Deaf people whose first language is sign language tend to avoid going to the GP because of communication difficulties, resulting in poor health outcomes. Using sign language interpreters for medical care is good practice, reduces risk and enhances health outcomes for deaf people. However, good practice is not necessarily common practice among GPs in Ireland. Two new developments can help GPs communicate better with deaf patients – the use of online video links to interpreters and a hassle-free pilot service for arranging appointments.

Ireland’s deaf community

While 8% of Irish adults (270,000) have a significant disabling hearing loss that impacts on their daily lives,¹ there is a small population of 5,000 deaf who depend on Irish sign language (ISL) to communicate.² This deaf ISL community experiences multiple disadvantages with high unemployment,³ low education levels⁴ and high levels of literacy problems⁵. The inequality and exclusion experienced are compounded by communication difficulties, resulting in more mental health issues⁶ and poorer health outcomes⁷.

Practice varies

Health policy now dictates that sign language interpreters should be used when dealing with deaf ISL users – see National Guidelines on Accessible Health and Social Care Services, 2014⁸ or the National Consent Policy – to facilitate the GP and the deaf person to communicate.

However, good practice is not always common practice.  The Sign Language Interpreting Service (SLIS) states that two-thirds of all barriers deaf people report to them concern medical contexts. These include:  

• Medical appointments going ahead without interpreters

• Medical practitioners forgetting to book interpreters, or expecting family members (including children) to interpret

• Many GPs refuse to engage with the HSE to fund ISL interpreters as they find the administration so burdensome

• When GPs do engage, deaf people report delays of two months before an appointment occurs.

These common situations are dangerous and increase risks of misdiagnosis and mistreatment.⁹ Research in the UK points to 33% of deaf people leaving consultations unsure about medication or taking wrong dosages, while 30% avoid going to the GP at all.¹⁰ The end result is evidence of institutional discrimination against deaf sign language users.¹¹ Irish evidence is not available, quite simply because there has been no investment in research in this area.

The key point is that having an interpreter present at GP appointments reduces risks, empowers the patient, increases self-efficacy and leads to better health outcomes. However, due to a the lack of awareness and a shortage of sign language interpreters, GPs and deaf people still find it difficult to book interpreters. There are two new developments which should help; the use of new technology and a pilot programme between the HSE and SLIS.

Skype in an interpreter

The Irish Remote Interpreting Service (IRIS) provides a live video link to an Irish sign language interpreter, and operates from 10am to 4pm each day. IRIS is a user-friendly way to access online interpreters using programmes such as Skype, oovoo or Microsoft Lyncs, particularly useful in rural areas or for short-notice consultations.

Remote interpreting is suitable for more routine appointments, rather than for those with intensive physical examinations, but it is clear that video remote interpreting is increasingly important in medical settings internationally.¹²

New pilot service 

The HSE has asked the SLIS to make it easier for deaf people to make appointments with GPs with a sign language interpreter, and a pilot initiative by SLIS will arrange and pay for sign language interpreters for GP appointments. The pilot service is limited to deaf people with medical cards only, but SLIS hopes this service can be expanded to include all deaf people in the future. (It is vital to note that deaf people without a medical card are also entitled to a sign language interpreter for medical appointments, paid for by the HSE, hospital or medical service.) 

To book an interpreter for an appointment the deaf person or the GP can now contact SLIS to arrange a sign language interpreter. SLIS will then arrange the sign language interpreter for an appointment agreed with all three parties.

This new service puts the patient at the centre of the process and takes account of their needs and interpreter preference. It helps them to better understand their health issues and treatment.