I had an MT ask me the other day if it was okay to transcribe without using ear phones, e.g. using their speakers. The short answer is no. If others can hear the audio, then you are violating HIPAA. Even in healthcare facilities where the entire office staff is covered with privacy paperwork, it is not okay to just share information. Each person being exposed to medical information has to have a need for the information. Playing audio aloud shares private information with anyone and everyone nearby. You never know who is listening or who might be on a phone nearby.
So get used to the headphones. I used to use the $300 Bose, but they are not needed. Personally I like the cheap $10 iPhone earbuds. The audio is easier to hear, you will make fewer mistakes, and you will preserve privacy.