Anna Pugh, the award-winning Hearing Therapist and Audiologist, talks to Hearing Aid UK about where it all began and how her career has grown from strength to strength. Here she tells us how being proactive, developing your skill-set and building a patient's trust through care and empathy, can really make a difference - especially to the most vulnerable.
I was working in a long term mental health hospital. It was the time when these old asylums were closing, and people were being moved out into smaller houses in the community and smaller institutions. The people who were left in the hospital were classed as “hard to place” as they had significant challenges to service provision, didn’t fit neatly into any of the available boxes, and basically needed much more individualised support. I was working in particular with two people who didn’t have spoken language.
Their records say that they were verbally oriented at one point, but they had gradually lost expressive spoken language communication skills. One person was known to be self-harming and would frequently scream and rock, hitting his face and head with his hands, or anything else he could reach. Often til he bled. To protect him from himself the staff had fitted him with a helmet. This covered the whole of his head and ears. one day, as I watched him potter about the ward on a “quiet day”, he was humming and seemed to be much happier without his helmet. He was still rocking but was much gentler to himself.
It occurred to me that he might have a hearing problem and might have tinnitus ( I had always had some understanding and interest in communication and hearing loss from having seen a movie when I was very little about a Deaf girl who learned to develop language, and communication was, and always will be, my “thing”).
But none of the people in the hospital had never had a hearing test, and certainly, no one had considered that his behaviours and self-harming was understandable if he was hearing a noise he couldn’t escape from when his helmet closed off all external sounds, and he had no other language to let anyone know how he was feeling.
I recognised that I had no skills to help this person, and so went off to train at the City Lit Centre for Deaf People as a Hearing Therapist. Hopefully, if I'm ever in a situation where I recognise I don’t have the skills, I can signpost to others, or learn new skills.
I work parttime for a family company, providing assessments, advice and hearing aid technological solutions to patients. On other days I have a small private practice offering specialist online tinnitus counselling, auditory training and communication support. I’m also a Council Member of BSHAA, and the UK Lead for the Audiology Project, but I know we will talk about that later. I do occasional training and teaching sessions, speaking at conferences, webinars and podcasts. I talk about hearing, communication, and audiology at every opportunity!
My profession defines me in many ways and gives me purpose and pride in our community. Coming from a person-centred ethos with Rogerian selfhood constructs, founded on OBriens normalisation principles with the theory of mind as fundamentals, I have grown to be more self-reflective and analytical. I still remain as passionate about making a genuine difference, and being authentic, as I ever was, but have tempered this with some experience and a voracious appetite to learn from people I work with.
Our professional body provides guidance and standards in a fast-changing world of hearing technologies, best practice and stakeholder interactions. When I first trained as a Hearing Therapist, audiology wasn’t a profession as such. I trained for two weeks to work the equipment in the hospital and became a Medical Technical Officer grade, which meant I could test hearing and fit and adjust hearing aids alongside my Hearing Therapy role. I have since taught on the BSc and MSc programmes and mentored FdSc students. We have come a very long way from simply learning how to press buttons!
BSHAA Council provides me with an opportunity to give back, to contribute to the profession as we develop further. It's also important that we reflect the changing diversity of the profession. When I trained, private Hearing Aid Dispensers were almost all middle-aged white men of a certain class. They were fundamentally often salesmen with a bit of technology thrown into the mix. Now we see more women, particularly younger women, people from BAME communities, and workplace returners swelling the ranks, adding to the conversation.
Being a Council Member is a big responsibility. My practice has to be on point! I need to constantly examine every engagement to ensure I do the best I can. It may not always be perfect, but as long as I can demonstrate validity, authenticity and positive intent, I'm confident that I can stand up for audiologists and offer support.
We Hearing Therapists are an odd breed, with few of us actually doing the same thing. It’s a profession initially built on idiosyncratic skillsets to work on a person-centred basis with individuals. Formed for space in between assessment of need, rehabilitation, and compliance with treatment plans, we provide a range of hearing, balance and communication specialist services.
