This week on the Future Ear Radio podcast, I’m joined by Jon Suen, AuD. Our conversation begins with Jon sharing his story of the winding path he took that eventually led him to Johns Hopkins where he’s working on his PhD. Jon’s story is a fascinating one and includes his passion for American Sign Language, his time at Gallaudet University for his AuD, and a stint with The Peace Corps.. Today, Jon is working to obtain his PhD within the Hopkins School of Nursing and is mentored by folks like Dr. Frank Lin and Jennifer Wenzel, PhD.
Jon’s work focuses on the intersection between Audiology, Gerontology, Nursing and Public Health and during the second half of the conversation, we talk a lot about community-based approaches to Audiology.
For example, Jon describes a potential for audiologists to work in multidisciplinary programs like CAPABLE, whose goal is to support older adults “aging-in-place.” The team is comprised of a Nurse, Occupational Therapist, and Handy Person (who helps with home modifications). An audiologist could contribute very meaningfully to such a team, though most are currently not yet trained to consider social determinants of health for older adults with hearing loss.
What strikes me about this approach is that Jon would essentially serve as the lead in his specific field of expertise, Audiology, which would allow him to delegate his expertise to his fellow teammates. So, not only would he benefit from being in the actual setting of the patient (their home), but he would also be able to further extend his knowledge so that it’s imparted by his teammates (to a certain degree) even when he’s not there.
Jon represents just one more example of how many people in the field of hearing sciences are thinking outside of the box and redefining the role of Audiology in 2021. While there’s a lot happening with tech innovation and new business models, there’s also a groundswell of entirely new ways to distribute the field of Audiology as well, which might help to dramatically expand the field’s influence and standing amongst fellow health professionals and the broader community of patients.
-Thanks for Reading-
Dave
EPISODE TRANSCRIPT
Dave Kemp:
Hi. I’m your host, Dave Kemp, and this is Future Ear Radio. Each episode we’re breaking down one new thing, one cool new finding that’s happening in the world of hearables, the world of voice technology. How are these worlds starting to intersect? How are these worlds starting to collide? What cool things are going to come from this intersection of technology? Without further ado, let’s get on with the show.
Dave Kemp:
Okay. We are joined by a great guest today. I’m very excited for this. Jon Suen. So Jon, tell us a little bit about who you are and what you do.
Jon Suen:
Sure. Hey, Dave. Thanks for having me. So hello everyone. My name is Jon Suen, and I am an audiologist and currently a fourth-year PhD candidate at the Johns Hopkins School of Nursing. And I also train with Dr. Frank Lin at the Cochlear center for Hearing and Public Health at the Bloomberg School for Public Health as well.
Dave Kemp:
Awesome. Well, thank you so much for joining us today. I think this is going to be a great conversation. There’s so much that I want dive into, but as we were talking before we started recording, I mean, I think the thing about this podcast is really for it to kind of be a who’s who in this world and really understand what you’re doing, but more importantly, who you are. And so I figure why don’t we just start from the top? Tell us a little bit about… Obviously, you’ve just already mentioned that you work with Frank Lin. You’re at John’s Hopkins. So let’s go back in time a little bit and talk about how did this come to be? You can go back as far as you want, but I would love to kind of hear about your journey of how you came into this world and then how you ultimately landed into where you are today.
Jon Suen:
Sure. So I will start with a little bit about just where I’m from. So I was born in Queens, New York, and I was raised in the New York City area and the suburbs as well. And basically, my first encounter with hearing loss was actually within my family. And members of my family, once they reach in their 50s, which is still relatively early for what we would call age-related hearing loss usually, usually in their 50s people in my family started to have slow onset hearing loss. And so it was something that growing up we just knew was present in my family. And I was also raised by my grandmother, who lived with us. And so it was very evident to me from the beginning that hearing loss not only impacted communication, but it impacted interpersonal dynamics across people. And so to be honest, though, I never really thought of it as a condition that healthcare providers need to address. A part of that, probably like what many Americans experience, is that we didn’t see it as something that needed to be addressed. It was something that we perceived as a part of getting older. Like I mentioned, it’s something that we noticed coming up when people in my family got older. So we had this bias perspective that once you get older, this is just what happens. There’s nothing necessarily you can do about it or need to do about it.
Jon Suen:
And so that kind of primed my perspective of hearing as just a condition you live with, not necessarily something that you need to run to the doctor about. However, like I mentioned, I noticed it impacted interpersonal dynamics. And so when I actually went to undergrad, I eventually became a speech language and hearing sciences major. So I think I had mentioned to you a couple of weeks ago, Dave, that I had a conventionally unconventional path to where I am now. And the conventional part is that my undergraduate studies was in speech and language hearing sciences, which is the pre-professional track that a lot of people who end up going on to become a speech language pathologist or an audiologist would study. And through my studies, I actually became much more interested in speech language pathology at the time. And a part of that upon reflection was really just because I grew up in a multilingual home. And so from a very early age, I was not only a very inquisitive child… I was always that kid that asked all the adults why, why, and follow-up why’s. So I was that annoying kid, and I was fascinated by specifically how the different languages that I was growing up around communicated the same concepts, but in different ways.
