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Dealing with Hearing-impaired Patients

This PatientPlus article is written for healthcare professionals so the language may be more technical than the condition leaflets. You may find the abbreviations list helpful.

One in seven people in the UK has a significant hearing impairment.1 However, recent research has shown that the needs of this patient group are poorly met in many GP surgeries.2

In this article, the term 'hearing-impaired' is used to include both profoundly deaf and other hearing-impaired patients.

What barriers to healthcare do hearing-impaired patients face?2,3

A survey run by the patient information website www.patient.co.uk and the charity SignHealth highlighted the barriers experienced by hearing-impaired patients using their GP surgery. Interestingly, patients with moderate degrees of hearing impairment were just as troubled as those who were profoundly deaf.

The problems began with booking appointments. Many surgeries expect this to be done by telephone, without providing alternatives.

  • "I have to visit the surgery personally (to book appointments)."

The next stop, the waiting room, was highly stressful for many hearing-impaired patients. They had difficulty understanding receptionists, felt embarrassed when talked to loudly so that the rest of the room could hear, and some patients missed their turn to see the doctor through not hearing their name called.

  • "Privacy is compromised at reception as staff inform the whole waiting room of my reason for appointment."
  • "It would help if the staff, including the doctor, would remember I have a hearing loss and face me and speak clearly."
  • "The key biggest issue for me is hearing when I am called for my consultation in the waiting room."

Difficulties continued in the consultation. Lip-readers were hampered by doctors looking at the computer or having a different accent. Many patients who would have liked an interpreter were not offered one, were refused or did not ask. Some patients relied on relatives to assist, and often felt left out of the discussion.

  • "Many doctors do not turn away from their computer screens when they are talking to me forcing me to ask them to repeat what they have said. I have then been addressed as though I am feeble of mind ..."

The result was a significant number of patients left confused about the content of the consultation. Written information would have helped, but was seldom provided.

The survey asked patients what would help, and various practical points emerged. Most of the recommendations are simple and require little extra time or money. It is more a question of awareness and of asking individual patients what they need.

  • "Whenever someone is flexible and willing to let me speak about my needs, things almost always go fine."

Practical points2,3

Awareness

  • One size does not fit all. Hearing-impaired patients use a variety of ways to communicate, e.g. lip-reading, British Sign Language (BSL), writing, and other methods.4
  • Encourage patients to inform the surgery of any hearing impairment - using posters, appointment screen messages, etc.
  • Highlight the hearing impairment on notes and computer records. Add a 'screen message' available to all staff viewing the record.
  • The Royal National Institute for Deaf People (RNID) provides Deaf Awareness Training.

Booking appointments

  • Allow booking of appointments by text/SMS, textphone, internet or email. Use similar methods when leaving messages for patients.
  • Ask patients what support they prefer for the consultation. Offer interpreters if preferred.
  • Allow extra time for the consultation.
  • Continuity of care (seeing the same doctor) may help.
  • In the waiting room, ensure patients understand the visual call system if installed (perhaps have a handout available to explain how it works), or ensure the doctor knows that the patient is hearing-impaired and will collect them from the waiting room.

Communicating

  • Use the patient's preferred method, e.g. lip-reading, BSL interpreter, pen and paper.
  • Look at the patient while speaking and listening.
  • For lip-readers, face the patient in good light. Speak clearly but not too slowly. Don't exaggerate your speech or shout (this distorts lip movements). Don't look at the computer while talking.
  • Voice recognition software is straightforward to set up on a computer.5,6 It displays your speech on the screen - very helpful for some patients.2
  • Back up the consultation with written material such as patient information leaflets.

Other things you can do

  • Online BSL interpreting is available free from SignTranslate (below) - requires a computer and webcam.
  • Work with pharmacists to aid prescribing.
  • Encourage patients to improve their communication, e.g. with hearing aids or lip-reading classes.
  • Install 'T-Loops' in the surgery for those with hearing aids.

    • What is good practice?

    • RCGP guidance highlights the Disability Discrimination Act and the need to provide an interpreter or other communication support.
    • Good communication is an important aspect of patient safety.
    • With an ageing population, hearing impairment is likely to become a more common issue, and cannot be ignored.

    Further information4

    Hearing-impaired people may use various methods to communicate. These include:

    • Lip-reading (can be aided by 'lipspeaking' interpreters - see Useful resources section, below)
    • Signing, e.g. British Sign Language (BSL)
    • Makaton (a simplified form of BSL)
    • Pen and paper

    Deaf-blind people may use additional methods, including:

    • Deaf-blind manual alphabet or 'block' alphabet (methods of spelling words on to the palm of the hand)
    • Hands-on signing
    • Visual frame signing
    • There are various other techniques depending on the level of visual or hearing impairment.

    Useful resources

    UK Council on Deafness

    The 'members' directory' link provides a comprehensive list of useful organisations and patient groups. This includes various bodies providing communication services such as professional lipspeaking or note-taking.
    Web: www.deafcouncil.org.uk/home.htm

    SignTranslate

    An online interpreting service to qualified British Sign Language (BSL) interpreters via webcam link.
    Web: www.signtranslate.com

    SignHealth

    A UK charity working to improve healthcare and achieve equal access for deaf people.
    Web: www.signhealth.org.uk

    Sense

    A charity providing information for deaf-blind people and their carers.
    Web: www.sense.org.uk

    Action on Hearing Loss (formerly the RNID)

    National charity for deaf and hearing-impaired people.
    Web: http://www.actiononhearingloss.org.uk/

    Patient UK

    Patient information leaflets in printable format.
    Web: www.patient.co.uk

    Document references

    1. Deafness Research UK
    2. Brooks G. Survey of people with mild to profound hearing loss. Patient UK, September 2009.
    3. SignHealth report. Deaf and disabled people’s experience of primary care. February 2009.
    4. Sense, Congenital Rubella Syndrome; (national deafblind charity)
    5. AbilityNet. Voice recognition software - an introduction. Factsheet, March 2009. (Useful introduction to setting up and using voice recognition software on a computer.)
    6. My Web My Way. Voice recognition in Windows XP.
    The clinicians responsible for the production of this document are:
    Original Author: Dr Naomi Hartree
    Last Checked: 26 Feb 2010    		Current Version: Dr Naomi Hartree
    Document ID: 12570  Version: 3    		Peer Reviewer: Dr Helen Huins
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