Before I started medical school I worked at a clinic that served the deaf and hard-of-hearing community. I was the “front office”, greeting patients, answering the phone by TDD/TTY or by relay service (this was before the existence of text messaging, instant messaging, or anything else that relied on cell phones or on the internet—none was in common use). I learned some rudimentary ASL (simple, polite phrases), and was introduced to the deaf community. It was simply fascinating. I learned about the controversies surrounding deaf culture (such as cochlear implants, assimilation, and literacy). We had an interpreter on staff, and many of the clinicians were fluent in ASL, so interpretation service wasn’t usually a problem.
But what about out in the community at large? Sharing the same space as our office was a program dedicated to HIV in the deaf community. The deaf are at increased risk of HIV disease for a variety of reasons, many of which center on communication. Many deaf Americans are fluent in ASL, but not in English. Educational materials aren’t widely available. Communication with the health care community can be a nightmare—for example, “positive” in ASL refers to something good, so if you tell an ASL’er that they are “HIV-positive”, this can be a disaster without a very skilled interpreter. When I was at the center they developed a variety of materials, including a (very explicit) picture book on how one can or cannot acquire HIV.
The deaf often have critical communication needs when seeking health care. Proper communication can be the difference between life and death. So what is a deaf person to do when visiting a doctor? How can they meet their communication needs?
The Americans with Disabilities Act places a great deal of responsibility on doctors to provide proper interpretation services. Court cases have regularly favored plaintiffs when doctors are sued for inadequate access, and doctors are expected to pay for interpretation services for their deaf patients, regardless of cost (or at least effectively regardless of cost). Most doctors have very small businesses and cannot afford to do this. If they provide interpreters, they risk the financial viability of their practice; if they do not, they risk being put out of business forever.
How do we approach this as a society?
Item 1: Deaf people have special needs with regards to interactions with the health care system.
Item 2: The government mandates that proper interpreters be provided for doctor visits.
Item 3: Neither patients nor doctors can afford to provide this service.
Now don’t go telling me that “all you rich doctors can afford to get the interpreter”—we most emphatically cannot. That is a simple fact, and if you don’t believe me, then you don’t. Epur, si moeve.
There is not a great deal of support for an expensive government mandate that would pay for interpreters for the deaf. How do we provide this critical service?