At medical school I was taught by Dr. Nimmo, an elderly Edinburgh physician who wore a pinstripe suit, carried a heavy gold watch, and whose combed white hair was held in place with pomade. If he realized that a patient was hard of hearing he’d take his stethoscope from his jacket pocket and ceremoniously place the earpieces into their ears. Taking the other end in his hands, he’d speak slowly and clearly into it as if into a microphone. The focus and amplification of the stethoscope meant that he didn’t have to shout loudly, and the privacy of the patient on the open ward was preserved. For the most part his patients found the role reversal hilarious; occasionally the medical students did too. I remember him turning to one student who was sniggering a little too conspicuously. “There’s nothing funny about trying to communicate properly,” he said. “Use whatever means you can to understand and be understood.”
In my clinical practice I still make use of his advice when meeting patients who are hard of hearing. Most of those who try on my stethoscope appreciate it, and yes—most of them find it funny. It’s less funny overcoming communication difficulties with those who are profoundly deaf. If a Sign interpreter is not available, and the patient’s lip-reading skills are not excellent, we cover pages of paper with written questions and answers. Even so, much of the breadth and subtlety of the consultation is lost.
One of my profoundly deaf patients is Miss Black, a woman in her early fifties whose lip-reading skills are good. But our appointments still take much longer than if she were hearing. Often we don’t have the luxury of discussing her emotional well-being, but focus on her physical complaint, diagnosis, and a plan for treatment. She lives alone on welfare benefits with little involvement in what the deaf sometimes call the “hearing world,” though she has many friends among the Edinburgh deaf community. Recently I needed to talk to her without the time pressure of the clinic, so I pedaled down from the office to visit her at home.
Beside a button on her front door was a sign: “Press Hard—Don’t Knock.” The wire was connected to a flashing light inside rather than a bell. The walls of her small apartment were covered with pictures, and the floors with toys for her cats. Among her small collection of books she had a medical encyclopedia; she told me she combs it for clues before our appointments. After years of encounters with doctors she’s learned that it’s quicker to propose her own ideas about diagnosis, and suggest her own treatments.
Outside there were workmen digging up the road. I was irritated by the pneumatic drills but of course they made…
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