Broaching Difficult Conversations: Recommendations for Audiologists

By John Greer Clark and Kristina M. English

This article is a part of the July/August 2019, Volume 31, Number 4,  Audiology Today issue.

Twentieth century American psychiatrist and internist George Engle observed that, in addition to biophysical and psycho-emotional concerns, patients also exist within a social context encompassing family, friends, and community. Dr. Engel's (1977) biopsychosocial model of health-care engagement underpins what we recognize today as person-centered care.

Many health-care providers, including audiologists, fail to engage in person-centered clinical behaviors that recognize the biopsychosocial interactions of health, even though patients prefer this dynamic (Grenness et al, 2015; Roter and Hall, 2006). Among the seven characteristics of person-centered care (see Table 1), the sixth characteristic—a holistic outlook for those we serve—draws attention to our need to confront the uncomfortable with patients. Two such uncomfortable topics include childhood bullying and encroaching dementia.

Childhood Bullying 

Childhood bullying is nothing new. Recent research has raised heightened concerns about the long-term effects of bullying: i.e., children with a history of being bullied are more likely to experience overall mental and physical health problems, anxiety, depression, and self-harm throughout their adult years (Lereya et al, 2015). To stress the importance of this concern, childhood bullying is now considered a form of child abuse (Takizawa et al, 2014).

Children who are being bullied hesitate to ask for help. Rather than wait for a child to mention the problem, the American Academy of Pediatrics (2009) adopted screening for bullying concerns as a standard of care. Squires and colleagues (2013) have since advocated for audiologists to assume the same responsibility, for instance, screening for concerns after routine assessments are completed.

We recommend that audiologists prepare for this kind of conversation by (1) reviewing the website StopBullying.gov for important information on red flags, cyberbullying, bullying concerns outside of school, and a child's legal rights to a safe educational environment; (2) staying up-to-date about local laws and policies regarding anti-bullying programs; and (3) communicating with school administration whenever possible.