Isabelle Williams shares the challenges of clinical practice when you have a hearing loss
“Sorry?” I say, once again. It got to that awkward stage where on the third request I still didn’t hear what was said. The patient I am speaking with has slurred speech and sagging face. They had a “classic” stroke, but for a medical student with hearing loss, these cases are anything but simple. The fact that this patient also suffers from age-related hearing loss turns our simplest interactions into a struggle.
I have been living with bilateral sensorineural hearing loss since birth. Few of my friends and colleagues are aware of my hearing loss, and even those who do can still confuse my inability to hear with “metonism” or “inattention”.
Hearing disabilities affect different people in different ways. I lost my high frequencies but have preserved my low to mid tones. My overall hearing is not affected, but my clarity and understanding of speech is. I hear people talking but I can’t always read what they are saying. Consonants are more difficult to hear than vowels; I could confuse “plane” with “plate”, for example. Fortunately for me, heart and lung sounds fall into the lower frequencies.
Being hard of hearing is a challenge, as is my transition from library learning to clinical practice. Deafness is not a visible disability, although hearing aids are clearly visible. When I first started rotating in departments, I felt caught between this contradiction: I wanted people to understand the obstacles I have to hear, while simultaneously wanting to appear ânormalâ.
Imagine learning clinical medicine in a foreign country and it may give you some idea of ââmy experience of life on the ward. If words are missing, I can often understand it from context or lip-reading, but it takes time and focus and can be exhausting. This is not selective hearing – I didn’t hear you ask me for a pen, but I made sense of your request a little too late, when you had already found another. I cannot make a speech as quickly as the others. Without my helpers, listening and talking is like trying to ride a bike with flat tires. It takes a lot of extra work and can be a tough struggle.
Healthcare professionals with hearing loss may find it difficult to work when one of the many factors that help hearing is compromised. For example, when we are in environments where there is a lot of background noise, such as intensive care, or in situations where lip reading is made difficult or impossible, such as MDT meetings or in the theater. Very loud noises can also be annoying and distorted. Likewise, raising your voice when I haven’t heard you may not help and, on the contrary, may sound a little patronizing. It’s much better to face me and repeat what you said at the same volume.
The impact of hearing loss on communication is partial, subtle, and (as you can now recognize) needs further explanation. It can be exhausting, especially when you have to do it every time you meet. Maybe that’s why in the past it seemed so much easier to get out of it.
On one particular occasion, not being fully open about my hearing loss led to a misunderstanding and a complaint. “Dear Isabelle, I’m sorry to have to contact you about this …” the email has started. Having attended, but unable to hear, a child psychiatry assessment behind a one-way mirror, I left early and without explanation. In my anxiety, I had forgotten the most important step to take, which was to fully communicate my situation to my colleagues. They misinterpreted my actions as disinterest and rudeness. I now recognize that this was an easily preventable outcome, but sometimes it can be difficult to admit a vulnerability.
I don’t want to be labeled as a person with a disability. I grew up believing that I was “normal”. I wore hearing aids when I was young, before rejecting them as a teenager, believing that I could overcome my “problem”. Like any other young person, I wanted to fit in. I am learning that acceptance of myself is the key to being accepted by others.
Identity is not always a matter of pairs and opposites: boy, girl; Very ill; valid, disabled. There are specters and nuances. Deafness can also be understood as a spectrum. I hope the growing recognition of this will help me accept myself and therefore encourage me to communicate my needs to others more effectively.
You might be thinking, âHow can I help you if you choose to be silent? “. You are not wrong. My silence, my reluctance to speak, has been a burden on me. I’m trying to change that, and I hope you are too.
The silence on deafness will not be broken overnight, but in the meantime there are some things you can do to help your hearing-impaired colleagues if you meet us on the ward. Speak clearly, but not too slowly and not loudly. Try to face us when speaking and keep your hands away from your face. Don’t be afraid to repeat yourself (without exasperation or frowning!) Ask us if we’ve heard you. And, as is the case with most people, the written word helps memory aid. I hope this article will be one for its readers.
Isabelle williams is a fifth year medical student at the University of Cambridge.
Competing interests: None to report.