quit doing because of your hearing difficulty? And, you know, that's gonna give you information. Well, let's get their hearing going again and maybe they'll take those hobbies back up. So those are things that you wanna incorporate in your case history. And everyone's got a different way they can ask, but I think in a nutshell, if you focus on these questions, you're gonna get a lot of information to help you dispense the appropriate hearing instrument. And then are you ready? You know, if I can help you, are you ready for hearing instruments? Cut to the chase, just come out and ask them. You know, are you ready? I mean, let's do it. And it helps establish where they are in the process. You know, I've seen some people, even before they test the person, they'll ask them this question. And that's really why I put it in the case history because it, once again, gives you a heads up on what you need to focus on. You know, it's a really quick and easy question and you know where their head's at and you need to know what you need to do. Because you know, I'm all into budging your time on what is needed. But you need to read between the lines of the case history, really, really devote on what is that person telling me? What are they telling me? You know, when you are asking them questions. And you know the old saying, I hate to always have to use this, but we have two ears and one mouth for a reason because we need to listen, listen, listen. Listen to what they're really, really telling you when they're answering these questions. Because if you really listen, I think you'll really pick up a lot of things that are subtle, just here or there. You need to realize that you're part psychologist along with hearing aid dispenser too. Okay. Okay, Deb, thank you so much. Well, everyone, we're really excited that well over 130 colleagues have joined us today on the webinar. You may have noticed that we did have some audio difficulties in the beginning. We're so sorry about that. But in case you missed the information about CE credits, et cetera, make sure you stick through to the end and we'll talk about that. We are gonna take some questions now. So if you have a question, please do enter your question in the question box on the webinar dashboard. And before we get started, again, Deb, thanks so much for joining us. Deb has earned her master's of science degree in audiology from Wayne State. And she has her own private dispensing practice called Audio Aid RX in Midland, Michigan. So we're really, really privileged to have her today. So our first question comes from Allen in California. And he wants to know, what is the most effective? Giving the patient the case history questionnaire when they arrive along with other forms like HIPAA disclosures, et cetera, or is it better to take their case history verbally? Deb, what do you say? I don't think there's a right or wrong answer. I can tell you what we do is, you know, I'm into time management. We have the patient fill it out and then we go over it very carefully with them. Because, you know, in this presentation, I was kind of noticed, I was really trying to be time management efficient. And by doing it that way, you kind of know what you need to focus on and get a heads up. I read over it before I even take them back. And I kind of know where I'm gonna go with my who, what, where, and when based on the information they've given me. So there is no right or wrong answer. I generally have them fill it out unless they're unable for some reason. Thanks, Deb. Thanks, Deb. Okay, we have a question from Martin and he wants to know, do you take pictures of your new patients? You know what? No, we don't, but I think that's a great idea. That's a great idea. And I assume put it in a file or I don't know if you, if we don't take pictures of it, but I think that's a great idea and put it on the wall possibly. Okay. Okay, great. All right, we have another question from Tom and he is interested to know if you ask about OXO, oh, excuse me, ototoxic medications and if so, what will you do with that information? Well, when I ask the medications they're on, if they are in ototoxic medications, I'm gonna usually find out why. It's so rare with my experience. The only time I've ever really focused on it is when they were having their hearing monitored because they were on ototoxic medications. But I don't mean to, I'm assuming what your question is, if you find out they are, how should you approach it with a physician? Obviously, you're not gonna call the doctor screaming, saying, oh my God, you're doing this, this and this. I guess I would just possibly write a little letter or you have to be very careful, but I would find out why. A lot of times they're on it because it's the only solution. In every case I've seen where they are on it, it's the only medication they can be on in their case for whatever reason. The case I had in particular, he had a major, major infection and he had a pump that he was being treated with and he had to do this or he was gonna lose a limb. So that's usually why they're on ototoxic medication. Okay, great. Felicia wants to know, if you think it's better to have two questionnaires, one for medical history and another for hearing aid related questions like lifestyle, difficulty listening, that type of thing, or should you just lump it into one lengthy questionnaire? I