How medicine failed the deaf.

By Zainab Suad


Recently, at work experience, I had the pleasure of interviewing some deaf patients and, just to start the conversation, I enquired of their experience with Physician. Hitherto, their attitude was optimistic, changing drastically with the mere mention of the ‘NHS’ or ‘Doctors’. Extremely perplexed, I began researching the situation surrounding the D/deaf community and their relationship with the NHS.


I was appalled.

1 in 6 have hearing loss in the U.K. or 10,000,000. 800,000 are severely D/deaf, most before they learn spoken English and thus communicate through BSL. They do not necessarily consider using BSL a ‘disability’, rather a linguistic affiliation and may find it offensive. One patient described BSL: “It’s so visual, expressive, beautiful. BSL is not a code, but a diverse language, with variations - like accents in spoken languages.” Others may be ‘hard of hearing’, who developed deafness gradually, thus can use spoken English. They may view their deafness as an auditory condition, communicating through lipreading or SSE. These individuals make up the Deaf community, with their own language, culture and identity.


The majority of D/deaf patients report bad experiences with health care, often due to miscommunication, with 77% experiencing difficulty. Research confirms effects on mental health, including clinical depression and deaf-identity issues. Anecdotal evidence suggests physical well-being too. 30% of BSL users avoid GP appointments due to preventable non-communication and 76% expressed they would visit more frequently were communication easier. Despite this, 87% GPs are confident in their communication with D/deaf patients.


Furthermore, mainstream health promotion, entailing preventative measures of common maladies, including AIDs and Diabetes, often exclude the D/deaf - with little available in BSL, causing poorer health literacy.. This, compounded with increased mental illnesses and three-folds higher unemployment rates, causes lower life expectancy - highlighting the importance of efficacious communication between Health Care Practioneers and the D/deaf further.




So, how to improve the health of the D/deaf?


Firstly, practising clinical empathy and good communication is vital. Patients are not just certain symptoms and D/deaf patients are no different. They deserve patient-focused care. One patient mentioned that, although they sometimes give inappropriate answers (owing to guessing in lip-reading), they are not stupid. Respect them, respect their autonomy. Understand that D/deaf patients have different preferences and establish the best mode of communication with them, individually. Flag their medical records. Participate in a “Deaf Awareness Program”. National guidance, co-written by various D/deaf persons intended as an NHS recourse is needed. Preventative services extending to include the D/deaf, with more health-related information in BSL.

Lip-reading Consultations:

  • Being mindful of facing the patient; wearing clear masks.

  • Allowing patients to book online or via text messaging.

  • Collecting patients from the reception or informing the receptionist.

  • Tapping the shoulder lightly, waving a hand in their purview to gain attention.

  • Shutting the door or taking the consultation in quieter environments as speech-recognition technologies pick-up noise.

  • Avoiding over-enunciation or speaking loudly. This distorts lip patterns and lacks confidentiality.

  • Being open to rephrasing or writing down.

  • Try communicate visually, through pointing to objects, particularly in examinations when patients face away from you.

  • Employing mirroring and active-listening to double-check patient understanding.

  • If the patient is fluent in English, consider typing up a summary letter of the consultation, for reference.

  • Only 30% of English is lip-readable, thus a lip-speaker is desirable.

For BSL Users, an interpreter is a necessity, should it facilitate under the “Equality Act 2010” and 63% of patients declared it “necessary” for such. More than half prefer professional interpreters, due to confidentiality, professionalism and complete medical knowledge. Those that didn’t tended to because of mistrust CSWs are undesirable, for the aforementioned reasons.

BSL consultations:

  • Check the interpreter’s NRCPD badge.

  • Seat yourselves close, so the patient can look to both simultaneously.

  • Look at the patient, even while they look at the interpreter, as they scan your face for expressions.

In conclusion, little changes make all the difference. Let us strive to provide the best care to all; to make a more inclusive, supportive and empathetic NHS.


References

  1. http://ehealth.kcl.ac.uk/tel/deaf-awareness-KHP/step/show/printable-materials/ - statistics

2. http://ehealth.kcl.ac.uk/tel/deaf-awareness-KHP/step/show/printable-materials/ - statistics

3. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(11)61670-X/fulltext

4. https://www.nationaldeafcenter.org/sites/default/files/Mental Health Care for Deaf Individuals_ Needs_ Risk Factors_ and Access to Treatment.pdf

5. https://www.apa.org/pi/disability/resources/publications/newsletter/2013/11/deaf-community

6.https://www.researchgate.net/publication/265058383_Access_to_Primary_Care_and_Accident_Emergency_Services_for_Deaf_People_in_the_North_West_A_report_for_the_NHS_Executive_North_West_Research_and_Development_Directorate_2002

7. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(11)61670-X/fulltext

8. https://www.apa.org/pi/disability/resources/publications/newsletter/2013/11/deaf-community

9. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(11)61670-X/fulltext

10 . http://ehealth.kcl.ac.uk/tel/deaf-awareness-KHP/step/show/printable-materials/ - defining-deafness

11.https://www.researchgate.net/publication/265058383_Access_to_Primary_Care_and_Accident_Emergency_Services_for_Deaf_People_in_the_North_West_A_report_for_the_NHS_Executive_North_West_Research_and_Development_Directorate_2002

12.https://www.researchgate.net/publication/265058383_Access_to_Primary_Care_and_Accident_Emergency_Services_for_Deaf_People_in_the_North_West_A_report_for_the_NHS_Executive_North_West_Research_and_Development_Directorate_2002

13. https://trustedpartner.azureedge.net/images/library/GulfstreamGoodwill2015/Programs-Services/deaf_woman_signing_chalkboard_help.jpg