You don’t need this stuff.

Barb recently received a letter with no return address on the envelope, just a postmark. Mailed from Missoula, Montana, the letter trashes Starkey, Jerry Ruzicka, former Starkey employee Jim Piccolo, and Hearing Fusion. Less obviously, Oticon and BluePrint is also trashed. The letter pimps HearForm, while briefly mentioning Timms and A photo of the letter and envelope are below.

While the letter raises a few valid questions (but doesn’t offer good answers), I couldn’t help but wonder: Why no return address? Why Missoula? Who is Ian Rubell, AuD? Who is Better Hearing Associates? And most importantly, who would go to the effort to compose the letter and pay to mail it?

Few answers are found via a web search. Mr. Rubell appears to be a ghost. Not just in Missoula, but anywhere in the US and Canada. A Google search for Better Hearing Associates results with an Oklahoma audiologist who sells Starkey hearing aids. It is unlikely that office sent the letter. Couldn’t find a Better Hearing Associates office in Montana via Google, or within Secretary of State business registry records in Montana, Idaho or Washington.

If someone wanted to be held accountable for their words, they sure went out of their way to make it difficult.

The only lead I found was when looking at the HearForm site, which was the highlighted alternative to Hearing Fusion in the letter. The HearForm testimonial page lists Starkey as one of their customers. One also learns HearForm is a family-run business based in Northport, Washington.

Okay, now it is not so hard to put two and two together. HearForm has enjoyed a snuggly relationship with Starkey but would feel slighted if Starkey backs upstart Hearing Fusion, too. And if you understand the geography and social fabric of the Spokane-Missoula-Boise triangle forming the population centers of eastern Washington, Idaho, and western Montana, you would understand that mailing the “anonymous” letter from nearby would be too easy to spot as possibly being mailed by a firm in Northport, Washington. But Missoula? Just far enough away, especially since few recipients would understand the connections among the northern Rockies area.

I have no proof the letter that Barb received was composed by a HearForm employee, or was written at behest of HearForm, but I don’t believe in coincidence either. To steal a phrase a colleague in the industry used upon reading the letter, it is “very subtle.” He is more understated than I. Yeah, it is subtle like a load of bricks falling on your head. In my opinion the letter is an advertisement by HearForm, cloaked in clothing intended to hide its source. The sort of advertising I abhor. Disguised origin and pretense. A phony grass-roots call to action.

My opinion. I hope I’m wrong. I don’t preclude somebody got pissed enough that they decided to fire off their opinion to fellow practitioners. After all, many of us have had that feeling at some point during our careers. But to spend a bunch of money on a mailing because you reached a breaking point? I guess it is possible. Unlikely, but possible. Do you own research. Form you own opinion.

In closing, I’ll add something my friend also said that relates to the context of the letter. Well known but glossed over fact.  Of the 6 major manufacturers only 2 do not sell to Costco. Widex and Starkey.  Oticon, Phonak, Resound and Siemens all do.  Also, all own clinics in one way or another.”

The industry isn’t the boys club it once was. Will never be so again. Get used to it and adapt.



Analyzing a failed business, to learn what you can do better.

I took business classes while attending college, and the car business taught me a few things about running a business, too. For a while believed I was a really smart business guy, when our practice was flying high enough to be sold at a premium price.

But the reality is, it is pitifully easy to make money dispensing hearing aids. If one is not mindful of how easy it is, it also becomes pitifully easy to believe that you have become an Economics God.

Ivan Plenty posted an analysis about the misadventures of EverPix, a picture storing and sharing site that went kablooey. His analysis serves as a primer about principles that we aren’t pressed to consider very often in our industry, if ever. All the more reason to slog through his neither short nor long article. Mr. Plenty’s analysis focuses on principles that apply to ANY business, including ours in the hearing profession.

Do yourself a favor and read his article. Then analyze your financial reports with a new perspective. You can’t go wrong.

Doctor referrals: Choosing who to contact.

Do you wish you knew which doctors see the most seniors in your area?  ProPublica has made it easy for you to find out.