Jon Suen:
And so I had that appreciation for communication and the interesting nuances of human connection through communication. And so that’s what kind of drew me to speech language pathology at first. However, while I was an undergrad, I also found my way over to the Deaf Studies Department at the School of Education. And this was a department that focused on deaf education and through sign language. And so that was my introduction to American Sign Language through undergrad. It actually started out as just a general elective requirement, ASL I. And I took it, and I mentioned to you I had this fascination with languages as a kid, and so my mind was just absolutely blown by this introduction of this visual spatial language. And so I ended up getting more involved with the Deaf Studies Department and eventually finished up with a minor in deaf studies.
Jon Suen:
And so, whereas I was sort of socialized into thinking that I will go on to grad school for speech language pathology, there were people in my life who started to say, “Well, why not audiology? I mean, you seemed very connected to the deaf community and deaf studies.” And even though it was a very different model of hearing loss, that is more of a social cultural model, as opposed to a medical model, there nevertheless was a connection that I seemed to have during my college years. And so people were trying to convince me to consider audiology. And as a 21-year-old at the time, I was very intimidated by the idea of grad school because I wasn’t ready for grad school, frankly, at that point. I didn’t feel completely invested in speech pathology, and audiology was something that I had really just learned a little bit about. Perhaps a lot of other listeners who had a similar major can attest to this, that a lot of these pre-professional tracks heavily emphasized, at least for me, a lot more speech pathology than audiology.
Jon Suen:
And so, long story short, it was actually my junior year of college that I knew somebody at the time who was applying to the Peace Corps for after graduation. And up until this point in my life, I had never considered Peace Corps. I had never even at this point really gone abroad, aside from like Canada, and that was it. And so I was curious about it. And I went onto the webpage for Peace Corps, peacecorps.gov, and out of nowhere the first thing that appeared on the home screen was this banner that said, “Learn Kenyan Sign Language.” And it was essentially advertising a deaf education program in Kenya, which the Peace Corps had been working with since the early 90s. And so I thought to myself this is something that’s interesting. And I read more about it. I read more about Peace Corps, spoke to more people who had done Peace Corps, even spoke to a Peace Corps recruiter. And I thought this is it. This is what I need. I need to learn more about the world as somebody who grew up in New York. I went to college in Boston. I’d only been to Canada. I had very limited world exposure.
Jon Suen:
And so I thought this was a good opportunity, plus to apply some of my training in deaf studies and American Style Language, to work in a deaf education sector in a school setting. And so that’s what I ended up doing. At the time when I applied for Peace Corps, you couldn’t choose where you wanted to go. That’s a little different now. At the time, it was sort of like you apply, you sort of show what skills you have, they do all their background checks and all their vetting and whatnot, and then they find a program to place you in. But I went into my interview basically being like, “This is my skillset. I know American Sign Language. I have some classroom experiences in a deaf classroom.” And I listed out a few other of my skillset, and the recruiter was like, “Yeah, sure. This sounds a great fit for you.”
Jon Suen:
And so that’s what I did after college. I went to the Peace Corps in Kenya, which was one of the most amazing experiences for me. Learned a lot. I’m sure other listeners who may be RPCVs, or return Peace Corps volunteers, themselves will know that it’s a pretty life-changing experience, but it also gives you an appreciation for what doesn’t work in the world and what approaches to working with a community other than your own may or may not work. And also going into a different community from your own, whether that’s abroad or domestically, realizing that you have your own world view and you have your own bias that you’re bringing into it.
Dave Kemp:
For sure.
Jon Suen:
And that will impact the way you approach a project. And if you don’t involve the direct stakeholders or the direct beneficiaries or whatever you’re working on in the process of whatever project you’re working on, it highly likely will fail. It’s unsustainable. And so that was an appreciation I got from the Peace Corps, this idea of working with direct stakeholders, involving direct beneficiaries in any projects and development of something new. But then after the Peace Corps, I had that realization that okay, I should really start looking at more options that can launch me further in my future. And so I thought okay, now’s the time for grad school. And at this point, I was much more enthusiastic about going for audiology. And consistent with my exposure to the deaf community, deaf culture, and ASL, I applied to the AUD program at Gallaudet University in DC-
Dave Kemp:
Awesome.
