One of the First Deaf Physicians in The United States feat. Dr. Zazove | Michigan Medicine

Blaise Delfino: 0:06

You're tuned into the Hearing Matters Podcast with Dr. Gregory Delfino, and Blaise Delfino of Audiology Services, and Fader Plugs, the show that discusses hearing technology, best practices and a growing national epidemic: hearing loss. On this episode, we are so excited to welcome Dr. Zazove from the George A Dean Share of Family Medicine at the University of Michigan. Dr. Zazove is the professor and share and Dr. Zazove, welcome to the Hearing Matters Podcast, it is a pleasure to have you on the show.

Dr. Zazove: 0:44

Thank you for having me.

Blaise Delfino: 0:45

Dr. Zazove, let's dive right into this. Can you please share with us your experience with regard to your educational journey? What were some of the challenges that you experienced early on in the classroom?

Dr. Zazove: 0:58

Dating back to the last Millennium, so a long time ago, I wasn't diagnosed until I was four. So for the first three, four years, there was nothing. I was diagnosed at age four, and then from then on my parents put me in mainstream. Interesting because in those days people who were deaf were put in the state deaf schools, but because I was not diagnosed unitl I was 4, my parents realized hey, maybe this person can compete. So they put me in mainstream classes? And the question about some of the challenges, I was the first person mainstream in the Northen Chicago suburbs. There was another person that was mainstream in Chicago ahead of me, but we had not known each other. By coincidence, we lived in the time, where the deaf kids from the northern chamber will come to the nice school system. So the deaf teacher would go to each class and work with the teachers, it got run through elementary school to work with them. Every year my mom and dad told me every year the teacher were picked by how am I gonna deal with a deaf kid? And every year during the year they were my biggest supporters. And I think I never had to deal with the deaf teachers. Telling them it's going to be okay, put him in the front of the class, look at him when you speak, and so forth. It was never the other kids, it was I was to the teacher, the biggest barrier. But I missed probably half of what they said, you know, half of what they said probably wasn't that important anyway.

Blaise Delfino: 2:43

Would you say that as you went through your educational journey and technology got better? Maybe increased awareness of overall hearing health care and teaching individuals who are deaf. Do you believe as though that innovation and technology eventually caught up to assist you and the teachers in the classroom as you went through your educational journey?

Dr. Zazove: 3:07

I would say think 25 to now 2021, well, absolutely. When I was there, there wasn't anything. No, obviously no cell phones, hearing aids were big and bulky and you wore them in your pocket. Yeah, yep. I refused to wear them cause I didn't want to be different, there wasn't anything. So the short answer to your question, for me, it makes a difference now to opportunity for people in technology.

Blaise Delfino: 3:41

So thank you to all of the individuals in hearing healthcare who assisted in that innovation to connect humans even more so to each other because even individuals who are deaf and hard of hearing, that is the biggest challenge and Dr. Zazove, you had reported in an interview and you referenced Helen Keller and she stated that being blind cuts you off from objects, but being deaf cuts you off from people. And you are the son of two physicians, and being deaf did not stop you from turning your passion of helping people into a successful career as a physician. Out of curiosity, where does your passion and your grit come from?

Dr. Zazove: 4:29

That's a great question. I'm sure some of it is inherent in who the individual is. I will say however, every single successful deaf person like whether small d or capital D deaf person I know have, one parent, parental support that really advocated for them. Think about it when we were 5,6,7 even 10-12 years old, You're not going to advocate yourself against teachers, the principal and the school system, but your parents will. I think, parental support is so much. I think once you get older, and you've lived and experienced it yourself and seeing how difficult, then you make friends and you see other people with disabilities. And I'm deaf, but people in wheel chairs, they do a lot take the edge off disabilities. I think we connect better and we appreciate what each other is going through. I think that help drive you to help others, especially other people with disabilities.

Blaise Delfino: 5:31

And how important is it when you do present with a hearing loss? Or you are hard of hearing and deaf? How important is it to advocate for yourself to say and to not be afraid to say I have a hearing loss, I am Deaf, can you please speak slower, maybe get better light on your face? How important is that, Dr. Zazove?

