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Healthcare and the Deaf:

Also see:  The Healthcare Experience from a Deaf Perspective

 

William C. Cameron
November 9, 2006

The Unique Challenges Encountered by the Deaf in Accessing Healthcare Services

Imagine for a moment that you are being poked and prodded at, and not being told why.  Would you accept, or tolerate that kind of treatment?  Would it matter to you if that person poking or prodding at you was a healthcare provider?  Likely, your answer would be no.  But that is what many Deaf report experiencing while receiving healthcare services (Iezonni, L., O’Day, B., Killeen, M., & Harker, H., 2004; Steinberg, A.G., Wiggins, E.A., Barmada, C. H., & Sullivan, V.J., 2002).  Would you feel like you your healthcare provider was treating you with respect, if they talked to you about your healthcare needs like you were a child (Mottram, V., 1999)?  Would you feel like you were having a meaningful share in making healthcare decisions? Likely, you would not feel that you were being treated with dignity, and respect (Iezonni, L., et al, 2004; Steinberg, A. G.  et al, 2002).

Why would people who devote their lives to help others act in such a way?  Likely, it is because they don’t know how to communicate with the Deaf (Iezonni, L., et al, 2004).  Many Deaf prefer to communicate in American Sign Language (ASL) (Iezonni, L., et al, 2004; Margellos-Anast H., Hedding, T., Perlman, T., Miller, L., Rodgers, R., Kiviland, L., DeGutis, D., Giloth, B., & Whitman, S., 2005).  Like other languages, ASL has its own vocabulary, grammar, and culture (Lotke, M., 1995).  Yet, ASL remains a little known, and misunderstood language to many in the healthcare community (Iezonni, L., et al, 2004).  This ignorance, presents unique challenges to Deaf, and hard of hearing persons who use ASL as their primary language (Margellos-Anast H., et al, 2005).  These unique challenges can inhibit the provision of optimal patient centered care (Iezonni, L., et al, 2004).What are the unique challenges that the Deaf encounter in accessing healthcare services?

Deaf people often report problems communicating with their healthcare providers (Iezonni, L., et al, 2004). Making an appointment for healthcare services can be a challenge for people who are deaf (Iezonni, L., et al, 2004).  Healthcare appointments are often scheduled via the telephone (Iezonni, L., et al, 2004).  Even with using specialized communication services or equipment, many who are deaf report having difficulty communicating with healthcare providers (Iezonni, L., et al, 2004; Mottram, V., 1999).  Healthcare providers may possibly own specialized communication devices, but might not have anyone in the practice trained in their use (Iezonni, L., et al, 2004; Lotke, M., 1995).  However, making an appointment is often only the beginning of further challenges which lay ahead.

Deaf people report of continued challenges once they reach the healthcare facility (Iezonni, L., et al, 2004; Steinberg, A. G.  et al, 2002).  For example, most waiting rooms are set up to accommodate those who hear.  So when people who are deaf are called by their name, or an assigned number, they do not answer.  This has resulted in their being overlooked, and thus they miss out on their scheduled services (Iezonni, L., et al, 2004).

Most healthcare facilities do not have a trained ASL interpreter on staff (Lotke, M., 1995).  So, in accordance with the American with Disabilities Act (ADA), healthcare providers are responsible to arrange for qualified  ASL interpreters to be present if the patient requests one (Lotke, M., 1995; U. S. Department of Justice, 2003).  Yet, even having an interpreter available doesn’t fully eliminate the challenges that people who are deaf are presented with (Iezonni, L., et al, 2004).  One deaf woman was viewed by her sons’ doctor as being unconcerned when she continued to focus on the interpreter, instead of looking at the doctor (Lotke, M., 1995)!  In addition, some people who are deaf report being expected to lip read, or communicate via written English (Iezonni, L., et al, 2004; Mottram, V., 1999; Steinberg, A. G.  et al, 2002).    Many people who are deaf report feeling as if doctors failed to fully inform them of, and involve them in their own healthcare decisions (Iezonni, L., et al, 2004; Steinberg, A. G.  et al, 2002 ).

As the foregoing shows, the Deaf encounter many unique challenges when they try to access, and utilize healthcare services.  These challenges don’t have to exist.  From a legal standpoint, these challenges should not exist.  It is clear that most times, these challenges arise from ignorance on the part of healthcare providers.  From the available medical literature, it appears that healthcare providers are slowing awakening to the role they play in creating these challenges for their patients who are deaf.  Hopefully, their desire to provide optimal patient care will motivate them to provide the services their patients who are deaf are legally entitled to.

References

Iezonni, L., O’Day, B., Killeen, M.,  & Harker, H. (2004). Communicating about Healthcare: Observations from Persons Who are Deaf or Hard of Hearing.  Annals of Internal Medicine. 140     356-63.

Lotke, M. (1995).  She Won’t Look at Me.  Annals of Internal Medicine. 123 54-7.

Margellos-Anast H., Hedding, T., Perlman, T., Miller, L., Rodgers, R., Kiviland, L., DeGutis, D., Giloth, B., & Whitman, S. (2005). Developing A Standardized Comprehensive Health Survey for Use with Deaf Adults.  American Annals of the Deaf 150 388-96.

Mottram, V. (1999). A Community Forgotten: Deaf People in Health Care.  studentBMJ. 14 380-1.

Steinberg, A.G., Wiggins, E.A., Barmada, C. H., & Sullivan, V.J. (2002).  Deaf  Women:  Experiences and Perceptions of Healthcare System Access.  Journal of Women’s Health.  11 729-41.

U.S. Department of Justice.  (2003).  ADA Business Brief:  Communicating with People Who Are Deaf or Hard of Hearing in Hospital Settings.   [Brochure] Washington DC:  Author.

 


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