Jon Suen:
Which is a predominantly deaf university, and primarily ASL’s the language on that campus. And so that’s what brought me to audiology. And now the next phase, I guess, of my story is how did I go from a program that trained me to work clinically to suddenly going into public health? It really kind of started with my internships when I was working clinically as a student clinician. And while clinical audiology that we learn, a lot of these principles and methods are absolutely important and they have a place, I personally couldn’t help but notice that the populations that we were often serving, and oftentimes it was people from minoritized backgrounds, black and brown folks, Spanish speakers, particularly, I just couldn’t help but notice that as an anecdotal trend, they weren’t achieving what we would define as success with hearing aids or success with any sort of rehabilitation options. And it was something that stuck with me, frankly. It was something that I didn’t quite know how to conceptualize or how to address.
Jon Suen:
And I mentioned to you a couple of weeks ago that what I know now is that it was the social determinants of health that we as audiologists were not trained, at least I was not trained, to consider and integrate into any sorts of rehabilitation plan. And so, however, I didn’t have this terminology at the time. I didn’t have this concept at the time in how I was approaching clinical work, but I noticed a lot of things that I’m sure a lot of other audiologists have noticed themselves. Either people are chronically no-shows, or they’re chronically late, or they just sort of are lost to followup. Many of us have had that experience. And I was just that person who remember as a kid, constantly inquisitive, couldn’t help but just wonder well, why is that?
Dave Kemp:
Why? Right.
Jon Suen:
What is happening? Why? Exactly. Why is this happening? And I personally, what was not good enough for me was this answer of well, that’s just the way it goes sometimes, which understandably, I understand that’s a reasonable assumption, but for me as a highly inquisitive person, it for some reason just didn’t satiate that curiosity of why is this happening? And so after I finished my training, I was in this position of okay, so what do I do next? Do I go for a job? Do I go back to school? What do I do? There’s a lot of training, a lot of specialized training I have now as an AUD prepared audiologist, but I personally couldn’t shake those questions of why? Why is this happening? Why is it that the people that we know could very much benefit from our services, from the care we’re trained to provide, why is it that they’re not succeeding? Or why is it that they’re not adapting? Or why is it not sustainable?
Jon Suen:
And that’s when I eventually found my way actually over to a postdoctoral fellowship with Frank Lin. And this was before the establishment of the Cochlear Center for Hearing and Public Health. This was still the Lin Research Lab at this point. And I got connected to Frank Lin because my old department chair, Dr. Matthew Bakke, was actually on an advisory board for a project that Frank was the PI for. And the project specifically was about how do we address hearing health disparities in the community, particularly among older adults with low income and predominantly from minoritized backgrounds? And so I thought wow, this kind of meets a lot of the questions, or tries to answer a lot of the questions, that I had, and in particular trying to develop a new model of hearing care.
Jon Suen:
Admittedly, that was something when I first started, I still didn’t really understand what that meant, because I had been trained in AUD school from a narrow path, if I will say. And I don’t want people to think that I’m saying that’s a bad way of training, but it was one approach to providing hearing care, and it was the only approach we were trained to provide hearing. And while there is a place and a need for that type of approach, it wasn’t meeting everybody’s needs, and it wasn’t helping everybody the way that they needed to be helped or supported. And that was something that I realized through working on this project. And like I mentioned before, my perspective from Peace Corps of when you go into a community that’s not your own and you’re trying to develop something new, you got to involve the people that are the target beneficiaries in that process, because they’ll tell you how it is. They’ll tell you why it doesn’t work or what doesn’t work. And you’ll be the one that has to try and collaborate with that and work with it.
Jon Suen:
And so that’s how I was introduced to the field of public health, and in this case, working with Frank Lin, adapting it to this context of hearing care and hearing loss as a public health issue rather than a medical issue. And then when I started with Frank Lin, I had mentioned to him that I do have aspirations for PhD studies. I really did enjoy research, but I didn’t know what I wanted to study my PhD in yet. And so that was a part of my charge from Frank actually during my postdoc, was, “You’re working on this project with me. You’re learning a lot of new things as well, but on the side, I want you to be meeting with other faculty members from different schools to be figuring out when you apply for PhD studies, what do you want to focus on?” And that particular study, again, it was a community-based hearing care study, addressing hearing health disparities. We had an advisory board with various faculty members from across Hopkins and other institutions. And there were prominent representation of faculty from the Johns Hopkins School of Nursing, particularly faculty who had experience and expertise in community-based behavioral interventions.
Jon Suen:
And it was the way that they answered my questions and then the way that they posed followup questions that really it resonated with me, and it sort of gave me an insight into how these faculty members who are coming from a nursing perspective are looking at these public health issues, are looking at social determinants of health, and are looking at what are community-based solutions that can address the gaps? That resonated with me. And so I remember going to Frank, whom up until this point, by the way, throughout my postdoc, both he and I had made this assumption that my PhD would be something within public health, whether that’s epidemiology, whether that’s social, behavioral interventions, whether that’s health communications or whatnot.