The founding idea was that only one person in every three actually benefited and actively used their hearing aids. The recognition that hearing aids were not the only or sole answer to acquired hearing difficulties lead to a demand for the NHS to offer a more radical holistic approach. Seen for a while as an unnecessary luxury, the training closed down. But new programmes with a more academic focus have allowed Hearing Therapists to underpin their interpersonal skills with theoretical foundations.
These days Hearing Therapy is often seen as a rehabilitation role, or for support for people with tinnitus. Hearing Therapists can be found in many NHS departments, but also in the private sector.
Some of us do not dispense hearing aids. Some of us are audiologists with additional training in rehabilitation skills. Some of us are trained counsellors providing tinnitus therapy, including CBT and sound therapies. Some of us deliver lipreading and communication classes. (In the early days we had an additional teaching qualification for adult learners) Some of us are vestibular specialists. Most of us will deliver auditory training programmes, with or without hearing technologies. Hearing Therapy is becoming much more mainstream and many audiologists are adopting a therapeutic transactional approach to their work.
That’s a really hard one as I’ve been doing this for a bit, and so there have been quite a few. From watching students work independently with service users, from winning awards for simply doing what I do every day, to people sharing their intimate secrets and fears with you because they trust you and know that you are listening. But to be honest, the most rewarding time is when you have someone tell you that they didn’t know what they were missing, and they wished they’d done something sooner, or to quote someone from last week “ you’ve opened up my world. I can go out now and can join in!”. Knowing that I can make a real and meaningful difference is an honour I'm proud to be given.
Actively and really listen to the person sitting in front of you. It’s often taken an awful lot of effort to get there, and irrespective of your learning or experience; they know about how they use their hearing and communication skills, so learn from them.
Never miss an opportunity to talk about hearing well and hearing healthcare.
Never miss an opportunity to professionally examine an ear (even if you’re simply retubing an old hearing aid), you might see something interesting….
Read and find out as much as you can. There’s so much to learn!
Don’t expect to be brilliant at everything. Be human, if you don’t know, say “I don’t know, but I will find out”.
Be genuine. Remember in a few years this will be you sitting opposite a bright shiny audiologist, how do you think you will feel?
Always question yourself and your actions. If you know why you do it, then its probably right.
Aseptic techniques and hygiene!
The Audiology Project (TAP) was founded by Dr Kathy Dowd in North Carolina. It’s an international collaboration of professionals working with people with diabetes to raise awareness of the impact of diabetes and the role of audiology in holistic person-centred service delivery models. The Centre for Disease Control (CDC) in the US commissioned research and supported the development of the Project and its adoption into their existing multidisciplinary Diabetes Prevention Strategy Programmes. TAP includes Audiologists, Pharmacists, Podiatrists, Ophthalmologists, Diabetes Professionals such as Nephrologists, Diabetologists and Diabetes Educators/Nurses.
I’m the UK Lead of a small group of intrepid UK audiologist and related professionals. We raise awareness by talks at conferences, podcasts and webinars, articles for publication etc. We are working toward the acceptance of research-based evidence of comorbidity impacts to the NHS Diabetes Prevention Programme, Diabetes UK and similar bodies.
Internationally we gather evidence, share ideas for raising awareness, fund research and generally make a noise about the fact that people with diabetes are three times more likely to have a hearing impairment than the general population.
I have three major focuses of opportunity and risks for the profession:
Imagine you go into a specialist appointment with a problem. The specialist is attentive, reflective, asks you all about any influencing factors in your problem. And then assess your ability with something possibly related to the issue, but not the issue, and then says, “ok, we can’t do anything about that problem, but we can solve this one, that you didn’t know you had. This is the solution to your problem.”
Remembering typesetters, how long do you think this is sustainable?
Myself. I am supercritical, concerned that I must be as reflective as possible in my practice. I regret not being able to have afforded to have a more academic career as it has limited my opportunities to teach. And now as I get older I may not always remember where I put that article on Dressage and Usher Syndrome, or biofeedback wristbands for conscious breathing exercises.
Thank you for the opportunity to talk about audiology!
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