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Communicating about health care: observations from persons who are deaf or hard of hearing
Lisa I Iezzoni1, Bonnie L O'Day, Mary Killeen
1Department of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Charles A. Dana Research Institute, Harvard-Thorndike Laboratory, and Third Sector New England, Boston, Massachusetts 02215, USA.
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.
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Cultural barriers:
Differences in values, beliefs, religion, knowledge, and tradition can significantly impact communication. Awareness of nonverbal cues is critical, especially when conversing with a patient from a different culture. What appears appropriate in one culture may be inappropriate in another.
Semantic barriers:
As a result of their tendency to use...