3 Visits to the ENT Just to Get Hearing Checked — Common Practice in Spain

In Spain it is becoming common practice to have the patients come and go to the clinic many times, to invoice medical insurance several times. Clinics want to get more money for what should be just one single visit.

The new system works like this:

- First day: the ENT looks at your ear with an otoscope and invoices your medical insurance as if the doctor had carried out a detailed examination of the patient. In my last visit the ENT (a new one I had not visited before) did not even look at my nose or throat. So basically this "doctor" is not doing his job but wants to get paid as if he had performed a thorough examination.

- Second day: the patient goes to the clinic just to have an audiometric test.

- Third day: the ENT has a look at the audiometric test and maybe prescribes some medication or, more likely in complicated hyperacusis and tinnitus cases, does not have a clue of what to say.

So this is how things are getting... worse. What used to be done in a single visit now entails going 3 times to a clinic.

Is this happening in your country too, or just a Spanish practice to rip off insurance companies and make patients lose their time?

 

Why do you still visit doctors when you know they are useless?

I recommend losing touch with reality as a controversial alternative.

 

It's really frustrating to hear that this happens in other countries as well. You can have similar situations like this in the United States, and honestly, I thought that was just how it went here. No idea other countries were facing this.

Why is healthcare in such a bad spot? I feel like I've been so disillusioned in thinking most doctors actually gave a rat's ass about your condition.

 

It depends if the ENT practice (usually the larger practices) has an audiologist, some don't. When I was going to ENTs, I found a practice that has an audiologist. I was sent to the audiologist first, then I waited for the ENT in another room who was provided the test results by the audiologist. The audiology tests seemed a bit short and rushed, even though they tested up to 8000 Hz, but better than going to a separate appointment. Find the large ENT practices that offer a lot of services, which usually also include audiologists who run tests as well as sell hearing aids, etc, all in the same office.

 

The third day seems unnecessary, just to go in to get results/get prescription. Here, with my blood tests, I ask the office to send the blood test results to me via the portal. The doctor calls if there is anything noteworthy/prescribes medicine by sending the prescription electronically to my pharmacy. If the test results are stable/nothing noteworthy, he doesn't call. With audiology tests, the audiologist tells me the results once that test is over.

 

Some clinics in Spain (a minority) do everything in one single day, but the trend is towards having the patients come and go to bill them more. The clinics who do everything in one single day have the patient explain the ENT their symptoms etc, then they are sent to audiology and then to a waiting room. Finally they see the ENT again and get prescriptions and medical advice, everything in one single visit. To me this is good practice.

To me having patients come 3 times for the same thing is just nonsense, because these patients have private insurance and they do not care if the clinic bills more or less to the insurance company.

So the war here is really between clinics and insurance companies, and patients are the hostages taken in this battle.

 

Well, I just go to get my hearing checked. Lately I am having a lot of trouble understanding speech and I am really worried about this, because my audiometric test is not that bad, but my personal feeling is that I understand speech and TV poorly.

As I have had hearing issues for a long time (hyperacusis, then tinnitus and hearing loss) I do not expect any solution from the ENT, but I like to have an audiometric test regularly (usually at least 4 times per year).

I am now considering intratympanic Dexamethasone injections. I will probably have the injections this year. Not very optimistic about the result but I hope not to lose anything for trying.

It is quite frustrating to see this condition is impossible to control. No matter how many adjustments I do to my life, my hearing still gets worse. I am just clueless about how hearing can get worse in a year when I barely go out at all, due to the pandemic, or just for a walk along the beach, earplugs on...

 

Well, in Sweden you cannot even get to see one*... public hospitals are almost inaccessible and private clinics are a joke.

*You want to know what happened when I called my clinic (public) right after my onset? Phone calls are "filtered" by a nurse who decides if you deserve or not to be seen by a GP. Not a specialist, a GP. I told to the nurse "My ears are ringing, I want to see a doctor"; "well", she replied, "it could be tinnitus. It should go away in one month" and she hang up the phone.

Honestly I have had much better experiences with the Italian healthcare system.

 

Given my experience with ENT doctors, their real (and only) function has been to sell me an expensive hearing aid.

It must be wearing to tell myriad numbers of patients on a daily basis that there is virtually nothing that can be done for whatever conditions they report and then charge $300.00.

 

All 3 of my visits looked the same. Made an appointment, arrived, waited, took audiogram, did the tympanometry test, gave me the results, saw the doctor and he didn't say much. The first one said my hearing looks typical for someone my age and that I have very mild hearing loss. The second doctor prescribed histamine phosphate. The third, was an otologist and have her PA give me instructions to sleep with sound, lower my anxiety and take Lipoflavonoids. They asked if I wanted ear molds and had one line in the handout that said stay away from loud noise, see you in 6 months!

 

I have also heard really bad things about the Swedish medical system. To me it is shocking, since people in Sweden pay very high taxes and they should get something in return.

