Accessing health care is challenging for Deaf people ā but the best solution isnāt āone-size-fits-allā
This article by Dr Christopher Shank, Lecturer in Linguistics and Anouschka Foltz, University of Graz was originally published on . Read the .
For many of us, a visit to the doctorās office can be wrought with anxiety. A persistent cough that wonāt go away or an ailment we hope is nothing serious can make GP visits emotionally difficult. Now imagine that you canāt phone the doctor to make an appointment, you donāt understand what your doctor just said, or you donāt know what the medication youāve been prescribed is for. These are all situations that face when accessing health care services.
We use Deaf (with a capital āDā) here to talk about culturally Deaf people, who were typically born deaf, and use a signed language, such as , as their first or preferred language. In contrast, deaf (lowercase ādā) refers to the audiological condition of deafness.
, we talked to Deaf patients in Wales who communicate using BSL to learn about their experiences with health care services. Their experiences illustrated the challenges they face, and showed us that patients have unique needs. For example, a patient born profoundly deaf would have different needs from a person who became deaf later in life.
Health inequalities
Many Deaf communities around the world face inequalities when it comes to accessing and , as health information and services are often not available in an accessible format. As a result, Deaf individuals often have low health literacy and are at greater risk of being or not diagnosed at all.
Problems with health care access often begin when making an appointment. Because many GPs only allow appointments to be made over the phone, many of those we interviewed had to physically go to health centres to ask for an appointment. Not only is this inconvenient, booking without an interpreter could be difficult and confusing.
Interpreters are essential for patients to receive the best care. However, we heard recurring stories of interpreters not being booked for appointments, arriving late, and ā in some cases ā not coming at all. Before interpreters were available, one woman described going to the doctorās office as intimidating ābecause the communication wasnāt thereā. One participant said they always make sure an interpreter has been booked, saying: āDonāt let me downā¦ I donāt want to be going through this again.ā
These issues are worsened in emergency situations. One woman recalled an incident where despite texting 999, she didnāt get help until her daughter phoned 999 for her, acting as her interpreter throughout her entire interaction with emergency services.
Emergency situations are made worse by a lack of understanding or help from emergency services.
Another person who texted 999 said:
There are all these questions that they are asking you. And all that we want is to be able to say, āWe need an ambulanceā ā¦ Because whatās happening is weāre panicking, we donāt understand the English, there are all these questions being texted to us, itās hard enough for us to understand it anyways without panicking at the same time.
Interviewees also recalled emergency situations where interpreters werenāt available at short notice. One Deaf woman recalled when her husband ā who is also Deaf ā was rushed to hospital. They received no support from staff, and no interpreter was provided to help them.
Deaf awareness and language
Many problems that our interviewees faced related to language, and a lack of Deaf awareness. Many health care providers didnāt seem to know that BSL is a language unrelated to English ā meaning many BSL users who were born Deaf or lost hearing early in life have limited proficiency in English. One interviewee explained that many health care providers think all Deaf people can read, without realising that many BSL users donāt understand English ā with many being given health information written in English that they couldnāt comprehend.
Interviewees wished health care staff were more Deaf aware, as many health care providers lacked understanding about Deafness. This affected the doctor-patient relationship, with many interviewees agreeing that doctors ācan be a bit patronising at timesā and that this patronising attitude made interactions difficult. A lack of Deaf awareness can also lead to Deaf patients feeling forgotten. Many interviewees felt that Deaf people are easily ignored, with one interviewee saying: āI always feel like Deaf people are put last.ā
No āone-size-fits-allā solution
New technologies and services are being offered to help Deaf patients ā such as having an interpreter call the doctorās office during a video call with the patient.
Video calling might be one solution.
Additionally, some health information is now available . Interpreters can also be more easily available at short notice, for example in emergency situations, through video chat. Remote services particularly show promise for mental health treatments, by providing and other types of confidential services.
Because Deaf communities are small and tight-knit, patients may be wary of interacting with local Deaf counsellors or interpreters, worried about potential gossip. Several interviewees even said that they would not want a Deaf counsellor even if offered, for fear that the counsellor might gossip about them with others in the community. One interviewee suggested a mental health service with a remote online interpreter as the best solution.
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The problems and potential solutions that emerged from our research are similar in . Though technology might offer some promising solutions, itās important to realise that these might not work for everyone.
Patients have individual differences, needs, preferences, and cultural differences. Some patients may prefer a remote interpreter, others face-to-face interpreting ā and these preferences may also depend on the type of appointment. Whatās important is that Deaf patients have choice, and that new services, such as through the use of new technologies, are offered in addition to, not instead of, established health services.
Publication date: 28 November 2019