Read my lips: the downside of PPE for people with hearing loss, and what we can all do to help

Having to wear a mask is a sometimes uncomfortable necessity during the pandemic. But, for the significant number of patients and staff with hearing loss, who often rely either partly or wholly on lip-reading, face coverings can make communication incredibly difficult. Neurology consultant Dr Helen Grote, who is herself deaf, shares practical ways that we can all make our Covid-19 world easier those who are deaf or have hearing loss, helping to ensure no one is excluded from discussions and decisions about their health or work.

Masks can make communication difficult – especially if you’re hard of hearing

The Covid-19 pandemic has changed the way we work, sometimes with unintended consequences. Masks – previously worn primarily by our colleagues in operating theatres – are now a mandatory part of personal protective equipment (PPE) for everyone within our hospitals. While vital in helping to ensure everyone’s safety, we don’t always recognise the impact on communication – especially for those with hearing loss.

I rely on lip reading to communicate. This is tiring at the best of times – when colleagues wear masks it’s completely impossible.  

I see my own daily frustration of trying to communicate shared by elderly patients, many of whom have hearing loss. The inability to lipread is just one aspect of communication that is lost; covering 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 clinician-patient relationship. Communication with deaf relatives is also affected. An intensive care doctor recently described verifying the death of an elderly patient with Covid-19, with PPE making it impossible to convey simple condolences and information to the patient’s deaf widow.

A bigger issue than you might think

Around one in six people in the UK have hearing loss, rising to 71 per cent of those over 70. The General Medical Council (GMC) makes clear that doctors have a duty to communicate ‘in a way that [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. The UK government procured 250,000 transparent masks from China in August. However, they are only suitable for use in low risk settings. Some intensive care units now have access to respirator hoods with a clear front panel. Whilst they do enable patients to see the faces of healthcare staff caring for them, they can be noisy for those wearing them. 

What we can all do to help patients and colleagues with hearing loss

There are some simple strategies and communication tools that can help, and they should be used wherever possible. Obviously, some approaches are impossible to use when wearing a mask but it makes the others even more important. 

Tips for communicating with someone who is deaf or has hearing loss (from the Royal College of General Practitioners' Deafness and Hearing Loss Toolkit).

  • Gain the person’s attention before you begin to speak
  • Avoid having the conversation with a lot of background noise. Hearing aids will amplify all background noise, so speech can be easily lost.
  • Ensure your face and lip movements are visible (if it is safe not to wear a mask)
  • Be calm and patient and leave enough time for the conversation
  • Do not shout! Speak clearly and not too fast or too slow
  • Repeat the sentence again (just once) if necessary, then rephrase
  • Write down important facts - times, dates, names, places, instructions
  • Gestures and facial expressions will help augment your message

Written communication – either on a whiteboard or pen and paper – is a low-cost, easy to access solution but can be time consuming when there are complex issues that need discussion. 

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. 
In an outpatient clinic, live dictation can be facilitated using Office 365 applications (MS Word, Powerpoint) through the dictation tool. Cardmedic – a series of digital communication flashcards - is available for free online or for download to a phone. The cards have been developed by clinicians and cover a variety of topics including anaesthetic assessments,  treatment escalation and end of life discussions and nasogastric tube insertion.

British Sign Language (BSL) 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 organisation has launched a new BSL health access service that can be used 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 or signs words like ‘hurt’ or ‘where?’ can go a long way to support communication with BSL users.

Many people with hearing loss struggle to use the telephone. Some may prefer video consultations, where available. The most commonly used digital consultation platform, Attend Anywhere, does not currently have inbuilt captions. Tech-savvy patients can use live transcription software, such as, for free in a separate chrome browser for a live transcript of their appointment.

MS Teams does provide inbuilt captions but they need to be selected by the meeting organiser before the meeting. Instructions can be found here. This is especially helpful if you are organising a meeting with staff members who have hearing loss. 

Necessity, as the saying goes, is the mother of invention. The Covid-19 pandemic has already ignited a huge increase in the use of video consultations, remote meetings and apps – which proves that the technology required to support communication is there. We also need awareness and advocacy from healthcare staff and a commitment to ensuring that patients with hearing loss are not overlooked and able to be fully involved and supported in decisions about their care. 

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