Problems the Deaf Have in Talking With Their Doctors
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 persons who are deaf or hard of hearing. With the increase in the aging population, more and more patients are faced with such challenges. Harvard scientists have studied where the main difficulties lie, 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, and 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' ages ranged from 23 to 51, and the hard-of-hearing subjects' from 30 to 74. 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. There were six main themes:
1) 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 the situation seriously - they merely talk louder, but show no sensitivity or compassion.
2) 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-savvy interpreters. With the hard of hearing, doctors often speak too fast and hurry through their checklist.
3) Risks of inadequate communication: Negative outcomes of poor communication include: misunderstood diagnosis, instructions, and information about drug side effects.
4) 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 to follow instructions (e.g. "hold your breath" during a chest x-ray) can necessitate repeat procedures.
5) Interacting with office staff: Often it's hard to know when the receptionist calls your name. And when asked to undress, did they say "take all your clothes off", or just some of them?
6) 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, 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:
1) 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.
2) 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.
Clinicians should ask the patient about their preferred method of communication, and try to utilize it.
3) When communicating, the clinician should always look at and talk directly to the patient, rather than the ASL or family interpreter.
4) 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. As a patient, you can gently point this out to them.