Jon Suen:
And then I went to him, and I was like, “How do you think nursing sounds for me actually?” And he lit up. He was like, “I can’t believe I didn’t think of that. That makes a lot of sense for you.” And I checked with my nursing advisors at the time, and I said, “Would you guys accept a PhD student without a nursing background?” And sure enough, they do. And that particular faculty member that I asked is now my nursing advisor for my PhD as well. So there was a little bit of a full circle with that there. And that’s where I am now. I am now primarily studying hearing loss through a public health lens, but with a nursing [inaudible 00:19:00] to it. And with nursing, because nursing also is a clinical field, there is a little more of an emphasis on so how do we address this from a intervention perspective? But also nursing as a field historically has needed to take care of patients with limited resources and particularly low resource settings. And so they had that particular expertise as well. And so, yeah, that’s the very quick little nutshell about how I ended up where I am now.
Dave Kemp:
Jon, that’s a really cool story. Thank you for sharing all of that. I have a bunch of questions along the way, but I want to stick on what you just mentioned with nursing. I think this is super fascinating. So what was the aha moment for you, where you ultimately decided it sounded like you sort of were kind of going through this period of contemplation? What am I going to do my PhD in? What was the light bulb moment for you? And it seems like you’re really confident in your decision. So help us to understand this a little bit more about what this whole intersection of the nursing component means for what you’re doing.
Jon Suen:
So one of my academic and personal mentors, Dr. Sarah Szanton, who’s now the dean of our School of Nursing actually, she is world renowned for an intervention that she created called CAPABLE. And the goal of CAPABLE is to promote aging in place, as in older adults, aging in their own homes and not rushing to essentially institutionalize them in a nursing home if they have limitations. And so promoting aging in place. There’s a lot of resource that shows how it’s cost effective, and also it’s most often what people want themselves. She created a program that was innovative in that it targeted older adults with low income who had disability, and she described in her experiences when she was a nurse practitioner who was doing home care, these were patients who couldn’t leave their room and so would have to drop the house key out the window for her to enter the house. And CAPABLE essentially is a team with a nurse, a handy person, and an occupational therapist, that works with older adults with disabilities to help set goals and help modify their home, so that’s through the consultation with the OT, and as well as a handy person, who can make these home modifications. That promotes aging in place.
Jon Suen:
And so this model of multidisciplinary team, community-based working directly in the home environment of an older adult, that was something that I looked at, and I thought if we’re talking about how highly prevalent hearing loss is within older adults, this team could potentially have an audiologist someday.
Dave Kemp:
Love that.
Jon Suen:
And yeah, this team could have an audiologist. And in fact, not just this program, the CAPABLE program in general, but what about other community-based programs that are working with older adults? Audiologists, we’re highly trained to address hearing loss and communications. We should be the ones that are present in these spaces with these teams doing this kind of work. And we’re not. It’s not anything I ever learned about in AUD school, about community-based intervention, about working with people in their home settings, working with other specialties besides SLPs and ENTs, but a nurse, an OT, or a geriatrician, working with these other disciplines to essentially provide more holistic care for patients.
Dave Kemp:
I absolutely love this. I think this is so fascinating, because first of all, I think aging in place, it’s a trend that’s only going to become, I think, more prevalent. I think it’s already really popular. I think most people would prefer to live in their residence for as long as possible. And so I love this idea of being part of a team that it’s community-based, like you said. And I think that… I just came from a show. Actually, Frank was there. It was the FCOM Show. And a lot of the theme there was around the whole brain and hearing link. And I think that this is something that needs to be more widely understood within the public domain, which is that hearing loss is usually, whether it’s causation or correlation, I’m not sure, but there’s obviously a link to a lot of these cognitive issues.
Dave Kemp:
And so I think that having that sort of approach where it comes at it from look, we’re a team. We’re trying to enable it so that you can continue the age in place, you can do what you want to do, but these are things that we need to really understand about you. And I think that in that setting, it elevates the audiologists in such a way where it’s much more holistic. It’s about okay, obviously, your hearing is one aspect of this, but it’s a portal into something much bigger. It’s a portal into your cognition. Are you suffering in any way from early onset of dementia? Are there worrying signs there? Or can we check the box and say like this is all really good? So I think that that’s an absolutely fascinating approach, because I think it ties into this broader theme that seems to kind of have this undercurrent right now within the profession, which is there really is this opportunity, I think, for audiologists, broadly speaking, to really elevate the conversation to be much, much more than just hearing loss and as if hearing loss is isolated in its own thing.
Dave Kemp:
So for me, this is really, really cool and exciting. And I think it’s innovative, because to your point, I think it can really scale in such a way where we could see this be something that’s highly prevalent. As more people want to age in place, they have this kind of team. I just think that’s really, really neat.
Jon Suen:
And what I would encourage other people to also consider is… I think it would resonate with audiology as a profession… to consider outcomes other than what people can hear with a hearing aid in a soundproof room.
Dave Kemp:
Completely agree.
