More than half of people with a hearing impairment wanted to see their GP but didn’t, according to a research study into the health of deaf people(1), writes Dr Amanda Powell.

This astonishing fact leads us to question why does this group of people feel they don’t want to access health care?

Not many of us like being a patient but put yourself in the shoes of a person with hearing loss and the experience just became much worse.

The obstacles are plentiful from booking the appointment, sitting waiting to be called and fearing you may have missed the announcement and the effort involved in having to communicate your symptoms and concerns whilst worrying whether the doctor understands you.

Then, receiving results that you don’t understand and feeling you can not discuss them properly and finally relying on an interpreter, putting all your trust that they are conveying the correct messages between you and the doctor. These are some of the reasons that are partly responsible for our opening statistic.  

Challenges

Doctors, in my view, also face challenges: an interpreter not always being available; concerns around getting the right history about the problem from the patient’s view; feelings that we may have offended them by perhaps taking a long time to correctly understand the problem; and finally, the pressure of time.

GPs, again in my opinion, do want to provide the best possible patient led care and want to deliver an excellent, seamless service.

Let’s have a look at the facts and figures. In the UK, approximately 1 in every 6 people have some form of hearing impairment(2).

Research conducted in 2015 investigated the health of the signing deaf community in the UK. It revealed that these patients have higher rates of known risk factors for chronic disease including cardiovascular disease, hypertension (high blood pressure) and diabetes and higher rates of self-reported depression.

In this subset,“there was a lack of health awareness, under-diagnosis and under-treatment of chronic conditions”. This may be putting them at risk of preventable conditions and potentially reduced life expectancy (3).Changes must be made to remedy this health inequality.  

Below are some simple ideas to deliver a streamlined service for patients with hearing loss:

• Make sure ALL staff complete a deaf awareness training course.
• Make sure your ebooking service is working. Alternatively, ensure your patients with hearing loss are aware of the ‘Next Generation Text Service’.

GPs are under significant pressure to complete their consultations in 10 minutes. Having an interpreter present can lengthen an appointment, it can be a good idea to book a double appointment. This can be discussed with your GP practice.

• Always ask the patient their preferred form of communication.
• Show the patient the screen in the waiting room where their name will appear so they don’t feel anxious about missing their appointment.  If there is no screen, the doctor could collect them from the waiting room or a vibration pager could be provided.
• Ensure the GP computer system flags a patient that has a hearing impairment (however mild or severe).
• Reduce noise in both clinical and non-clinical areas and improve background lighting. Never talk to a patient with your back against the window. It is very difficult to lip read in poor lighting. Always face the patient when communicating with them, never look down and keep your hands away from your face.
• A patient wearing a hearing aid doesn’t mean they can hear normally.
• ALL deaf patients are entitled to an interpreter. Interpreters are often difficult to book. If possible, for routine care, try and book an interpreter 3 weeks before the appointment. This should be done by the health care provider.
  

Unless a patient tells you they want a friend or family member to interpret for them, never ask, always just go ahead and book the interpreter.

• Always ask the patient to repeat back to you what you have said to check their understanding.
• There are now virtual interpreters.

References:

1. Research into the health of deaf people, Study conducted by Ipsos Mori for SignHealth, 2013.
2. https://www.actiononhearingloss.org.uk/about-us/our-research-and-evidence/facts-and-figures/
3. The Current health of the signing deaf community in the UK compared with the general population: a cross-sectional study. Emond A, et al. BMJ Open 2015;5:e006668. doi:10.1136/bmjopen-2014-006668

About Dr Amanda Powell BM DRCOG MRCGP

Having qualified from Southampton University Medical School in 2006, Dr Powell subsequently completed her General Practice training in Winchester, Hampshire.

During various roles in the community she undertook two postgraduate diplomas focusing on Women’s Health (DFRSH and DRCOG). In 2012 she left her clinical GP role to move abroad and focus on raising her young family.  

Living in Kuwait and now The Sultanate of Oman has exposed her to a diverse cultural approach to healthcare and provided an opportunity to pursue her non-clinical GP roles.

Dr Powell now works as a freelance medical writer and is soon to train as a health coach. She looks forward to returning to NHS General Practice building on experience gained in her non-clinical roles abroad.  

ENDS

Dr Amanda Powell has no conflict of interest pertaining to any companies or products mentioned in the article.

More Information:

Dot Sign Language is able to help with deaf awareness training, more details can be found here.

50,000 people in the UK use British Sign Language (BSL) as a first language. Unlike other courses, Dot Sign Language provides teaching in basic sign language.  This could be an excellent way to make your GP Practice more accessible and welcoming to BSL users and stand out from other surgeries. The training sessions also serve as a great way to motivate staff and bond the team.