Consulting with deaf patients
Often family members translate during consultations, but during certain consultations that is inappropriate. Ideally the interpreter will be a member of the Register of Sign Language Interpreters. The interpreter should be seated opposite the patient, next to the doctor. The doctor should look at the patient while talking and listening. Apart from clearly stating when the interpreter's services are no-longer required, nothing should be said to the interpreter. Interpreters often charge for a minimum of 2 hours, making them very expensive for a routine consultation. They are also in short supply so particularly difficult to get at short notice. Videophones are increasing in popularity, and although expensive (~£800) it is a one-off cost. They enable you to access an interpreter using a signing service such as that provided by the RNID.
In the UK a telephone service, Text-talk, is available. The deaf person types on a terminal and a telephone operator reads the resulting text to the other. The growth of online chat programs such as Gaim, GoogleTalk and other less standard alternatives using Internet protocols could have the effect of disintermediating this process. Not all consultations can be conducted without presence, and the NHS Net currently blocks ports needed for some parts of these services. Confidentiality can be enhanced by encryption of the network traffic, and by direct connection rather than use of a central server. The decision whether to keep a log, where to keep the log, and whether that log is part of the medical record is not obvious in its solution, balancing actual usefulness and the usual treatment of voice calls against technical capabilities.
Deaf but not totally
Hearing aids can be activated via induction. Many public places have induction loops, and hand-portable loop devices are available for around £100. These can make a noticeable difference to a consultation with the very hard of hearing.