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Effective communication and hearing loss

Lorraine Gailey
BSSc PhD DipCCS Reg MRCSLT
Chief Executive
LINK Centre for Deafened People East Sussex

Deaf, born-deaf, profoundly deaf, profoundly deafened, prelingually deaf, hard of hearing, hearing-impaired, late-deafened … the terms describing deafness are numerous. When faced with a deaf patient in practice, what you need to know is not the term describing their hearing loss, but how best to communicate with them. Do they read lips, use sign language, write things down or use a combination of methods?
Until recently, Jenny Knight always took her husband Paul with her to GP and hospital visits. "I always pretended that I was following what the doctor said to me, and would nod politely and bluff my way through. As soon as we were out of the door, I would ask Paul to fill me in. I always came away feeling stupid and embarrassed."
Jenny's hearing loss was so severe that even the most powerful hearing aids were of very little help. "I needed people to speak clearly so I could lipread, and to write things down when I got really stuck," says Jenny. "Visits to the doctor can be stressful at the best of times, but I always felt anxious about communication and the pressure of time, so at the end of the day it seemed easier to rely on my husband whose way of speaking was familiar to me. Even though my doctor was well-intentioned, what she needed was some guidance in basic communication tactics."
Jenny's experiences are not uncommon among the significant population of late-deafened people in the UK - those who started out with normal hearing but have become severely or totally deaf in adult life. With little or no sound as backup, most late-deafened people depend on lipreading, expression and writing. It is therefore essential that both parties have an understanding of how to communicate with one another. Without this, communication becomes muddled, frustrating and unproductive for everyone. This awareness has particular significance in any confidential situation such as discussions with healthcare professionals.
The LINK Centre for Deafened People specialises in training nurses, social workers and other professionals in deaf awareness, with the focus on making health- and social care professionals aware of the communication issues facing late-deafened people. There are a staggering eight million patients in the UK with a hearing loss, yet it can be easily overlooked or misunderstood, causing patients to suffer unnecessary distress when obtaining medical attention. Patients worry about whether they will follow what is being said, whether the clinician will become irritable and impatient if they do not, and even whether they will know if they have been called by the receptionist.
Since the incidence of severe or profound acquired deafness is relatively high, it is essential that all health professionals know about it, not as experts in audiology, but as effective communicators so that they are in a better position to help their patients manage their primary presenting complaint. At the same time, health professionals are in an excellent position to direct late-deafened patients to appropriate hearing services, be that audiology, hearing therapy, employment services, or to social services for special equipment. There is a particular stigma attached to deafness that causes people to deny there is a problem. Late-deafened people, who are disabled by their condition, become isolated, are notoriously uninformed about the available help, and face health inequalities as a result.
Until this stigma is overcome and until medical, health and social welfare workers and professionals become more aware of the communication needs of late-deafened and other hearing-impaired people, patients like Jenny will continue to find visits and consultations at best an ordeal, and at worst something to be avoided.
There are three main populations of deaf people:
Hard of hearing: it is likely that most deaf patients you will come across belong to the largest group of deaf people - those who describe themselves as "hard of hearing" and who are likely to be elderly. These people usually have had a gradual loss of hearing and are likely to have retained some hearing, which can be helped by hearing aids. Communication with them is usually a mix of speech and lipreading.
Late-deafened: similarly, most "late-deafened" people (like Jenny) have acquired their hearing loss in adult life. Their ages range from early adulthood through middle age and into the later years. Their hearing loss is severe, profound or total rather than mild or moderate, and hearing aids often offer little or no benefit. Some late-deafened patients may be cochlear implant users. For this population, lipreading and the written word are extremely important due to their heavy reliance on seeing what is being said. Use of expression, gesture, body language and finger spelling can all assist communication with deafened people enormously. Research suggests that there are 300,000 late-deafened adults in the UK.
Deaf: people who describe themselves as "deaf" have probably been deaf since birth or early childhood and probably use sign language as their preferred language. They are usually proud to consider themselves as part of a deaf sociolinguistic minority with its own culture, history and traditions. Estimates of the size of the deaf community in the UK vary from 20,000 to 60,000.

Ten tips for good communication
People with a hearing loss need special understanding, which in some situations requires extra patience and spending a little more time in consultation. Ten tips for good communication are:

  • Find out the patient's preferred method of ­communication.
  • Ensure good lighting and minimise echo in the consultation room.
  • Make sure the patient can see your face. Position the patient with their back to the window so your face is in the light.
  • Make sure you have the person's attention before speaking.
  • Look directly at them and maintain eye contact without turning away while speaking.
  • Speak clearly and a little more slowly.
  • Speak up but do not shout.
  • Rephrase rather than repeat what you say, or write things down if the patient does not follow. This will help especially with names, addresses, number, and so on.
  • Supply written as well as verbal instructions for medication and other information.
  • If a hearing person accompanies the deaf person, do not focus only on the hearing person.

For more information contact the LINK Centre (see Resources) - established in 1972, LINK is the only UK resource offering specialist rehabilitation for late-deafened people. Its primary aim is to provide ­psychological support and ­rehabilitation to late-deafened adults from the moment they become ­deafened and all through their lives.

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Resources
The LINK Centre for Deafened People
19 Hartfield Road
Eastbourne
East Sussex
BN21 2AR
T:01323 638230
Text:01323 739998
F:01323 642968
E:linkcntr@ dircon.co.uk
W:www.linkcentre.org