SUMMARIES FOR PATIENTS

Communication and Perceptions of Health Care: Observations and Suggestions from Persons Who Are Deaf or Hard of Hearing

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The summary below is from the full report titled "Communicating about Health Care: Observations from Persons Who Are Deaf or Hard of Hearing." It is in the 2 March 2004 issue of Annals of Internal Medicine (volume 140, pages 356-362). The authors are L.I. Iezzoni, B.L. O'Day, M. Killeen, and H. Harker.

What is the problem and what is known about it so far?

Patient-centered care—respecting patients' preferences and values—is increasingly discussed as an important facet of health care reform. Effective doctor–patient communication is an essential component, but it can be severely hindered when the patient has impaired hearing. Inadequate doctor–patient communication in this context can lead to negative effects such as difficulty in making appointments, patient anxiety, and medication dosing errors. Approximately 25 million Americans have clinically significant hearing loss. That number is expected to increase as the population ages, indicating that health care providers must learn to attend to the special needs of this growing patient population.

Why did the researchers do this particular study?

To learn about communication problems and barriers commonly faced by health care consumers with impaired hearing, as well as their suggestions for improvement.

Who was studied?

14 deaf adults and 12 adults who are hard of hearing.

How was the study done?

Study participants were drawn from a larger study on health care experiences among persons with disabilities. Participants were divided into 4 groups according to sex and level of hearing impairment. A moderator trained in American Sign Language facilitated the deaf participants' groups, and real-time translation technology was used for participants who were hard of hearing. The interviews covered health care quality, access to care and special services, communication issues, and improving accommodations for patients with disabilities.

What did the researchers find?

Most complaints were related to communication. Participants felt that doctors incorrectly perceive those who are hearing impaired as being unintelligent and disinterested in their treatment decisions. Doctors frequently insist on inadequate communication methods and do not take the time to ensure that their patients understand everything that has been said, both of which can lead to medication and treatment errors. Participants also described anxiety during procedures when they cannot see the doctor and understand what was about to happen.

Participants offered numerous suggestions for improving health care communication, including implementing special protocols for treating hearing-impaired patients and recording and respecting patients' preferred method of communication.

What were the limitations of the study?

This was a small study involving people who may not be representative of the overall and hearing-impaired population. In particular, elderly patients and nonwhite patients were not well represented.

What are the implications of the study?

Doctors and other health care providers will increasingly encounter patients with hearing impairment. Effective doctor–patient communication will ensure that this patient population receives appropriate, patient-centered care.