Ralston E, Zazove P, Gorenflo D W
University of Michigan, Ann Arbor, MI 48109-0708, USA.
J Am Board Fam Pract. 1996 May-Jun;9(3):167-73.
We wanted to validate reports that deaf persons have difficulty obtaining medical care by comparing physicians' attitudes towards these patients with physicians' attitudes toward their patients in general.
Two questionnaires were randomly distributed to physicians attending continuing medical education conferences at the University of Michigan during a 3-month period. The questionnaires were identical except that one asked about deaf patients and the other about patients in general. The questions assessed the respondent's perceptions of communication with patients, attitudes toward their patients, knowledge of current information about deaf people, and demographics.
One hundred sixty-five physicians responded, 94 to the general questionnaire and 71 to the deaf questionnaire. The two physician groups were similar demographically, but 165 differed significantly in communication and attitude variables. Physicians receiving the questionnaire focusing on deaf patients reported greater difficulties in understanding (P < 0.001) and maintaining free-flowing conversations (P < 0.001), and that these patients had more difficulty understanding them (P < 0.001), trusted them less (P < 0.001), asked them to repeat statements more often (P < 0.001) and were less likely to understand the diagnosis and recommended treatments (P < 0.001). Physicians also reported feeling less comfortable with deaf patients (P < 0.001) and that they asked fewer questions (P < 0.001). Physicians were more likely to say that deaf patients rely on interpreters (P = 0.040), get frustrated easily (P < 0.001), and are harder to communicate with (P < 0.001). There were no significant differences between the two groups in knowledge about deaf people. All physicians, however, displayed ignorance about their legal obligations under the Americans with Disabilities Act to provide interpreters for their deaf patients.
Physicians surveyed about deaf patients reported significantly greater difficulties communicating with and different attitudes toward these patients than physicians surveyed about their patients in general. All physicians were unaware of their obligations under the Americans with Disabilities Act to provide interpreters for deaf patients. Research is needed to determine whether physician attitudes and beliefs affect the actual quality of care they deliver to deaf patients.
我们希望通过比较医生对聋人患者的态度与对普通患者的态度，来验证关于聋人就医困难的报道。
在3个月的时间里，向参加密歇根大学继续医学教育会议的医生随机发放两份问卷。两份问卷除了一份询问关于聋人患者，另一份询问关于普通患者外，其他内容完全相同。问题评估了受访者对与患者沟通的看法、对患者的态度、对聋人当前信息的了解以及人口统计学特征。
165名医生回复了问卷，94人回复了普通问卷，71人回复了聋人问卷。两组医生在人口统计学特征上相似，但在沟通和态度变量上有显著差异。收到关于聋人患者问卷的医生报告称，在理解（P < 0.001）和保持流畅对话（P < 0.001）方面困难更大，并且这些患者更难理解他们（P < 0.001），对他们的信任度更低（P < 0.001），更频繁地要求他们重复陈述（P < 0.001），并且不太可能理解诊断和推荐的治疗方法（P < 0.001）。医生还报告说，与聋人患者相处时感觉不太自在（P < 0.001），并且他们问的问题更少（P < 0.001）。医生更有可能说聋人患者依赖口译员（P = 0.040），容易感到沮丧（P < 0.001），并且更难沟通（P < 0.001）。两组医生在对聋人的了解方面没有显著差异。然而，所有医生都对《美国残疾人法案》规定的为聋人患者提供口译员的法律义务一无所知。
与接受关于普通患者调查的医生相比，接受关于聋人患者调查的医生报告称，与这些患者沟通的困难显著更大，并且态度也有所不同。所有医生都不知道他们根据《美国残疾人法案》为聋人患者提供口译员的义务。需要进行研究以确定医生的态度和信念是否会影响他们为聋人患者提供的实际护理质量。
