Communicating about health care: observations from persons who are deaf or hard of hearing.
BACKGROUND
Achieving patient-centered care requires effective communication between physicians and patients. Persons who are deaf or hard of hearing face considerable barriers to communicating with physicians.


OBJECTIVE
To understand perceptions of health care experiences and suggestions for improving care among deaf or hard-of-hearing individuals.


METHODS
4 semistructured group interviews, 2 conducted in American Sign Language (for deaf individuals) and 2 using Communication Access Realtime Translation (for hard-of-hearing individuals). Men and women were interviewed separately. Tapes of interviews were transcribed verbatim for analysis.


METHODS
Greater Boston, Massachusetts, and Washington, DC, in 2001.


METHODS
14 deaf adults (23 to 51 years of age) and 12 hard-of-hearing adults (30 to 74 years of age).


METHODS
Commonly expressed themes or views organized around dimensions of communication.


RESULTS
Concerns coalesced around 6 broad themes: conflicting views between physicians and patients about being deaf or hard of hearing; different perceptions about what constitutes effective communication (such as lip reading, writing notes, and sign language interpreter); medication safety and other risks posed by inadequate communication; communication problems during physical examinations and procedures; difficulties interacting with office staff, including in waiting rooms; and problems with telephone communication, such as lengthy message menus. Participants offered extensive suggestions for improvements, starting with clinicians' asking patients about their preferred communication approach. Having patients repeat critical health information (such as medication instructions) can identify potentially dangerous miscommunication.


CONCLUSIONS
As the population ages, physicians will encounter many more persons with hearing limitations. Physicians are not reimbursed for making some accommodations, such as hiring sign language interpreters. However, ensuring effective communication is essential to safe, timely, efficient, and patient-centered care.
Iezzoni
Lisa I
LI
Department of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Charles A. Dana Research Institute, Harvard-Thorndike Laboratory, and Third Sector New England, Boston, Massachusetts 02215, USA.
O'Day
Bonnie L
BL
Killeen
Mary
M
Harker
Heather
H
D000328:Adult; D000368:Aged; D003142:Communication; D003638:Deafness; D003695:Delivery of Health Care / Q000379:methods / Q000592:standards*; D005260:Female; D034381:Hearing Loss; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D009819:Office Visits; D010808:Physical Examination; D010817:Physician-Patient Relations