Elderly Deaf Patients' Health Care Experiences
Elderly Deaf Patients' Health Care Experiences
Background: Approximately 10% of the US population has some degree of hearing loss, and 2 million Americans are deaf. Most medical school curricula and major textbooks characterize deafness as pathologic condition only, which is at odds with the movement to understand the Deaf population as a minority group with a unique language and cultural tradition. Physicians might therefore be unprepared to meet the needs of deaf patients effectively and sensitively. This study seeks to understand the health care experiences of elderly Deaf adults in Richmond, Va.
Methods: The authors conducted focus groups of elderly Deaf persons. Real-time voice-interpretation of the sign language communication allowed for tape recording and full transcription. The authors independently analyzed the transcripts using an editing style, and incorporated feedback on their interpretation from participants.
Results: Participants experienced many practical barriers to effective health care, including problems with scheduling appointments and communicating with providers. They believed that providers are ill-prepared to care for them and worried that prejudice might be a more subtle obstacle. Participants seemed resigned to these circumstances.
Conclusions: The authors suggest a possible explanation for this perspective, and make specific recommendations for three levels of competency in caring for deaf patients. When the provider and the office staff provide methods to communicate with deaf patients using telephone-assisted communication, qualified interpreters, and some basic knowledge of lipreading or sign language, the care of deaf patients is greatly enhanced and the physician-patient relationship improved.
Approximately 10% of the US population lives with some degree of hearing loss. Within this group is a subset of persons who are profoundly deaf. Deafness affects approximately 2 million Americans, for a prevalence of 1 in 100, making it likely a primary care physician will encounter a deaf person.
Although these 2 million Americans share profound hearing losses, they are a heterogenous group and have a range of perspectives about their own deafness. Some members take a perspective of hearing loss as a pathologic condition and think of themselves as having dysfunctional ears. They tend to label themselves as deaf, hard-of-hearing, late-deafened, or hearing-impaired.
In contrast to this group are those who describe themselves as Deaf. The capitalization denotes that these persons do not consider their hearing loss a disability, but rather a unique trait linking them to others like themselves, forming the basis for shared language, culture, and life experiences. In most communities in the United States, the language is a visual or signed language - in its most linguistically natural form, American Sign Language. This cultural group includes those with less than profound hearing losses who describe themselves as Deaf because they feel a greater psychosocial link to the culturally Deaf community than to the hearing majority. In this report we will use deaf to refer to a person with profound audiologic loss regardless of her or his group identity, and Deaf to refer to a member of the subset with a cultural affiliation. Hearing refers to a person without audiologic loss.
How does this diverse and distinct deaf population experience health care? Reportedly persons who are deaf and hard-of-hearing visit physicians more frequently, experience more difficulties in communicating with and understanding their physicians, have a lower comfort level with their physicians, and report lower subjective health status. It is also reported that there is a lack of knowledge and wide-spread misinformation on the part of physicians with respect to deaf patients.
Despite the apparent gap in physicians' knowledge and abilities, there remains minimal attention to the deaf patient or the Deaf culture in medical education or in the classic adult patient generalist textbooks. The focus is instead on the pathophysiologic characteristics of deafness. It is not surprising that even the most well-intentioned medical student or physician might know little about this topic.
The size of the deaf community in the United States, its heterogeneity, and the limited attention to its health care needs within medical curricula raise many questions. How do members of the deaf community access health care? What is their experience? How do hearing physicians typically interact with deaf patients? What, if anything, is problematic about the experiences of deaf patients and the providers who care for them? What might be done to correct any problems?
Background: Approximately 10% of the US population has some degree of hearing loss, and 2 million Americans are deaf. Most medical school curricula and major textbooks characterize deafness as pathologic condition only, which is at odds with the movement to understand the Deaf population as a minority group with a unique language and cultural tradition. Physicians might therefore be unprepared to meet the needs of deaf patients effectively and sensitively. This study seeks to understand the health care experiences of elderly Deaf adults in Richmond, Va.
Methods: The authors conducted focus groups of elderly Deaf persons. Real-time voice-interpretation of the sign language communication allowed for tape recording and full transcription. The authors independently analyzed the transcripts using an editing style, and incorporated feedback on their interpretation from participants.
Results: Participants experienced many practical barriers to effective health care, including problems with scheduling appointments and communicating with providers. They believed that providers are ill-prepared to care for them and worried that prejudice might be a more subtle obstacle. Participants seemed resigned to these circumstances.
Conclusions: The authors suggest a possible explanation for this perspective, and make specific recommendations for three levels of competency in caring for deaf patients. When the provider and the office staff provide methods to communicate with deaf patients using telephone-assisted communication, qualified interpreters, and some basic knowledge of lipreading or sign language, the care of deaf patients is greatly enhanced and the physician-patient relationship improved.
Approximately 10% of the US population lives with some degree of hearing loss. Within this group is a subset of persons who are profoundly deaf. Deafness affects approximately 2 million Americans, for a prevalence of 1 in 100, making it likely a primary care physician will encounter a deaf person.
Although these 2 million Americans share profound hearing losses, they are a heterogenous group and have a range of perspectives about their own deafness. Some members take a perspective of hearing loss as a pathologic condition and think of themselves as having dysfunctional ears. They tend to label themselves as deaf, hard-of-hearing, late-deafened, or hearing-impaired.
In contrast to this group are those who describe themselves as Deaf. The capitalization denotes that these persons do not consider their hearing loss a disability, but rather a unique trait linking them to others like themselves, forming the basis for shared language, culture, and life experiences. In most communities in the United States, the language is a visual or signed language - in its most linguistically natural form, American Sign Language. This cultural group includes those with less than profound hearing losses who describe themselves as Deaf because they feel a greater psychosocial link to the culturally Deaf community than to the hearing majority. In this report we will use deaf to refer to a person with profound audiologic loss regardless of her or his group identity, and Deaf to refer to a member of the subset with a cultural affiliation. Hearing refers to a person without audiologic loss.
How does this diverse and distinct deaf population experience health care? Reportedly persons who are deaf and hard-of-hearing visit physicians more frequently, experience more difficulties in communicating with and understanding their physicians, have a lower comfort level with their physicians, and report lower subjective health status. It is also reported that there is a lack of knowledge and wide-spread misinformation on the part of physicians with respect to deaf patients.
Despite the apparent gap in physicians' knowledge and abilities, there remains minimal attention to the deaf patient or the Deaf culture in medical education or in the classic adult patient generalist textbooks. The focus is instead on the pathophysiologic characteristics of deafness. It is not surprising that even the most well-intentioned medical student or physician might know little about this topic.
The size of the deaf community in the United States, its heterogeneity, and the limited attention to its health care needs within medical curricula raise many questions. How do members of the deaf community access health care? What is their experience? How do hearing physicians typically interact with deaf patients? What, if anything, is problematic about the experiences of deaf patients and the providers who care for them? What might be done to correct any problems?