Advanced consultation skills: Communicating with hearing impaired patients in GP consultations

Qualified lipspeaker Denise Watson offers tips for speaking to lipreaders during a medical consultation.

Every effort must be made to ensure a meaningful exchange of information takes place
Every effort must be made to ensure a meaningful exchange of information takes place

When communicating with a deaf or hearing-impaired patient for the first time, the situation can be very uncomfortable, with time later spent on considering how one might have handled it better.

During the consultation, every effort must be made to ensure that a meaningful exchange of information takes place.

Sign language users may have communication support with them (a family member or an interpreter), but putting in place some very basic practices can improve communication with lipreaders.

Looking at what hampers communication will in turn improve the quality of the appointment for the patient.

Hearing people are often unaware of the problems that can hamper the understanding of speech. For example, a high ceiling or lack of soft furnishings in a room can cause echoes from any sounds made.

Light coming from a window or reflecting off an object may make it difficult for the lipreader to concentrate on the speaker's lips.

A busy wall behind the speaker (for example, posters, a clock and wall charts) may make concentrating on the speaker's lips more difficult, and background noise can make hearing each word almost impossible.

Hearing people know what someone is saying even when they are moving their head or they have their back towards them. For a person with hearing loss in the same situation, piecing together a sensible conversation or trying to keep track of what is happening will be very difficult.

Natural flow of words

Shouting does not help, because lip patterns become impossible to read, as there is no longer any natural flow to the communication.

Unnecessary noise (such as tapping a pen or turning the pages of a report) will interfere with a hearing aid.

In comparison, a hearing person will be able to handle any of these distractions. Addressing these matters will enhance communication.

Echoes may not be a problem in the consulting room, due to lower ceilings and soft furnishings, but it may be that light from the window is shining into the eyes of the hearing-impaired patient. Moving your chair or sitting in another seat is all that is needed to correct this. The same goes for the busy wall; simply sit in an area that offers a fuss-free wall as the backdrop.

When speaking to the person who is reading your lips, keep your head as still as possible, do not turn away during the conversation and speak at a normal pace.

Lipreading is not easy. One reason for this is that certain letters look the same on the lips. For example, words beginning with 'b', 'm' and 'p' may display identical lip patterns, as do 'c' and 'g'.

The letter 'h' cannot be seen on the lips, so words such as 'heart' and 'hand', if they stood alone, would appear as 'art' and 'and'.

Some spoken numbers are not easily distinguishable (for example, 14 and 40 or 16 and 60). Numbers are better read in the context of a sentence (such as 'I retire at 60') and facial expression will go a long way to support some words that may look the same (such as 'I ate' or 'I hate' carbohydrates).

Lipspeaking skills

To support those confusing first letters, one of the skills of a qualified lipspeaker can be used by the GP in the surgery.

A lipspeaker will discreetly use their index finger to draw a capital letter in front of their body, the mirror image of the letter being seen by the lipreader, at the same time as that letter is being shaped on the speaker's lips.

Remember that many words are easy to read within the context of the conversation (such as hospital or medication), so letters that may sometimes confuse the lipreader will not do so in every case.

Choose everyday words to get your message across, because these are the ones with which lipreaders have had the most practice. If a word cannot be read on the lips, using paper and pen may be helpful.

Whether your patient is hearing, a sign language user, or a lipreader, kindness and respect are qualities that can be seen, making for a better experience for all.

  • Denise Watson is a British Sign Language communicator, a Level 2 lipspeaker and a qualified person-centred counsellor.

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