Caring for deaf and hard of hearing patients in dermatology during the COVID-19 pandemic.

Dear Editor,

The novel coronavirus disease 2019 (COVID‐19) has caused drastic interruptions in traditional dermatologic patient care globally. Safety procedures have been implemented to protect patients and providers, some of which may interfere with effective communication for deaf and hard of hearing (DHH) patients, who already face significant challenges. Hearing loss has been associated with increased health care expenditure and resource utilization, making it more difficult for DHH patients to receive appropriate care. In this letter, we make recommendations for mitigating communication barriers for DHH dermatological patients during the COVID‐19 pandemic.

In‐person dermatological care has changed, mandating the use of personal protective equipment by both patients and health care workers to minimize the risk of viral exposure and spread; masks negatively impact communication for DHH patients by reducing a dermatologist's vocal volume and preventing lip‐reading. Safe'N'Clear is a Food and Drug Administration approved clear face mask for non‐COVID‐19 medical use. , Therefore, dermatologists may consider using this mask when treating DHH non‐COVID‐19 inpatients, and outpatients with negative COVID‐19 testing within 72 hours of their appointment. Alternatively, dermatologists may use standard N‐95 masks with a sign language interpreter. To minimize risk to interpreters, the Health Insurance Portability and Accountability Act (HIPAA) compliant videoconference‐based platforms should be used. Many health care institutional policies do not allow for friends or family members to attend medical visits. Exceptions should be made for DHH patients whose companions assist with communication. If a sign language trained companion or professional interpreter is not available, a smartphone speech‐to‐text app can be utilized to create automated captions.

To limit the risk of COVID‐19 transmission, dermatology practices have dramatically reduced in‐person visits and increased the utilization of telemedicine and telephone calls, posing significant and unique challenges to DHH patients. Televisits with DHH patients should employ three‐way videoconferencing with a sign language interpreter. Dermatologists may also provide a visual prop with photographs of various skin morphologies and questions about symptoms, such that patients may respond to questions even with limited hearing. If an interpreter is not available for videoconferencing, dermatologists should facilitate the encounter via telephone, so that DHH patients may use their preferred telecommunication relay service. This system utilizes an operator who voices the typed conversation to the physician and then types the responses back to the DHH patient, such that communication can occur using a standard telephone. Written instructions on taking photographs of the area of concern should be given prior to telephone calls. Images must be in‐focus, with multiple viewpoints, and a coin or ruler can be placed in the frame for scale.

The COVID‐19 pandemic requires that dermatologists be creative in providing DHH patients with timely and effective care. Strategies used for each DHH patient will vary depending on the severity of hearing loss, and language and communication preferences. We hope that this letter will make our dermatology community more sensitive to the needs of DHH patients and that these recommendations will be useful in diagnosing and treating these patients both during and following this pandemic.

CONFLICT OF INTEREST

The authors declare no conflicts of interest.