Deaf and hard of hearing (DHoH) people must overcome significant professional barriers, particularly in health care professions. A number of accommodations are available for physicians and other health providers, such as electronic stethoscopes and closed-captioning technologies, but are these approaches making a difference?
A team of researchers from the University of California, Davis, the University of Texas Health Science Center at San Antonio and the University of Michigan surveyed DHoH physicians and medical students to determine whether these and other accommodations enhance career satisfaction and their ability to provide care. This research has important implications for DHoH medical students, educators, employers and patients.
The article, titled “Deafness Among Physicians and Trainees: A National Survey,” appears in the February 2013 issue of Academic Medicine.
“We found that many deaf and hard-of-hearing students and physicians are interested in primary care practice and have a special affinity with those who also have a hearing loss," said Darin Latimore, assistant dean for student and resident diversity at UC Davis School of Medicine and one of the study’s coauthors. “By enhancing training for a diverse range of physicians, we can improve quality of care and access for underserved populations, especially individuals who are deaf or have a hearing loss.”
The study showed that while DHoH physicians were aided by accommodations they spent significant amounts of personal time arranging for these tools. Institutional support was a critical lynchpin in determining job satisfaction among DHoH physicians and students. Prior to this study, little was known about DHoH physicians in the clinical workplace.
The team created an 89-question electronic survey that covered demographics, accommodations, job satisfaction and personal health. Recruitment was a big challenge, as there is no database for DHoH clinicians. To overcome it, the researchers adopted snowball sampling, in which participants recruit peers to take the survey. Ultimately, 86 medical students, residents and practicing physicians were recruited and 56 completed the survey.
Of the participants, 73 percent described their hearing loss as severe or profound; with all but one having bilateral loss, meaning both ears have a loss of hearing. The majority of the practicing physicians (68 percent) were in primary care, while 23 percent of trainees planned to enter primary care. On average, practicing physicians reported caring for DHoH patients 10 percent of the time. The majority of trainees were uncertain how many DHoH patients they would see.
“Our results confirm that DHoH medical students and physicians use a wide range of accommodations, implying that adapting accommodations to each individual's needs will be more successful than any single approach,” said Christopher Moreland, assistant clinical professor at the University of Texas Health Science Center at San Antonio and the study’s lead author.
The most common accommodation was amplified stethoscopes (89 percent). Participants also used auditory equipment (32 percent), computer-assisted real-time captioning (21 percent), signed interpretation (21 percent) and oral interpretation (14 percent). The survey also examined phone use, which can be problematic for hearing-impaired physicians, and found the majority (56 percent) used amplified phones.
At the UC Davis School of Medicine, for example, a third-year student on a surgical rotation used tablet technology to link the sounds in the operating room to an off-site medical transcriptionist. The student was able to "listen" — in real time — to every word uttered by the surgeon performing the operation. The transcriptionist, working like a court reporter, received audio from the operating room and simultaneously typed the surgeon's words, which the student then watched on an overhead monitor while also observing — and even assisting when asked — the surgeon.
The survey also found that DHoH physicians and trainees invested a great deal of personal time arranging accommodations: submitting requests or coordinating with captionists or interpreters. While most spent around two hours per week making these arrangements, two medical students estimated they spent 10 hours each week arranging accommodations. Overall, participants appeared satisfied with their accommodations.
“Successful accommodations may contribute to career satisfaction,” added Moreland, who completed his medical residency at UC Davis and medical school at the University of Texas with the assistance of a sign-language interpreter. “This, combined with these physicians' relatively high interest in serving the DHoH community, suggests that recruiting and effectively training DHoH medical students may benefit the health of deaf and hard of hearing people.”
In addition to being the second largest disabled group of Americans, the hearing-impaired face disparities in cancer screening and other care and have a higher incidence of depression, making their medical needs a high priority.
“This study highlights a little understood but clearly growing group of physicians who are demonstrating that hearing loss doesn't keep them from being a physician.” said study co-author Philip Zazove, professor and the George A. Dean, M.D. Chair of Family Medicine at the University of Michigan. “These doctors connect with DHoH patients in a way that hearing physicians can't.”
This study was partially funded by the Health Resources and Services Administration.