Communicating about Health Care: Observations from Persons Who Are Deaf or Hard of Hearing

2 March 2004 | Volume 140 Issue 5 | Pages 356-362

Background: Achieving patient-centered care requires effective communication between physicians and patients. Persons who are deaf or hard of hearing face considerable barriers to communicating with physicians.

Objective: To understand perceptions of health care experiences and suggestions for improving care among deaf or hard-of-hearing individuals.

Design: 4 semistructured group interviews, 2 conducted in American Sign Language (for deaf individuals) and 2 using Communication Access Realtime Translation (for hard-of-hearing individuals). Men and women were interviewed separately. Tapes of interviews were transcribed verbatim for analysis.

Setting: Greater Boston, Massachusetts, and Washington, DC, in 2001.

Participants: 14 deaf adults (23 to 51 years of age) and 12 hard-of-hearing adults (30 to 74 years of age).

Measurements: Commonly expressed themes or views organized around dimensions of communication.

Results: Concerns coalesced around 6 broad themes: conflicting views between physicians and patients about being deaf or hard of hearing; different perceptions about what constitutes effective communication (such as lip reading, writing notes, and sign language interpreter); medication safety and other risks posed by inadequate communication; communication problems during physical examinations and procedures; difficulties interacting with office staff, including in waiting rooms; and problems with telephone communication, such as lengthy message menus. Participants offered extensive suggestions for improvements, starting with clinicians' asking patients about their preferred communication approach. Having patients repeat critical health information (such as medication instructions) can identify potentially dangerous miscommunication.

Conclusions: As the population ages, physicians will encounter many more persons with hearing limitations. Physicians are not reimbursed for making some accommodations, such as hiring sign language interpreters. However, ensuring effective communication is essential to safe, timely, efficient, and patient-centered care.

Editors' Notes Context Few studies describe communication between physicians and deaf or hard-of-hearing people. Contribution This qualitative study of 26 people who were deaf or hard of hearing suggests that patients and physicians may have varying views about what it means to be deaf and about effective communication modalities. It also identifies sev-eral consequences of inadequate communication with deaf and hard-of-hearing patients, including embarrassment, discomfort, fear, misdiagnosis, and medication errors. Cautions This small study conducted in 2 urban sites may not be generalizable to other deaf and hard-of-hearing patients and to different settings. –The Editors

 

Author and Article Information

From Harvard Medical School, Beth Israel Deaconess Medical Center, Charles A. Dana Research Institute, Harvard-Thorndike Laboratory, and Third Sector New England, Boston, Massachusetts; and Cherry Engineering Support Services, Inc., McLean, Virginia.

Acknowledgments: The authors thank the many persons who assisted in recruiting participants, Melissa Wachterman for her meticulous logistical support, and the interviewees for their insights and thoughtful suggestions.

Grant Support: By the Agency for Healthcare Research and Quality grant RO1 HS10223-03.

Potential Financial Conflicts of Interest:Employment: L.I. Iezzoni; Honoraria: H. Harker.

Requests for Single Reprints: Lisa I. Iezzoni, MD, MSc: Division of General Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center RO-137, 330 Brookline Avenue, Boston, MA 02215.

Current Author Addresses: Dr. Iezzoni: Division of General Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center RO-137, 330 Brookline Avenue, Boston, MA 02215.

Dr. O'Day and Ms. Killeen: CESSI, 6858 Old Dominion Drive, McLean, VA 22101

Ms. Harker: Third Sector New England, 18 Tremont Street, Suite 700, Boston, MA 02108.