Jon Suen:
Those are the metrics we’ve been trained to collect and use as markers of oh, it works, but it is also consistent with audiology trainings, particularly with rehab, AR, that’s we look at okay, so where are you having communications issues? And what are the limitations in that particular setting that I can work with you on and maybe we can strategize together? At the heart of that kind of approach to rehab is what is this particular client’s goal? What is it functionally in their life that they are currently limited in being able to do and the audiologist can advise and counsel them accordingly? So this idea of going to a multidisciplinary team that’s community-based, that focuses on goal setting and functional outcomes, it vibes, I think, with what audiologists are able to do, but because we’ve become so wrapped up in a medical model and a medical approach to hearing loss, that’s what we end up focusing on, is this is what your pure tone average was unaided. Let me put the aids on you, put you back in the sound proof room, and let me see what your PTA is now with the aids on.
Dave Kemp:
Yeah. I couldn’t agree more with you here. And it’s a really interesting distinction too, what you’re describing as sort of this medical approach, as opposed to this community approach. Really, the first time I was exposed to this myself was when I was talking to your colleague, Nick Reed, and Nick was really adamant about this too, which is community intervention and this idea of it’s part of a bigger thing, it’s less about how well they can hear. And I think that’s a big part of it, but I think more importantly, it’s about how they’re engaging with their environment around them. And so I think that this whole distinction is really important, because again, I think there’s a number of sort of subtle things that go on when you take this different approach. Just as you mentioned, it’s a little bit more collaborative with other specialty doctors. So I’m curious. I can kind of see how a lot of the audiology profession might think about this, but what’s been your initial reception and I guess maybe what you’re aspiring toward with how nurses perceive this, how those occupational therapists perceive this? I mean, it seems obvious to me that this is a perfect sort of fit into this little ecosystem here, but what’s been the reception that you’ve had from some of these specialty doctors?
Jon Suen:
So when I speak to other people with different clinical backgrounds, who all of us work with older populations, it’s like the moment I say I’m an audiologist and that I specialize in hearing loss, everyone’s eyes just kind of light up to be like oh my God, yeah, I confront hearing loss a lot.
Dave Kemp:
Totally.
Jon Suen:
I see it in my client population, or my patient population, a lot. Hearing loss is not something that people never encounter if they’re working with older adults in a healthcare or just in a public health context. And so when they see me there, the reception is sort of like they’re happy. They’re like, “Oh my goodness. Thankfully we have you here to work on this because it’s clearly something that we encounter, but we move on with other things because it’s not something that we have the tools or the expertise to address.” And so this is my spin on it, but whenever I hear people kind of… Their faces light up, and they’re like, “Oh my God, I encounter hearing loss all the time,” I hear a followup in my mind, which is, “Where have you been this whole time?” And I kind of ask that of my fellow audiology professionals. “Where have we been?” We’ve just been in the clinic. We’ve been right in the hospital settings. We are focusing on audibility with hearing aids or cochlear implants, and that’s it. We’re not actually out working with people who are looking at other outcomes and then supporting them towards those outcomes with our particular expertise.
Dave Kemp:
And the irony is that there’s this narrative, and I’m not pointing fingers or anything like that, but there’s this sort of theme right now that the world of hearing healthcare is sort of being disrupted, or it’s under attack, and that there’s going to be this shortage of patients. And I think that it’s the furthest thing from that. I think that there’s not nearly enough audiologists out there to service all these people when you really, like you said, get out of the clinic and you see how often does the occupational therapist or the nurse encounter these obstacles that are really challenging to them that you could be the remedy for. And so I think that the opportunity is 100% there, but I think it takes an entirely new mindset into all right… And I guess maybe my question to you, so that this is productive, is what would you recommend for somebody that maybe is a legacy, call it… I’ve been in practice for 10 years and I do spend the bulk of my time in the clinic. How can you get more involved in more of this community approach? Are there simple things that that can be done?
Jon Suen:
Sure. So first, I just want to take a moment to speak specifically to other audiologists who may have this sense of anxiety of our world is being disrupted with a lot of other things that are happening right now. I empathize that audiologists, particularly in large medical settings, which is predominantly where my trainings have been set in, we’re busy throughout the day. We’re constantly on our feet. We’re seeing-
Dave Kemp:
For sure.
Jon Suen:
Clients after clients after clients. We’re getting add-on from the ENTs for audiograms, and we’re constantly busy. And so I have empathy that, yes, we see a lot of patients, and through those experiences, it informs our perceptions of what patients need. But I would encourage everyone to kind of take a step back and just kind of entertain this idea for a moment that the people we’re seeing isn’t representative of the entire population. And the people that we are busy seeing every hour throughout the day, five days a week, if not more, they are a very small sliver of the population who would benefit from the types of services or the type of care that we would recommend and/or advise.
