As more medical professionals consider how they deliver patient-centered care, one question to consider is how your office works with deaf patients, who have different needs than the hearing population, which affect care outcomes and engagement.
“The more a patient understands the causes of his problem, the mechanics of how to correct his problem and the tools to prevent reinjury, the more effective his treatment will be,” says Beth Allbritton, PT, Northlake Physical Therapy, Lake Oswego, Ore. “It is very difficult to ‘fix’ a problem without patient participation in his treatment, [and] proper communication with the patient is key.”
Medical offices are responsible for providing effective patient communication with deaf patients, according to the Americans with Disabilities Act (ADA), Title II: “Effective communication is particularly critical in healthcare settings where miscommunication may lead to misdiagnosis and improper or delayed medical treatment.”
Some deaf patients might require the services of a qualified sign language interpreter, who can be nationally certified by the Registry of Interpreters for the Deaf. Smaller offices might be eligible for government tax credits when they use these interpreters.
Family members or friends are not qualified by the ADA as interpreters because they are not trained or unbiased, and might not have adequate sign language skills for medical settings.
The facts
Deafness is an invisible condition. While some deaf people prefer to use their own voices, that doesn’t mean they can fully understand speech. If a patient requests an interpreter for an appointment, medical professionals should avoid asking if a patient can read lips because only about 30% of English sounds are visible on the lips; the remaining 70% are made in the throat. As a result, lip reading or speech reading, which is the preferred term, can be difficult, especially since the majority of people who are profoundly to severely deaf might not be fluent in English.
In fact, an average reading level of third grade is often typical of graduates of deaf education programs, which only indicates that English is the patient’s second language. It is not an indication of intelligence level.
Most of these patients prefer to be referred to as deaf or hard of hearing, not hearing impaired, which is perceived as a negative term that implies they need to be fixed. Most of these individuals are proud to be deaf and do not consider themselves handicapped.
"A common language is the most important aspect of the deaf culture because it is visually accessible. American Sign Language is often misunderstood as an abbreviated, visual form of English, but it is actually a different, rich language with its own syntax and grammar."
Knowing how to provide services to a deaf person is invaluable since up to 22 out of every 1,000 people have hearing loss, according to statistics.
Effective communication
If you have never met or provided medical or mental health services to a deaf person whose primary language is American Sign Language (ASL), you might not be aware that the deaf community has its own culture.
Knowledge of this culture — and efforts to engage with these patients — can help mitigate patients’ feelings of being left out. Feeling oppressed by hearing people in a variety of settings is a common experience among deaf people, according to published personal experiences, which emphasizes the need for providers to completely acknowledge and respect a deaf person’s autonomy.
Communication tips
A common language is the most important aspect of the deaf culture because it is visually accessible. ASL is often misunderstood as an abbreviated, visual form of English, but it is actually a different, rich language with its own syntax and grammar.
"Knowledge of this culture — and efforts to engage with these patients — can help mitigate patients’ feelings of being left out."
Eye contact is also a critical element in deaf culture. Although the interpreter is present, medical professionals should look directly at a deaf patient as if those two were communicating directly.
Certified interpreters are required by their code of professional conduct to interpret everything they hear. Directing questions to a patient via the interpreter ensures the patient is involved and empowered. The patient will most likely look at both the professional and interpreter to take in all facial expressions and gestures as well as the ASL.
One practice that has started to use an interpreter says the additional help “provides the recipient with translation of daily instructions and expectations provided by staff. This service also allows the recipient to be clear in communication with his peers and vice versa. Without this service, the individual would not be able to involve peers or staff with the necessary level of understanding of this culture,” says Koreen Zuker, CLSP/Great Center coordinator, Gratiot County Mental Health, Alma, Mich.
Body language
When communicating with deaf patients, medical providers should watch for what some call the “deaf nod,” a mannerism commonly used if a patient does not fully understand what is said or signed but does not want to interrupt the communication process. Asking open-ended questions or asking a patient to repeat pertinent information can be helpful techniques to confirm understanding.
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