think that's a great question because I think you can do whatever you want. I think it depends on your practice. If you have, if most of your patients are one type, I think it's easy to have one questionnaire, but let's say you have multiple different groups of people coming in because for instance, we'll have one for the VA, medical VA, and then medical adult. So, you know, it's, I don't think there's a right or wrong. I think you can do whatever fits into your practice based on your clientele and your patient load. And you know, you probably think that this is a lengthy case history form, and it is. That's, and I put everything that I think, and I think you can pick and choose what works for you. Okay, excellent. Elisa would like to know, how many of these questions do you have people fill out in advance while they wait, or even through the mail, or do you prefer to ask all of this face-to-face? And it kind of goes back to that first question I asked you. And actually we had a couple of people ask, do you send this type of questionnaire in the mail once you know, after they book their appointment, once you know that they're coming in so that everything's filled out when they show up? You know what we have? It depends on when their appointment is, obviously. If they make it three days, we can't get it to and fro, but to them in time. But I think it'd be great if you could send it to them in advance, because then they can really think about it. And once again, it's time efficient for you, because they'll have it filled out. Because if not, we always insist people get, before their appointment, they have to get there at least 15 minutes early. And that's with any medical practice you go to. You always have to go early to fill out paperwork. If not, you're running behind. So to answer your question, I think mailing it is a great way to do it. I think the key is, is there's no right or wrong, mailing, having them fill it out when they come in, or you just filling it out for them. I can't imagine me filling it out for them, to be honest. They gotta do the work. I'll look it over, and then focus on what I need to focus on. Okay, fair enough. Sheila wants to know, if you think a spouse should fill out a separate hearing assessment? That's a good question, too. I think you could have how you rate your overall hearing. I think you could have a special form for the spouse. I think if you took how you rate your overall hearing, that rating scale, and then possibly create where would you like your spouse to hear better. I think that's another great idea. You guys really, you're putting me to shame, because I never even thought about that. I think that's great, because it is a family affair, and it involves a third party. And I mean, that's what we always are trying to do. So I think that's a great idea. I think somebody needs to work on that. And send me a copy. Hey, Deb, Barbara asks if it's important to get information on vitamins and herbal supplements the patient might be taking. Yes, I think it is. As I said, I'm not an expert on herbal medicines or vitamins, but you need to remember that there's a lot of stuff out there. If you look at the side effects, it can cause certain things. And the problem is when you have, if you ever take a class on ototoxicity, which I was blessed to take, and I thought I knew everything, like tinnitus too, like I said. But the rule of thumb is anytime you start mixing drugs, there's like a percentage, and I can't remember. If you have four, then there's, multiply it by such and such to get that many more side effects. But to answer your question, yes, because when you're, because an herb is a drug. And I think sometimes we forget it is. And a doctor had to rudely tell me one day when I said, I don't wanna be on this medication, I wanna take this herb instead. And he looked at me, he says, well honey, that's a drug too, that's so. Yes, to answer, it's a natural one, but it is still a drug. And we need to figure all that out so you have a complete case history. Plus, you know what, the more interest you show in your patient by gathering information, the more confidence they're gonna have in you. Just like when you go to the doctor and they do an intense case history and listen to you, it makes you feel like they care. You know, they really do care. Okay, Deb, Barbara would like to know when and how would you update the case history? Would you do it at an annual hearing test, more often, et cetera? What do you think? I think annually it needs to be updated. And you know, it may seem like a lot of work, but if you let them do the work, you know, you're not doing it, you're letting them. And you know, everybody loves doing things for themselves that they should. I mean, if it shows you care. Because those questions may have changed, especially the medications. They may be hearing differently. They may have had chemo. You know, in a year, I think an annual, and you know, I think that's one thing we need to get into there. I'm guilty of it. I think we need to kind of help start instilling to our patients from day one, okay, we're gonna have to annually test your hearing. I think that's an important part because it, you know, that's like with any medical test. You have it done, well, most tests, yearly. So I would have them fill it out all over again. Have them fill it out. It