Jon Suen:
And so the reason why I want to say this is because I think there’s a lot of implicit and as well as explicit resistance to embracing new models when we talk about community-based models of care. Like I said before, the model that most of us, if not all of us, were trained to provide, it’s necessary, it’s needed, but it’s not the one that fits everybody’s needs. And so kind of building off of what you said, by changing the field, it’s really just opening it up, opening the types of people that we are qualified to work with even more. And so for the clinician who is predominantly still clinic-based and is wondering what they could do or contribute to the emergence of these community-based models is I would say take a step back and consider what are your metrics of success? How are you defining success with your clients? Is it just audibility? Is it that they are able to repeat more words in a quiet, soundproof setting with their aids on? Because if it is, that may not be what their goals are, and it may inadvertently be contributing to some clients having a perception of I’m not sure if this is actually worth it for me. I’m not sure if this is actually giving me what I need.
Jon Suen:
And so think about the bigger picture of how what we were trained to provide can actually enhance and improve people’s lives, and then let that be the north star in guiding how you would approach your rehabilitation services.
Dave Kemp:
Yeah. I mean, I think it’s a really interest team thought, because I think that, on one hand, there is the current model that is very taxing. And so I think there is a challenge of I only have enough time in the day, and so what can I do? And I think maybe even just being engaged within this community outreach effort, it allows for you to almost delegate some of your expertise to some of these other professionals so that you’re almost training them in a way where the nurse is more equipped to how they can handle these things, the occupational therapist, whoever it might be.
Dave Kemp:
So I feel like you have such a specific and much needed skillset, and it’s a matter of how do we make that proliferate? How do we make that more accessible? And it obviously can’t just be that you are going to be in all these places at once. You have to almost somehow take that knowledge and that expertise, and you have to share it in such a way. And so I figure that might be part of it, is that… And this is what’s so fascinating to me about what you’re doing, which is it seems like it’s really trying to help be the expert within your field of study, but be engaged in such a way to where it’s more communal amongst these other professionals so that you’re imparting a lot of that knowledge on them and that they can then kind of represent that when you’re not there as well.
Jon Suen:
Right. And I also want to take a moment to just acknowledge that this medical model of hearing care provided by audiologists, it’s upheld that way by policy. I want to acknowledge that we as audiologists are working within a healthcare reimbursement system that doesn’t incentivize or support us in changing our practice. And so that’s why I admire the works that the faculty here at the cochlear Center are doing, which is not only are they conducting epidemiologic studies, but they’re doing so to influence policy, to change policy, because if you can change the framework that clinicians like audiologists have to work within, if you change it at that level, the idea is that it trickles down, and it enables the audiologists who does have interest and a heart to go community-based or think other types of outcome metrics. It enables and supports them to be able to do that. And so I want to acknowledge that I don’t think that the majority of… This is just my opinion. I don’t think the majority of audiologists don’t want to help more people. It’s that we are working within a system that conspires us to not do so.
Dave Kemp:
Yes. Couldn’t agree more. And that’s why I think what Frank’s team is doing with the ACHIEVE trial is so important. I mean, I think it’s crazy to me, and I’ve said this before, but the fact that when you go and you see a physician, your family physician, that you don’t have a annual hearing test in the same way that you get your blood pressure taken. It’s wild. And so to your point, the policy is extremely important here, because I think that if the ACHIEVE trial is able to really demonstrate basically that that needs to be taking place, I mean, that’s what would influence the policy here. And that’s just one small example of this, but I agree with you that the frustrating part of all of this is that, I mean, having talked to a lot of professionals, the commonality is there’s a very altruistic streak across this profession. Many, many of the people I’ve talked to would be more than happy to help as many people as possible, but they are sort of confined to the model of this is how you generate revenue. This is the current way in which business exists. And they’re handcuffed in such a way to that.
Dave Kemp:
And so I think that that’s what’s really exciting in my opinion, though, about kind of what’s on the horizon right now, whether it’s going to be what hopefully comes through the door with the Medicare expansion and what that ultimately might look like, things like what you’re all working at Johns Hopkins through things like the ACHIEVE trial, because I agree, I think that policy is a massive part of this. And I think that most people that are listening to this are probably nodding along and like I wish that I could be doing more of this.
Dave Kemp:
And so it’s a challenge. And that’s where I’m trying to almost find a happy medium, is to say even in your current model, what can you do to at least get the ball rolling a little bit, to be a little bit more engaged maybe overall with the broader healthcare community in your environment, because I think, again, going back to what you said earlier when you were talking about where have you been, I think it’s such a pervasive thing that they deal with older adults. We all know that older adults obviously comprise the bulk of the hearing loss population, so it’s common that they’re running into these issues. And those issues tend to probably lead to all kinds of different frustrations for those professions as well. So it’s like this is such a much needed thing, and it’s a matter of how do you make this something that is more widely accessible? That’s the big million dollar question I feel like we’re dealing with.
