Patients seeking medical care during the pandemic have witnessed first-hand the changes that health care institutions have made to minimize exposure to COVID-19 in clinical settings. Face masks and face shields, new visitation restrictions, and the elimination of critical in-person support staff like medical interpreters have been safeguards that hospitals and clinics have implemented to keep patients safer from transmission of the coronavirus. However, these health care changes create significant communication barriers for deaf and hard of hearing patients.
In a new piece published in the journal JAMA Otolaryngology, Michael M. McKee, M.D., M.P.H., associate professor, Christa Moran, lead of the Michigan Medicine Interpreter Services, and Philip Zazove, M.D., the George A. Dean, M.D. Chair of Family Medicine, discuss how health care institutions can keep patients and health care workers safe while maintaining accessible and effective communication for our deaf and hard of hearing patients.
“Deaf and hard of hearing patients already struggled with communication in the pre–COVID-19 world. Now, with additional barriers added, we must not forget the basis of good patient care and patient satisfaction—effective clinician-patient communication,” write McKee and his team.
Here are some of the solutions they lay out:
Clear face masks allow DHH patients or family members to lip-read the health care worker. Clear face masks are not currently approved for COVID-19 inpatient services.
Remote or virtual sign language interpreters who are certified and trained to interpret in medical care settings.
Mobile apps that provide automated captioning. These in-person communication tools can be used by either the patient or the providers. Examples include Google Live Transcribe, Otter.ai, and Interact Streamer.
3-way virtual care visits and virtual visits with relay service. The authors note that “many approved virtual care platforms do not support 3-way video visits, a requirement for interpreters to facilitate communication between a clinician and a patient.” Relay services provide an operator who signs or types out conversations allowing DHH patients to communicate with people using a standard telephone.
Signage to indicate patients with hearing loss. Signage helps “reduce clinician and staff assumptions that the patient is able to hear and communicate effectively and encourage the arrangements of necessary services.”
“We believe [barriers] can be addressed to the satisfaction of all,” writes the authors. “The disruption of existing communication paradigms allows us to creatively use personal and remote technology to maximize communication accessibility.”
“With the quick expansion of virtual care or telemedicine during this COVID-19 pandemic, we must ensure that patient safety, comprehension, and access to quality health care are maintained for many DHH patients.”
Hearing loss is not a one-size-fits-all experience, and the authors emphasize the importance of asking patients what communications strategies work best for them. Earlier this week, U-M Family Medicine and Dr. McKee hosted a Facebook Live event in American Sign Language (ASL), answered COVID-19 health and safety questions questions from a global online audience. Viewers asked about the differences between types of masks, how testing works, transmission and the safety of schools and restaurants, and how to make sense of COVID-19 case numbers. The live broadcast has attracted 2,600 views in two days, with over 5,000 individuals viewing the one-hour ASL event.
McKee and Zazove lead the Deaf Health Clinic at the Dexter Health Center, a full spectrum primary care clinic developed by and for deaf and hard of hearing people.
Article citation: McKee M, Moran C, Zazove P. Overcoming Additional Barriers to Care for Deaf and Hard of Hearing Patients During COVID-19. JAMA Otolaryngol Head Neck Surg. Published online July 16, 2020. doi:10.1001/jamaoto.2020.1705