Before the visit:

Preparing Your Clinic

ASL Interpreter

Under the Americans with Disabilities Act (ADA), hospitals must provide effective means of communication for patients, family members, and hospital visitors who are deaf or hard of hearing. If this is a new patient, schedule the interpreter at the same time as the initial visit is scheduled. For a list of interpreting agencies and video remote interpreting services, click here.

24 hours before the visit: Confirm with the interpreting agency that an ASL interpreter is scheduled to arrive for the patient's appointment.

Pen and pad

Your office should have pens and pads ready before the visit at both the front desk and in the exam room. While patient visits can be facilitated by medical interpreters, Deaf patients suggest keeping a pen and pad ready at the front desk and in the exam room. This can be useful for quick communication at the front desk, drawing things out in the exam room, or writing down specific terminology they can look up afterwards. This also may serve as a last resort if the interpreter fails to show up.

Visual aids

During visits, it is helpful to use visual aids to describe differential diagnoses. For example, in a spine clinic, health care providers may show laminated images or physical models of the spine to demonstrate a disc herniation and what a discectomy would look like. It is also useful to pull up any radiographic films or lab trends from their patient chart.

Educational handouts

One of the biggest frustrations Deaf patients have is that they often leave visits with incomplete information or that their questions are not all answered. To supplement provider-patient discussions, print out handouts that describe conditions and medications, therapies, and procedures.

Exam room

Reserve one of your clinic's bigger exam rooms and make sure it is well-lit. Deaf patients suggest that having a larger room with ample lighting makes it easier to communicate with their interpreter while reading their healthcare provider's body language. Additionally, bigger exam rooms give space for remote interpreters to see both the provider and patients and their respective body language.

Patient stickies

Check the patient sticky to see if there are any patient preferences to help prepare clinic. This may include tidbits like whether the patient prefers typing on an iPhone at check in vs. writing on a pad, whether s/he prefers an in-person or virtual interpreter, how many companions typically arrive, or that you have reserved a larger room.

VRI Equipment

This is applicable to visits where there is a remote interpreter involved.

Set up your clinic's or hospital's VRI equipment and place it in the exam room you plan to use. Try to avoid having someone on your staff hold the tablet because it makes it challenging for the interpreter to see the patient's body and relevant areas while the patient signs. Click here for a demonstration of assembly of VRI equipment.

WiFi

Test your clinic's Internet connection to ensure there are no delays or freezing with the video remote interpreting services. Click here for an Internet speed test.

Check-in flow

1

Message the patient to remind them of their visit. Request any necessary items for the visit (e.g., records from OSH, assistive devices).

2

When the patient checks in, their interpreter may not be there, so be prepared to communicate via a pen and pad.

If your clinic has a TV, it could be helpful to tell the patient a two-digit number and display that number on the TV when the patient is ready to be roomed.

3

Once the patient is ready to be roomed, tap the patient on the shoulder or wave in their line of sight to get their attention.

4

If you need the patient to change into a gown prior to taking vitals and measurements, explain why. Request the interpreter to step out with you.

5

Prior to re-entering the room, flick on and off the lights to signal that you are coming inside the exam room.

6

Let them know that the doctor/APP will be with them shortly

During the visit:

DOs

Flick on and off the light prior to entering the room. This is the equivalent of knocking on the door and is considered polite.
Make eye contact directly with the patient, even if the patient is making eye contact with the interpreter
Be deliberate about taking turns while speaking with the patient. It is very challenging for the interpreter to simultaneously translate for both of you.
Be mindful of your body language and facial expressions
Refer to visual aids, radiographic images, lab values, and models
Point to relevant parts of the body while you are speaking and ask them to point to parts of their body that may be causing them discomfort
If your exam requires the lights to be dimmed or turned off, explain as much as you can of what you will be doing before the lights are dim
Include the patient in the decision-making process
Double check with the patient at the end of the visit to make sure they agree and understand your assessment and plan

DON'Ts

Refer to the patient in the third person when you are speaking to the patient and interpreter
Use culturally insensitive vocabulary (e.g., "hearing impaired," "mute," "deaf and dumb")
Rely on family members or companions to translate or convey information from the visit. Family members may be unable to interpret accurately in medical contexts and are often focused on comprehending the diagnoses and recommendations.
Ask the interpreter to censor any part of the conversation. Whatever you say will be translated.
Over-exaggerate the way you speak because it actually makes it more difficult for patients who can lip-read
Expect the interpreter to edit out anything spoken as an aside or to others in the room

Suggestions for positioning

It is critical for the patient to be able to see both you and the interpreter in their line of sight. Therefore, it is probably best to allow the interpreter to stand next to you. The set-ups shown below have worked at an orthopedic surgery outpatient clinic. When the attendings wanted to demonstrate a spine pathology, I would pull up the X-rays or MRI while they continued to speak with the patient. If physical models or visual aids are more relevant to your clinic, these may be beneficial, too.

Furthermore, if there is a staff member on your team who can assist with any computer activity (e.g., retrieving old notes or results), enlist their help. The goal is for your entire body to be seen because that is how Deaf and Hard of Hearing patients can detect your tone and feel your undivided attention.

After the visit:

Reference material

In the electronic medical record, if there is a patient instructions section, insert reference material from UpToDate (or a similar resource) so that the patient can read up on any conditions or treatments discussed. Dot phrases linked to descriptions of diagnoses and treatments offered by the clinic may be helpful.

Update patient chart

Document patient preferences from the most recent visit using your electronic medical record's sticky note feature. Notes could remind clinic staff at the follow up visit how patients would like to be contacted for reminders of visits, which method of communication patients prefer in the office, and whether patients prefer an in-person or virtual interpreter or same-gender interpreter.

Follow-up visit

Schedule follow-up visit and ASL interpreter. For a list of interpreting agencies and video remote interpreting services, click here.

Patient portal

Often, a Deaf patient's visit will be longer than a hearing patient's because an interpreter has to translate for both the healthcare provider and for the patient. While it may be difficult to extend the length of the visit so that all questions get answered without sacrificing the efficiency of clinic, Deaf patients have stated that they have a positive experience with getting their questions answered through the patient portal or e-mail.

Healthcare Providers