Consultations with deaf patients

GPs can improve how they approach patients who are deaf or hard of hearing, explains Laura Foreman.

GPs should always try to face a deaf patient when talking to them
GPs should always try to face a deaf patient when talking to them

About 20 per cent of people over 18 years have some form of hearing impairment.1 Such patients may have difficulty communicating effectively during a consultation with their GP, and such encounters are increasing as the population ages.

These difficulties must be overcome if hearing-impaired patients are to have the effective communication with their GP that is necessary for efficient, safe and patient-centred care.

Several studies have unfortunately revealed that many hearing-impaired patients have negative experiences in primary care. Deaf patients (for whom sign language is their first language) were found to be less likely to hold positive views about their GP when compared with the general population.2

Access to primary care for the deaf or hearing impaired can be stressful, from arranging the appointment by telephone to the fear of not hearing what is said in the consultation.

Deaf patients report that because they do not hear clearly, they tend to withdraw, lose confidence and feel isolated. They wish hearing loss was taken more seriously, and feel that medical personnel think that it is easy to deal with hearing loss.

The impression many hearing-impaired people have is that health professionals just talk louder and do not have a genuine sensitivity or compassion for hearing impairment.3

An awareness of the potential barriers to effective communication, and the implementation of some simple strategies, will dramatically improve communication with deaf and hard of hearing patients.

Resources

For GPs and patients:

Royal National Institute for Deaf People. www.rnid.org.uk/VirtualContent/91875/1496GPlft7.pdf

For GPs:

SignHealth. Includes an application for online BSL/English interpreting surgeries. Available from www.signhealth.org.uk

For patients:

  • Association of Teachers of Lip Reading to Adults. Information about local lip reading classes. Available from www.lipreading.org.uk

Recognising hearing loss
It is important to recognise when a patient has a hearing problem. For patients with known hearing impairment, this should be documented clearly in their notes so the clinician is alerted at every visit.

Hearing aids should not be used as the primary means of identifying hearing difficulty. Many people with hearing impairment do not wear hearing aids, or they may be too discreet to see. Nearly 47 per cent of 61- to 80-year-olds, and 93 per cent of over 81-year-olds in the UK suffer from some degree of hearing loss,4 so the older the patient, the greater the consideration that should be given to optimising communication.

Such optimisation should include improvements to the surgery environment. There should be good lighting at reception desks and in consulting rooms, and background noise should be reduced as much as possible in clinical and non-clinical areas.

Patient confidentiality
An induction loop system in reception will optimise listening for hearing aid users and help preserve patient confidentiality. Display screens in the waiting area, or the issuing of vibrating pagers, will help patients to relax and be sure they will not miss being called.

Portable loop systems are available that can aid in the consulting room, especially if there is a high level of reverberation and background noise. Telephone communication using the Typetalk service converts spoken word to text for patients with textphones. Email and text messaging can also be useful. Deaf awareness training is recommended for all staff.

Excellent advice for GPs on improving communication with deaf and hard of hearing patients can be found at the RNID website (see resources).

  • Laura Foreman is an audiologist at Addenbrooke's Hospital, Cambridge
Tips for optimum communication with deaf patients
  • Ask the patient about their preferred communication strategy and comply when possible.
  • Ensure the patient is looking at you before you start speaking.
  • Speak clearly, but not too slowly. Do not over exaggerate lip movement and do not shout.
  • Ensure you are sitting in good light, and keep your hands away from your face to facilitate lip-reading.
  • Do not sit with your back to a window.
  • If you are not understood, re-phrase rather than repeat.
  • Always look and speak directly to the patient, rather than an accompanying family member or sign language interpreter.
  • During the consultation, ask the patient about the effectiveness of the communication and make adjustments as appropriate.
  • Ask the patient to summarise their understanding to identify any miscommunications before the patient leaves.
  • Be aware that hearing aids cannot restore normal hearing.
  • Deaf awareness training is highly recommended for all staff, including receptionist and administrative staff.
  • Telephone communication via the RNID Typetalk service converts spoken word to text for patients with textphones. Email and text messaging can also be useful.

Source: RNID

References

1. Davis A, Moorjani P.

The epidemiology of hearing and balance disorders. In: Luxon LM, Furman JM, Martini A and Stephens D (editors). Textbook of Audiological Medicine: Clinical Aspects of Hearing and Balance. Martin Dunitz Taylor & Francis Group, 2003.

2. Reeves D, Kokoruwe B. Communication and communication support in primary care: a survey of deaf patients. Audiol Med 2005; 3: 95-107.

3. Lezzoni LI, O'Day BL, Killeen M et al. Communicating about health care: observations from persons who are deaf or hard of hearing.

Ann Intern Med 2004; 140: 356-62.

4. RNID factsheet: Facts and figures on deafness and tinnitus. November 2004. Available from www.rnid.org.uk.

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