I found the information by accident. Common Dreams had published an article about the profits that a company, called IMS Health Holdings Inc., was making by selling records of the prescription drugs that you and I take.

Apparently, IMS Health Holdings has records of “over 85 percent of the world’s prescriptions by sales revenue, as well as comprehensive, anonymous medical records for 400 million patients.” (Okay, maybe not including you and I, or maybe so. The point is, you don’t get to choose.) IMS “processes and brings order to more than 45 billion health care transactions each year from more than 780,000 different feeds around the world. All of the top 100 global pharmaceutical and biotechnology companies are clients of its products.”

Unfortunately, you and I can’t afford access to IMS Health Holdings information. ProPublica reporters could, but IMS (and other, similar data sources) wasn’t keen on selling that information to ProPublica reporters at any price even though ProPublica had helped defend, during a US Supreme Court trial, IMS’ first amendment right to sell the records.

Prescriber CheckupProPublica reporters did the next best thing they could think of, though. They requested and obtained from Medicare the records of providers in its taxpayer-subsidized drug program, known as Part D, serving 36 million people and fills more than one in every four prescriptions nationally. ProPublica then provided a tool “to find and compare doctors and other providers in Part D in 2011″.

In other words, a list of doctors who see what we call, our customers. You create a list of how many Medicare patients each doctor has, plus information is included about the prescription habits of each doctor.

Check out the database, then let me know if a light bulb goes off in your head about how you could use the information. Click the example above to see what your report will look like. Also, keep in mind the data is from 2010, as reported in 2011.

By the way, I was excited that I had found the list. Had it waiting for Barb to see first thing after she came home. Turned out that four of the top five on the list were already referring to Barb, as were number seven, eight and ten (excluding opthamologists, who we need to reconsider). Blew the air right out of my optimism balloon. Thought I had found a Magic Nugget for Barb to use. Oh well. Perhaps next time.

What’s the NRR of snow?

A rare snowfall, all the more rare this early in the year. Knocked snow off palms fronds on our palm tree. Yes, a couple varieties of palm trees will grow in our climate.

It’s so quiet outside. Snow has a nice sound deadening quality. So I’m shoveling it into boxes.

Figure it’s going to be great sound insolation material for Barb’s sound booth. Does anybody know if the NRR of snow is OSHA compliant?

Ashland forest fire

Ashlander’s are used to seeing forest fire smoke near town. Seeing snow on the ground is unusual.

Building an audiology practice on a micro budget.

Facade detail. Visible is a corner of the wall hanging that started this mess.

Pretty barren to start.

IMG_0001While Barb was thinking about how she would return to audiology, I was more concerned about keeping her fixed expenses low. We found a 18′ by 12′ space owned by a Russian lady. Growing up in Stalingrad, tall ceilings were the norm for her so the room we rented was built with a 12′ ceiling.

Which was a perfect height for the wall hanging that Barb found on sale in Palm Springs (at 75% off). Barb asked if I could design an office using the wall hanging as the theme.

The pictures speak for themselves, so I won’t go into detail about how I designed Barb’s office other than to note that I had roughly 200 square feet and tall ceilings to work with. Barb needed a fitting station, sound booth, and repair lab. Managed to fit everything in plus added a conference area, too.

Barb’s concern was all the tall “buildings” designed as part of the decore would make her office seem small. A valid concern, but adding receding roof lines removed the sense of standing on a New York street corner.

All shots of Barb’s office were taken “as is”. Just walked in and started shooting. Click on any photo to better see detail in the scene.

Barb’s office, as it is today.

The look and feel of your office tells your clients what, and who, you value. Details matter.

View from the entrance

View from the entrance. Fitting desk is to left, conference area is straight ahead, sound booth is on right. Lab, storage and display cabinet is not visible in this view.

Lab is to left, sound booth is to right.

Sound booth on right, lab on left.

View when jooking towards entrance.

Same “buildings”, this view looks towards front entrance.

View of sound booth from audiologist seat.

