Good communication is essential for doctors, patients, and their family members to work together successfully. Many physicians rely on written communication with their deaf patients; however, writing may be less effective than expected, as the median reading level of a deaf high school graduate in the United States is 4th–5th grade (J.A. Holt, 1993), and the medical vocabulary knowledge of U.S. deaf adults is similar to that of non-English speaking immigrants to the United States (Dean and Haslam-Hopwood, 2000). Communication in ASL, facilitated by an interpreter, allows the deaf patient to focus on content rather than on the communication itself.

According to Steven Barnett, MD, to be effective, the placement of the interpreter is important. Specifically, the interpreter will often be to the side and a bit behind the physician. This allows the deaf person to see both the interpreter’s signing and the physician’s nonverbal expressions, and the physician is able to hear the interpreter while maintaining eye contact with the patient.

Translation
Any idea that can be communicated in English can be communicated in ASL, although the ways an idea is communicated may differ. Plus, ASL does not have names for some things named in English. Homonyms are another area where ASL and English differ. In Barnett’s 2002 article in Family Medicine magazine, he cites an example of a translation error related to homonyms involving HIV test results. “The English word “positive” has many meanings, including present, as in “HIV positive,” as well as confident, beneficial, electrically charged, and greater than zero. The ASL sign typically translated as the English word “positive” has fewer meanings; it means beneficial or, in a mathematical context, it means plus. A translation error occurs when it is assumed that the English word “positive” and the ASL sign typically translated as “positive” have all the same meanings.”

Legislation
The Deaf community in the U.S. and its access to healthcare communication is protected by civil rights legislation and other government regulations. Both Section 504 of the Rehabilitation Act of 1973 and the American Disabilities Act of 1990 (ADA) require the provision of interpreter services to achieve effective communication when communicating with deaf patients or deaf family members of patients. The ADA also specifically mandates the availability of qualified interpreters.

It is important to note that these tips will not apply to all situations. As in any country, people from different socio-economic strata, educational backgrounds, and religions may behave very differently from what is considered the cultural norm.

SOURCES:
1. American Disabilities Act (Communicating with people who are deaf in a hospital environment).
2. Steven Barnett, MD. “Cross-cultural Communication with Patients Who Use American Sign Language,” Family Medicine. May 2002.
3. J.A. Holt. Stanford Achievement Test, eighth edition. “Reading comprehension subgroup results.” Am Ann Deaf. 1993;138:172-5.
4. R. Dean and T. Haslam-Hopwood. “Interpreter translation decisions in psychotherapy: What clinicians don’t know is happening (but should).” Rochester, NY, June 5, 2000.