Dealing with Hearing-impaired Patients
Professional Reference articles are designed for health professionals to use. They are written by UK doctors and based on research evidence, UK and European Guidelines. You may find the Hearing Problems article more useful, or one of our other health articles.
Treatment of almost all medical conditions has been affected by the COVID-19 pandemic. NICE has issued rapid update guidelines in relation to many of these. This guidance is changing frequently. Please visit https://www.nice.org.uk/covid-19 to see if there is temporary guidance issued by NICE in relation to the management of this condition, which may vary from the information given below.
One in six people in the UK have a significant hearing impairment.However, recent research has shown that the needs of this patient group are poorly met in many GP surgeries.
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?
People with hearing impairment can experience many barriers when using their GP surgery. The problems begin with booking appointments. Many surgeries expect this to be done by telephone, without providing alternatives.
The next stop, the waiting room, can be very stressful for many hearing-impaired patients. They may have difficulty understanding receptionists, feel embarrassed when talked to loudly so that the rest of the room can hear, and may miss their turn to see the doctor through not hearing their name being called.
Difficulties may then continue in the consultation. Lip-readers may be hampered by doctors looking at the computer or having a different accent. Sometimes the person has to rely on a relative or friend to assist, and then feels left out of the discussion.
The result can be confusion about the content of the consultation. Written information may help but it is often just a question of awareness and an understanding of the difficulties that a person with hearing impairment may be having, and asking individual patients what they need.
- One size does not fit all. Hearing-impaired patients use a variety of ways to communicate, eg lip-reading, British Sign Language (BSL), writing, and other methods.
- 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.
- 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.
- Use the patient's preferred method - eg, 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. It displays your speech on the screen - very helpful for some patients.
- 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 - eg, with hearing aids or lip-reading classes.
- Install 'T Loops' in the surgery for those with hearing aids.
Hearing-impaired people may use various methods to communicate. These include:
- Lip-reading (can be aided by 'lipspeaking' interpreters).
- Signing - eg, BSL.
- Makaton (a simplified form of BSL).
- Pen and paper.
Deafblind people may use additional methods, including:
- Deafblind 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.
Further reading and references
UK Council on Deafness; access to very extensive list of specific patient groups (click Members Directory)
Introduction to deafblindness; Sense for deafblind people