Breakdowns in communication with patients who have difficulty in understanding, speaking or hearing may occur during a consultation. The authors of this paper studied the hearing-related breakdowns in communication especially amongst older adults with hearing impairment (HI) using conversational analysis of video recorded appointments and the environment in which they occurred. They found that many of these breakdowns occurred when the audiologist was multi-tasking while talking to the patient and there was an absence of mutual gaze. This is an important concern not only for those with communication impairment but also for all clinicians. The authors suggest that all healthcare providers should be aware of their own movements and gaze to improve communication with their patients, especially if they are hearing impaired. This study highlights the importance of face-to-face communication between clinicians and patients and is relevant to all those in clinical practice.