certainly can't hurt. Deb, we have a question from Charles, and it's a great question. He wants to know if you include a copy of the case history questions to the doctor, the physician, or do you just include some important points as important in terms of how important you think they are related to the report? Do you include facts from questions within your letter? You know, what exactly would you send back to the doctor? You know, that's an excellent question. Number one, you need to realize doctors hate reading stuff. I hate reading stuff about people. We all do, let's be honest. So whenever I write a letter to the doctor, it's one page, brief, to the point. In fact, I hope you all get the template for this in because there's a letter that you can use as a guide to send to the doctors. Basically, I make it short and sweet to answer your question. I do not send the case history because that's my information. I mean, I'm writing little notes all over it. You know, like this person's a, I won't even say, you know, little notes. We all have those people. We make little code names so we know how to handle them. So I would never do that, but you know, with your letter, a letter and a copy of the test. In the letter, first paragraph, explain the type of loss, bilateral, sensorineural, mild to moderate, scram, dah, dah, dah, tympanometry, if you do it, ear canals, unremarkable, get into the problems they're having, and then the solution. I'm gonna give them a trial of amplification, put them in the aurorabilitation program. I'll keep you updated, doc. Oh, quick and to the point, and then your name's there, their patient's there. They like simple, simple, simple, simple. Okay, great, Deb. We have one more question, and I actually have a follow-up question after this. One of the attendees wants to know, or actually makes an assertion that she's noticed more seniors are using cell phones these days, and she's interested to know, is that something you should ask on the questionnaire? Should you ask what type of phone they use regularly? I'm assuming because of the implication of the type of the phone, cell phone, versus just the regular landline and how that might affect their hearing. What do you think about that? You guys are just too smart. I really can't deal with this, but you're absolutely right. On our case history, we have phone, home, cell, work. Absolutely, because you're right, that is important information to know, because you wanna be able to get contact with them, but also because of the fitting process, you kinda know, and usually we'll have them put an asterisk next to the number that they use the most. I think that's a very good question. Good morning, Melinda. Okay, well my follow-up question to that is that I know a lot of people who use earbuds to listen to loud music on their MP3 players. Is that the type of question that you would include in the lifestyle portion as well? Yes, and the lifestyle questions, I made it very short and simple, and I based it on noise, how much background noise they're exposed to, and really, you need to go in a little bit more depth, because I wanted to make it somewhat simple, because obviously, those are questions that you wanna ask if they use their headphones, and that's gonna be an active lifestyle. You can really go in depth, but usually what I do is I let them pick possibly where they're at, and then from that, I'll ask them key questions to help me. That way, the case history won't have to be like 23 pages long. So if I see, oh, they're an active lifestyle then, or even the next one, I'm gonna get into, oh, okay, do you use your iPod or your iPad, do you have an iPhone, how do you do it, da-da-da-da-da, based on that information. Because remember, this case history's a guide. It's kind of like an outline, and then you wanna kind of tweak it based on what information you get. Great, Deb. Thank you so much for all that information, and I'm gonna turn it over to Keri now. She's gonna tell everyone how to get all the information with CE and all the bonus materials, okay? Keri? Thanks, Fran, and thank you, Deborah, for an excellent presentation. And thank you, everyone, for joining us today on the IHS webinar on how to design an effective case history questionnaire. If you'd like to get in contact with Deborah, you may email her at dlwall at ameritech.net. For more information about receiving a continuing education credit for this webinar, visit the IHS website at ihsinfo.org. Click on the webinar banner or find more info on the webinar tab under professional development. As a reminder, you can get bonus materials from this presentation, including a case history questionnaire template and a physician letter template by completing the CE quiz and submitting it with payment to IHS. IHS members receive a substantial discount on CE credit. So if you're not already an IHS member, you will find more information at ihsinfo.org. Please keep an eye out for the feedback survey you'll receive tomorrow via email. We ask that you take a moment to answer a few brief questions about the quality of today's presentation. Thank you again for being with us today, and we'll look forward to seeing you at the next IHS webinar next month.

webinar

designing

case history questionnaire

patient information

treatment plans

annual updates

patient engagement

phone usage

headphone habits