Masks, Video Calls: Pandemic Is Hampering Communication for Those With Hearing Problems
Face masks help prevent the spread of COVID-19, but they have a huge downside for people with hearing problems: They muffle sound and prevent lip-reading.
But that's only one of several ways that pandemic-related safety precautions are making communication more challenging for those who are deaf or have hearing problems, researchers say.
Limits on visitors in medical settings bar interpreters who help foster dialogue between doctors and patients, and the rise of telemedicine has added yet another hurdle with its lags in video transmission and poor image quality.
"Sometimes, we just forget how some of these additional safety guidelines can create problems," said Dr. Michael McKee, an associate professor at the University of Michigan Medical School in Ann Arbor. "So we have to remind people to take a moment to think about solutions that will help not only keep us safe but also allow for communication access to still take place."
While safeguards are necessary to protect health care workers and patients, they also interfere with the right to accessible and effective communication for patients who are deaf or have hearing problems. That right is guaranteed in the Americans With Disabilities Act, the study authors noted.
Poor communication in health care settings can be risky, and adults with hearing loss are more likely to be less satisfied with their care, experience longer stays and be readmitted to a hospital after being discharged, according to a report published online July 16 in JAMA Otolaryngology -- Head & Neck Surgery.
In the report, McKee's team detailed some workarounds -- both high- and low-tech -- that can help remove some of the communication barriers.
The new guidelines emphasize six ways to help people with hearing problems communicate clearly in health care settings:
- Clear face masks: Use clear face masks to make lip-reading possible. Though only one is approved for medical use, the authors expect others to be on the market soon. Until then, a powered, air-purifying respirator could allow patients to see a speaker's lips.
- Interpreters: When in-person sign language interpreters are barred from hospitals and clinics, videoconference services can be used to involve remote interpreters.
- Captioning apps: Use automated captioning apps to transcribe voices. These can be used on a patient's personal device or on institutional devices.
- Virtual visits: Use video-captioning or include a remote interpreter via three-way conferences during virtual visits.
- Signage: Place signs outside and around the room of any patient who is deaf or has hearing problems to inform health care workers of communication barriers.
- Communication boards: Use basic communication boards to facilitate dialogue with a patient via written messages.
McKee noted that many of these strategies could improve doctor-patient communication overall, not just for those with hearing difficulties. He and his colleagues have already adopted many of them.
For instance, they mounted tablet computers in clinics and hospital settings to provide live captioning or facilitate video conferences with remote interpreters. They have also expanded telemedicine visits to include an interpreter, if necessary.
Tricia Ashby-Scabis, director of audiology practices at the American Speech-Language-Hearing Association, said "flexibility" is the key to ensuring that patients with hearing problems are treated properly in medical settings.
"People have to understand that communication is a universal right for everybody," she said. "You've got to think outside of the box."
Clear and open dialogue between doctors and patients is essential, and miscommunications can have serious consequences, Ashby-Scabis pointed out.
"In health care, we look at these issues like noncompliance and hospital readmissions, but we're fairly confident that a large portion of that is due to patients not being able to hear effectively or understand the directives that they've been given," she said.
For more about coronavirus and hearing loss, visit the U.S. National Institute on Deafness and Other Communication Disorders.
SOURCES: Michael McKee, MD, MPH, associate professor, department of family medicine, University of Michigan Medical School, Ann Arbor; Tricia Ashby-Scabis, AuD, director, audiology practices, American Speech-Language-Hearing Association, Rockville, Md.; JAMA Otolaryngology Head & Neck Surgery, July 16, 2020, online