- Can you share an unforgettable experience with a patient?

I tested a little lad who had just started at school. His family had recently moved from abroad, so they were new to the country. He was very charming, little chap. Testing showed he had a moderate hearing loss, and certainly needed hearing aids. You could probably tell that from his speech and certainly in his awareness, or lack of it. He was a very unswitched-on little guy. His mother questioned my ability to test her child and was clearly unhappy about being there.  It was impeding my ability to develop a good rapport with her and make progress in the appointment. I was definitely not feeling warmly disposed towards her. 

Just previously to that, I had been on a course in Nottingham with the very wonderful Kris English. It was a counselling course for Audiologists, called Listening with the Third Ear, educating about the counselling skills required by people involved with deaf children and their families. Kris encouraged having frank, open and honest conversations. She mentioned in her talk that people are driven by fear, and then that comes out in their behaviour. You mustn't judge that behaviour, but try to understand it and where it stems from.  
I thought, “Right, I'm going to try this advice”, so I said to the mother, “What do you fear most about this situation?”  
And she just burst into tears. I then, of course, felt guilty for feeling prickled by her attitude to me, and that I'd been judging her as an awkward and unpleasant human being. 

I was blown away by that little tip that Kris English provided. From there the mother and I had a very open conversation, and we were able to identify that her fear was driven by being stigmatised by her family who felt that she had produced a ‘defective’ child. He was viewed badly by the family and she felt guilty about this. But because we got to the root of her issue and had the right conversation, in the end she did accept that help for her child we moved forward. 

I was really impacted by this idea from Kris English’s course that changed the entire situation.  Initially, we were getting nowhere. Without that simple question, the session would likely have had a very different outcome. She would have left without a hearing aid for her son that day and I'm not sure I would have been able to entice her back. It taught me that seeking to understand her lowered the barrier between us and then we could talk. It was a very powerful moment for me.  I wasn't doing my best, I was judging her and I was responding to her attitude to me, rather than the root cause of her attitude.  

- What do you find most exciting about audiology at the moment? 

I suppose the most exciting thing at the moment is linked to the saddest thing, which is the issue with paediatric audiology services. Big quality issues have been unearthed and there’s a push to get everyone over the IQIPS hedge with the assumption this will make us safe and fit for purpose. Over the years, many services haven't had the staff they need and have had to adopt a make-do attitude.  We haven't been growing sufficient people for senior positions.  It’s a hard thing to do if you’re a small service or pressured to prioritise waiting lists.  I think, in part, we’ve created this problem ourselves by promoting people into positions without insisting on formalised underpinning knowledge and assessed clinical competency. Paediatric-specific training and qualifications have been around for a long time now.  We heard Claire Benton talking at the BAA conference in 2023, saying maybe clinical judgment isn't good enough. If clinical judgment isn't underpinned and validated by examinations and assessments, then maybe it's not good enough.  Holding a certain job title isn’t a validation of ability and quality.  

There are loads of paediatric audiologists who are hugely experienced and very valuable to the profession, but there must be somewhere in our ranks people who aren’t. The fact that the equivalency route, brought in to examine experienced Paediatric Audiologists, doesn’t have a 100% pass rate shows that some people thought they were doing the right thing but weren’t.   Left alone, there’s the danger of settling into practices and a mindset that can persist unchallenged for many years. Out of this sad situation, though, comes something exciting. This is the moment to grasp the nettle, to get ourselves into a stronger position. The BAA has been working hard to create resources like the tool kit.  All sorts of things are coming out to support Audiology departments set their house in order, establish a Quality system, and hone their clinical skills.  As a small department, accessing these resources is really valuable.  I now see the danger in being ‘small’. In larger departments where you’re awash with trainees and scientists, STP students and the like, there are people – sometimes super-numerary – equipped, keen and looking for project work such as writing policies and procedures, auditing, but in smaller services you rarely have these resources to tap into.  Sometimes the weigth of important responsibilities sit on the shoulders of just one or two people: the Service lead, the Quality lead, the Governance Lead, the Equipment Lead, the Training lead, and so on.  And you can’t have a fraction of a document or quality program just because you’re the fraction of the size of the Audiology service down the road. 

- What do you think is a common misconception about Audiology?

I think we’re often viewed as “diagnostic”.  People think we just test hearing, which of course we do, but the great thing about audiology is that it doesn’t just stop there, we manage our own caseload from referral to outcome. We don't just do a test and then send the patient elsewhere for the results and management plan.  We have the privilege of following through. There’s also so much more to Audiology than hearing tests: there’s hearing therapy, balance testing and balance rehab, implant work, for example. We're more holistic and hands on, and an all-age service too. That’s something that I think people don't always realise because we can get lumped in with other diagnostic services.

- You use Auditbase at Bedford Hospital Audiology department. Why do you think it's important to have a good patient management system?

I do like my patient management system. We're nearly coming up a year since we migrated from Practice Navigator to Auditbase.  Since moving we’ve had a lot of help, and asked a lot of questions.  I’ve always had a keen curiosity about my patient management system.
We're at a point where we’re running our reports again through Auditbase, and I'm very proud of our data.  I like access to and visibility of what we report. Then on top of that, obviously it's just groovy, isn't it, having the patient journal, clinical data, and the appointment booking system all in one place. I know various hospitals have moved their bookings onto their hospital systems because their hospitals very much want to have control of the data, whereas I think Auditbase is perfectly capable of producing the information. We get our DM01 report, our RTT reports, all of our performance figures, from Auditbase, and we know the data is clean and accurate.  I think it makes for a safe and quality data management system.  Functions in Auditbase support our progress towards IQIPS accreditation.  You get out of the system what you put in. If you're prepared to work with Auditdata, help is always on hand so I think it's only limited by the mindset of the person who uses it.