"The Ear Bones Connected to the What?" feat. Dr. Archelle Georgiou | Chief Health Officer at Starkey

About This Episode

Dr. Georgiou believes that patients should take an active role in their own healthcare, not only when they have an acute or chronic illness or when they’re dying, but at all times. When patients are fully engaged, she says their outcomes are better. She believes that is true with hearing healthcare as well. The ear is a vascular organ, which means it requires a blood supply. Factors that affect your other vascular organs, like your heart, kidneys, and brain can also affect your ears. There is an overlap between these organs. If you have diabetes, for example, a high blood sugar can be toxic to your ears. We know that untreated hearing loss is also linked to cognition issues, a higher risk of falling and numerous other chronic illnesses.   

Primary Care Physicians have a Role

 Most primary care physicians do not refer their patients to an audiologist for a regular hearing exam. One of the most important reasons they don’t is that they generally don't have the expertise to understand the nuances of hearing loss. They certainly don't have the equipment or the expertise to diagnose it, and they don't have the expertise to treat it. We live in a world of specialty care. When primary care physicians recognize that someone has difficulty hearing, they should refer that person to an audiologist. Primary care physicians do not need feel that they need to diagnose or treat it. But they should be asking, “Are you having difficulty hearing?” And if the answer is yes, and it will be in the majority of people 70 and older, that individual should be immediately given a referral to a hearing specialist.

 Informing the Primary Care Physicians 

 Audiologists should continue to educate PCPs on the interfaces between hearing and overall health. They need to understand that a patient who has hearing impairment, even a mild hearing loss, makes that physician’s life more difficult. Office visit will be longer, they’ll need to repeat what they say, and the patient may not understand the treatment plan. Many studies show that even people with mild hearing loss can't hear if an individual’s voice is directed away from the patient. They may call back for more questions about refills, how to take their medications, etc. Appealing to the selfish side of physicians who want their practices to run more efficiently by telling them what's in it for them. 

Listening to the Patient 

 How important is it for hearing healthcare providers to truly listen to their patients and understand what their needs are? It's important to listen because you will be more successful as a professional. You can tailor your treatment plan to what's most important to that individual. Unless a care plan meets their needs and their lifestyle, and unless they go home owning the device, the experience, and the accountability of using a device, they're not going to use it. Listening is the pathway to good outcomes.

 Looking to the Future 

 Dr. Georgiou would like to make hearing healthcare an integral part of overall health care. That means making sure the traditional medical industry, the primary care physicians and others in that world, recognize how important hearing is to a patient's overall health. Equally important is that audiologists and hearing professionals recognize that they have to be a part of the overall health care system.

Transcript

Blaise Delfino: 0:06

You're tuned in to the Hearing Matters podcast with Dr. Gregory Delfino, and Blaise Delfino of Audiology Services and Fader Plugs, the show that discusses hearing technology and best practices and a growing national epidemic, hearing loss. On this episode, we have Dr. Archelle Georgiou. She is the Chief Health Officer at Starkey, Archelle, welcome to the show.

Archelle Georgiou: 0:34

Oh, thank you for having me.

Blaise Delfino: 0:35

It is such an honor to have you on the show. And thank you so much for all that you continue to do for the hearing healthcare industry. Truly, Dr. Giorgiou, you earned your medical degree from the Johns Hopkins University School of Medicine. And you served as a senior executive and the Chief Medical Officer of United Health Group from 1995 to 2007. And as a medical expert, you have covered over 1500 medical topics during your weekly segments on KSTP. TV, the ABC affiliate in Minneapolis, St. Paul, as a thought leader, really a true thought leader in the field of healthcare and medicine. What is your why?

Archelle Georgiou: 1:23

Well, Blaise, it took me many years to actually put words around my why I would have to say that my why is making sure that people understand how to have a voice in their health care. I can't think of anything more important that we want to be in control of than our own health care and medical care. Our health is our most important asset. But way too often, we've been socialized to differ to the medical system to doctors, to professionals. And there is a place for listening to the professional. But it does not replace an individual knowing what their preferences, their priorities and their values are. So everything I do, whether it's at Starkey, whether it's at KSTP, whether it's at the University of Minnesota, where I teach, my whole focus is teaching people how to have a voice in their health care. Having a voice in your health care, when you have an acute illness, a chronic illness, when you're dying, I believe that people should have a voice throughout all of their health care and partner with their physician and be on a level playing field with their physician and their professional. So, you know, I didn't really see that early on in my profession, I really saw it in the context of my role at United Health Group in the multiple roles that I had. So when I was there, United Healthcare was a little bit smaller, I oversaw the health and medical care for 17 million individuals at that time. Wow. And what I could see was that physicians did a great job, organizing care for people. But unless individuals themselves played an equal part in taking their medication, following up, stating what was important to them, and having dialogue about this surgery is the right choice for me. But that surgery is not unless people got fully engaged, the outcomes weren't as good. So I recognized when I was at United that it takes a great health system. But it also takes great patients to have great outcomes