View of sound booth from audiologist seat. Booth is about 3.5′ by 3′.

Decore detail on sound booth.

Another view of sound booth. Lefty audiologists, go ahead and cringe.

Bonne Rue is reference to Barb's maiden name.

Bonne Rue is reference to Barb’s maiden name.

Door to lab, and decore detail.

Door to lab, and decore detail.

The lab is cozy, but big enough to work in.

The lab is cozy, but big enough to work in. About 6′ long by 2.75′ wide.

Counter opposite from previous view. Storage shelves are above and below counter on both sides.

“Other’ side of lab. Storage shelves are above and below both counters.

A better view of the most used side of the lab.

A better view of the most used side of the lab.

Display and storage, adjacent to fitting desk.

Display and storage, adjacent to fitting desk.

I try to hide clutter that is usually on audiologists desks. Unfortunately, two computers became a necessity.

I try to hide clutter that is typically on audiologists desks. Unfortunately, two computers became a necessity.

View from audiologists perspective. HiPro, real ear and otoscope hardware is in cabinet see lower left corner)

View from audiologists perspective. HiPro, real ear and otoscope hardware is in cabinet (lower right corner).

Impedance bridge had to go somewhere. This spot works pretty well, despite not looking like it would.

Impedance bridge had to go somewhere. This spot works pretty well, despite not looking like it would.

View from patients side of desk.

View from patients side of desk.

Interfaces and cables are hidden in compartment at end of desk. A slot allows only cables to be seen.

Interfaces and cables are hidden in compartment at end of desk. Cables run to patient through a slot.

Facade is backdrop to  conference area.

Conference area facade.

Conference area has room for 6 people, or 4 plus a dog on the bench seat.

Conference area has room for 6 people, or 4 plus a dog laying on the bench seat.

Facade detail. Visible is a corner of the wall hanging that started this mess.

Facade detail. Visible is a corner of the wall hanging that started this mess.

A corner of the hall leading to four offices serves as waiting room.

A corner of the outer hall leading to four offices serves as waiting room.

Unintentionally artsy-fartsy shot that Barb took of the outer hallway leading to her office.

Artsy-fartsy shot that Barb took of the hallway leading to her office.

If you want to dive deep, here are a few shots of the construction.

Lab and sound booth being framed. A mixture of 2x2 and 2x4's.

Lab and sound booth are framed with 2×2 and 2×4′s.

Conference area facade. Frame was built at home, reassembled on site.

Conference area facade. Frame was built at home, reassembled on site.

If I ever talk about building another sound booth, shoot me. Then wrap my remains in mass loaded vinyl.

Kim is great with sheetrock. But at 5’4″ tall, he wasn’t much help hanging 2 pound per square foot mass loaded vinyl. The door Kim works on weighs around 250 pounds.


Had the woodwork for Barb's desk desk professionally built, finished the rest ourselves.

Had Barb’s desk desk professionally built, the base actually, and finished the rest ourselves.





Finally, getting close to done.

Finally, getting close to done.

If we owned the office space rather than renting, I would have gone more elaborate and worried less about making holes in walls. Thing is, doing the big stuff that looks elaborate isn’t expensive. The building materials we selected are usually the cheapest stuff we can find, and paint is cheap. In our home theater below, cheap wood and foam was used to create the look and feel of the walls and ceiling.


If what draws your eye is not flat against the wall, chances are it is inexpensive pink foam that has been carved, textured using Parex, then painted.


Gold leaf provides visual interest, and is proper with the Mayan theme.


The walls are not painted gray. Seven colors are applied, giving what looks like gray a rich depth as you move around the room.

Not ready to do a big redecoration of your office?

Here are three quick kills with the most bang for the buck that anybody can do.

For most immediate effect: Reduce clutter.

This is the most difficult suggestion only because you are used to seeing your office every day, so you don’t see the clutter. Or worse, don’t think it is clutter. Brochures, patient charts, manufacturer posters and forms litter your counters and walls. I visit offices regularly during our travels and this, by far, is the most common problem encountered.