 

It is really downlifting that ENTs can do so little for real hearing problems. They can fix some conductive issues, prescribe some drugs for allergies, inflammation, fix turbinates and nose etc...

As far as the inner ear is concerned, they can do nothing. It is so frustrating. And hearing aids do not really work. I have relatives who use hearing aids, and their devices have spent more time sitting in a drawer than inside their ears... sometimes hearing aids are useless.

 

According to what they told me, it used to be much more efficient twenty years ago. Years of underfunding turned it in to the utter disgrace that is now. Completely unprepared to deal with emergencies. Imagine trying to get Prednisone in Sweden after an acoustic trauma, ha ha! They'd give you Alvedon (Paracetamol) and tell you to fuck off.

 

Yes, that's what I am concerned about this change for the worse in medical attention. If a clinic or hospital faces an emergency, they won't be ready to react, the opportunity window to get corticosteroids or identify a problem will be missed.

 

My God, I would've smashed my keyboard... only that would make too much noise.

This is absolutely ridiculous and unacceptable. There has to be a way we can call them out for this BS. Not being able to do anything for tinnitus is one thing, but making three visits when you would normally do only one?

 

In fact the clinics that follow the "3 visit system" to get hearing checked are really aggressive and they even lie to patients. For instance they tell them it will take one visit to do everything and once patients are at the clinic they tell them some story to book another 2 visits. Or they tell them that they will provide audiometric test results on the spot and then they create some other story for not giving patients the results.

I am amazed that no one complains about this. I am thinking of filing a claim against them.

 

@twa, your otologist recommended Lipoflavonoid?

My mom worked for an ENT for like 30 years. She told me he used to prescribe that too for people with tinnitus. I took them when I first had tinnitus back in 2015. I don’t really know if they helped but my tinnitus did go away after a few years and I was tinnitus for three years.

Maybe I should restart them.

 

In Portugal it is the same thing. Hahha.

 

Juan!

How’s life in Spain with ear problems...?

Loud people with small barky dogs everywhere? Loud fast furious cars and dirt bikes?

 

I will finally see one after seven months of waiting. I could have easily offed myself in the meantime; probably the Swedish state thinks that my life is worthless.

At least this is one is a neuro-otologist who does research in the field.

 

Yes, it's pretty awful. Spain is a very loud country. Tourists come here to party for like a week, but we have to live here all year round. The place is just noisy. Spanish people, in general, are noisy and love those horrible loud motorcycles. Tourists are noisy. Flats and apartments have poor soundproofing, and most people live in dense urban areas even though most of the country is empty and has a rate of inhabitants per km2 lower than Lapland.

Now there's noise everywhere, as every bar, restaurant, hotel, supermarket, any business, will have its own noise or piped music at full volume. Restaurants here are just deafening. I think this happens in most countries anyway... today it is rare to find a place where there is peace and quiet, and one can actually hear the waves and the sea.

 

And I thought Sweden was a developed country... Sweden sounds even worse than Spain, to be honest, although public healthcare here is really slow too.

 

Hmmm, no quiet fishing villages with only old people sitting outside on chairs to greet you as you walk to the only supermarket to buy ice cream to enjoy when walking on a quiet beach ?

I thought you said you moved to better place... I agree you’re describing a very common trend, restaurants playing so loud you can’t have a dialogue, noise flowing out of every shop etc.

Well, thanks for the information. Perhaps rural Nepal or something...

 

I did, but I had to relocate and now I live in a slightly worse place as far as noise is concerned. It is still a coastal city, actually smaller than the other (less inhabitants) but more "concentrated", there is more population per km2.

Anyway, in my last comment I was talking in general about Spain as a noisy country.

If asked about my particular situation, I would say it does make a big difference to live let's say in downtown Madrid from living in a small village, BUT the thing is, even in a medium sized coastal town in Spain there will be firecrackers, fireworks, the odd construction noises, loud bikes etc. Not every single day, but many days per year. In some towns there are like 20 local feasts per year, and each one does not last only one day, so it can be like 60 days of local feasts per year, and that may mean all kinds of noise, and often firecrackers and some fireworks for the bigger feasts.

So I relocated because for instance the local feasts where I used to live were getting longer and longer every year, and it was harder to avoid noise every year, and this was not normal noise, but full volume firecrackers for pretty much 24 hours a day in some days... so I would just leave the place at the beginning for the day, or the worst week of the year.

I had to adjust my work schedule for this and adjusting became harder too, I would not be able to get those days off etc... accommodating was increasingly complicated.

So in the end I thought I would just move somewhere that was slightly noisier, but there would not be so many noise peaks (firecrackers...). Where I live now there are more motorbikes (but I lost hearing over the years, so it is more or less ok) but there are a lot less days of firecrackers per year.

To sum up: it's hard to live with hyperacusis haha.