Blaise Delfino: 3:29

And how essential that is for hearing health care to implement that team approach when working with a patient, maybe who is a first time hearing aid user, the patient, of course has to have a voice. I love that that is so, so important. And again, thank you for everything that you're doing for the field of healthcare in general, but specifically hearing healthcare. Dr. Giorgiou, you are the first Chief Health Officer in the hearing healthcare industry. And your work has definitely proven and will continue to prove essential in our field with the understanding that you have of Internal Medicine and comorbidities. Share with us some of the comorbidities linked to untreated hearing loss.

Archelle Georgiou: 4:14

I'm going to do that. But could we just pause for a second and just give kudos to Brandon Swalot and Starkey for recognizing that bringing someone like me into a hearing aid manufacturer would be important and I so important cause I never ever imagined that I would be in any device manufacturer, let alone a hearing aid device manufacturer. So I just think we need to pause and give a lot of credit to that.

Blaise Delfino: 4:42

Yes, absolutely. And you absolutely nailed it the vision because Starkey has vision driven leaders and Autumn and I were talking about this, Archelle, on the plane ride here, and I was sharing your background and Autumn said for Starkey to see how am I important it is to have a Chief Health Officer that is cutting edge and so essential. So yes, absolutely. Kudos to Brandon and that executive and vision driven team.

Archelle Georgiou: 5:11

So back to your question, what are the interfaces between hearing an overall health care? Well, if we just go to the basics of the anatomy of the ear, which you are much more expert in than me, the ear is a vascular organ, it requires blood supply. And so the factors that affect your other vascular organs like your heart, and your brain can also affect your ears. So of course, there's an overlap between heart disease and hearing loss. That's an obvious one in your bloodstream. If you have high blood sugar levels, and you have diabetes, that high blood sugar can be toxic to your eyes, to your kidneys, to your nerves, and to your ears. So there's a big overlap between diabetes and hearing loss. There are bones in the ear, just like there's bones everywhere else in our body so they can be affected by bone diseases or osteoporosis is the most common. Our ears are so important in maintaining our balance and our vestibular function. So we know that there's such a high frequency of fall risk, and individuals with even mild hearing loss three times the risk of falls in people with mild hearing loss. And of course, there is a strong direct connection between the ear and the brain. And so when you can't hear well, your brain doesn't get the nutrient of sound. And so we don't know what the causal relationships are. But we do know that hearing loss is strongly associated with cognitive impairment, and dementia. And so we need to think of all of these health issues as one and not keep separating, hearing healthcare into a different world of health care than all of the rest of these chronic health conditions. And that's my job.

Blaise Delfino: 6:56

Hearing Health Care is health care. Starkey has been saying for years hear better live better. Our Celt, why should primary care physicians be encouraging their patients to visit an audiologist or hearing healthcare professional for their annual hearing evaluation? We all get our eyes checked and our teeth cleaned. Why must we all get our hearing screened?

Archelle Georgiou: 7:18

One of the most important reasons why primary care physicians and all physicians who are not specialists in hearing should refer patients to hearing specialists is that physicians generally don't have the expertise to understand the nuances of hearing loss. They certainly don't have the equipment or the expertise to diagnose it, and they don't have the expertise to treat it. So we live in a world of specialty care. And when primary care physicians recognize that someone may have some difficulty with their hearing, they should not ignore it, they should send them to someone who can improve that individual's quality of life with the expertise that they have. A big problem with primary care physicians is that they don't even screen for hearing loss. So of course, we don't want primary care physicians to feel like they need to diagnose or treat it. But being a good physician blase means really asking all the right questions you ask people if they have headaches, changing their vision, if they have jaw pain, or abdominal pain, or tingling, why don't all primary care physicians ask the basic screening question? Are you having difficulty hearing? And if the answer is yes, and it will be in the majority of people that are over the age of 70, and many people even under the age of 70, that individual should be immediately given a referral to a hearing specialist

Blaise Delfino: 9:35

I can confidently say that at our practice, we have reached out to community physicians and provided them and educated them with different pamphlets and newsletters, things of that nature, referral cards if they have a patient who presents with a suspected hearing loss to visit an audiologist, because it is really up to the hearing healthcare professional as well to educate the physician and maybe provide some tools like a toolkit for these physicians because they're so incredibly busy seeing patients on a day to day basis. What can we as hearing healthcare professionals do to raise awareness of the importance of hearing health care within our community, specifically physicians?

