Communicating with Deaf patients
BMJ 2005; 330 doi: https://doi.org/10.1136/bmj.330.7494.s138 (Published 02 April 2005) Cite this as: BMJ 2005;330:s138
- Marije Davidson, (Deaf) Master of Law in the Netherlands and legal policy officer
Abstract
Deaf patients have specific communication needs. Channa Panagamuwa, Kate Wellman, and Marije Davidson consider the role of BSL/English interpreters and the legal obligation of doctors to provide them
Britain's Deaf community, like many other minority groups, has a language and a culture of its own. But unlike hearing minorities, access to the majority language and culture is limited by disability. Access to society is also severely limited by prejudice and a lack of understanding of Deaf people, their language, and their culture.
Language of the British Deaf community
Have you ever tried to access healthcare services in a country where you don't speak the language? How do you explain what's wrong—by gesture or drawing? How confident do you feel to consent to an operation, take prescribed drugs, or accept that you are “OK”?
Good communication between patients and doctors is essential to effective care
For Deaf people who use British sign language (BSL), access to health services is almost always in another language. It is a common misconception that BSL is a visual representation of English and that it follows the grammar and word order of English and simply substitutes signs for words. This is not the case. Much of the grammar and intonation of BSL are to be found in facial expressions and mouth patterns, and the sign order and structure of the language follow different rules.1 This is why a Deaf BSL user's written English may look “foreign” and ungrammatical.
For many Deaf BSL users, English is therefore a second or even a third language. Communication via pen and paper, while useful for basic short exchanges, is not appropriate or safe for conducting medical consultations or obtaining consent. As with users of other minority languages, the solution to this is to communicate through an interpreter.
Definitions of Deaf and deaf
In this article, “Deaf” with a capital “D” is used to refer to Deaf people whose first or preferred language is British sign language and who identify themselves as being part of the Deaf community. The term “deaf” with a lower case “d” is used to refer to people with all degrees of deafness, including deafened, hard of hearing, and Deaf.
Some Deaf people may require additional or alternative communication services to a BSL/English interpreter—for example, a Deaf person with minimal language skills may require a specialist interpreter to work either instead of or alongside a BSL/English interpreter
What is a BSL/English interpreter?
BSL/English interpreters are trained accredited professionals. They have undergone training and assessment in both languages, in cultural mediation and in interpreting. In England and Wales interpreters are registered with the Independent Registration Panel (IRP) and/or are members of the Association of Sign Language Interpreters (ASLI). In Scotland, interpreters are registered with the Scottish Association of Sign Language Interpreters (SASLI).
While interpreters are bound by a code of ethics, which includes impartiality and confidentiality, friends and relatives are not. Sadly, hearing children of Deaf parents are often used to “interpret” during medical consultations. This is obviously dangerous for the patient and also places inappropriate responsibility on the child. Alongside ethical considerations, with sign language we cannot assume that friends and relatives of a Deaf person can sign to a sufficient level. For medical consultations, it is essential that someone with the proper level of interpreting skills—not a member of staff with a basic knowledge of BSL—is used.2 While it is extremely helpful when NHS staff can conduct basic conversations in BSL, as with medicine a little knowledge can be dangerous if the person is not aware of their limitations.
A professional duty
“We as a profession have a duty to maintain a good standard of practice and care towards our patients.” The General Medical Council (GMC) requires its doctors to3:
Respect the rights of patients to be fully involved in decisions about their care
Give patients information in a form they can understand
Listen to patients and respect their views
Respect patients' dignity and privacy
Recognise the limits of your professional competence.
It is difficult to see how the above can be achieved when doctor and patient do not use the same language.
The GMC standards and ethics committee also made the following statement “Make arrangements wherever possible to meet particular language and communication needs, for example, through translations, independent interpreters.”4
A legal duty
Since 1999 there has been a legal requirement on service providers to make “reasonable adjustments” to ensure their services are accessible to disabled people. One example of a “reasonable adjustment” listed by the Disability Discrimination Act is the provision of sign language interpreters.5 A further extension to the Disability Discrimination Act in October 2004 requires that physical features of surgeries and hospitals also be made accessible. For deaf people this could include the use of visual information displays for calling patients from a waiting room.
Box 1: Facts
On 18 March 2003, the UK government recognised British sign language (BSL) as a language in its own right5
30% of BSL users avoid going to see their general practitioner because of communication problems6
33% of BSL users are either unsure about instructions for taking drugs or have taken too much or too little of a drug because of a communication problem6
Box 2: Tips for working with a BSL/English interpreter
Seating should be arranged so that the Deaf patient can see the interpreter and the doctor easily
Lighting is important—try not to sit with lights or windows behind you or the interpreter
Talk directly to the patient (even though he or she will need to look at the interpreter)
Be patient—a BSL/English interpreter is working between two different languages. Some concepts are quick to interpret, others are not
If consultations have previously been carried out without an interpreter it is worth checking your information and the patient's understanding
How to book a BSL/English interpreter
Deaf people use a range of communication services, so you should always try to find out the patient's preferred means of communication. If you are unable to sign, ensure that your face is clearly visible and speak clearly. Alternatively, write it down in plain English and use visual pictures where appropriate.
If you need a BSL/English interpreter:
Check with your department, primary care trust, or hospital trust whether they have a central booking system and/or a contract for the provision of interpreting services
If you need to book an interpreter directly, ensure that you are booking an IRP or SASLI registered and/or ASLI member (box 3 gives contact details)
Bear in mind that there is a shortage of interpreters and allow as much time as possible when booking
Try to be flexible with the appointment date and time.
Box 3: Useful websites
Independent Registration Panel, C/o Council for the Advancement of Communication with Deaf People: www.cacdp.org.uk
Association of Sign Language Interpreters: www.asli.org.uk
Scottish Association of Sign Language Interpreters: www.sasli.org.uk
RNID for deaf and hard of hearing people: www.rnid.org.uk
Royal Association for Deaf People: www.royaldeaf.org.uk
British Deaf Association: www.bda.org.uk
Disability Rights Commission: www.drc-gb.org
Conclusion
The provision of BSL/English interpreters is not only a professional duty and legal obligation but also fundamental to providing a safe and accessible health service for Deaf people.
Footnotes
KW and MD write here in a personal capacity