All that stuff screams at patients that you are either: Disorganized, or always looking to sell, sell, sell. So hide the important junk in cabinets or behind curtains. Make it easy to get at, but hard for patients to see. You’ll be amazed at how much more appealing and professional your office will look. I didn’t clean anything in Barb’s office before taking the pictures above. It looks like that for every patient. (Note that Barb has a few brochures in the display behind her desk. Haven’t convinced her, yet, to make them to disappear.)

Next: Paint walls.

Paint is the cheapest way to make a dramatic change to the look of your office. But you’re not going to simply throw some plastic on the floor and grab a paint roller. You want the wall color to have texture and depth. You’ll use a simple to learn technique called rag-off. For your first foray into creative painting, apply a solid base coat of a light color using a roller. Then apply a second color (a complimentary color is easiest for beginners) with a dry brush. Bunch up a rag (a cloth about  2′ square is good) and roll it across the wall where you just painted. The more you roll, the more paint is removed to reveal the undercoat. Paint small sections of the wall at a time, and overlap brush strokes slightly into areas you just finished. Vary the amount of rag rolling you do within each section, leaving some areas covered more than others.

There’s no right or wrong way to rag off. Experiment. Don’t worry about getting everything perfect. The beauty of this technique is you can always apply a new base coat to any section you mess up and start over. Below are examples of this technique in our house. As you can see, you can go crazy with colors. I think eighteen paint colors are present in the five photos. It would be a jarring experience walking from room to room IF there wasn’t a common element. In this case, beige, gray, black or green smoothes the transition between rooms.





You can create a false chair rail look, too. You don’t have to stencil the chair rail, it can be a band of paint or a strip of wallpaper.


Third step: Change lighting.

Those florescent fixtures in what seems to be every office ever built aren’t soothing to the soul. They also don’t provide good lighting. You can make a dramatic change by adding floor and desk top lights around your office. The goal is to create shadows and bright spots – like nature does, through direct and indirect lighting.

I prefer to add enough lights such that there is no need for overhead lights to be used, but that isn’t always possible. In those cases I make shields that are attached to the overhead fixtures so light is redirected sideways rather than down (watch the weight, you don’t want to yank the fixture out of the ceiling). This creates a reverse cove lighting effect, if one could call it that, which plays well with the painting of your walls (and ceiling) that you just finished doing.

I have also installed rope lighting (LED versions are now affordable) near the ceiling using commonly available wall trim, hiding the lights while directing light where I want it to go. If you float trim an inch or so from the wall, light will wash upward and downward. Or you can direct light in one direction, as seen below. The effect can be quite dramatic.


Lousy picture with an old camera phone of rope lighting directed upward. The ambient light is enough to see one’s way around the room. Task lighting is installed for when one needs to see something really well.

I hope this post serves as food for thought and inspiration. The main point I want to make is that decorating an office doesn’t have to be complicated or expensive. You don’t need to hire an interior designer. You have good ideas in your head already. You just have to be brave enough to try them.


You gotta see this dentists office. Mind glowingly excellent. Ya think his patients talk about him and his office? A special thanks goes to Patti R in Cali for sending me the link.

Quick tips: Video help, marketing to grown ups, passion about being there.


If you create video or intend to, here’s the best primer I’ve seen. From FilmmakerIQ, about aspect ratio and framing (composition).

Two hints I would add for when you shoot: Set up as you normally would but before pushing the record button, grab the tripod with camera, take two steps closer to the subject, then plant the tripod where you stand. Don’t change a thing otherwise. Your scene will instantly look 50% better (works for still portraits, too, every time).

Pay even more attention to what’s visible in the background than what your subject looks like. Particularly with a eye towards vertical lines spouting from a subjects head – such as wall corners, picture frames, trees. Nothing screams amateur more.


Great tips for marketing to grown ups (our 50+ year old patients) from Bob Hoffman. Bob’s list of top ten mistakes. Number 8 is a puzzle worth solving. All are worth discussing. The answers are not obvious.