Jon Suen:
For sure. For sure. And then, like I said, when I have been in these other spaces where traditionally a lot of audiologists have not been in, and I meet other clinicians and public health scholars, they’re enthusiastic that I’m there along with others, like Nick Reed. They know it’s an issue. They’ve seen it, but they haven’t had a means of even starting to think about a solution most of the times, because they also have their own plate that they have to sort of be addressing with their project goals and their objectives and their boxes that they have to check. So when we show up, there’s enthusiasm there, and there’s support there. And so if anyone is interested in going in another direction, an unconventional direction, like I’ve tried going down, just know that there will be people that are excited to receive you and excited to hear how you can contribute with your expertise.
Dave Kemp:
Yeah. I couldn’t agree more. So tell us a little bit about what’s kind of going on in your world currently. I know that you’re involved with a lot of different research. What’s really exciting to you right now with your personal work in the things that you’re focused on?
Jon Suen:
So what I am current working on is my dissertation research. And it’s exciting because it was disrupted by COVID. And so data collection stopped for a while. And so it’s exciting because it was on a hold, but now I have data, and so I am doing my analyses right now for the first part of my study. I’m doing a mixed methods dissertation, and so I’m doing the quantitative analyses right now, and I’ll be doing qualitative interviews starting next year. And so that’s what I’m working on right now. It’s exciting because… I don’t know if you have experience with statistical coding, but coding is not something that comes intuitive to me. I’ll admit. It’s not something that is super easy for me. In fact, it’s challenging for me, but it’s like a puzzle for me, trying to code for something. It’s like learning a new language. Again, I had this fascination early on with language. So it’s almost kind of like trying to learn a new grammar. And so again, it’s not intuitive to me. It’s not something that is super easy for me, but I like doing it because you learn by trial and error. And obviously I have the support from actual biostatisticians who can support me, but it’s exciting. It’s like trying to learn, again, like I said, a new language.
Jon Suen:
Outside of my dissertation research, I, like you mentioned, am sort of collaborating on other people’s research a lot. One of the papers that I was actually just accepted for publications has to do with racism and the impact over the life course on the health of older Black Americans. And so that’s something that particularly through… And then the senior author of that paper is Dean Sarah Szanton, and so having somebody who I admire, who also is my academic mentor. Thinking about public health disparities, again, through the social determinants of health lens, but from racial equity and social justice perspective, it’s something that I find fascinating, and I’m sure there are a lot of other, as you may have even seen yourself, a lot of other conversations that’s increasing around this, people calling racism as a public health crisis and whatnot. It’s something that I reflect on in how do we sort of address this within audiology?
Jon Suen:
And my other colleague, Dr. Carrie Nieman and I, we actually have a paper in press that’s trying to take social epidemiology as a discipline that really specializes in addressing social determinants of health, such as racism as well. And we wrote it for the… We adapted it. Excuse me. We adapted social epidemiology for hearing health and hearing care for a hearing audience, that is audiologists and auditory scientists. And so that’s exciting as well. Communicating across disciplines is something that I find personally really exciting.
Dave Kemp:
Yeah. I was going to say, I would say one of the things I really have gathered from you throughout this conversation and getting to know you a little bit before we started recording is you have a real knack… And I don’t know if this is something that is really encouraged top down within John’s Hopkins, because I feel like I see this with a lot of the people there, but you all are amazing at cross-pollinating ideas across different sort of, I guess, professions or these walks of life. I think it’s fascinating, because to your point, I think by doing, you’re kind of taking approaches that have never really been taken before. You’re looking at things through a totally different lens. And I just find that to be really interesting, because you don’t typically hear these cross-disciplinary fields as being related. And then it seems you and others, you’re really making a concerted effort to find ways in which these things are linked.
Dave Kemp:
And I think what’s really interesting about it is you as an individual are learning about these other disciplines, and then that helps to influence your thinking too. I just find people like that are usually real creative, out-of-the-box thinkers because they’re not stuck in one way of thinking. They’re very much taking some of the best parts from some of those around them. So I just want to kind of give a tip of the hat to you and some of the others over there, that it really does seem like something that’s kind of in the water in Baltimore or something that’s going on at Hopkins.
Jon Suen:
It’s a tale as old as time, like with fusion cuisine. Sometimes it creates something even better than the original. And so I thank you for that. I appreciate that acknowledgement. And I have to acknowledge that it all starts at the top with Frank Lin. That’s something that I remember when I was in the postdoc, pretty fresh out of Gallaudet University. That was something that he would emphatically encourage and emphasize… Excuse me… he would just repeat again and again, is, “You have to look at the bigger picture. You have to see what other people are doing.” I am an audiologist, but I’m also a gerontologist and a public health scientists. And that can exist. And we are a growing cadre. I’m meeting more and more audiologists who are going back for other degrees, particularly with masters of public health. So we are a growing cadre, and I think that is a trend that hopefully will only get more and more prevalent, because these intersections are where innovations emerges.
