Serving Deaf Patients 9/23/17

So this week, I got to visit Galludet University as part of my psychiatry rotation. For those that aren’t aware, Galludet is considered the“mecca” of schools for the  deaf and hearing impaired. I had absolutely no clue why this visit was being incorporated into our curriculum.

I vaguely remember hearing something about learning how to serve deaf patients, but besides making sure there was an interpreter present, I didn’t know what else we could possibly have to discuss  for FOUR hours!!!

But I can honestly say, I learned SO MUCH during this visit, and I want to share it with you guys.

1.       Audism is a thing- Audism? What’s that? Yeah girl, I had never heard of audism before either.  But essentially audism is defined as the idea that one is superior to another based on one’s ability to hear. It’s an inherent bias that many of us aren’t aware we possess. It’s the idea that those who can’t hear are somehow less intelligent than we are because we don’t communicate in the same ways. Deaf people are able to communicate, not through spoken English, but rather through American Sign Language (ASL). Our inability to communicate isn’t due to what we’d view as a disability on their part, but rather a language barrier between the both of us. Once we’re aware of this inherent bias, it’s up to us to focus on bridging the communication gap.

2. Deaf culture is a thing- Normally when I see a group of deaf/hearing impaired people using ASL, I don’t think about their signing as being a part of a distinct culture. But that exactly what it is! Think about it: in American culture many of us speak English. In deaf culture they communicate through ASL. This culture isn’t just confined to language, however. Deaf culture has its own nuances

          -  Name signs: in the deaf community, people are given name signs to represent their names. When a person introduces themselves, they spell out their name in letters using sign language then they tell everyone their name sign, which is a single sign that represents their entire name. Just like how our names have their own unique spelling,  but are pronounced in a specific way. Hearing people don’t spell out our names every time we meet someone, we just say it. Similarly, in deaf culture name signs are used to substitute for spelling out a name. 

          -  Eye contact: eye contact is incredibly important in the deaf community. It lets them  know that you are listening to them. If you don’t make eye contact, then a deaf person may feel as if you aren’t grasping everything they're saying. In addition when you’re speaking with a deaf person via an interpreter, you should address the deaf person  and not their interpreter. You and the interpreter are not supposed to become besties. The interpreter is there to facilitate communication between you and the deaf person. So when you ask the patient a question, look at them and not the interpreter.

3.  Lip reading is not a thing. Well it is, but it’s not the best thing. Expecting a deaf person to read lips instead of communicating with them through sign language is unreasonable. Some people are better than others at reading lips. But even for those who do it well, many words may look like other words. And just think about all the different accents there are out there. Words may appear different than what they are.

 4.  Cochlear implants are a thing, but they aren’t perfect. We’ve all seen the videos of the babies who hear their parents’ voices for the first time after receiving a cochlear implant. We double tap and retweet and continue scrolling, assuming that the baby will be able to hear perfectly for the rest of their lives. Gee willikers, science is so amazing. But in reality, studies have shown that cochlear implants allow patients to hear at best 70% of what everyone else hears. In really noisy settings, it gets even more difficult to filter out what is being said, so people with cochlear implants may choose to turn down the volume on their implants and communicate through sign language in those settings. 

Those are just a couple of general things I learned at our session. As it pertains to serving as the physician to a deaf person, we were also informed that an outside, neutral interpreter was required to facilitate discussion in the doctor’s office setting. Relatives fluent in sign language are NOT adequate. Only trained, licensed interpreters should be used to ensure that communication is unbiased and informative to the patient.  

Additionally, as a physician it is important to realize that pushing cochlear implants without asking the patient which options they’d like to use is dismissive and disrespectful of deaf culture. Some patients may not want an implant because they’re content to communicate through ASL. Many patients don’t see their deafness as a disability to be fixed, but rather a difference to be accommodated. Be open to hearing from the patient and taking their feelings into consideration.

And finally if a deaf person comes into an office DO NOT ask them about their deafness if they are coming in for another reason (e.g. a sprained ankle). They are there to have their concerns taken care of, not to tell you their life story. Respect that.

Judy Oranika