Showing passion for your craft

Yet another video of Steve Jobs. This one really struck a chord because when the interview took place, Steve Jobs knew his time on this earth was limited. His passion is obvious. His advice, priceless. A interview that runs an hour and a half long. Worth your time if you resolutely care about how patients will sense your passion for your work, and how it benefits them.

Should offering assurance to existing patients be the goal of your web site ?

Have been thinking about comments patients have made to Barb. Particularly by new patients. I should note that every once in a while a new patient calls or wanders in because they liked what they read on her site. Huzzah! Isn’t that what we hope our web sites will do? Bring new patients through our door?

Maybe not. Here’s the question I’m grappling with after listening to Barb’s patients: Is it possible that in our field, new business should be the secondary goal of our on-line efforts?

I have come to believe our primary goal is to reassure patients who have already scheduled an appointment that they weren’t flat-out stupid for calling you. Before you dismiss the idea as bat-shit crazy, consider how behavioral studies have proved over and over that we make decisions emotionally, then search for rational reasons to justify our decision.

I have no empirical evidence to prove the studies correct, but there is abundant anecdotal evidence provided by Barb’s patients. The trickle of new patients who find Barb is overwhelmed by the sheer number who visit her site after scheduling their first appointment. Why would they do that, and so consistently? Sounds to me like they are searching for the justification. They worry their doctor or friend who referred them to you has missed something important about you that makes their suggestion worth dog poop. Or they worry about whether you can handle their problem. They worry if you are just minimally competent. Worry about finding your office, and what will happen when. Or, and this is a biggie, they worry about whether you are trustworthy. So many possibilities.

Looking at Barb’s site, I can see no obvious path for new patients to find the justification they seek. What they are finding is being discovered on their own. Maybe building a mini-site is in order, then sending each new patient a link to the site. What do you think? I don’t know of anybody who has tackled this area but listening to Barb’s patients, there seems to be a need and opportunity. Has anybody looked into this area, or built something for patients?

On a related note, do you ever wonder what visitors to your site actually do?

The site stats provided by Automattic, the company behind where Barb’s site is hosted, are pretty useless for a hyper-local practice like Barb’s. There is no way to know how much traffic is coming from her geographic area. So those daily visitors and page views? Looks like something useful should be coming from it, but why would Barb care if somebody living in Switzerland really likes her? Here is 30 days worth of her most recent stats.

Barika Audiology site visits

Barika Audiology site visits (click to enlarge)

Sure there are also other stats telling you what pages are most popular and a bunch of other stuff **, but what I’ve always wondered about is where are visitors lingering and what do they skip? How do they move through the site? I would think knowing how visitors interact would be a lot more useful than the information that most stat packages provide (granted, Google Analytics is much better than Automattic’s but doesn’t allow embedding the necessary code).

If you wondered the same thing, check out Lucky Orange. I have no experience with the service beyond glancing through the site (because it likely couldn’t be installed on Barb’s site unless her blog was moved to a different host) but it looks like a neat tool if you want to get into the spooky art of heat maps and mouse tracking and stuff like that. Lucky Orange provides a way to see how visitors are interacting with your site. Cost is reasonable, too, for a small practice to get access to tools that have previously been out of our price range. $10 to $30 per month, depending on how white label you want to go. There is one question in the Common Questions (scroll to the bottom of the page) that gave me pause. “Will this hurt my search engine rankings?” Answer,”It shouldn’t. Our software doesn’t do anything illegal.” That’s one hell of a way to begin an answer before explaining more. Just a warning to be aware of should  you decide to look into this package. As long as you aren’t thrown into jail or patients start sending you death threats, this tool may help you build a better web site.

** One thing I can glean from Barb’s stats is if you simply want traffic to come to your site and you don’t care who it is or why they are visiting, write posts about the Lyric hearing aid and hearing tests that can be done from home. Month after month those are the two posts that consistently generate traffic. Of course, one shouldn’t stop there and call it good but rather, consider why ARE those two the most popular? Says something about our patient’s expectations that is only barely revealed and the real reason goes much deeper?