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Deaf and hearing-impaired patients suggest ways doctors can improve communication to improve care quality and safety

Inadequate communication with deaf or hard-of-hearing patients can lead to misdiagnosis and medication errors, as well as patient embarrassment, discomfort, and fear, according to a study supported by the Agency for Healthcare Research and Quality (HS10223). Researchers led by Lisa I. Iezzoni, M.D., M.Sc., of Beth Israel Deaconess Medical Center, conducted in-depth interviews with 14 deaf and 12 hard-of-hearing adults about their communication concerns during medical visits and procedures and how communication could be improved.

Those interviewed suggested that clinicians ask hearing-impaired patients about their preferred way of communicating instead of requiring them to use ineffective ways to communicate such as lip reading (doctors often turn their head or lips are hidden by a mask or beard), writing notes, and using family members to interpret. Also, when treating deaf patients, doctors should use interpreters who are trained specifically for medical settings, and they should speak more slowly to hard-of-hearing patients. The study participants suggested that doctors ask patients to repeat critical information such as medication instructions, as well as put it in writing, in order to avoid potentially dangerous miscommunication.

Interviewees described not understanding therapeutic regimens, medication dosages, or side effects or not knowing what to expect during physical exams and procedures. They suggested that doctors use lights as signals for required actions, such as holding one's breath during a mammogram, and find alternatives to lengthy phone message menus such as E-mail or fax. Offices should acquire and train staff to use a teletypewriter or telecommunications device for the deaf, and staff should be trained to communicate better with deaf and hard-of-hearing patients.

See "Communicating about health care: Observations from persons who are deaf or hard of hearing," by Dr. Iezzoni, Bonnie L. O'Day, Ph.D., Mary Killeen, M.A., and Heather Harker, M.P.A., in the March 2, 2004 Annals of Internal Medicine 140, pp. 356-362.

Editor's Note: Another AHRQ-funded study on a related topic describes a community-based educational forum to enhance communication skills. The forum improved people's confidence in their ability to communicate effectively with their doctor. For more details, see Tran, A.N., Haidet, P., Street, Jr., R.L., and others (2004). "Empowering communication: A community-based intervention for patients" (AHRQ grant HS10876). Patient Education and Counseling 52, pp. 113-121.

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