Physician Prep: Interacting With Deaf People

Jun 2, 2016 | News & Press

By Marilyn Weber


Although deaf or hard-of-hearing patients can easily shop for physiotherapy equipment here, making it easy for them to get what they want without using verbal communication, communicating effectively with deaf or hard-of-hearing patients is always a challenge. A challenge that physicians are now successfully meeting with some forethought and planning. It’s important to take the time to be familiar with their specific needs and how to communicate properly to that deaf patient.

It’s not only emergency situations you need to worry about. There are a wide variety of situations in which communication can be absolutely critical. These include obtaining a medical history, explaining diagnoses, explaining medication, treatment and prognosis of an illness, obtaining informed consent and permission for treatment, conducting psychotherapy, communicating prior to and after major medical procedures, explaining medical costs and insurance issues, and explaining patient care upon discharge from a medical facility.

Here’s a checklist of tips you can use to make sure your office is prepared:

  • Have a sign language interpreter ready. The Americans with Disabilities Act (ADA) of 1990 requires that physicians provide deaf patients with an interpreter and not charge either the patient or his insurance for it. If an interpreter isn’t on staff, one can usually be contracted to ensure interpreters are available for effective communication between all medical staff and the deaf patients.
  • Consider video remote interpreting. Some hospitals and medical facilities provide communication access through the use of video conferencing technology equipment and a high-speed Internet connection to access an interpreter in a remote location (called “video remote interpreting” or VRI service). If you choose this route be sure you have reliable technology set up, and be sure to provide your staff with regular training on how to use the equipment.

Also, make sure you are using a company that specializes in sign language when working with the Deaf Community. Problems can arise when hospitals use a spoken language company for their deaf patients who need sign language. Translation companies may try to include sign language as one of their languages, but “translating” a language and “interpreting” a language is very different. Sign language is a three dimensional language where much of it is dependent upon the “non-manual” aspects, and could have different “interpretations”. The difference between being able to ‘sign’ and being able to ‘interpret’ sign language could be compared to the difference between a medical assistant and a medical doctor. It’s critical to have a certified sign language interpreter that is skilled and familiar with Deaf Culture, and understands all of the nuances and esoteric aspects of the language.

  • Don’t assume you can communicate effectively with writing. For most deaf people, American Sign Language (ASL) is their first language and English is a second (and sometimes a third) language. There are significant differences between the two languages. Unless the deaf person has an extremely good command of the English language, writing notes in English would have little benefit. It could be compared to writing notes in English to a Spanish-speaking person. For proper medical diagnosis, it’s crucial to have accurate communication in the deaf individual’s primary language for complete understanding. Not providing accurate and effective communication for that deaf individual could result in tremendous liability.
  • Don’t assume all deaf or hard-of-hearing folks can read lips. Some can. Some can’t. Many, even if they can read lips, do it with only limited proficiency. At best, only 40 percent of what’s being said can be read on the lips, and that is only if the deaf person has complete knowledge and understanding of the topic and terminology being discussed.  This is due to the fact that so many words are formed in the back of the mouth, as well as numerous words looking the same on the lips. To help provide cues and information to those who do have some lip reading ability, be sure not to speak too fast or too slow, do not over exaggerate enunciation, make sure you’re facing your patient, be sure you’re speaking in a well-lit area (but NOT in front of a window), and make sure you are not chewing gum as this makes it impossible to read the lips. Additional things that interfere with the ability to read lips are: facial hair around the mouth of the speaker, lisps, those with very thick or very thin lips and people speaking with accents. Most importantly, don’t rely on lip reading as a cure-all method or primary mode of communication.

To see first-hand what I mean, try this experiment: silently mouth to another person ‘island view’ and see what they think you said. You will get everything from ‘I love you’ to ‘elephant juice’!

  • Pay attention to the way you communicate. To get a patient’s attention, tap the person on the shoulder or arm. Always face the patient while speaking since this helps the patient see critical facial expressions. Maintain eye contact. Look through them right through their multifocals. Pay attention to your body language since this can provide important cues about what you’re saying. All of this is true even when utilizing a sign language interpreter to communicate with a deaf patient. In addition, when using a sign language interpreter never address your questions to the interpreter (ex: “ask him if his stomach hurts” or “does she have pain…”) – always look directly at the patient. The interpreter will place themselves next to the medical professional so the deaf individual can glance between the doctor and the interpreter to get the total concept of what is being said, with accurate tone and inflection from the face of the speaker.

In summary, be proactive. Individuals who are deaf or hard-of-hearing often have different communications skills, and the best way to handle a dialogue is to consult with each individual to determine what aids or services are necessary to provide effective communication for them in that particular situation.

In a world where physicians are increasingly being judged not just on the number of fee-for-service procedures they perform, but on the quality of care, it’s important to provide tailored service that meets the needs of all your patients, including those who are deaf and hard-of-hearing.  Additionally, this knowledge is key to limit your liability for failing to provide effective communication to your patient.

Your efforts will almost invariably be greeted with much gratitude, appreciation and praise for your professionalism.

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