Exploring communication difficulties with deaf patients

Abou-Abdallah, Michel Lamyman Abigail

Causes of hearing loss can be conductive, relating to abnormalities of the external ear or ossicles, sensorineural, relating to inner ear structures, or mixed.4 70,000 of the UK's deaf population are profoundly deaf prior to acquiring speech,5 and in developed countries 80% of congenital hearing loss is genetic.4 National Institute for Health and care Excellence guidance suggests the use of hearing aids for adults and children in whom hearing loss impairs their quality of life, and cochlear implantation in those without benefit after 3 months (unless contra-indicated or inappropriate).6 There exist socio-economic and health education barriers to hearing aid uptake, and people may choose not to be implanted for psychological and cultural reasons.7 Members of the Deaf community define deafness as a cultural identity rather than a disability. A survey by the RNID showed that 77% of BSL users had difficulty communicating with hospital staff, and 33% left consultations with their family doctor unsure about instructions or taking incorrect medication doses.10 30% avoided seeing their family doctors because of communication difficulties.10 It is important to note that from August 2016, the Accessible Information Standard introduced a legal requirement in England for NHS organisations to ask for, record and meet communication needs.11 Clinical case A recent trauma on-call shift saw the admission of a 95-yearold male who had fallen and broken his hip. A study by Reeves in 2002 found that BSL interpreters were present at just 17% of GP and 7% of ED consultations, despite over half of the sample expressing desired support from these services.17 An interpreter had not been engaged for 42% of scheduled GP appointments where it would have been useful and 57% of A&E attendees would have found it useful for the doctor or nurse to know BSL, or for there be a 24-hour interpreter service.17 The 2018 Good Practice Report by the RNID echoes this, with 64% of patients leaving GP consultations feeling unclear at least some of the time.18 The reality is that while interpreting services are generally available, either in person or virtually, staff are often unaware of how to access them. Doctor-patient interactions in general practice or the hospital setting are often under time constraints outside the clinician's control and interpreters often need advance notice, with technological barriers to virtual consultations requiring specific apps and planning.17 The confounding factor of cognitive state Hearing loss has been shown to be independently associated with delirium in the ED.19 Patients are concomitantly often affected by chronic cognitive conditions such