Sign Language for Medical Procedures

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 msnvarious 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 promsn1cedures, 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 ofmsn2 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 msn3certainly 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 mdof 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 msn6physicians 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:

  1. 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. Thismsn7 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.
  2. 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:
    1. The cost of the interpreter.
    2. 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.

msnExample 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.

 

About Robert Traynor

Robert M. Traynor, Ed.D., MBA is the CEO and practicing audiologist at Audiology Associates, Inc., in Greeley, Colorado with particular emphasis in amplification and operative monitoring, offering all general audiological services to patients of all ages. Dr. Traynor holds degrees from the University of Northern Colorado (BA, 1972, MA 1973, Ed.D., 1975), the University of Phoenix (MBA, 2006) as well as Post Doctoral Study at Northwestern University (1984). He taught Audiology at the University of Northern Colorado (1973-1982), University of Arkansas for Medical Sciences (1976-77) and Colorado State University (1982-1993). Dr. Traynor is a retired Lt. Colonel from the US Army Reserve Medical Service Corps and currently serves as an Adjunct Professor of Audiology at the University of Florida, the University of Colorado, and the University of Northern Colorado. For 17 years he was Senior International Audiology Consultant to a major hearing instrument manufacturer traveling all over the world providing academic audiological and product orientation for distributors and staff. A clinician and practice manager for over 35 years, Dr. Traynor has lectured on most aspects of the field of Audiology in over 40 countries. Dr. Traynor is the current President of the Colorado Academy of Audiology and co-author of Strategic Practice Management a text used in most universities to train audiologists in practice management, now being updated to a 2nd edition.

4 Comments

  1. As a profoundly deaf person who grew up with hearing aids, I appreciate that the hearing aids help me hear sounds – even though the sounds are all garbled and voices are like 90% incomprehensible. Even though I have very bad hearing, the hearing aid helps me appreciate music and the voices that sing. Many of my deaf friends say the same thing. But when we meet an audiologist who uses ASL, WE REALLY APPRECIATE this person. I’d guess 95% of audiologist don’t bother to use ASL with us, and that’s rude and puts the deaf customer at a serious disadvantage in our ability to obtain quality audiological services and often leads to the wrong type of hearing aids selection and wrong aid sound adjustments… At a huge waste of financial cost to the deaf customer. Audiologists who do not want to use ASL with their ASL deaf/hh customers … With eyes only on the $$$ signs, have no business being in this field of work. Many of us consider it criminal conduct on their part to sell us misdiagnosed matching hearing aids that has extremely limited benefits to us. Communication is the key. Most non- signing audiologists are glad to fit profoundly deaf/hh hearing aid users with ill- matching & wrong – adjusted hearing aids, and glad to get u out the door. They do not even bother to tell you that you have the right to come back for adjustments, or even to try another hearing aid that is more correct for you. Now where is the oversight in this lucrative business when the deaf/hh customers are getting negligent and improper service? This is a terrible insult to the nation’s 38 million deaf & hard of hearing population.

    1. Douglas:

      Thanks for your comment on blog at Hearing International. You certainly have a right to be upset with the myriad of audiologists that do not use ASL in their practice. Also, as you have observed there ARE a number clinical people that are more interested in selling products than providing true rehabilitative treatment of the issues at hand. I do not understand how these people can do a good job without “getting to know ” their patient through communication. These professionals have a fiduciary responsibility to communicate with their deaf/HH patients in THEIR language that is how you get to know them so that you can do the very best job in working with them to hear at their capability. While many audiology training programs are now adding ASL sign language programs to their curriculums, this is happening at a very slow rate and these new clinicians will not be in the clinics for another few years. I apologize to you and others in the hearing impaired community that have had to tolerate this frustration and, thus, end up with the feeling that these professionals are only after your cash.
      At one time I was almost an interpreter, but moved on to other things and now I use ASL in my practice but am a bit rusty as IK do not have a lot of individuals that use ASL as their primary means of communication. Like any other language you lose it if you do not use it routinely. With that said, between my rusty signing and my patients oral capability, their tolerance of my rusty signing and their help we work to communicate usually get the job done, building a lasting relationship.
      I would first find someone that signs enough to get to know you before you do any business with them. Thanks again for taking your time to comment back to us at Hearing International.
      Bet Regards;

      Bob

  2. As an audiologist who also has worked as an interpreter in a variety of situations, I agree that it is necessary to have an interpreter for any medical care! My patients who sign are comfortable with me signing for myself because of my background, but I always offer to have one available for their appointment if they prefer. Depending on written notes is a very bad idea, as many ASL users do not have good written English skills. Explaining anything complex and confirming their understanding is not easy. I have seen many medical professionals positive that their written communication was adequate, then the patient confided in me they were not sure what was going on – could I please explain it? Our job is to make communication less of an effort – please provide interpreters when needed!

    1. Donna:
      Sorry for the late reply. Sounds like you are doing a great job with your patients. I have always advocated that if you are an audiologist working with the hearing impaired, you need to know THEIR language. How else do you get to know them well enough to a good job in meeting their hearing care needs. Keep up the good work. thanks for your comments back to us at Hearing International.

      Bob

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