One strong suggestion is to use the word “communication” in place of “your hearing.” The primary reason to use “communication” is because the patient can be sensitive to and defensive about conversations addressing his personal deficiencies. In fact, he/she may be a master at fending off suggestions of a hearing problem. Second, most people view communication as a two-way street for which they are not totally accountable. Third, in most cases, we really are more interested in communication ability as opposed to hearing or audibility (remember, a lot of patients say they hear fine, they just can’t understand people).
If you're a die-hard anti-book-marker, you may object that the margins, the space between the lines, and the end-papers don't give you room enough. All right. How about using a scratch pad slightly smaller than the page-size of the book -- so that the edges of the sheets won't protrude? Make your index, outlines and even your notes on the pad, and then insert these sheets permanently inside the front and back covers of the book.