Dave Kemp:
Okay. Couple of last questions as we come to a close here. So going all the way back to the beginning of the conversation, you said you grew up in a multilingual home. What languages were you exposed to at a young age?
Jon Suen:
So my first language was Mandarin Chinese. Like I mentioned, so my family are immigrants, and so they worked multiple jobs when I was born. And so it was the grandparents that were at home. So my paternal grandparents speak Mandarin Chinese, and so that’s what I first grew up speaking.
Dave Kemp:
Very cool.
Jon Suen:
My mom speaks Japanese with her side of the family, and so I was also immersed around Japanese. And then my parents speak Taiwanese to each other-
Dave Kemp:
Wow.
Jon Suen:
Because Taiwan as an island is multilingual and multiethnic throughout history. And so in my home growing up, it was Mandarin Chinese, Taiwanese, and Japanese.
Dave Kemp:
That is so cool. I’m jealous of you in a way that I would love to have… I actually have… My sister, she married an Argentinian, and so my two nieces, they’re like two and three, and they’re exposed to Spanish all the time. And it’s amazing to watch a little kid, and their little brain absorbs a language like a sponge. And they’re both bilingual already. And it’s just incredibly fascinating to watch their brains are really malleable. For me, it is a Herculean effort at this point in my life to try to learn another language. So I’m envious of those that are immersed at a really young age. I think that’s super cool.
Jon Suen:
I have three toddler nephews as well, and I can relate to that experience of you just watch their faces when they’re speaking to you, and you can see them thinking and putting the words together. And they may use the wrong word, but you knew where they were going. And it’s not only adorable, but yeah, it’s absolutely fascinating as well.
Dave Kemp:
It’s fascinating. It is. It totally is. Peace Corps. I would love to have honestly had a conversation just about that, because that experience is so incredibly fascinating. What was that like, the first… I have a buddy that his little brother, he did a similar thing in Rwanda. And so I’ve kind of asked him this question, but I’m curious, what was the first few days like for you when you went to Kenya? Total culture shock? I mean, were you just blown away with just how different that part of the world is? Or what were kind of your first impressions?
Jon Suen:
So when I arrived in Kenya, I was sick. I actually left the US with a little bit of a cold.
Dave Kemp:
Oh boy.
Jon Suen:
And so my first few days was miserable because I was trying to get over a cold in a new country. But after that was over, a combination of bewilderment and anxiety, excitement but fear. Like I mentioned, going to Peace Corps was the first time I ever left North America. And when I look back on it, I have told other people before that it was the exact kick in the butt experience that I needed as an American, 20-something-year-old, who grew up in the suburbs, who went to a really good college and hadn’t been exposed to the world that much. It was a kick in the butt and knocked me down, but I needed it.
Dave Kemp:
You grew a lot from it.
Jon Suen:
You grow a lot from it, and it just opens your world. It was still to this day one of the hardest things that I have done so far, but it’s also one of the more empowering things that I reflect on, that I was able to do that. It was hard. I had my days that was not great, but it makes other things a little less scary. Let me put it this way. It makes doing a dissertation here at Johns Hopkins a little less scary as well when I think about it.
Dave Kemp:
Yeah, exactly. It toughened you up a little bit, but it definitely sounds like it shaped your world view and it shaped you as a person, and that’s really cool as well. Yeah, you’re an impressive person, Jon. I’m really glad to have had a chance to meet you a little bit through this. Definitely following along with what you’re doing. So as we come to a close here, any closing thoughts? Anything that you want to share as we sort of wrap it up here?
Jon Suen:
I am so glad that I got a chance to speak with you further as well, get to know you. It was years ago that you and I first connected over Twitter. And likewise, over the years kind of following you on Twitter and kind of seeing the things that you promote and you talk about, it resonates with me as well. And as a sign-off, for me, the field is changing. In fact, change is a constant. Change is ongoing, constant. And it’s exciting. And we have an opportunity to really shape it and define it and make it into what it will be someday. And so be a part of the conversation. Be at the table and participate. And embrace it. It’s exciting. And so I hope I see more and more people in audiology becoming more interdisciplinary and more transdisciplinary, even, in the years to come.
Dave Kemp:
Awesome, Jon, thank you so much for coming on. A fascinating story. I’m sure this won’t be the last time. We’ll have to have another one of these down the line once you’ve finished your dissertation, you’re fully immersed in whatever you’re going to do next. But really, really enjoyed this conversation. So thanks for everybody who tuned in here to the end, and we will chat with you next time. Cheers.
Jon Suen:
Take care, everyone.
Dave Kemp:
Thanks for tuning in today. I hope you enjoyed this episode of Future Ear Radio. For more content like this, just head over to futureear.co, where you can read all the articles that I’ve been writing these past few years on the worlds of voice technology and hearables and how the two are beginning to intersect. Thanks for tuning in, and I’ll chat with you next time.