Archelle Georgiou: 10:19

Well, I would keep doing what you're doing, educating them on the interfaces between hearing and overall health. But you know, physicians are humans too. I know some physicians think that they're more than human but they are human. And I would appeal to the selfish side of them because we all have it. And I would make sure that they also understand that a patient who has hearing impairment even mild hearing loss makes that physicians life harder, they have to spend more time in an office visit with them, they need to repeat what they say the patient may not understand the treatment plan. There are so many studies that demonstrate that even people with mild hearing loss, can't hear if the individuals voice is directed away from the patient themselves. They might call back for more questions about refills, how to take their medications, explanation. So I would frankly, appeal to the selfish side of physicians that wants their practice to run more efficiently by telling them what's in it for them.

Blaise Delfino: 11:25

Absolutely. Thank you so much for that golden nugget there truly because it is really a goal of every hearing healthcare professional to get on board and have that team approach and that buy in of healthcare as community based. And as you had previously said earlier in this interview, the patient needs to have a voice in their hearing healthcare, which you report that we make about 33,000 decisions per day talk about decision fatigue, there are Catholics truthfully. But when it comes to our overall health and medical care, we sort of freeze and your work has always focused and continues to focus on giving people a voice in their hearing health care. And how does this translate into hearing health care? And what can fellow audiologists and hearing care professionals do to carry this over in clinic

Archelle Georgiou: 12:18

Hearing professionals think a lot about how to convince someone to address their hearing loss. And that is so important. What I would add to that comes directly from my book, which shows people how to have a voice in their health care. The book is called health care choices, five steps to getting the medical care you want to need. And that includes hearing care, you want a need. And I lay out five steps that apply to primary care physicians, surgeons, hearing health professional, so I'm going to go through those and put them in the context of Audiology and Hearing Healthcare. So the first is making sure that patients understand their condition. So that's the C in a model that I call the Charis Model C stands for condition, make sure that the individual actually understands their condition, do they understand there's a loss, have you talked through the Audiogram and how their audiogram compares to a normal audiogram, give them a copy of it so that they can take it home and they have documentation, people have to have objective evidence of a loss in order to even consider going down the path of addressing their hearing. The A in the cares model stands for alternatives. Every patient has alternatives. That includes getting a hearing aid, maybe using an accessory, sometimes doing nothing. And we need to recognize that you need to lay all of the alternatives on the table, and list the benefits, risks and advantages of all of the alternatives to allow them to make a choice. So the hearing professionals job is to give the patient the evidence around all of the evidence based alternatives. And it's the patient's job to decide what choice they are going to make. The R stands for respect to your preferences. We haven't been really trained as humans to articulate what our preferences are. If somebody said blase, blase, you have hearing loss, like what are your preferences and priorities? You might say? Well, I just I just want to hear better. I just want to hear better and better. So it's up to the professional to say, let's take that one step lower. Do you have a preference on cost, or size or sound quality, or any other features around what choice you make given all of these alternatives that we laid out, so make sure that you elicit the individual's priorities and preferences in the conversation. Only the patient can decide what their preferences and priorities are. The E in cares stands for evaluate your options. So on the patient side, they need to have time and space to determine what the best choice is for them. And frankly, Blaise I know that when people come into the office, you don't want them to walk out without getting a treatment. But it is important to give them the time and the space and the privacy without the pressure of a professional staring at them to make a decision to talk with their loved one who may be in the office with them. Give them space to evaluate their options so they can feel good about their decision. And then the S means start taking action once they make a decision. Then work with them to be an equal partner and to take responsibility for their care

Blaise Delfino: 15:38

Were going to put that model in the show notes and Archelle, to dovetail off what you were just saying. Oftentimes it takes us about an individual's seven to 10 years to actually make that appointment to get their hearing tested. And when you have an individual, a patient coming into the office, and you implement high tactic selling techniques, which we're not about at our office by any means, and majority of hearing healthcare professionals are not what I see personally, as a hearing healthcare professional is a human in front of me. And to break down the barrier Archelle, I'm not here to sell you anything. I am here to help you make an educated decision regarding your hearing health care, because we know the science. And I think it's so important, and you know, this way better than I do, because you are, of course, a physician, and you've been practicing for many years. How important is it for us to listen to our patients, we were just talking about this with Dr. Favori. Last night, we have two ears and one mouth. So listen twice as much as we speak, how important is it for hearing healthcare providers to truly listen to their patients and understand what their needs are?

