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Read my lips: the downside of PPE (and how you can improve communication)

Last week was Deaf Awareness Week and in this article neurology registrar Dr Helen Grote explains how healthcare professionals can help patients with deafness or hearing loss.

The coronavirus outbreak has changed the way that we work, and also what we wear. Masks – typically worn by our colleagues in operating theatres – are now a mandatory part of PPE on general medical ward rounds, outpatients and community settings. Whilst these are vital in ensuring the safety of healthcare workers and patients, the untoward effects on communication, especially for those with hearing loss has been overlooked.

I am a deaf Neurology registrar, currently redeployed to the ‘pandemic medicine’ rota at my hospital trust. I rely on lip reading to communicate. This is tiring at the best of times – and when colleagues wear masks – completely impossible.  I see my own daily frustration of trying to communicate, shared by elderly patients on our ward, many of whom have hearing loss. The loss of ability to lip read is just one aspect of communication that is lost; the covering of faces also hides a number of important non-verbal and social cues, and can exacerbate anxiety, particularly for those with learning disabilities and autism. My own experience is not unique; those working in deaf mental health units have found the use of masks especially challenging to the doctor-patient relationship. Communication with deaf relatives is also affected; one ITU doctor recently described verifying the death of an elderly patient with Covid-19, and found the PPE and mask made it impossible to convey simple condolences and instructions to the patients’ deaf widow.

Around 1 in 6 people in the UK have hearing loss, rising to 71% of those over 70. The GMC makes it clear that doctors have a duty to communicate ‘in a way that they [patients] understand’. Clear communication is vital for informed consent, patient safety, and good patient care.  The ideal solution would be transparent masks approved for use in healthcare settings – but at present, only one company in the world manufactures these, and they are unavailable in the UK.

As healthcare professionals, we need to ensure that the right of patients to be fully informed and involved in decisions about their care is not forgotten in the pandemic. There are some simple communication tools that can help, and should be used wherever possible. Being patient and rephrasing sentences rather than simply ‘repeating it louder’ helps. Speech-to-text apps such as Google’s Live Transcribe, Microsoft translator and even Apple Notes can help to decipher speech, but do not always work well in noisy settings.  Written communication – either on a whiteboard, or via pen and paper is a low–cost, easy to access solution, but can be time consuming when there are complex issues relating to healthcare that need discussion. Fortunately, a number of NHS trusts have now signed up to use Cardmedic; an app with a series of digital flashcards with text that can be used to explain procedures, and even assist with complex discussions around resuscitation.

It is worth noting that British Sign Language has an entirely different grammatical structure to written English, and those who use BSL as their first language may prefer video-relay, the most commonly available one in the UK being SignHealth. This organization has launched a new BSL Health Access service for Deaf BSL users that can be used for free, 24/7 to support communication in any health setting. As a healthcare professional, it is also worth learning a few signs – even being able to finger spell your name, and a few simple signs, such as ‘hurt’ and ‘where’ can go a long way to support communication with BSL users.

Given the increasing importance of digital solutions to assist with communication, patients should also be placed on wards with access to high-quality wifi. Likewise, not all patients have access to a smartphone; and wards should have access to tablets with internet connectivity that can be used on loan.

As the saying goes, ‘Necessity is the mother of invention’. The coronavirus outbreak has already ignited a huge leap increase in the use of video consultations, remote meetings and apps – which proves that the technology required to support communication is there. We still need transparent masks, but we also need awareness and advocacy from healthcare staff, and a commitment to ensuring that patients with hearing loss are no longer overlooked, but are fully involved and supported in decisions about their care.