Isabelle Williams shares the challenges of clinical practice when you have a hearing impairment
“Pardon?” I say, again. It has got to that awkward stage where on the third asking, I still haven’t heard what was said. The patient I am speaking with has slurred speech and a facial droop. They’ve had a “textbook” stroke, but for a medical student with a hearing impairment, these cases are anything but straightforward. The fact that this patient also has age related hearing loss turns our simplest interactions into a struggle.
I have lived with a bilateral sensorineural hearing loss since birth. Few of my friends and colleagues know about my hearing impairment, and even those who do may still mistake my inability to hear for being “ditsy” or “inattentive.”
Hearing impairments affect different people in different ways. I have 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 can hear people talking but I cannot always decipher what they are saying. Consonants are harder to hear than vowels; I might mistake “plane” for “plate,” for example. Luckily for me, heart and lung sounds fall in the low frequencies.
Being hearing impaired is a challenge, as was my transition from library based learning to clinical practice. Deafness is not a visible disability, although the aids to hearing are conspicuous. When I started rotations on the wards, I felt caught between this contradiction: I wanted people to understand the obstacles I have to hearing, while simultaneously wanting to appear “normal.”
Imagine learning clinical medicine in a foreign country and it may give you some idea of my experience of life on the wards. If I miss words, I can often work it out from context or lip reading, yet this takes time and concentration and can be exhausting. It is not selective hearing—I didn’t hear you ask me for a pen but made sense of your request a beat too late, when you’d already found another one. I can’t formulate speech as quickly as others. Without my aids, listening and speaking is like trying to ride a bike with flat tyres. It takes a lot of extra work and can be an uphill struggle.
Medical professionals with hearing impairments can find working difficult when any one of a number of factors that aid hearing are compromised. For example, when we’re in environments where there is a lot of background noise, such as the ICU, or in situations where lip reading is made difficult or impossible, such as MDT meetings or in theatre. Very loud noises can also be unpleasant and distorted. Similarly, raising your voice when I have not heard you may not help and, if anything, can feel a little patronising. It is much better to face me and repeat what you’ve said at the same volume.
The impact of hearing loss on communication is partial, subtle, and (as you can recognise by now) requires greater explanation. This can be exhausting, especially when it has to be done with each new encounter. Maybe this is why, in the past, it has seemed so much easier for me to muddle through.
On one particular occasion, not being completely open about my hearing impairment led to a misunderstanding and a complaint. “Dear Isabelle, I am sorry to have to contact you about this…” the email began. Having been present at, but unable to hear, a child psychiatry assessment behind a one way mirror, I left early and without explanation. In my anxiety, I had overlooked 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 recognise now that this was an easily avoidable outcome, but it can still at times be difficult to admit to a vulnerability.
I do not want to be labelled as a disabled person. I grew up believing that I was “normal.” I wore hearing aids as a young child, before rejecting them as a teenager, believing I could overcome my “problem.” Like every other young person, I wanted to fit in. I am learning that acceptance of myself is key to being accepted by others.
Identity is not always about pairs and opposites: boy, girl; well, ill; abled, disabled. There are spectrums and nuances. Deafness can be understood as a spectrum too. I hope that increasing recognition of this will help me to accept myself, and therefore encourage me to communicate to other people about my needs more effectively.
You might be thinking, “how can I help if you choose to stay quiet?”. You aren’t wrong. My silence, my unwillingness to speak up, has been a burden to me. I am trying to change that, and I hope you will too.
The silence on deafness will not be broken overnight, but meanwhile there are some things you can do to help colleagues with hearing impairments should you encounter us on the wards. Speak clearly but not too slowly, and not loudly. Try to face us when you speak and keep your hands away from your face. Do not be afraid to repeat yourself (without exasperation or an eye roll!) or to rephrase information if we stare at you blankly, or with a bewildered smile. Ask us if we have heard you. And, as is the case for most people, the written word is a helpful aide memoire. I hope that this piece might act as one for its readers.
Isabelle Williams is a fifth year medical student at Cambridge University.
Competing interests: None to declare.