As an incoming high school freshman, I enrolled in an introductory American Sign Language (ASL) class to fulfill my world language requirement. Sign language was completely foreign to me, but I quickly fell in love with learning to communicate solely with my hands. After discovering that there were members of my church who were deaf or hard-of-hearing, I wanted to learn how to interpret. I achieved this goal by studying sign language online, taking community college ASL courses and attending deaf social events at a local frozen yogurt shop. From my junior year of high school, I have had the privilege of helping interpret for the Deaf community at weekly church services. In getting to know the Deaf community, I am more aware of the health disparities that they face. This awareness has shaped my goals as a future doctor.
Through conversations with individuals who are deaf, I have learned that a trip to the doctor’s office can be especially difficult. Appointment wait times can be delayed minutes or hours as clinic staff members arrange for a certified ASL interpreter to arrive. In the absence of a certified interpreter, relatives of deaf patients are often recruited to facilitate conversation between doctor and patient. Family members usually cannot interpret adequately because they are emotionally involved and lack the training necessary to accurately and completely translate medical terminology.
Cultural barriers can also prevent a deaf individual from feeling as if proper care is being provided. Through my experience as an interpreter, I have learned that deaf individuals often view their deafness from a cultural perspective. They form tight-knit groups with others who communicate through sign language and refer to themselves as members of the Deaf community (capitalized just as other groups with commonalities: Hispanics, Native Americans, etc.). Since those who are deaf often do not view deafness as a disability, they may oppose having a hearing aid or cochlear implant designed to “fix” them especially since they have formed such closeness with others in this group. On the contrary, other deaf individuals who are candidates may be eager to have a device that will aid in their ability to hear and interact with those who do not know sign language.
Nonetheless, members of the deaf population are medically underserved. Thus, the question remains as to how we, as future physicians, can improve the quality of health care provided to them. The first step to improving quality of care for deaf patients is being aware of the need that exists in this group for proper translation between physicians and patients. It is our duty not only to inform deaf patients of all their options regarding treatment, but also to broach such with cultural sensitivity while ultimately respecting the patient’s decision.
To further improve interactions with deaf patients, one should learn basic sign language beginning with fingerspelling, which is simply reciting the alphabet with one’s hands. Even though it may require significant time to communicate with fingerspelling alone, any word or sentence can be constructed with this tool. The next step would be to learn signs applicable in a clinical setting. Any amount of signing can help a health care provider build rapport with a deaf patient and may prove useful in situations when an ASL interpreter is not readily available.
It is also important to understand that ASL is a unique language that consists of its own grammar and syntax. It even differs from other sign languages around the world. For this reason, some deaf individuals may not be well-versed in written English, and writing may not be an effective form of communication. When notes are used, it is essential to be thorough to avoid depriving deaf patients of important information regarding their health.
Lip-reading is another mode of communication that may or may not be effective depending on the deaf individual. For deaf patients who are comfortable lip-reading and who prefer this method, it is important to speak at a normal pace and to maintain eye contact. However, many health care providers incorrectly assume that deaf individuals can lip-read though this is not always the case. This assumption can leave deaf patients frustrated and uninformed about their health statuses.
In most clinical encounters with a deaf patient, a certified ASL interpreter should be present. The Americans with Disabilities Act (ADA) mandates that all medical facilities provide deaf and hard-of-hearing patients access to an ASL interpreter if requested. When communicating via interpreters, health care personnel should talk to the patient directly as if the interpreter is not present. It is considered disrespectful to talk to the interpreter about the patient and refer to them in the third person. To further accommodate deaf patients, I would suggest informing deaf patients of the online resource deafhealth.org. This website lists numerous illnesses and medical tests along with a video description in ASL to educate them about health topics in their language.
Finally, it is important to encourage the parents of deaf children to learn sign language. When I visited the California School for the Deaf, Riverside (CSDR) as a sign language student, a mother of a deaf child approached me. She wanted to know if I could ask her son’s teacher in sign language whether he could be checked out of school. My heart sank; if she could not sign this simple question, I wondered how she could converse with her son on a daily basis. Sadly, data have revealed that only about twenty-five percent of hearing parents with deaf children become fluent in sign language. The lack of communication between parent and child at home can be detrimental to a deaf child’s mental health and well-being. While at CSDR, I learned that the school has a physician on-call since many of the children live at the school in dorms; however, this physician had no knowledge of ASL. This inspired me to become proficient enough in ASL to be able to use it to help deaf patients feel more comfortable when communicating their medical concerns.
It is my goal to use American Sign Language in my practice, and I hope that other future physicians will also aspire to reach out to the Deaf community. It is not mandatory to read an entire textbook on deaf culture or to be fluent in ASL to make an impact — a simple level of understanding will go a long way to bridge the communication gap. We can all make a difference in the quality of health care provided to deaf patients and that difference starts with you.