Monday, January 29, 2007

395: A Television Has No Bedside Manner

You show up at your doctor’s office. In the past there was an interpreter there. The terp helped you through the intake process; if you had questions you could ask them whilst in the waiting room. If your doctor was late, the interpreter would tell you, and they would make sure that when the so-forgetful hearing people called your name, you would know. (You tell them you're Deaf every time you go. They always forget.)

Now they've decided to use VRI. This means no interpreter meets you at the office; the VRI system itself isn't very portable, requiring plugs and high-speed internet, so they wait till you're actually in the doctor's office to set it up. When you ask why they say it's a small clinic, they have no money, and VRI charges by the minute instead of the usual ASL-interpreter-two-hour-standard. Although you've mentioned accessibility is tax-deductible, they've convinced you to try this for a few months. But now any communication you attempt in the lobby is written; you can’t trust yourself to lipread whatever accent the receptionist has, and in any case they don’t have the patience or time to communicate. After a few short messages they ask you to sit down and be patient. You wait nervously on high alert in the waiting room, afraid to read your book, afraid to miss any movement in case it might be someone out of sight calling your name. You have questions about your insurance and how it works, but you have to wait until you see the doctor. You can speak and lipread pretty well, but you’re nervous about doing so in a medical situation – you do it now and then and they instantly expect you to do it all the time. You tell them you can't, not consistently, but they just nod, and you know they aren't really listening.

You get called in-they forget to come get you, again, but thank Goddess you were paying attention. A nurse writes (rolling her eyes with frustration; she repeatedly tried to speak to you until you fiercely pointed at the pad; she doesn’t want to take the time) that the equipment is on the way and will take another half hour. You have a book but are afraid to read in case someone calls you or something happens and you miss it. Doctor’s visits are important. This is your health at stake, and you’re very aware of how important health is. You wait nervously for an hour and when nothing happens you try to go outside in the hallway, look for someone to remind of your existence. A nurse walks by, sees you, says something like OH! and mouths ONE MINUTE – your insides grate at her patronizing expression, but at least someone’s doing something. Or that's what you tell yourself.

The doctor comes in and talks loudly and isn’t looking at you – you want to bang on the table and remind him that it says PT IS DEAF on the cover of your folder where you insisted on writing it several months ago in the vain hope it would remind people to be aware of your communication boundaries, but you know he would get pissed off and leave and write comments about PT INTRACTABLE in your folder again. So you smile and in a soft voice which he doesn’t hear at first you remind him to look at you when he speaks. He smiles and ignores you. You repeat your request. When he finally gets it he sighs, and you realize he’s frustrated again.

At this point you’re concentrating so hard on lipreading that you forget all your questions. Insurance? What's that? The equipment is on the way, or maybe not – you’re not sure. You’re trying so hard to catch all the words and make sense out of them – maybe a complete sentence will make more sense than just these few words? you think – that it’s hard to find the time to stop him. Finally you ask him to write down what he says and he just writes WAIT HERE on a piece of paper and goes off.

The equipment finally arrives and takes 15 minutes to set up, and another 20 to connect. The interpreter is tolerable, is totally new to you, since VRI interpreters are randomly selected. (You have mixed feelings about this. On the one hand they're not in town, so you have privacy of sorts; on the other hand, you have a new interpreter every doctor's appointment, so many more people know your medical situation. Also, the terp has to ask the doctor to spell out the names of every medically-related term he uses, sometimes several times. Since this has happened every time you've visited, you're kind of used to it - it's amazing the things you learn to get used to. But the doctor hasn't gotten used to it at all, and he stamps his foot impatiently; you're the one in the room, and you get the psychic brunt of his frustration. Deaf people see expressions the way hearing people see sirens.

The doctor informs you of your diagnosis rapidly, and, frustrated at the waste of time, rattles off a list of medications. By the time the VRI terp finishes spelling out everything, the doctor has taken off, and so has the nurse. You couldn’t stop them without taking your eyes off the VRI terp, you couldn’t ask any questions, and you didn’t have the chance to tell him about any new problems. You aren't sure you have the energy anyway: the terp doesn't seem to understand your fingerspelling unless you sign at a tiny fraction of your usual speed, and you have a sneaking suspicion the interpreter may not be interpreting what you say totally correctly. You're divided between paying attention and trying to judge the quality of communication through VRI. The doctor didn’t waste any more of his time making sure you understand what to do; in his opinion that’s the job of the interpreter. He’s fulfilled his responsibility and provided access. What more do you want?

What you want is to check the spelling of some of the meds, since the doctor’s handwriting on his prescription pad is about as legible as Egyptian heiroglyphs, but you can’t. The television is off; the technician has come to take it away. You’re angry, but also exhausted, and sick. You just want to go get the medications, hope they’re the right ones, and go to sleep. On the way out you have a bad scare: you left some document on the floor in the waiting room, and the receptionist, who unbeknownst to you had been screaming your name, came up behind you and jerked you roughly for attention, then pointed, annoyed, at the paper on the floor. Harried, you pick it up and leave, aware of all eyes on you.

On the way out you think fondly of the days when you had a live person and your entire trip was interpreted; when the same interpreter came to all your visits and knew your case and was able to help you far more effectively; when you didn't have to waste so much time on waiting for technology, and when your Deafness wasn't a point of embarrassment and frustration. Oh, people looked at you before, talking the small talk with the terp, but at least they were looking at something you could be proud of: ASL. You don't mind if they use the VRI when they have to, but to have to go through this again and again? Ugh. And the truth is, you know no more about your health than when you started.
NOTE: I think VRI is a powerful, wonderful tool which can and should be used when a live interpreter is not available. It has its place in our lives and rightly so, because there are far too few terps to suit the extant need. But I've heard and witnessed a lot of problems, and I compiled them into this fictional account. Can these problems be dealt with? Maybe. Maybe not. Maybe this story is exaggeration. Maybe it's understating the case. But there are no unilateral studies of the use of VRI in a health care situation. The one study I found online compared VRI... to using tty-based relay systems. It's been used to show Deaf people prefer VRI. But it was not a comparison of VRI to a live interpreter at all! Anyone else have links to studies out there? I hope this fictional account helps us move forward in our understanding of the place and value of VRI, for both doctors and patients.


Joseph Rainmound said...

Does this seem familiar to anyone?

Keri said...

Oh yes, this scenario has happened to me numerous times. It was as if you were a fly on the wall and saw it happening to me!

Very thought-provoking post. I will definitely be sharing it with the Deaf Culture class I teach. If there were Oscars for best lines in a blog post, this line would win: "Deaf people see expressions the way hearing people see sirens."

Anonymous said...

The attitudes of some hearing people toward deaf people, especially when it comes down to writing, are horrible. There is no excuse for the health professionals to be impatient with their deaf patients.

If they know a deaf patient is coming, then for heaven's sake, why don't they set up the VRI in advance??? Live interpreters are much better.


Anonymous said...

i had 9 medical appts where the terp didnt show up.
and i i live in med size city.
we do need alternatives here.

breenie said...

I had this cranky old eye doctor who recently retired. He has an interpreter on Tuesdays and deaf folks know when to come to see him. Like Joe described, the terp would come in, let you know the status of the dr appt etc. This terp has a strong personality and got along real well with the dr, especially when he's dawdling. They would engage in friendly bicker and her pushing him to proceed with appointments. I miss that kind of ambience, ya know?