Doctors Must Address the Needs of Deaf Patients

Summarized by Robert W. Griffith, MD
September 3, 2004

Introduction

If health care is to be effective, complete and effective communication between clinicians and patients must occur. This presents a challenge for the physician caring for persons who are deaf or hard of hearing. With the increase in the aging population, more and more doctors are faced with such challenges. Harvard scientists have studied where the main difficulties lie - at least from the patients' perspective - and gathered suggestions for improving the situation. Their report in the Archives of Internal Medicine is summarized here.

What was done

Group interviews were conducted with 26 deaf or hard-of-hearing patients at an independent living center in Boston, Massachusetts. There were four groups - men and women were seen separately, as were the deaf and the hard of hearing. The two deaf groups used American Sign Language (ASL) with the help of a translator, while the hard-of-hearing groups used Communication Access Realtime Translation (phonetic input translated into English on a screen display). All the interviews were transcribed verbatim, and then analyzed independently by three investigators.

Results of the analyses

The numbers of subjects per group were 8 deaf women, and 6 each for deaf men, hard-of-hearing women, and hard-of-hearing men. The deaf subjects were between 23 and 51, and the hard-of-hearing between 30 and 74 years of age. Otherwise, the groups were very similar.

The subjects reported difficulties with insurance coverage for hearing aids, audiology services, and prescription drugs. But most complaints related to communication problems. The analysts grouped them into six main topics:

• Conflicting views about deafness: Most physicians, often unconsciously, have fundamental assumptions about deafness that undermine the doctor-patient relationship. This can lead to serious underestimation of the patient's intelligence and willingness to co-operate. Hard-of-hearing people felt that doctors don't take their situation seriously - they merely talk louder, but show no sensitivity or compassion.
  
  
• Different perceptions about what constitutes effective communication: Physicians often request what the patient may feel are inadequate modes of communication - lip-reading, note-writing, or bringing a family 'interpreter'. Doctors don't understand their responsibility to ensure effective communication, which may be costly in time, equipment, or hiring medically-trained interpreters. With the hard of hearing, doctors often speak too fast and hurry through their checklist.
  
  
• Risks of inadequate communication: Major negative outcomes of poor communication include misunderstood diagnosis, instructions, and information about medication (dosage regime and potential side effects).
  
  
• Difficulty communicating during physical exams and procedures: Not knowing what the doctor or technician is going to do next can be frightening, even alarming. Failure of the patient to follow instructions (e.g. "hold your breath" during a chest x-ray) can necessitate repeat procedures.
  
  
• Interacting with office staff: For deaf or poorly-hearing people, it's hard to know when the receptionist calls their name. And when asked to undress, they may not hear whether they are asked to take all their clothes off, or just some of them.
  
  
• Problems with telephone communications: Physicians don't often have teletypewriters (TTY) or telecommunication devices for the deaf (TDD). And hard-of-hearing patients have great difficulties with office staff who speak indistinctly on the phone, and with automated telephone systems.

Suggestions for improvement

The study participants were asked to suggest the main areas to be tackled, in order to improve the situation. Their many suggestions included the following:

• Basic training for all office staff, including clinicians, should raise awareness of the specific needs of deaf and hard-of-hearing patients, and provide appropriate protocols for dealing effectively with such patients.
• Resources and equipment should be upgraded to include provision of an ASL interpreter, TTYs, TDDs, and audio sound systems, when needed. A vibrating pager may help with getting the attention of a deaf patient in the waiting room.
• Clinicians should ask the patient about their preferred method of communication, and try to utilize it.
• When communicating, the clinician should always look at and talk directly to the patient, rather than to the ASL or family interpreter.
• Patients should be periodically asked to repeat back critical health information (diagnosis, treatment measures, medication instructions), to ensure that they've understood the important messages.

The published report includes many more suggestions, as well as striking anecdotal accounts that indicate the need for them. If doctors are to provide effective patient-centered care, they must make the effort to meet these needs of the deaf and the hard of hearing.

Source

• Communicating about health care: observations from persons who are deaf or hard of hearing. LI. Iezzoni, BL. O'Day, M. Killeen, H. Harker, Arch Intern Med, 2004, vol. 140, pp. 356--362

Related Links
National Institute on Deafness
Dizziness in Old People
Deaf or Hard-of-Hearing: Tips for Working With Your Doctor

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