Communicating With Patients Who Are Deaf or Hard of Hearing

The Americans With Disabilities Act requires you do whatever necessary to ensure "effective communication" with deaf or hard-of-hearing patients. Here are some tips to help you do this:

  • Know who is a qualified interpreter. When a deaf or hard-of-hearing person makes an appointment with your office, he or she most likely will be calling in via a federally funded video relay service (VRS). A sign language interpreter and the deaf person see each other on video screens and interpret the conversation, both spoken and signed. They may request a qualified interpreter to be present during their appointment to guarantee all the information is accurate and completely understood.

    NOTE: In medical settings, friends or family members are not considered qualified because they are neither trained nor unbiased. A qualified interpreter is one who is nationally certified with the Registry of Interpreters for the Deaf (RID).

  • Know how to speak through an interpreter. While working with an interpreter, even though the deaf patient will be watching the interpreter the majority of the time, you should still look at and directly address the patient, as if the interpreter was not present. Don't say to the interpreter, "Tell Mrs. Jones …" The patient will look back and forth between you and the interpreter to observe your body language and facial expressions. 
  • Know your options. If providing an on-site interpreter is not feasible, another option is to call a video remote interpreter (VRI). VRI is similar to VRS, but it is not federally funded because it requires that the patient and physician be in the same room. Many deaf people prefer the anonymity of a video remote interpreter so they won't be embarrassed by seeing their community interpreter face to face in town.

    NOTE: On-site interpreters typically charge a two-hour minimum plus travel fees, while VRI interpreters work via the Internet and charge either by the minute or the hour with no travel fees. Expenses for interpreting services are often a tax deduction for the medical office.

  •  Don't rely on speech reading. Assuming a deaf or hard-of-hearing person can understand instructions by speech reading is, in most cases, incorrect. Only about 30 percent of spoken words are visible on the lips; the other 70 percent of sounds are produced in the throat, leading to many possible misunderstandings. (Try watching the news on television with the volume turned off and see how much you can catch.)
  • Don't rely on written English. Because English is a second language for many deaf people, expecting them to communicate via written English is often not effective and is more time-consuming than using an interpreter. For example, a patient may misunderstand the meaning of a "positive" test result as being good news. It is also important to know that many deaf adults have only a third-grade English reading level upon graduating from high school. They likely have limited experience with medical terminology.
  • Use visuals. Using a model or prop paired with the services of a sign language interpreter can be effective while explaining a patient's condition or injury.  Asking open-ended questions to ensure understanding can also be quite helpful.

For more information on the laws regarding physician responsibilities under the Americans With Disabilities Act, including hearing impaired and limited-English proficiency patients, read "Good Communication" from Texas Medicine, November 2013.

Thanks to certified interpreters Teresa Von Loh and Linda Deichsel of Virtual VRI for these tips.

Published Oct. 7, 2014

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Last Updated On

June 23, 2016