When COVID-19 first struck, physicians were plummeted into a dangerous, unpredictable new world. For Carolyn Stern, a deaf family practitioner who works in urgent-care clinics run by the University of Rochester Medical Center, there was an added challenge: retooling communication with her patients.
Pre-pandemic, Stern, 57, could gain valuable medical information about her patients by reading their lips and carefully observing their facial expressions and body language.
“Fortunately, I speak well and am fluent in American Sign Language,” she wrote in an October 2021 article published in the medical journal, Annals of Internal Medicine. “These factors let me navigate between Deaf and hearing communities.”
Masks changed all that. “I could see only eyebrows and crinkles in the corners of eyes that might hint at happiness or anger,” she writes in the article titled, “Doctoring with a Double Disability.” Adds Stern: “Before, I could take a look at someone’s face and it would tell me enough to prompt me to ask more probing questions—a sneeze, a laugh—I can’t catch all of that anymore.”
Sometimes, Stern’s patients would offer to lower their masks so she could lip read, but that “simple act would have put us all at risk,” notes the physician. These communications challenges left the Brighton resident, who has been an urgent-care physician since 2006, feeling “frustrated, challenged, despondent, and increasingly stressed.”
To treat in-office patients, conduct telehealth appointments, assist colleagues, or attend meetings, Stern now uses full-time American Sign Language interpreters trained in medical terminology. By using masks with clear plastic over the mouth, she has some ability to read lips.
Technology presented another steep learning curve. Before COVID, Stern attended professional conferences in person. Now, she must do so via Zoom using a split screen—speakers and interpreters displayed on one side; PowerPoint slides on the other.
“It is as though I am watching a virtual tennis match, my eyes going back and forth to see both, while the presenter talks without pause,” she writes. “Should I ignore the slides and focus on the interpreter? Should I review the slides and tell the interpreter to cease for a moment? Should I message the speaker, asking them to pause so I can review the slides? Should I just grin and bear it?”
A clinical and research expert in disability health, Philip Zazove M.D., chair of the Department of Family Medicine at Michigan Medicine in Ann Arbor, understands Stern’s challenges. He has access to captioning during Zoom meetings.
“If there are multiple screens, though, it’s not doable,” adds Zazove, a family practitioner, who is also deaf. “And the breakout rooms do not have captions.”
Like Stern, Zazove uses full-time interpreters and surgical masks with a transparent film around the mouth. He says the masks allow him to see faces and lips, but adds that the film gives off some glare, and the masks often shift around, partially obscuring the lips.
“I think (COVID) has affected every physician who has a hearing loss, Zazove says.
For Stern, there is an upside of having full-time interpreters: She feels more connected to her co-workers. Through the interpreter, she knows when someone is ordering lunch, when it’s a co-worker’s birthday.
“It makes me feel more part of the group,” she says. When Stern was communicating one-on-one with patients, she felt left out of office happenings.
Stern was born with severe hearing loss. Her mother contracted German measles (rubella) 13 weeks into her pregnancy, resulting in the infant to be profoundly deaf in the right ear and with severe to profound hearing loss in her left ear.
“I was able to function fairly well with hearing aids (in my left ear),” says Stern.
Further hearing loss occurred when Stern, during her medical residency, contracted Ménière’s disease, a disorder of the inner ear that causes vertigo, ringing in the ears (tinnitus), hearing loss, and a feeling of congestion in the ear. Overnight, she lost the remainder of her hearing in her left ear.
Stern, who is married with three adult children, has spent her life fighting for the rights of deaf health care professionals. During medical school, she sued Northwestern University after learning the school would no longer pay for her interpreters. The case was settled out of court—and also resulted in the creation of an office for students with disabilities at the medical school.
Stern has mentored many deaf/hard of hearing health care providers. She also has taught courses to American Sign Language interpreters on how to best interpret in medical settings and served as a consultant for the National Board of Medical Examiners, to evaluate the needs of medical students with disabilities in regard to testing and other accommodations.
Out of necessity, she has adjusted to practicing medicine in the time of COVID. But Stern, who works some 12-hour shifts, says she feels exhausted.
“You get tired of asking people to repeat themselves. It’s an effort to understand what’s being said before I can do the doctor thing. My eyes and brain get tired. I need to be more vigilant than hearing doctors.”
Ultimately, she turns to her interpreters.
“I don’t know what’s important or not until the interpreter tells me what’s important,” Stern says. “That’s what I struggle with every day.”
Donna Jackel is a Rochester-area freelance writer. All Rochester Beacon coronavirus articles are collected here.