A 48-year-old deaf man comes to the office for a new patient visit. The patient recently moved to the area and is accompanied by a friend with whom he communicates using American Sign Language. The office staff informs the physician that the patient has also been communicating by reading lips, using gestures, and nodding his head in agreement. At the start of the appointment, the friend says that the patient has asthma and uses an inhaler as needed. The patient gives the physician a handwritten note indicating that he would like to try a longer-acting inhaler. Which of the following is the most appropriate next step in evaluation of this patient?

Question

A 48-year-old deaf man comes to the office for a new patient visit.  The patient recently moved to the area and is accompanied by a friend with whom he communicates using American Sign Language.  The office staff informs the physician that the patient has also been communicating by reading lips, using gestures, and nodding his head in agreement.  At the start of the appointment, the friend says that the patient has asthma and uses an inhaler as needed.  The patient gives the physician a handwritten note indicating that he would like to try a longer-acting inhaler.  Which of the following is the most appropriate next step in evaluation of this patient?

Quizplus · Accepted Answer

11ec160b_367f_d030_9249_ddb487767d49_MD0001_00 This deaf patient is communicating with health care providers using standardized American Sign Language (ASL) via a surrogate, nonstandard gestures, lip reading, and handwritten notes. However, in general, the most accurate and effective method of communication is to use a medical interpreter (or provider) trained in ASL. As with spoken languages, communicating medical information in ASL requires precise wording and use of terminology that is not typically used by lay persons in daily communication. Using a trained medical ASL interpreter can help to avoid potentially dangerous miscommunication. As with any nonprovider personnel, the use of an ASL interpreter is subject to patient preference and consent and should be offered to all deaf and hard of hearing patients. If a face-to-face interpreter is unavailable, alternate modes of communication include computer-assisted real-time transcription and assistive listening devices. (Choice A) Friends and family members are not preferred for interpretation due to lack of impartiality, unfamiliarity with medical terminology, and possible barriers to open discussion of sensitive topics (eg, domestic abuse). Even though this patient has used his friend to assist in communication, this method should not be used unless the patient specifically requests it. (Choice B) Handwriting can be time-consuming, leading to use of abbreviations and shortcuts; many nuances can be lost or misinterpreted, and information may be left out for the sake of brevity. Therefore, writing is not recommended as the primary mode of communication. (Choice C) Supplemental communication measures can include written information sheets, standardized questionnaires, and captioned educational videos; however, the information conveyed by these modalities is limited, and they should not be used as the primary method of communication. (Choice D) Many deaf and hard of hearing individuals learn lip reading and expressive gestures to facilitate communication in casual settings. However, these methods are subject to error or misunderstanding and should not be relied on as a primary communication modality in health care. Educational objective: Deaf and hard of hearing patients should be offered the services of an interpreter trained in medical translation and American Sign Language, subject to patient preference and consent. Alternate modes of communication include computer-assisted real-time transcription and assistive listening devices.

A 48-Year-Old Deaf Man Comes to the Office for a New