Caring for Patients Who Are Deaf or Hard of Hearing

The physical environment directly affects how well a deaf or hard of hearing patient can follow and participate in a clinical conversation. Before the interaction begins:

Place computers, laptops, and tablets to the side — not between you and the patient. This allows you to maintain direct eye contact throughout the encounter.

Avoid bright lights or windows behind you. Backlighting makes it significantly harder for patients to read lips and facial expressions.

Ensure the room is well-lit so your face is clearly visible at all times.

Reduce background noise. Turn off televisions, lower the volume on medical monitors, and minimize competing conversations. Loud or distracting ambient noise affects both lip-reading and residual hearing.

When speaking directly with a deaf or hard of hearing patient, follow these core principles:

1. Ask the patient their preferred communication method first. Everyone with hearing loss is different — some lipread, some use sign language, others prefer written or typed exchanges. Never assume.
2. Get their attention before speaking. A gentle wave or light touch on the arm is appropriate. Do not begin speaking until you have the patient's visual attention.
3. Speak clearly and slowly. You may speak slightly louder than normal, but do not shout — shouting distorts sound and lip movements, making comprehension harder, not easier.
4. Do not overenunciate or exaggerate your words. This distorts how words appear on the lips. Speak naturally and deliberately.
5. Rephrase, do not repeat. If the patient does not understand, choose different words rather than repeating the same phrasing at a higher volume.
6. Maintain direct eye contact with the patient — not with the interpreter, family member, or electronic health record. Even when using an interpreter, always address the patient directly.
7. Verify understanding actively. Ask leading questions or have the patient repeat key information back. Do not assume a nod or smile means the message was received.

Use visual cues, educational materials, and pictographs when explaining procedures, diagnoses, or medication instructions.

Use web-based images (such as Google Images) when discussing complex concepts that benefit from visual support.

Consider using a scribe to handle medical record entry during the consultation — this allows you to maintain direct eye contact with the patient throughout.

Use transparent masks. Standard surgical masks obscure lip movements and facial expressions. Where possible, use FDA-approved transparent masks to support lip-reading and visual communication

Proactive preparation significantly reduces communication barriers on the day of the visit:

1. Provide clear pre-visit information. Share everything the patient needs to prepare: old medical records to bring, current medications, insurance coverage details, and what accommodations will be in place.
2. Send arrival instructions. Include parking information, the location of ramps, doorways, elevators, and where to sign in. Reducing logistical uncertainty on arrival reduces stress for the patient.
3. Confirm communication preferences at scheduling. Ask about the patient's preferred communication method when the appointment is booked and document it in the electronic health record (EHR).
4. Arrange interpreter services in advance. In-person sign language interpreter services and/or video remote interpreting (VRI) should be scheduled before the appointment — not arranged on the day of the visit.
5. Inform the patient of accommodations being arranged to confirm they are appropriate and to set expectations.

Accessibility for deaf and hard of hearing (DHH) patients is a team effort. All staff — not just the primary provider — need to be informed and prepared:

Identify DHH patients clearly. Use hearing loss symbols on rooming charts, wristbands, EHR banners, or signage at the bedside to alert all staff that a patient has hearing loss.

Place hearing loss diagnostic codes on the problem list and document communication and language needs in the EHR.

Document hearing loss in disability fields where available in the electronic health record.

Set scheduling alerts so that accommodation needs are automatically flagged whenever the patient books a future appointment.

Notify all relevant staff before the appointment — reception, nursing, and any specialist involved in the encounter should be aware of the patient's hearing status and preferred communication method before they interact with the patient.

Use qualified, certified interpreters. Depending on the state, providers may be required to use licensed or certified ASL interpreters. The Registry of Interpreters for the Deaf (RID) maintains a directory of qualified professionals.

Do not rely on family members or companions to interpret medical information. This compromises patient privacy, the accuracy of medical communication, and informed consent. Use a family member only if the patient specifically and explicitly requests it.

Video Remote Interpreting (VRI) is an ADA-compliant alternative when an in-person interpreter is unavailable. VRI connects patient and provider with a remote sign language interpreter via a live video link — suitable for unscheduled visits or facilities with limited interpreter access.

Avoid looking at the interpreter during the conversation. Always maintain eye contact with the patient, not with the interpreter or accompanying family members.

Beyond interpreters, several tools support effective communication with deaf and hard of hearing patients in clinical settings:

• Two-way communication devices — such as UbiDuo2 or Interpretype, which enable typed back-and-forth exchanges between patient and provider. Particularly useful for hard of hearing patients who do not use sign language.
• Speech-to-text applications — real-time transcription apps that display spoken words as text on a tablet or smartphone. Useful for informal or spontaneous interactions.
• Sound amplifiers — portable personal amplifiers that increase the volume of the provider's voice directly to the patient. A practical tool for brief interactions where other options are unavailable.
• Written communication — for complex or critical information (diagnoses, medication instructions, consent forms), always provide written confirmation in plain language. Supplement with illustrations or models where appropriate.