Archelle Georgiou: 16:50

I love one day favorite says that and I have I have repeated it many times, it's it's a beautiful thing to remember. And it's important to listen because if you listen, then you will be more successful as a professional, you can tailor your treatment plan to what's most important to that individual. Because unless a care plan meets their needs, needs their lifestyle, and unless they go home and own it, not just owning the device, but owning the experience owning the accountability to using a device, they're not going to use it. And so the outcome, there is a poor outcome for everyone for patient, the patient and the professional. So listening is the pathway to having good outcomes

Blaise Delfino: 17:35

Well, we are still experiencing the effects of the COVID 19 virus, which I have to say thank you for your work when COVID-19 first entered our country, and a lot of our offices shut down. You and your team here at Starkey took that initiative and started to host different web conferences for the professional, how is this going to affect our patients and just your knowledge and the information that you are able to relate to us as professionals but also to the community? Thank you so much, because that truly did help us as a practice. And I think I'm speaking for 1000s of hearing healthcare professionals. So truly, thank you. With the use of masks, of course and social distancing. This continues to adversely affect those with hearing loss. But of course, Starkey's mask mode has assisted in that. While we can implement different compensatory communicative strategies. What can our patients with hearing loss do to remain connected with their family, friends and loved ones? I know we're not completely out of this pandemic right now. But what can these patients do to remain connected and practice their cognitive abilities?

Archelle Georgiou: 18:51

Well, we are definitely not out of this pandemic, this new variant is throwing us all for a loop, and there's probably going to be more variants. And even when there aren't more variants, masks are going to be around for a while, we need to get used to this new world of mask wearing, which really disproportionately affects people in a negative way with hearing loss. So what else can people do? You mentioned mask mode, Edge mode for people that have our devices. And I'll just take that to just a higher level, which is to say make sure that if you've made the investment in Starkey hearing aids or any hearing aids, that you really understand how to optimize your use of that device, it's been an investment, know how to use it, because there's probably many features that could bring you greater quality of life overall, and especially in the world that we're living in right now where we're socially distance and wearing masks. The other thing that's not device related that I would also suggest is for you to request others, particularly in your family, those who you communicate with often to wear the masks with the clear shields, because being able to lip read, along with hearing really complements people's ability to comprehend and understand the conversation that's going on. The third thing is that if you're using zoom and all of the remote technologies that will continue using forever, that is going to be such a big part of how we work in the workplace. Regardless of whether there's a pandemic, make sure that the transcription the real time transcription service is on. It's available on all of the major platforms. Dr. D Favori is so good at always making sure that the real time captions are on whenever we're having a meeting and I really respect that he remembers to do that all of the time. And we can request that. And one of the other things that I point out is that For parents who may be listening, who have children that have hearing impairment, make sure that you're a voice for your child in the classroom, and make sure that you advocate to make sure they get a seat at the front of the classroom, that the teacher is wearing a mask with a clear shield, that if necessary to get a sign language interpreter in the classroom, you know, for more severe cases, so be a voice as a parent and empower yourself to advocate for your child

Blaise Delfino: 21:17

Archelle, I'm so curious to know. And I'm just so excited because being the first Chief Health Officer, you have to have so many goals with regard to positively influencing this industry. So what do you hope to accomplish with your team here at Starkey the next 5,10,15 years

Archelle Georgiou: 21:37

Thats a really long time to look into the future. And so therefore, those are big, aspirational goals. And, of course, it's to make hearing healthcare an integral part of overall health care. If we take that one level down, that means that we need to make sure that the traditional medical industry, the primary care physicians and others in that world that I've come from, recognize how important hearing is to a patient's overall health. But Blaise I would also say that it's equally important that audiologists and hearing professionals recognize that they have to be a part of the overall health care system. And since I now live in a world where I deal with more hearing health professionals rather than medical professionals, I feel some resistance to that. And I think that it is really important to push our industry now, to thinking more about the role that the hearing professional plays in overall health, I recently gave a talk at a large conference, and really encourage the audience to say, after you've gained trust with an individual and change their life by diagnosing their hearing loss, fitting them with a device, and now they can hear better use that moment of trust, to address other issues that are important to their health, learn how to measure and monitor their blood pressure, not because you're gonna diagnose it or treat it, but because one in three people with hearing loss, have hypertension, and many of them are undiagnosed. So why don't you take that moment to identify an additional health related issue? And then send them back to the PCP and refer back? Why shouldn't you do a cognitive screening, again, not to diagnose dementia or cognitive impairment, but to say, you know, you may want to talk to your doctor about this. Unfortunately, I'm feeling a fair amount of resistance from the industry in going outside the bounds and outside what people are saying the scope of practice. I'm going to question whether or not there's really a regulatory barrier to going to this place that I am suggesting. So I think I love it. I love it, you can help. Well, let me just say that the American Dental Association and the American Optometric Association since 1975, in 1976, have encouraged and put in their standards of practice that their practitioners should check blood pressure, what's happening to audiologists and hearing professionals I think that we're a little far behind.

Blaise Delfino: 24:08

You're tuned in to the Hearing Matters Podcast with Dr. Gregory Delfino, and Blaise Delfino of Audiology Services and Fader Plugs. On this episode we had Dr. Archelle Giorgiou, the Chief Health Officer at Starkey. Until next time, hear lifes story