Dr. Zazove: 5:51

And I think Henry Kaiser says it better than me. The people with hearing loss are so focused and unhappy and noted that they actually hurt themselves. And people who have hearing loss, other than the completely deaf community, the rest of us 95% of us do not want anybody else to know that we have trouble. We don't say anything, we're quiet, we'd rather not understand and the people who know that we are deaf, we don't want them to repeat that. I think it's very important, to answer your question I think people rarely do it because they're embarrassed and we don't quite understand that. People don't want to wear hearing aids because they're embarassed, they wear glasses, they say hey I can't see you. I like to use a story where somebody walks in who is blind, what's the first thing you do, you get up and say hey, can I help you sit down? So what if somebody else walks in, and they're deaf, what do you do?

Blaise Delfino: 6:55

It's invisible.

Dr. Zazove: 6:56

Unless they say something, and they won't say anything, so you'll never know.

Blaise Delfino: 6:59

Right, right.

Dr. Zazove: 7:00

So the other thing right now with the masks. I know we have clear masks, but most people don't wear clear masks. I think I saw some more of us telling somebody hey, I'm deaf, I can't understand you. And I'm most people are totally fine with pulling the masks down or sometimes writing. It been very gratifying to do that. But I think that's the big issue, most people, vast majority of people with hearing loss will not want to tell you.

Blaise Delfino: 7:27

It is so important. And to anyone out there listening right now. And you currently wear hearing aids and you've been wearing hearing aids; don't be afraid to advocate for yourself to say excuse me, can you slow down your speech. And while we understand that you don't want to bring attention to the fact that you wear hearing instruments, it's okay, we are all human. Dr. Zazove, and we've been doing a lot of research on your incredible career, all the lives that you've changed and enhanced and it is so empowering, being a younger clinician to see what you've experienced because when you were younger, there were educators who would say you know, maybe the best that he's going to do is get into janitorial services and what's so interesting is that sometimes you have to believe in someone else's belief in yourself before you actually believe in yourself and you're very passionate about what you do and you love helping the community and love helping patients on their journey to better health. You report that people with hearing loss often receive sub optimal health care. Share with us why this is and how we can fix this.

Dr. Zazove: 8:39

We will keep talking about people with hearing loss don't want to tell you, the doctors don't know they have hearing loss. You have a hearing loss, you go to the doctor you're having abdominal pain, the doctors say do this, but you don't understand what the doctor says or they ask you questions and you give me an answer that may not be accurate. It's a problem, I can't get good health care but the flip side is a problem too. Most physicians, not all, but most are uncomfortable taking care of patients with hearing loss. Mind boggling in many ways because we we take care of so many things, but people are afraid. When we were doing some of our studies, people said to me, well I have hearing loss what do I do, I don't know what to do. And probablybecause we get very little training in medical school about it. Probably the whole stigma around hearing loss which is why we think most people who have hearing loss don't want to admit it ya know the whole deaf and dumb thing. And it's a real issue, we've done studies where I had a grad student, who did a very in-depth study to show the physicians treat the hearing patient differently in terms of recommended mammograms, colon cancer screening, opposed to those who have a hearing loss, it's is really impressive. And I think the other thing that we need to think about is when I wear glasses, they really help. Hearing aids make things louder. But you know, probably more than most, they don't necessarily make things clear, sometimes making it louder hurts. But it's just more noise to some people. So people, and they're expensive, medicare doesn't cover it, many insurances so it's an issue. Long answer to your question.

Blaise Delfino: 10:25

No, absolutely. And one of the many reasons why we host this show, the Hearing Matters Podcast is to raise awareness of the importance of best practices, raising awareness of overall hearing healthcare because Dr. Zazove, at our family private practice, we know where our patients come from, and I have to say, our physician referrals are rather low. Even though we've gone out in the community, we've introduced ourselves, we've let them know that we are a sounding board, and we are an office that if you have a patient who presents with a hearing loss, we can help them and unfortunately, when you talk about your journey with this implementation science, how physicians can help more patients because we understand that the physician is they have their hands full, they have to see how many patients a day maybe 40-50-60 patients a day. So maybe they see 20 patients a day and they're sort of cut for time. So with regard to raising awareness of the importance of hearing healthcare, the importance of the physician making a referral to an audiologist or licensed hearing healthcare professional, how will your work with implementation science enhance the process and enhance the ability of physicians to assist in the hearing journey and make the appropriate referral?

Dr. Zazove: 11:50

Thank you for asking that question. I think the first thing we should do is get quickly to buying implementation science amongst everybody so we can get how to make things that clearly work actually happen in the real world. For example going into hearing loss, we know it works but how do you make it happen? We have a EARPC working Early Auditory Refer Primary Care study. We develop a plan and electronic alert and electronic medical record to tell the physician anytime a high risk patient comes in to ask about hearing loss. How do we implementation sciences and how to make it most effective? We have to increase referrals seven times, seven times as many people referred. Having said that, most people were still not referred. I think we got up to about 10 to 15% of the high risk people being referred. So it's a great improvement.

