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Healthcare and the Deaf:

Also see:  Unique Challenges Encountered by the Deaf in Accessing Healthcare Services

 

Kathryn J. Little
4/28/2008

The Healthcare Experience from a Deaf Perspective

According to I. King Jordan, a past president of Gallaudet University, “Deaf people can do anything hearing people can do except hear” (King, 2005). Due to the fact that this truth is often forgotten or ignored, deaf people sometimes endure inferior or patronizing treatment from uninformed individuals. At best, this lesser treatment must be insulting, but at worst, it may be life-threatening. A person receiving healthcare treatments or preventions can not afford to be ignored or misunderstood. This paper will explore some of the most common causes for miscommunications between healthcare providers and their patients, and options for improved communication will be presented.

An estimated 9% of the US population is deaf or hard of hearing, and that percentage is increasing. Individuals who were born deaf or deafened before the age of three constitute the Deaf Culture. Many healthcare providers erroneously believe that members of the Deaf Culture simply have a disability, while members of the Deaf Culture are actually a culturally and linguistically distinct entity. Some features of the Deaf Culture that are important to understand include: individuals live by distinct norms, are often educated in specialized schools for the deaf, use a non-English language, and often socialize and marry within their own community (Ross & Feller, 2005).

There are many dangerous implications to consider when a healthcare provider cannot communicate effectively with a patient. According to a study by the Agency for Healthcare Research and Quality, “Inadequate communication with deaf or hard-of-hearing patients can lead to misdiagnosis and medication errors, as well as patient embarrassment, discomfort, and fear” (Agency for Healthcare Research and Quality, 2008). Unfortunately, the risk for miscommunications and misperceptions seem to be higher in healthcare settings. Among deaf individuals who regularly used ASL interpreters, interpreter utilization was lower in physicians' offices than in other settings.Also, at least one-fifth of deaf individuals report rarely or never communicating with hearing persons, and physicians report rarely communicating with deaf persons either inside or outside of the office. The deaf rarely receive healthcare from a deaf physician or nurse. It’s thought that the cultural barrier that divides the patient from the provider is as important as the practical barrier between them. The provider and the patient often both have misconceptions about one another and the situation, and this may complicate the mounting feels of distrust. The results of poor communication between the patient and provider may include prejudice, avoidance of acute and preventative care, low healthcare literacy, and ultimately, poor quality care overall (Ross & Feller, 2005).

There are many considerations to be aware of as a healthcare provider, and one should be made aware of them long before their first deaf patient ever steps into their office. Some key concepts to remember regarding the understanding of deaf patients will be reviewed. First, all deaf individuals will communicate differently. Their style and methods of communication will depend on their age when they became deaf, type of deafness, comprehension of spoken English, intelligence, speech-reading abilities, personality and educational background. Some deaf patients will identify strongly with the Deaf Culture and will use ASL as their language of choice. For some of these people, English will be a second language, if not a foreign language altogether. For this reason, they might have problems with written English, and this should in no way be taken as a reflection of their education or intelligence. The Department of Health and Human Services has recognized that there is a large distinction between ASL and English, and the use of unskilled interpreters or the use of written notes are not effective means of communicating with a deaf patient. Many deaf people are poor lip readers, since only a small percentage of words are visible on the lips (King, 2005).

There are many strategies that healthcare providers can implement to enhance their communication with a deaf individual. To get a patient’s attention, the provider should tap the person on the shoulder or arm, or flicker the overhead lights. The provider should always face the patient while speaking, since this will enable the patient to observe crucial facial expressions. The provider should also maintain eye contact with the patient because deaf people are primarily visual learners and communicators. This is the reason that facial expressions and body language are critical to communication with a deaf patient. Also, maintaining eye contact promotes a feeling of enhanced communication. The provider should always speak slowly and clearly since overemphasizing or yelling distorts lip movements and can cause confusion. A good rule is to speak at a normal volume, as one would speak to a hearing patient. The provider should refrain from placing anything in their mouth while speaking since this may obscure the lips and make it difficult for the patient to understand. The provider should also always make sure that the patient knows what subject is being discussed so that they can pick up key words and understand more fully. As a provider, one should not assume that the patient understands simply because it appears that they are nodding in agreement; often, this is feigned understanding of what’s being stated. The provider should take care to avoid standing in front of a light source because this may create glare and shadows and hinder comprehension and communication. If an interpreter is present, the provider should speak directly to the patient rather than addressing the interpreter at any point. A provider should be as proactive as possible in learning how to foster positive, effective communication with their deaf patients. One great way to do this is to research community outreach programs to refer deaf patients to if needed and to participate in ASL classes so as to communicate with deaf people in their first language (King, 2005).

As a deaf patient, there are several steps that can be taken to ensure effective communication occurs when seeing a healthcare provider. While in the waiting room, the patient should alert the receptionist if calling out their name is not the best way to tell them that their doctor is ready to see them. If the patient prefers to communicate with ASL, they should request an interpreter when they schedule their appointment. The interpreter should be certified by the Registry of Interpreters for the Deaf, and this certification ensures competency and confidentiality. It’s not a good idea for a patient to use a friend or family member to serve as an interpreter, since the provider might need to ask personal questions. Some patients will want to read lips or use some spoken language. These patients should be assured that they need not feel awkward if they didn’t understand something, and since it’s critical to understand everything, the patient should be made to feel comfortable to ask for repeats as often as necessary. If the provider will be wearing a face mask for a procedure, the patient should be told what they need to know ahead of time. The provider and patient may find that they need to repeat each other’s sentences to one another, and this is one way to illustrate a comprehensive understanding of the other person. The patient should request that the provider writes down and clearly explains any word they don’t understand. Additionally, the patient should request written information about their condition, medications, treatments choices, and wellness promotion (American Academy of Family Physicians, 2004).

The patient and the provider are a team in pursuit of the highest level of health and well-being, and clear, positive, effective communication is a cornerstone of this partnership. With these simple, considerate actions, the patient and the provider can feel confident that they are understanding one another and achieving their goals together.


References

American Academy of Family Physicians. (2004). Deaf or hard of hearing: Tips to share with your Doctor. American Family Physician, 69. Retrieved April 20, 2008, from http://www.aafp.org/afp/20040301/1214ph.html


King, J.F. (2005). Practical considerations for accommodating the deaf patient. Patient Care, 39. Retrieved April 20, 2008, from http://proxy.lib.csus.edu/login?url=http://search. ebscohost.com/login.aspx?direct=true&db=rzh&AN=2009297703&site=ehost-live


Ross, T., & Feller, E. (2005). Communication: Deaf patients and their physicians. Medicine and Health Rhode Island, 8. Retrieved April 20, 2008, from
http://findarticles.com/p/articles/mi_qa4100/is_200508/ai_n14898578/pg_1
 

 


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