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Patient Commentary
Deborah L. Wolter, MA
Arch Fam Med. 2000;9:526.
Relating With Diverse Individuals
A major purpose of descriptive research is to provide insights on beliefs, attitudes, or practices that are held by groups or subgroups of persons such as the deaf and hard-of-hearing (D&HH). This study suggests that preventive beliefs and attitudes of D&HH persons differ from hearing persons. It also points to communication difficulties between physicians and D&HH patients. In many cases, this may be true. However, there is an inherent danger of readers misinterpreting and developing stereotypes without acknowledging the limitations of such studies. Physicians who read reports of studies such as this must recognize that there are difficulties in applying scientific approaches to social problems. These difficulties involve the complexity of the subject, subjectivity in observation, inability to replicate results, and lack of precise measurement tools. Such variables can be controlled in physical and biological studies but not so easily controlled in studies of human attitudes and behaviors. The authors of this study clearly outlined and defined the limitations of their research. They also noted that further inquiry is needed in several areas.
Therefore, a good practice for physicians who work with D&HH patients (as well as any other diverse individual) is to make a diligent effort not to make assumptions about an individual or their knowledge and beliefs. This can be done by being flexible with one's own thoughts about people, reading reports such as this in a positive light, and by avoiding rigid and simplified views. For example, according to this study, D&HH people as a group were significantly less likely to rate "smoking less and exercising more" as beneficial behaviors toward improving one's health. However, the one D&HH individual a physician may have contact with could be a competitive cross-country skier with a healthful lifestyle. Thus, physicians should continue to approach their individual patients with an open mind as if they were conducting a single-subject ethnographic study.
Furthermore, our multiethnic society can be viewed in 2 ways: as a melting pot or as a salad bowl. This study attempted to find common threads among 140 D&HH persons belonging to 3 distinct subgroups. Service delivery approaches, such as providing American Sign Language interpreter services or the use of peer educators in health care establishments, are often guided by studies such as this. Certainly, not all D&HH patients are alike in their communication needs. This approach becomes especially harmful to those who do not benefit from such services and have no other resources.
Fortunately, physicians are in an excellent position to adopt a "salad bowl" view simply because they have contact with patients on an individual basis. Therefore, physicians should determine, obtain, and adopt whatever communication method an individual D&HH patient is comfortable with. Most importantly, physicians must make solicitous attempts to listen to and understand their D&HH patients' needs.
Ann Arbor, Mich
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