Deaf and Hard of Hearing Populations

Effective communication for individuals who are deaf or hard of hearing is particularly critical in health care where miscommunication may lead to misdiagnosis and improper or delayed treatment. Because critical medical information is communicated at many points throughout a health care encounter, it is important that information on communication needs be collected at the earliest point possible, such as at patient registration/admission to a hospital or during registration. The U.S. Department of Justice has issued the ADA Business Brief: Communicating with People Who Are Deaf or Hard of Hearing in Hospital Settings (PDF), which identifies situations in which providing auxiliary aids and or services may be needed to meet the deaf or hard of hearing individual's needs for effective communication. These include, but are not limited to, the following:

• Discussing a patient's symptoms and medical condition, medications, and medical history
• Explaining and describing medical conditions, tests, treatment options, medications, surgery, and other procedures
• Providing a diagnosis, prognosis, and recommendation for treatment
• Otaining informed consent for treatment
• Communicating with a patient during treatment , testing procedures, and during physician's rounds
• Providing instructions for medications, post-treatment activities, and follow-up treatments
• Providing mental health services, including group or individual therapy, or counseling for patients and family members
• Providing information about blood or organ donations
• Explaining living wills and powers of attorney
• Discussing complex billing or insurance matters
• Making educational presentations, such as birthing and new parent classes, nutrition and weight management counseling, and CPR and first aid training

The following are auxiliary aids and services:

• Qualified interpreters
• Note-takers
• Computer-aided transcription services
• Written materials
• Telephone handset amplifiers
• Assistive listening devices
• Assistive listening systems
• Telephones compatible with hearing aids
• Closed caption decoders
• Open and closed captioning
• Telecommunications devices for deaf persons (TDDs)
• Videotext displays
• Oother effective methods of making aurally delivered materials available to individuals with hearing impairments

People who are deaf or hard of hearing use a variety of ways to communicate with hearing people. Some rely on sign language interpreters or assistive listening devices. Some rely primarily on written messages. Many can speak even though they cannot hear. The method of communication and the auxiliary aids and services the health care provider must provide will vary depending upon the abilities of the person who is deaf or hard of hearing. It will also vary depending on the complexity and nature of the communications that are required. It should be recognized that a person who may use written notes or lip-reading in day-to-day situations may need a different mode of visual communication when discussing medical or financial matters.

Interpreting services should be provided by a qualified interpreter, which means an interpreter who is able to interpret effectively, accurately, and impartially both receptively and expressively, using any necessary specialized vocabulary. It is never appropriate to ask or rely on a family member or friend as an interpreter; however, if that is the request of the individual who is deaf or hard of hearing after having been informed of the availability of interpreting services, it may be considered. In certain circumstances, notwithstanding that the family member or friend is able to interpret or is a certified interpreter, the family member or friend may not be qualified to render the necessary interpretation because of factors such as emotional or personal involvement or considerations of confidentiality that may adversely affect the ability to interpret "effectively, accurately, and impartially."

The problems that may arise with having a family member or friend interpreting in a medical setting are considerable. There may be necessary information that the family member fails to communicate, in a misguided effort to shield the deaf patient. There may be questions the deaf person will not ask in the presence of the family member or friend. The family member or friend may be too emotionally upset by the medical situation to interpret correctly.

It is a common misconception that "sign language" is merely a pantomime of the English language and is therefore easily understandable in print if not through auditory means. "Sign language" is a term that describes a visually interactive language that uses a combination of hand motions, body gestures, and facial expressions. There are several different types of sign language, including those based on English (such as Cued Speech and Signed English). There are several versions of American Sign Language, and other countries have their own versions of sign language.

American Sign Language (ASL) is a manually communicated language distinct from English and whose idioms and concepts are not directly translatable into English. It uses different sentence structure, grammar, and syntax than English, and is as much a foreign language to English speaking persons as is French or German. Conversely, English is equally foreign to most deaf persons who rely on ASL for communication. ASL sentences do not follow English sequential patterns. As a result, direct translation of English, as with written notes, into an English-based sign system will not necessarily convey the intended message. Similarly, much of English idiomatic speech would be lost on the ASL user whose frame of reference for idiom is significantly different from the hearing person.

It should be noted that a relay interpreter also may be needed in situations where the individual who is deaf or hard of hearing uses the sign language of another country. See the ADA Business Brief: Communicating with People Who are Deaf or Hard of Hearing in Hospital Settings (PDF) for more detailed information.