Appropriate and safe prescribing of strong opioids
After being diagnosed with deafness, Dr Judith Langfield soon realised she would have to embrace technology to cope with her new muffled world
I found myself slowly slipping into the world of the deaf. The patients were mumbling. I could not hear what colleagues were saying at meetings. Then I misdiagnosed a chap with pneumonia. Fortunately I sent him into hospital as he was obviously ill, but I had missed the signs in his chest. My friends kept telling me to get my ears syringed. So I did, but it did not make any difference.
Eventually, I had my hearing tested. The audiologist told me I had the banana-shaped loss of hereditary sensorineural deafness. My father and grandfather had both developed hearing loss in their 50s but had not been diagnosed accurately.
The feeling I had after the first hearing test was actually one of elation. Suddenly everything fell into place and it explained the problems I had had over the years. For instance, as a child I thought Sherwood Forest was Sherbet Forest, until I saw it written down, because I had misheard the 'w' and the 'd'.
Chatting with my father about it, he said he had had similar problems with hearing things as a child, and we both then realised that we had had mild deafness even as children but never knew, simply because we had nothing to compare it with.
I had my first hearing-aid fitted in 1995, a year after the diagnosis and, just as when I wore spectacles for the first time and realised that fuzzy vision was not normal, I found that fuzzy hearing was not normal either. I began to understand what I had been missing.
I also understood why a lot of elderly people never manage to cope with wearing a hearing-aid. When I first wore it, it felt like a huge piece of concrete in my ear. It was fiddly putting it in and taking it out. Furthermore, it had to be washed once or twice a week and the tubing replaced every six months.
Then I discovered the loop. This is a magical device by which a current is passed round a loop encircling a room, converting speech into an electromagnetic field that is then picked up by the telecoil in the hearing aid and converted back into speech. For the first time ever I could hear people speaking clearly and sharply. My hearing-aid and I became firm friends.
Lip-reading classes were a revelation. For two years I learned how to distinguish lip shapes. I discovered how varied people are in their speaking. Some have clear voices, some muddy. Some people speak slowly and distinctly, others speak quickly, softly and do not articulate clearly at all. Context is crucial. Missing the first few words of a sentence means I miss everything.
Last year I had a second hearing-aid fitted. This is a marked improvement as I now have bi-aural hearing.
My experience has completely altered the way I deal with deaf people in my practice. All members of my staff have had deaf awareness training.
My receptionist fetches patients personally from the waiting room. I make sure I face people so they can see my lips. I try to have the light on my face.
I do not start to speak until I see patients have my attention so they get the first words of my first sentence. I speak slowly, pronouncing the consonants clearly as it is these that cannot be heard. If they look blank, or say they have not understood, I repeat what I have said. If they have still not got it, then I rephrase what I have said. Some words are unlip-readable, for example, the word 'doctor'.
Where someone is very deaf or unable to lip-read then I write things down. What I do not do is bawl in somebody's ear as I have seen happen so often in residential homes. This really makes me cringe.
I have bought amplifiers for use in the consulting-room and on home visits. A mini-loop has been installed in the reception desk. A textphone is used for deaf patients who have textphones at home.
I also make use of our excellent local audiotherapist.
She is marvellous at advising patients about equipment for the front door, the television and the telephone, and can really make a huge difference to the quality of life of many elderly people.
I use equipment myself. I have an amplified telephone both at home and in my consulting-room. My stethoscope is amplified and I have found one which has headphones, instead of earpieces. This means I can keep my hearing aids in while listening. Patients think I am really up to date with this fancy stethoscope.
Mobile phones are a nuisance as, being digital, they interfere with analogue hearing aids causing a loud painful buzz. I therefore have to have a neck-loop that fits into the mobile phone but, because it takes time to fit, only use it for outgoing calls. When I am on call I still use a message-pager. At meetings, I use a listening device with a neck-loop. E-mail and fax are wonderful for deaf people. I use these in preference to telephoning.
I am beginning to hate using the telephone as, of course, lip-reading is impossible, and sometimes I just cannot understand who is on the other end of the line. For this reason I refuse to do advice sessions for the deputising service. Instead, I do mobile sessions where I can actually see the patients.
Deafness has also changed my hobbies. I sang in my church choir for years but, with increasing deafness, found I could not pitch properly. I therefore resigned and started learning to play the organ instead. I have passed grade V of the Associated Board examinations and am one of the assistant organists at our church services.
My hearing will get progressively worse over the coming years and it is just something I have to accept. I shall make sure I make maximum use of whatever equipment is available and suitable as the years go by.
Judith Langfield is a GP in Bristol and a
BMA council member
What I have learned about treating deaf patients