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