Blaise Delfino: 12:46

Yeah.

Dr. Zazove: 12:47

I prefer not to. The other study were doing which to me makes it interesting is retrospective data that means looking at surveys, national surveys suggest people with hearing loss get readmitted to the hospital 30% more than hearing people who don't have hearing loss. In other words, you got pneumonia and you go home, if you have a hearing loss, you're 30% more likely to get readmitted within 30 days than if you didn't have a hearing loss. The truth. Now, actually doing a cospective study, we are going to room to room at the hospital checking hearing and testing so we know whether the person has a hearing loss, how severe, not telling the doctor and we're going to see if they do indeed have higher readmission rate. And again let's get back to what we said before, we were getting comments from patients, if we do this my doctor coming and talk to me I have no idea what they're saying, I can't hear I just nod my head. People are embarrassed they don't tell the doctor, the doctor don't know that they have a hearing loss, then they don't communicate. So we find there is indeed a higher readmission rate. We're getting back to implementation science, we have to figure out now how do we implement policies to help the physician not only know the patient has a hearing loss, but appropriately respond to it to make sure the patient understands what's goes on.

Blaise Delfino: 14:10

We always talk about processes and procedures. And number one, this not only raises awareness, but it creates a greater process for the overall health and well being of these patients because we do know that individuals who present with hearing loss are at a greater risk of hospitalization, and I'm very excited to see what your study finds. And if you do find that individuals who do present with hearing loss are readmitted sooner than those without hearing loss. Dr. Zazove, a question that we almost always get at the office is my son or daughter was just diagnosed with hearing loss and for parents who are raising a child who's deaf and hard of hearing. What advice would you give them, you know, what can they do to support their child throughout their hearing journey? Would you suggest support groups? What does this look like?

Dr. Zazove: 15:54

Wonderful question, I get that question all the time too. I didn't know if you remember earlier when I said successful people, d/Deaf people, all have very strong parent advocates. I think number one, yeah, the child may have a profound hearing loss, but that's okay we all have our own disability, you need to be out there advocating they can and telling the kid, they can do whatever they want to do, they may have to do it a different way. But anything is possible that's number one. Number two, I would suggest that people are open to their communication style, there's a big debate about sign language, versus books, I think the most important thing, you need to learn a language by age three, for your brain to develop. And the third thing accommodation. People may need some accomodations, whether simple one's are sitting in front of the class, whether it's hearing aids, whether it's cochlear implants, whether it's all kinds of things a full interpreter, it's having accomodation, it's mandated by the ADA, Americans with Disabilities Act. And the last thing I think you mentioned it, you're not alone. Many support groups, many places where people can provide help parents who are going through similar things, and who can talk to you and say, hey, what did you do here, what did you do there, where you can get more information from the newsletter. I would love it. I have two parents who were very very advocate.

Blaise Delfino: 17:19

And it made all the difference. And having strong parents who were advocating for you made all the difference.

Dr. Zazove: 17:24

It 100% made a difference, I wouldn't be here if it wasn't for them, I'd be maybe in some janitorial school or whatever. I'm not trying to put that down, I'm saying that I wouldn't have had the option to do anything else.

Blaise Delfino: 17:36

Right. Absolutely. And what's so amazing and I love that you brought this up is learning a language by age three. And for our listeners tuned in, there is a difference between speech and language. Language is a code in which ideas are shared and speech is a neuromuscular process. So learning sign language number one it is a beautiful language. Number two, it allows that child to feel connected correct, Dr. Zazove?

Dr. Zazove: 18:09

Sure, the brain is forming the connections the first 2-3 years and some of the connecting has to do with language acquisition. And whether it's sign language or to get different grammar and whatever language whether it's English or Russian doesn't really matter as long as you have a language. After age three you can if you didn't have sign language, you can learn that, if you learned sign language first, learn other languages and different things, but then your brain can do it, because it's got those connections.

Blaise Delfino: 18:38

And neuro plasticity is a real thing, it definitely is. Dr. Zazove, Rutgers was the only medical school that would accept you into their program. How did this affect your journey to becoming a doctor? Wow.

