In the audiology clinic we are familiar with patients that are among the non-speaking deaf and use sign language. While many of us use sign language with our hearing impaired patients, others use an interpreter so that they understand the 
various products and how to use them and/or the audiological procedures that are conducted on them or their family members. This could be new hearing aids, cochlear implants, hearing or balance evaluations, and many other procedures that are conducted in audiology and otolaryngology clinics worldwide.
What of other medical procedures required by people who are deaf ? These could be births, deaths, surgical pro
cedures, neonatal check ups, physical therapy, wellness clinics, routine physical examinations and other medical procedures that we all require from time to time. Even if they have some hearing and speech, the deaf using sign language will find it much more difficult to understand the world of routine medicine. What if surgery is required? What’s a gall bladder? Why do I need these pills? How often do I take them? Why do I need this injection? Even a question as simple question as “Why do I need to take off my clothes?” can be a miscommunication. Imagine how difficult it would be to understand what is going on, especially for those scary surgical procedures or for heart disease or cancer.
Medical Sign Language History
The history of sign language was presented by Hearing International some months ago in a series titled “The French Connection Part I, II, III”. Probably some of
the first medical sign language was conducted during the development of that French system of communication.
Sign language as the world knows it began in the 1750s in the streets of Paris, France with the poor deaf population. After some time spent working with deaf street people, Abbe Charles Michel de l’Epee founded the Paris Deaf Institute in 1760, teaching the signs that were used by these street people as a language that later became American Sign Language (ASL).
It is thought that medical sign language clarifying various procedures followed in short order, most likely provided by the faculty of the Paris Deaf Institute. On July 29, 1791, the French legislature approved government funding for the Institute and it was renamed: “Institution Nationale des Sourds-Muets à Paris.”
While there were 
certainly other physicians that may have used sign language with their deaf patients in those early days, arguably among the earliest physicians to learn sign language was Dr. Jean Marc Gaspar Itard. In 1800, Itard was appointed as the physician to the Institution Natationale des Sourds-Muets and was responsible for the health of the students and faculty. As part of the process he learned sign language to communicate while studying the functions and malfunctions of hearing. Itard devoted a great deal of his time and private fortune to the education 
of deaf and the medical study of deafness.
Upon Itard’s death in 1838, none other than Dr. Prosper Meniere was his successor and became another famous physician that learned sign language. Meniere described the disorder that bears his name while studying deafness and attending to the health needs of the students and faculty at the institute. That was the beginning of the medical use of sign language. Today the use is quite different in most countries.
What’s It Like Today?
Sign language differs depending upon the country involved. American Sign Language (ASL) has developed from that taught at the “Institution Nationale des Sourds-Muets à Paris.” Due to the influence of Thomas Hopkins Gallaudet and Laurent Clerc who worked at the Paris School before coming to the United States. Other countries have their own history relative to their sign languages but it appears that, according to Harrison (2004), ASL is the language of over 2 million people, second only to Spanish and Chinese sign languages. While there are variations in sign language most are based upon the culture with different signs for many things.
When is a Medical Interpreter for the Deaf Necessary
and Who Pays for the Service?
While not mandated in many countries, sign language communication with the deaf by 
physicians and other professionals is mandated by the Americans with Disabilities Act (ADA) (1990). In the US, the ADA prohibits health care professionals from discriminating against individuals on the basis of disability. Generally, a health care professional discriminates on the basis of disability (and violates the law) if:
1. A sign language interpreter is necessary to ensure effective communication between a patient and health care professional,
2. The patient has requested an interpreter.
3. The health care professional refuses to provide a qualified interpreter and does not offer to provide other auxiliary aids and/or service that would result in effective communication.
However, there are two exceptions to this general rule:
- A health care professional does not have to provide an interpreter if doing so would result in a “fundamental alteration” of the professional’s services. This
exception will almost never apply to a clinical situation, as a sign language interpreter would not result in a fundamental alteration of a health care professional’s services. - A health care professional does not have to provide an interpreter if doing so would result in an “undue burden, i.e., significant difficulty or expense.” In determining if the provision of an interpreter would result in an “undue burden,” the professional must consider the following:
- The cost of the interpreter.
- The professional’s overall financial resources.
Additionally, the professional may not refuse to provide and pay for an interpreter because the cost of the interpreter exceeds the professional’s fee for the office visit.
Example of a visit where an interpreter is probably not required:
A deaf individual goes to their physician for a bi-weekly check-up, during which a nurse records the patient’s blood pressure and weight. Exchanging notes and using gestures are likely to provide an effective means of communication at this type of check-up.
A situation where an interpreter is very necessary is offered by this example:
Upon experiencing symptoms of a mild stroke, the same patient returns to their physician for a thorough examination and battery of tests and requests that an interpreter be provided. The physician should arrange and pay for the services of a qualified interpreter, as an interpreter is likely to be necessary for effective communication, given the length and complexity of the communication involved.
In the US and some other countries, the use of interpreters for effective communication of medical information is mandated by law; in other countries, it just plainly the right thing to do!
References
Arizona Center for Disabilities (2011). The Duty of Health Care Professionals to Provide Sign Language Interpreters. Americans with Disabilities Act (1991). Retrieved May 9, 2016.
Harrington, T. (2004). American Sign Language: Ranking by number of users. Retrieved May 9, 2016.
Traynor, R. (2015). International Giants of Otology: Prosper Meniere. Hearing Health and Technology Matters, LLC. Retrieved May 9, 2016.
Traynor, R. (2011). The French Connection, Part I. Hearing Health and Technology Matters, LLC. Retrieved May 9, 2016.
Traynor, R. (2011). The French Connection, Part II. Hearing Health and Technology Matters, LLC. Retrieved May 9, 2016.
Traynor, R. (2011). The French Connection, The Exciting Conclusion. Hearing Health and Technology Matters, LLC. Retrieved May 9, 2016.
Images:
Arkansas Registry of interpreters for the Deaf (2016). Retrieved May 9, 2016.
ASL Services (2016). On Site Medical Interpreting. Retrieved May 9, 2016.
Sherman, P. (2016). WP Clip Art: ASL Medical Procedures. Retrieved May 9, 2016.
