March 11, 2020, my nightmare began.
“Ready to switch?” asks my American Sign Language interpreter during an all-day virtual conference. Switching from speaker view to gallery view, I search for a different speaker’s interpreter among numerous attendees, pin her video, and switch back to speaker view. This interpreter updates me on what I missed during the transition.
I do this every half hour throughout the conference, peering through my reading glasses while viewing a microscopic workspace—the split-screen display shows the speakers and interpreters on one side and slides on the other. It is as though I am watching a virtual tennis match, my eyes going back and forth to see both nearly simultaneously while the presenter talks without pause. Should I ignore the slides and focus on the interpreter? Should I review the slides and tell the interpreter to cease for a moment? Should I message the speaker, asking them to pause so I can review the slides? Should I just grin and bear it?
It is exhausting, yet I am unable to plug in headphones, walk around, or stretch; I can’t even close my eyes while listening. However, this is what I signed up for. The only way I can obtain information is by watching the interpreters.
I am a Deaf family physician working in urgent care. Fortunately, I speak well and am fluent in American Sign Language; these factors let me navigate between Deaf and hearing communities. I doggedly pursued my medical career, taking on premed coursework and medical school. I survived Ménière disease during residency, although the overnight loss of my residual hearing and the incessant tinnitus and vertigo almost floored me. Still, I persisted. I have consulted with many accreditation organizations and fought for disability accommodations for health care professionals throughout my career.
Before the pandemic, I interacted with patients without an interpreter. Over time, my finely honed armamentarium allowed me to prevail in the hearing world. I studied salient nonverbal behaviors, such as facial expressions and body language; developed a mental filing cabinet of appropriate responses given situational contexts; and harnessed my residual hearing and dexterity in speechreading to understand and communicate with patients. I requested interpreters for occasional meetings, social events, medical or patient–family conferences, and phone calls.
After COVID-19 hit, my world turned upside down.
Everyone started wearing masks that covered their faces from nose to chin. Meetings and events became virtual nightmares. Communication, once manageable and enjoyable, became exponentially more difficult. I could see only eyebrows and crinkles in the corners of eyes that might hint at happiness or anger. My years of experience and communication techniques no longer sufficed. I felt lost, even despondent. People offered to lower their masks to help me understand; although they meant well, this simple act would put us all at risk. If a patient or colleague knew American Sign Language, information exchange was easier but imperfect. American Sign Language requires facial expressions for full comprehension, and masks block most of these. Although we had a common language, my ability to communicate at work was diminished.
No one anticipated how the pandemic would impact their Deaf colleagues’ work environment and career opportunities. Yet, 15% of adults report some form of hearing difficulty. This number increases dramatically with advancing age, with 50% of those aged 75 years or older experiencing hearing difficulty. The exact number of Deaf/Hard of Hearing (DHH) physicians and other health care providers is unknown. However, according to the Association of Medical Professionals With Hearing Losses, the numbers have increased over the past few decades. This increase is in part due to legislation (such as the Americans With Disabilities Act of 1990) and evolving technologies (such as electronic and visual stethoscopes and speech-to-text applications). Although these changes have enabled more DHH professionals to work in health care, none was sufficient to address the COVID-19 pandemic’s effect on DHH physicians.
I grieved this change in my life. I could not rely on my usual communication methods to understand people. To succeed in this new reality, I had to advocate for full-time interpreters at work to treat my patients, urgently help a colleague with their shift, or attend a last-minute meeting. I needed to select skilled, compatible interpreters while consciously redesigning my work environment to consider their needs, methods, and availability.
Interpreters showed me what I was missing after COVID-19—and even before, such as a nurse asking for lunch orders, someone announcing a department event, or a colleague discussing an interesting case. My interpreters are part of the care team; they accompany me when I see patients. They wear masks with clear panels so I can see most of their face while they interpret.
Telehealth, now an integral part of the daily workload, creates possibilities but still hinders success. I thought telehealth would be easy. I could see the patient’s entire face—they usually do not wear a mask at home. Yet, even this is not straightforward. One patient had to show me a rash, so she moved the camera to her arm and continued to talk before returning the phone to her face. For this reason, a simple telehealth call requires an interpreter.
Even with interpreters and clear masks, state requirements and institutional policies in response to COVID-19 (such as room occupancy limits and space requirements) impeded my career development by eliminating my opportunity to work with, mentor, and teach students. These policies were drafted without considering the needs of, and effects on, diverse professionals, ultimately affecting the entire workforce.
Although masks and technology are challenging, they often lead to innovation and Deaf Gain. Deaf Gain is the concept that the majority hearing community gains from the cultural diversity and human capital of the Deaf community. For example, captioning started in the Deaf community, and the DHH community influenced the spread of text messaging—both now widely used by the hearing community all around the world. The pandemic spurred development of clear masks for DHH health care professionals; these are now loved by hearing patients and colleagues because they enhance communication and improve the doctor-patient relationship. Deaf speakers on virtual platforms pause and give people time to review slides before speaking; if hearing speakers do the same, it will benefit DHH and hearing participants.
Practicing medicine as a Deaf physician is an uphill battle in the best of circumstances; COVID-19’s effect on policies, networking, scholarship, and in-person and virtual interactions has added new dilemmas. My experiences remind us that information exchange, whether in person or virtual, requires thoughtful consideration of the many aspects of communication: facial expressions, body language, volume, tone, and cadence.
Modifications—both digital and physical—used by DHH health care professionals should be embraced by the hearing community. When we understand and learn from DHH clinicians, we do not only support DHH coworkers; these accommodations can benefit all. Deaf and Hard of Hearing professionals have much to offer the medical community. Learning from our experiences reinforces why a diverse and inclusive environment leads to innovation, workplace satisfaction, and better patient care.
We all prudently anticipate further COVID-19 mutations and variants. This pandemic is far from over. Deaf Gain has made us more ready for this eventuality. However, what other changes are coming in the near future that will disenfranchise others within our profession? What of climate change, with its torrid fires in the West and the horror of flooding in the Northeast? Is medicine prepared for the predicted population shifts? What of global terrorism? Can medicine accommodate a huge influx of immigrants with their own special cultures and languages that we do not share? How will medicine assist governments in dealing with antiscience sentiment in misinformed, politically divided countries?
An equally important question is, how can Medicine partner with DHH professionals and the DHH community, who have already fought major battles, to confront these revolutionary changes in our profession?
Carolyn Stern is a family physician. This article originally appeared in the Annals of Internal Medicine.
Image credit: Shutterstock.com
