William C. Cameron
November 9, 2006
The Unique Challenges Encountered by the Deaf in Accessing
Imagine for a moment that you are being poked and prodded at, and
not being told why. Would you accept, or tolerate that kind of
treatment? Would it matter to you if that person poking or
prodding at you was a healthcare provider? Likely, your answer
would be no. But that is what many Deaf report experiencing
while receiving healthcare services (Iezonni, L., ODay, B.,
Killeen, M., & Harker, H., 2004; Steinberg, A.G., Wiggins, E.A.,
Barmada, C. H., & Sullivan, V.J., 2002). Would you feel like
you your healthcare provider was treating you with respect, if they
talked to you about your healthcare needs like you were a child
(Mottram, V., 1999)? Would you feel like you were having a
meaningful share in making healthcare decisions? Likely, you would
not feel that you were being treated with dignity, and respect
(Iezonni, L., et al, 2004; Steinberg, A. G. et al, 2002).
Why would people who devote their lives to help others act in such a
way? Likely, it is because they dont know how to communicate
with the Deaf (Iezonni, L., et al, 2004). Many Deaf prefer to
communicate in American Sign Language (ASL) (Iezonni, L., et al,
2004; Margellos-Anast H., Hedding, T., Perlman, T., Miller, L.,
Rodgers, R., Kiviland, L., DeGutis, D., Giloth, B., & Whitman, S.,
2005). Like other languages, ASL has its own vocabulary,
grammar, and culture (Lotke, M., 1995). Yet, ASL remains a
little known, and misunderstood language to many in the healthcare
community (Iezonni, L., et al, 2004). This ignorance, presents
unique challenges to Deaf, and hard of hearing persons who use ASL
as their primary language (Margellos-Anast H., et al, 2005).
These unique challenges can inhibit the provision of optimal patient
centered care (Iezonni, L., et al, 2004).What are the unique
challenges that the Deaf encounter in accessing healthcare services?
Deaf people often report problems communicating with their
healthcare providers (Iezonni, L., et al, 2004). Making an
appointment for healthcare services can be a challenge for people
who are deaf (Iezonni, L., et al, 2004). Healthcare
appointments are often scheduled via the telephone (Iezonni, L., et
al, 2004). Even with using specialized communication services
or equipment, many who are deaf report having difficulty
communicating with healthcare providers (Iezonni, L., et al, 2004;
Mottram, V., 1999). Healthcare providers may possibly own
specialized communication devices, but might not have anyone in the
practice trained in their use (Iezonni, L., et al, 2004; Lotke, M.,
1995). However, making an appointment is often only the
beginning of further challenges which lay ahead.
Deaf people report of continued challenges once they reach the
healthcare facility (Iezonni, L., et al, 2004; Steinberg, A. G.
et al, 2002). For example, most waiting rooms are set up to
accommodate those who hear. So when people who are deaf are
called by their name, or an assigned number, they do not answer.
This has resulted in their being overlooked, and thus they miss out
on their scheduled services (Iezonni, L., et al, 2004).
Most healthcare facilities do not have a trained ASL interpreter on
staff (Lotke, M., 1995). So, in accordance with the American
with Disabilities Act (ADA), healthcare providers are responsible to
arrange for qualified ASL interpreters to be present if the
patient requests one (Lotke, M., 1995; U. S. Department of Justice,
2003). Yet, even having an interpreter available doesnt fully
eliminate the challenges that people who are deaf are presented with
(Iezonni, L., et al, 2004). One deaf woman was viewed by her
sons doctor as being unconcerned when she continued to focus on the
interpreter, instead of looking at the doctor (Lotke, M., 1995)!
In addition, some people who are deaf report being expected to lip
read, or communicate via written English (Iezonni, L., et al, 2004;
Mottram, V., 1999; Steinberg, A. G. et al, 2002).
Many people who are deaf report feeling as if doctors failed to
fully inform them of, and involve them in their own healthcare
decisions (Iezonni, L., et al, 2004; Steinberg, A. G. et al,
As the foregoing shows, the Deaf encounter many unique challenges
when they try to access, and utilize healthcare services.
These challenges dont have to exist. From a legal standpoint,
these challenges should not exist. It is clear that most
times, these challenges arise from ignorance on the part of
healthcare providers. From the available medical literature,
it appears that healthcare providers are slowing awakening to the
role they play in creating these challenges for their patients who
are deaf. Hopefully, their desire to provide optimal patient
care will motivate them to provide the services their patients who
are deaf are legally entitled to.
Iezonni, L., ODay, B., Killeen, M., & Harker, H. (2004).
Communicating about Healthcare: Observations from Persons Who are
Deaf or Hard of Hearing. Annals of Internal Medicine. 140
Lotke, M. (1995). She Wont Look at Me. Annals of
Internal Medicine. 123 54-7.
Margellos-Anast H., Hedding, T., Perlman, T., Miller, L., Rodgers,
R., Kiviland, L., DeGutis, D., Giloth, B., & Whitman, S. (2005).
Developing A Standardized Comprehensive Health Survey for Use with
Deaf Adults. American Annals of the Deaf 150 388-96.
Mottram, V. (1999). A Community Forgotten: Deaf People in Health
Care. studentBMJ. 14 380-1.
Steinberg, A.G., Wiggins, E.A., Barmada, C. H., & Sullivan, V.J.
(2002). Deaf Women: Experiences and Perceptions of
Healthcare System Access. Journal of Womens Health. 11
U.S. Department of Justice. (2003). ADA Business Brief:
Communicating with People Who Are Deaf or Hard of Hearing in
Hospital Settings. [Brochure] Washington DC: