Trying not to shout at the hearing impaired

On my last placement, we had a range of conditions presenting in the gerontology field. And a range of cultures too. One patient I treated, with my supervisor present, was an elderly German female with balance problems. When trying to get her subjective history, I found she was having difficulty hearing me. She had a hearing aid and impairment in the ear furtherest from me and reported no difficulty on the near side. I also inched my chair closer until I was very close. None the less, I began to speak louder as she asked me to repeat the questions. She still could not understand me. I tried to be very specific and brief with my questions, using single phrases and step-by-step questioning. Still she struggled to understand me. I was using very simple English, but still no progress. We were both getting frustrated and I was running out of ideas.

My supervisor repeated one of my questions to the patient from the other side of the room. To my surprise, the patient heard her clearly and responded appropriately. The supervisor was sitting on the side that the patient reported a hearing impairment. I was really stumped. It wasn't the language, the distance or the phrasing that was a barrier. So it must be volume or the patient's quality of hearing with the near-side ear. I don't think volume was the problem - I was being as loud as I could with out yelling. So I now conclude that it was related to my position in regards to her hearing.

Just because a patient is diagnosed with a hearing impairment on one side does not mean the other ear is normal. Just because we are given a set of facts, does not discount the room for change, error and thinking outside the box. I never thought of trying to change my position at the time. I wish I had to see if it was the key factor. But as physiotherapists we always need to think outside the square and see the link. Might mean we stop yelling at our patients when it is a language barrier that is the problem, or speaking as though to a two-year old when they can't hear!