This week, September 19th - 25th, 2022, is celebrated as International Week of Deaf People. Led by the World Federation of the Deaf, this year's theme is something close to our hearts here at Accessibility.com - Building Inclusive Communities for All. Today's focus for the week-long celebration is on "Health for All."
As a medical professional, you do your best to make patients feel comfortable and safe when they are under your care. Even doctors with the best bedside manners will meet patients who are terrified of them. Iatrophobia (eye-AT-rah-FO-bee-ah) is fear of doctors and medical tests. Patients who are typically brave and calm under stress can experience iatrophobia if worried about a diagnosis.
All the stress and anxiety of visiting the doctor can compound when you add a communication disability to the mix. Often, Patients who are D/deaf or hard of hearing worry about their ability to communicate with their doctors. When an interpreter is not present, basic questions, such as asking for some water or scheduling a follow-up appointment, can be challenging.
Is your medical practice required to provide ASL interpreters, or does that burden fall on the patient? What can you do to provide a better experience for D/deaf and hard of hearing guests? Use this guide to learn what the law says and the medical experience for your patients with hearing disabilities.
Healthcare offices are required to provide accommodations.
When looking for ADA guidelines on bringing an interpreter, the first place to turn is Title III, Subchapter III - Public Accommodations - Section 6. This section highlights how public places are required to provide aid when necessary to ensure there is effective communication unless it places an undue burden on the organization. This section specifically calls out healthcare providers, hospitals, and doctor’s offices as public places required to provide accommodations.
While this can open the door for debate on what counts as an undue burden or fundamental alteration, it is unlikely that providing an interpreter would significantly impact a doctor’s ability to provide care to a patient or complete a medical procedure.
The next step is to look at whether an interpreter is necessary. Most lawsuits and debates around reasonable accommodation cover whether the business provided enough accommodation, even if it was less than the desires of the customer or employee requesting it.
A doctor may decide that it’s enough to communicate with a patient who is D/deaf through notes or a talk-to-text system. While this might work for a basic check-up, it wouldn’t be ideal for sensitive medical discussions or communicating with the patients while they undergo procedures. Patients might not feel they can fully communicate their health needs through a few scribbled notes.
Imagine a woman giving birth. She doesn’t have the ability to write notes to the doctor because she is in pain. Meanwhile, the doctor is too focused on the baby and the birth canal to read whatever the woman says. A live interpreter providing oral translation is essential in this case.
Not all hospitals provide ASL Interpreters
Unfortunately, some states and cities are facing a shortage of ASL interpreters, which makes it hard for patients to communicate with staff and advocate for their needs when receiving medical care. This can be annoying for routine visits while placing emotional and mental burdens on patients who are D/deaf and facing medical emergencies.
Mary Pat Donovan of Connecticut shared her experience of facing a mental health emergency that led to a three-day hospital stay. She could not communicate with doctors or medical staff because an interpreter was not provided. She couldn’t understand her care plan and was unable to participate in group therapy sessions.
“I felt like my self-esteem was kind of crushed,” Donovan said through an interpreter. “I wasn’t able to say what I wanted to say. I wasn’t able to express myself.”
Some medical facilities have expanded to offer virtual interpreters to keep up with the shortage. Once again, this solution can benefit some patients, but there are times when a patient who is D/deaf needs to be able to communicate with someone in the room. Not every doctor’s visit is routine, and not all patients can wait for a virtual interpreter to become available.
Donovan isn’t alone in her experiences. Many patients who are D/deaf have expressed frustration when requesting the presence of an ASL interpreter during their appointments.
Masks make it harder to talk with patients with hearing disabilities
The pandemic normalized wearing masks in healthcare offices, even if the staff and patients are fully vaccinated against COVID-19. This is an important precaution because doctors frequently work closely with the human body and meet with people who are sick or immunocompromised. However, these masks also create challenges for D/deaf and heard of hearing patients.
Katelyn Cheng shared her experience visiting the doctor at Start ASL. She is hard of hearing and can easily misinterpret what people say. Her doctor wearing a mask made it much harder to understand the treatment process, and she did not follow the directions correctly. The issue was quickly fixed with only minor problems, but this example highlights how removing the ability to read lips can make it harder for D/deaf and hard-of-hearing patients.
Fortunately, this challenge has a low-budget solution that is easy for medical offices to implement. Transparent masks can prevent the spread of germs while allowing the patient to read lips. The issue is educating medical offices to keep some of these masks in stock.
What should doctors and healthcare providers do?
There are two parts to every accommodation that medical providers offer: what they are legally bound to do and what benefits the patient in the long run. While medical offices can get away with providing the bare minimum accommodations, they should consider offering more.
One example comes from the lawsuit by Rose Adams, who was not provided an interpreter by Cleveland Clinic. Adams was told she was there for a few hours of bloodwork. After receiving a gown, Adams realized their plan to admit her to the hospital. If there had been proper communication, it would also have been possible for the staff to avoid prescribing a medication that she has an adverse reaction to, Benadryl.
Eventually, the hospital used a virtual interpretation service, but the connection kept dropping, and Adams didn’t have her glasses or contacts, leaving her unable to see the screen. There needed to be an in-person communicator.
Whether you work in a large-scale hospital or run your small practice, there are a few best practices to follow to accommodate patients who are D/deaf and hard of hearing:
- Provide multiple resources for patients. Keep an ASL interpreting service on-call, use transparent masks for lip reading, and stay abreast of the latest assistive technology.
- Ask the patient for their preferred form of communication. Not all patients who are D/deaf speak ASL. Don’t assume every patient who is D/deaf uses the same accommodation.
- Confirm their accommodation needs ahead of time. Make sure an interpreter is available and ready before the patient arrives.
- Be patient during the appointment. Even when you are busy and have other patients to see, take your time to explain medical concepts because every patient deserves your undivided attention. You may need to explain the same thing in different ways.
Additionally, you may want to take a basic ASL class or become familiar with common words and phrases that patients might use. The Massachusetts College of Pharmacy and Health Sciences provided a guide on basic ASL for medical professionals. Understanding and using words like pain, allergy, symptoms, medicine, and treatment can help break down communication barriers.
Offering the bare minimum creates barriers to healthcare.
Do you have to provide a live ASL interpreter to your patients who are D/deaf? Yes, courtesy can help your patients ask questions, communicate with staff, and advocate for their patients. You can make a case that providing in-person interpreters leads to better patient outcomes:
- Your patients will seek treatment earlier because they won’t dread a medical visit – early intervention is often easier to address.
- Your diagnoses are more likely to be accurate because you will receive a complete picture of patient symptoms.
- Once a treatment plan is made, your patients can better follow your instructions to prevent infection or complications because they understand what you need them to do.
Conversely, offering the bare minimum creates barriers to healthcare as it is harder for patients to communicate and they may avoid treatment altogether. By the time they seek treatment, a minor issue could have bloomed into a medical emergency. If your office is genuinely concerned with the health of your patients and helping them live their best lives, it’s worth the investment to provide in-person ASL interpreters who need them.
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