Seven years ago, Dr Akmaliza Ali had barely heard of person-centered care (PCC). The young audiologist was just starting her PhD in Queensland, Australia, having first studied on the only audiology course in Malaysia at the time and completed a Masters in Southampton, UK.
Three years later, she co-wrote a paper that triggered the first conversations about PCC in Malaysia and the beginnings of a new approach to hearing rehabilitation.
“I hadn’t read much into patient-centeredness before. But having those discussions with my supervisors at Queensland helped open my eyes about that aspect of the service.”
Through their research, the Queensland team found that while many clinicians in Malaysia believed that treatment should align with patients’ beliefs and values, that a human connection between clinician and patient is important, and that it’s crucial for an audiologist to understand the patient’s background - key aspects of PCC – these were rarely implemented in clinical practice.
Several years on, implementation is still the main challenge, as in many countries around the world.
But Dr Ali, now a lecturer at the National University of Malaysia (Universiti Kebangsaan Malaysia, UKM), has made it her mission to spread the word, and the practice, of PCC across the country, and she’s making progress – “little, baby steps” as she puts it.
Obstacles to person-centered hearing care
Since the 2018 paper, Dr Ali has noticed that her audiology colleagues in Malaysia are more open to talking about person- (or patient-) centered care.
But a key challenge to turning theory into practice, as in many countries, is the way the public healthcare system functions, often not allowing for longer appointments or for clinicians to offer services beyond the tests requested by the referring ENT.
Dr Ali also believes cultural norms in Asia hold patients back from engaging in the management of their condition.
“We grew up with the idea that the person in authority has the power in terms of dictating what we should or shouldn’t do. So even when we do try to involve the patients, sometimes they still just say, ‘whatever you think is best for me.’”
Older patients are often particularly concerned about becoming a burden to their families and refuse to consider treatments or strategies that would require support or input from their younger relatives.
Small changes to improve counseling
Changing a country’s culture or healthcare system is beyond Dr Ali’s abilities, but she does what she can within these bounds – and encourages other practitioners to do the same.
For example, many of her younger patients are keen to be involved in decisions about their hearing loss management, and she adapts her approach to suit.
“I feel very excited when I meet those kind of patients, because I feel I can share more, I can have a discussion with them. But if someone is a bit older, perhaps they need a more traditional, conventional approach.”
She also advises clinicians who are keen to make their practice more person-centered to set aside a day for counseling so they can focus on that rather than tests and assessments.
“Changing the system in the hospitals would be a huge task and involves many departments,” Dr Ali says. “So I say, ‘maybe just change how you do your own clinic, to accommodate your patients. What you can do is start small.’”
But Dr Ali has big ambitions too. Working with others, she’s translating the Ida Motivation Tools into Malay and developing a patient-centered counseling module for practicing clinicians. She hopes it will be ready within the next two years.
Preparing the audiologists of the future
As in many countries, training the next generation is key to the expansion of person-centered hearing care.
The current audiology curriculum at Universiti Kebangsaan Malaysia focuses almost exclusively on the biomedical approach. Keen to change this, Dr Ali has co-created two modules in aural rehabilitation for the new curriculum, drawing partly on the Ida Institute’s University Course resources. Future students will learn about hearing care management beyond amplification with a focus on hands-on, practical sessions, including the use of some Ida tools.
Currently, Dr Ali tries to compensate for the students’ lack of person-centered training by showing them Ida tools and resources in the classroom and providing guidance when they arrive at the university clinic for their internships.
“At the start of their time in the clinic, the students focus mainly on the patient’s impairment and the biomedical approach. They are so attached to the audiometers and otoscopes – they feel that if they’re not doing any procedures, they’re not providing a service to the patient.
“But I make them understand that just having a chat – finding out how the person is coping with the hearing aids, how they’re doing at home – should be part of the service. And I encourage them to ask more probing questions and to think about the patient as a whole person, rather than just a hearing loss.”
And she often sees success, with students much more open to asking about communication needs and discussing management beyond amplification by the end of the semester.
“It’s a small success, but hopefully it can build up from there,” says Dr Ali.
She’s aware though that her battle is an uphill one and that she may be leading the charge alone.
“To my knowledge, I’m the only one really pursuing the PCC aspect of the audiological services in Malaysia. But I’m encouraged by the fact that others are more open to management beyond amplification now. I guess we will need a few more years to transfer those beliefs into practice.”
Image: Dr Akmaliza Ali