Dr. Zazove: 18:54

The first year I applied to I think 15-17 medical I think it affected my journey because it made me schools, I didn't get into any. Finally, had better grades, more extracurricular activities. Superb letters of of recommenda ions cause I still have 1 or 2 f them. And a friend of ours w o are at the University f Illinois Medical Scho l Admission committee, I was in llinois visiting, told my pare ts it was because of my hearing oss. It's definitely a packet s ores. And I was lucky. I am th third deaf person to go to med cal school. The second person person with two years ahead of me at Rutgers had done well. od opened the door, so to speak so when I went to Rutgers, even though I was out of st te, they were intrigued and they took me. realize what other people with disabilities go through I mean, I've been there, that's why I focused on making my career helping them.

Blaise Delfino: 19:50

And what's so amazing is you did not let those letters of rejection define you. You still went after what you wanted to go after. And that's become a doctor and help 10s of 1000s of patients on their journey to better living. Your story's incredibly empowering, and for Rutgers to say yes, he has a great background, he wants to become a doctor and help patients on their wellness journey. Thank you to Rutgers, that is incredible. That is truly incredible.

Dr. Zazove: 20:21

If I could add one more thing here. I'm going to add on your listeners here who may have profound hearing loss to be you have an opportunity to be a role model too. It's been very nice, even now, I hear from people regularly around the world who grab my autobiography which is public, proud of me in different ways. And tell me how, knowning about me, has given them motivation. You could do the same thing. We have a group now an association of medical professionals with hearing loss, people with hearing loss in different fields, medicine, dentistry, and so forth, we have role models, and we encourage you to do that.

Blaise Delfino: 21:01

And to share the light and to show others that it can be done. We absolutely agree with that. Hearing health care, we believe is not an online model, right? It's important to visit a hearing health care professional. With that being said, what can we do as a team to spread awareness of the importance of visiting an audiologist or licensed hearing healthcare professional?

Dr. Zazove: 21:28

That's a great question. I'm not saying that's necessarily the first step with some people, but other people may be a great first step, we've have many of these discussions and one is. People need to be willing to accept they have a hearing loss, it's okay to get out and say I have a hearing loss, I need help. We all have a disability of some kind. Second, talk to your family doctor talk to him or her and say, hey, I'm having a hard time, can you help me? If you can make them refer you, then you can get it covered by insurance. Third, I think a revolution is coming. Now I can go to the store and buy reading glasses. Before I had to get prescription. I do know, there is over the counter hearing devices. I think it can be more complicated than the glasses, because hearing loss is more complicated.

Blaise Delfino: 22:16

Yes.

Dr. Zazove: 22:17

Having said that, I'm hoping more people try them and if it doesn't work, then the next step is going to an audiologist, or somebody who knows the technology, or otolaryngologist, and saying, Hey, I tried taking that it didn't work. And the last thing I would say, kind of what I said before but even more so, when Ronald Reagan and Bill Clinton both wore hearing aids, what they did in public people, it made it more normal, and lots of people came out of the woodwork and said oh, if the president can do this, maybe I can.

Blaise Delfino: 22:50

Yes. And I believe it was Bill Austin from Starkey Hearing that fit President Reagan with his first set of hearing instruments. I believe they were CIC hearing instruments. So Dr. Zazove, we want to thank you so much for joining us on the Hearing Matters Podcast. Before we conclude today's episode, is there anything that you would like to share additionally, with our listeners about your journey, any words of wisdom to any parents who are raising a child or children who are Deaf or hard of hearing?

Dr. Zazove: 23:24

Yeah, and maybe kind of a personal thing. We've set up a foundation so if you have kids with hearing loss who are planning for college, the foundation we have provides guidance for people who are going to college who have hearing loss. The LTG - Louise Tumarkin Zazove Foundation Medical Foundation you can find it online and we usually pay for four years. We have funding to do that, and now in our 17th year of doing this, so we'd love to have applicants. So if you have that take your time.

Blaise Delfino: 23:57

Yes, Dr. Zazove, we will put that foundation in the description of this episode. And we will absolutely share that with all of our colleagues and peers who are in the hearing healthcare industry and individuals we know who present with hearing loss who are about to start their journey at the collegiate level. You're tuned in to the Hearing Matters Podcast with Dr. Gregory Delfino, and Blaise Delfino of Audiology Services and Fader Plugs. Today, we had Dr. Zazove from the George A Dean, chair of Family Medicine at the University of Michigan. Until next time, Hear Life's Story.