In days past, patients accepted what their medical caregivers told them without question. But now, patients want more information, ask more questions, and expect a clear, comprehensive, two-way dialogue between themselves and their medical team.

In most cases, communicating with a patient simply involves talking with them, one on one. But some patients have unique communication needs.

I'm one of those patients. I am deaf-one of the 28 million deaf or hard of hearing persons in the US. Although I've met many dedicated medical professionals, I've found that there is a real lack of knowledge among the medical community on the issues involving deaf patients. Because this population is relatively small, you may never encounter a deaf patient. But if you do, there are certain measures you should take to make the process smooth for your patients and your staff. Here are a few that I would recommend, based on my experiences in medical facilities.

Facilitate the pre-op process: On the day before a recent outpatient procedure, I called the facility to receive pre-op instructions. I use a relay service for telephone communication, which requires a third party to translate the information from my text telephone to an aural phone. Instead of taking the time to work through the relay service, the pre-op nurse exclaimed, "Can't you just drive down here?" After I pointed out that she would never ask a hearing patient to make a pre-op trip, and a face-to-face interview would take longer without a sign-language interpreter on site, she finally agreed to work with me over the phone. The final interview may have taken twice as long as a standard call, but not nearly as long as a face-to-face meeting.

The lesson here? Assume that these patients know their own needs best. If you listen to them, rather than suggest that they adapt to your procedures, it will save you time in the long run.

Provide a certified sign language interpreter, and inform that patient ahead of time that one will be available: During the interview, I asked the nurse if there would be a sign language interpreter at the facility. She replied that she would have to check with administration and never got back to me. I had to wait until I arrived at the facility the next day, not knowing if adequate communication would be provided. This increased the anxiety I already had about my surgery. Fortunately, an interpreter did arrive at the last minute, just before I was about to enter the pre-op area.

According to the American with Disabilities Act, if a patient feels that he or she needs an interpreter, you are required to provide one. A certified interpreter ensures that the entire surgical process can run as smoothly as it does with a hearing patient. I have had interpreters in the OR with me, communicating everything until I was asleep. He or she would again be by my side as I began to regain consciousness.

Don't assume a deaf person can lip read: Many people assume that every deaf person can lip read; however, most are not endowed with any special expertise in this area. Also, in many instances, English is not the first language for persons who were deafened pre-lingually.

In the rare instance that you can't provide an interpreter, it is vital that you provide clear, complete written communication with the same full information that a patient would receive orally. However, written communication, no matter how complete, is always a last resort. Having a certified interpreter isn't just a convenience -it's a patient's right under law, and it benefits patients and staff equally.

The next time you encounter a deaf patient, remember that the deaf community views deafness as a culture with its own language, not as a handicap. The onus is on you to educate yourself and your staff about the patient's needs, and he or she will be happy to help you do so (the National Association of the Deaf web site at www.nad.org is also a great resource). We want to talk to you-but you have to know how to listen!