There may be places, especially off season, but it is hard to find work in those towns.

 

Depends on your health insurance. In Germany there are two classes of health insurers, private or statutory. Patients with statutory insurance are less profitable for doctors.

If you have statutory insurance, then you don't need to come several times, but as a tinnitus patient you don't get any help either. The ENT will hoover your ears and maybe let his assistant do a perfunctory audiogram and then send you on your way without doing anything else.

 

Thanks mate for letting me know the grass isn’t always greener on the other side

I can imagine you must sleep with windows closed. That sounds brutal in hot weather which you probably have 100 days a year...

I’m up here in Norway, fireworks are getting more common here too because in pandemic times the municipalities decided to exchange some usual activities with more fireworks. I guess the next year it’s both. The main activity for people here after work is renovating homes and raise children. So it’s not easy living in apartments here too, but not many fiestas like in Spain.

As someone who always had a desire to retire or early retire in Spain I appreciate your detailed personal information a lot.

My experience here last year is quite similar to your struggles down there. I had to leave my home for half a year due to neighbour renovating.

One good thing is the public can only buy fireworks 4 days a year!

And our health system is pretty good although ENTs are useless here too

Wish you a good weekend

 

In my opinion, the best practice would be for an ENT to do all tests in one day, in one single visit. First the ENT would receive the patient and talk about how things are going. Then the doctor would ask for all tests needed (audiogram, including speech audiogram and speech in noise test, tympanogram, etc); the tests are carried out by an audiologist, so this does not take time for the ENT, who is in the meantime seeing other patients. After the tests are completed, there is a briefing with the ENT to discuss the results and possible treatment, if any.

The speech in noise test is very important, as results can vary a lot over time even if the tonal audiogram stays more or less the same.

At the end of the day, this is just a matter of billing, and as a patient who pays for private insurance, I don't care if a clinic bills the insurance 3 times in a day, instead of 3 times divided by 3 visits, which usually means going downtown, dealing with traffic, paying for parking space, etc

The cost for the insurance company is also the same, because a patient that really needs to have tests done will go 3 times anyway...

 

Yes, I have to sleep with windows closed due to the motorbikes. I am used to the weather, but even for me it is really hot for a few weeks in summertime.

I visited Norway once, after my hyperacusis was not so extreme, but still quite problematic, reactive, and it worsened easily. At the time it was my first trip abroad in like 5 years. I spent 3 weeks in Oslo, Bergen and the Lofoten islands. I really liked the country, specially the Lofoten islands. Overall it is a lot quieter than Spain, although one can encounter noise anywhere, even being very careful. Two examples:

- In Oslo I stayed with a friend, so it was a really nice and also controlled environment. I arrived on Friday evening, and I remember thinking the neighbourhood was very quiet until gardening started really early on Monday morning. There was gardening noise right at the doorstep, so I waited till it stopped to leave the apartment and go exploring the city. One thing I noticed is that some gardeners in Oslo parks had really good earmuffs that also allow them to communicate through the radio. It's great that they are provided with good hearing protection.

- One very positive thing I noticed in Norway is restaurants are generally a lot quieter than in many other countries and of course quieter than in Spain. It was possible to eat out often and being ok with noise.

- In the Lofoten I was just amazed at the scenery. So beautiful! So there was this day when I was driving around, and I would stop here and there to take a picture. Well, I stop the car in the middle of nowhere, just by the road, get out and walk like 50 metres, and I am there taking my picture in the quiet. Suddenly there is huge noise, like a power saw, so I turn around only to notice too late that I had just parked the car in front of a barn where someone was doing carpentry hahaha... how likely is that? So I waited at a distance, until sound stopped to return to the car.

To sum up, living with bad hyperacusis has been a compromise between trying to do thing and trying to preserve hearing and not worse too fast. Sometimes unexpected noise happens, anywhere, so that's something we have to live with. It is good to take precautions but it is impossible to completely avoid noise and some setbacks. In my case a single noise exposure could give me pain for 3 weeks and produce lasting setbacks, so it wasn't easy...

I hope I haven't bored you guys too much with the long post...

Enjoy your weekend!

 

Doctors ripping off the government is not surprising. Spain has a very high unemployment rate: In January 2021, Spain was the highest in the EU, at 16%.

"FocusEconomics Consensus Forecast participants expect the unemployment rate to average 17.4% in 2021 and 16.0% in 2022."

These very high numbers are not only due to COVID-19, the rate has been double-digit in Spain for years, well before COVID-19 struck.

I can't understand how this country even survives. I guess they live off the backs of the rest of the EU, and laugh at the U.S., where the unemployment was 5.9% in June, 2021.

 

I do not know about the other Nordic countries - I have only lived in Norway for few months - but Sweden definitely has few sinister features you would not even imagine as an outsider. One is, indeed, that advertised belief that everything is perfect.