Attending hospital can be a nightmare for deaf people. Marie Mangan explains what doctors should be doing to help deaf patients

The Royal National Institute for Deaf People (RNID) gathered quite a collection of hospital horror stories from its deaf and hard of hearing members in a recent survey. One in four reported leaving a doctor's appointment without knowing what was wrong with them. One in six admitted that they did not go to the doctor when they were ill because communication was such a problem. More than two thirds thought that hospitals could do better.

Disturbing experiences

Mr and Mrs Bates, both deaf and BSL users, had mixed feelings following a car accident. In emergency situations it is often difficult to get hold of an interpreter; worse still, to cut costs Buckinghamshire health authority had recently axed its only medical sign language interpreter. In the absence of any communication support and growing chaos with police and paramedics shouting at them, their 4 year old daughter, who is hearing, said "My mummy and daddy are deaf and cannot speak." She then proceeded to interpret for her parents who, grateful that they now had a way of understanding the questions being thrown at them, were also concerned that their little girl should not have to be doing this.

Elizabeth Arendt was incensed by the way she was treated in a specialist ear, nose, and throat hospital: "I had been waiting for ages, so I mentioned to a senior nurse that my appointment time was well past. A few minutes later a nurse came out and shouted something unintelligible. I asked if she was calling me but she stalked off, muttering something over her shoulder. I caught up with her, trying to lipread, but she was walking very fast, and I still couldn't make out a word she was saying. ... It was so frustrating. It's not as though she wouldn't realise I was deaf--I have a hearing dog with a bright yellow coat, so it's pretty obvious."

Had the nurse sat down or stood face to face with the patient and allowed Elizabeth to lipread this situation, the stress and humiliation it caused could have been avoided.

The insensitive treatment Julie Bradshaw experienced, when she went for a cervical smear, left her angry and embarrassed. "The doctor didn't say much but pointed to my trousers, which meant 'trousers off.' She then pointed to the bed, which meant 'get on the bed,' as if I should already have thought of doing that. When I lay in the wrong position she pushed me into the right position. She didn't try to make me feel calm at all."

How things could be improved

Such treatment may make patients reluctant to go back to the doctor, or hospital, next time, and that may be just the time when a serious health problem needs attention.

Great improvements can be made at little cost, and existing procedures should be examined to see if they are creating barriers for deaf and hard of hearing people. It is vital that they feel confident with the health service--from making appointments to ensuring that any diagnosis has been communicated and understood.

When talking to a patient, make sure that you do the following
• Face the light, stand or sit on the same level as the patient, 3-6 feet away
• Speak clearly, just a little more slowly than normal. Shouting will only distort the pattern of your speech and make it harder to understand
• Keep your hands, your pen, and your notes away from your face
• Keep background noise at a minimum. Hearing aids can magnify all noise
• Check that the Deaf person has understood what you are saying. Lipreading is very tiring. This is especially important in a situation where the patient may be nervous and finding it more than usually difficult to take everything on board
• Write down any important information or instructions, particularly on medication.

Legal improvements

The NHS Executive recently engaged a specialist disability consultancy to draw up an action programme to implement Section 21 of the Disability Discrimination Act across the NHS. This falls under Part III of the act and comes into force in October 1999. Service providers must ensure "reasonable access to services." They will have to take reasonable steps to change practices, policies, or procedures that make it especially hard for disabled people to use a service. The consultancy reported that inappropriate staff attitudes and behaviour were the greatest barrier for disabled people in accessing health care.

The RNID provides a disability consultancy service that can advise surgeries, health centres, and hospitals on how to make their service accessible, as well as deaf awareness training.

Videophones are one solution to the shortage of qualified sign language interpreters. They make "emergency interpreting" possible, overcoming the problem of an interpreter having to travel to the incident. They provide a remote, real time, interpreting service via a personal computer that has a digital camera and ISDN link. Any PC--in a doctor's surgery or a hospital setting - can be adapted at small cost to double up as a videophone. These can then link up to the RNID sign language interpreter "on call."

For information about RNID services, videophones, and other equipment to aid communication, contact the RNID helpline on 0870 6050123, textphone 0870 6033007, email helpline@rnid.org.uk, or visit the RNID's website (www.rnid.org.uk).