Communicating with Patients with Hearing Loss or Language Barriers: Skills Every Health Practitioner Needs

What should you ask at the start of the encounter?

Instead of relying on a “speaks Arabic” tick box, ask every patient which language they want you to speak to them in and which language they read, then record the answers in the medical record. That is AHRQ’s recommendation, and it warns against assuming that patients who do not speak the local language, including sign language users, will understand written notes. ^[3]

For hearing loss, NHS England’s implementation guidance for the Accessible Information Standard stresses that what should be recorded is the need and how best to meet it, not the disability itself. The word “deaf” on a record does not show whether the person reads written text, uses sign language or lipreads. ^[1]

The useful information may be a need for a qualified interpreter, a preference for a written message instead of a phone call, or a room where the speaker can be seen clearly. These needs are confirmed with the patient, not turned into a permanent assumption about everyone with the same condition. Never infer understanding from nationality, appearance or the presence of a companion.

How do you communicate with a patient with hearing loss?

Ask first what helps, and do not make raising your voice the default. NHS England’s guidance gives practical examples: keep your face and lips visible, do not cover your mouth with your hand or anything else, talk in a well-lit area, use a hearing loop for people with hearing aids, offer longer appointments or quieter times, and use a visual alert rather than calling names in the waiting area. ^[1]

Some patients need professional support, such as a sign language interpreter, a speech-to-text reporter, a notetaker or a deafblind manual interpreter. ^[1] Do not assume that lipreading or exchanging written notes suits everyone.

If the patient needs sign language interpreting, check that the interpreter’s sign language is the patient’s own, as sign languages differ between countries. If infection-control policy requires a face mask, arrange an alternative that allows communication without compromising safety requirements.

When do you need a qualified interpreter?

AHRQ defines a qualified interpreter as someone proficient in both languages who interprets effectively, accurately and impartially and follows interpreter ethics, including confidentiality. It warns against relying on clinicians or staff with basic or intermediate language skills, and advises confirming bilingual staff members’ proficiency before they communicate directly with patients. ^[3]

Family and friends should generally not interpret, because their presence makes a private conversation with the patient impossible. If the patient insists on a relative, respect the request but bring in a qualified interpreter as well to ensure accuracy. Minor children should never be used as interpreters. ^[3]

AHRQ recommends scheduling interpreters in advance for both in-person and video visits, using on-demand telephone interpreting for unexpected needs, and making sure the right equipment is available wherever staff talk with patients. ^[3] In the encounter itself, speak to the patient, not the interpreter, give information in short segments, and check understanding by asking the patient to explain the next step in their own words, rather than asking the interpreter whether they think the patient understood.

The same source distinguishes interpreters, who work with spoken or signed language, from translators, who work with written text. Forms and instructions need quality-controlled translation; where none exists, a trained interpreter can sight-translate the document into the patient’s language. ^[3]

How do you carry the need from reception to the consulting room?

The organisational problem starts when a need is recorded but never reaches the person delivering care. NHS England’s guidance sets out a sequence that starts with asking and ends with regular review, including flagging the need with a clear alert and sharing it in referrals, handovers and discharge. ^[1]

Then link each need to an action and a way of checking it, as in the template below:

Do not send sensitive data through an unapproved channel just because it is easier; identify the method available to the patient and use it within the facility’s controls. When a service moves from a face-to-face visit to a phone or video consultation, check that the support method still fits instead of carrying assumptions across automatically.

Hypothetical example: the patient who “does not respond” to calls

A hypothetical patient arrived for an appointment after missing several confirmation calls, and the system had labelled him “non-responsive”. At reception he explained that he has hearing loss and prefers written messages through an approved channel. The problem was not a refusal to engage; it was the wrong communication channel.

The receptionist recorded his preference in line with facility policy, flagged it on the record, arranged the right method for future appointments and told the team that the conversation needed adapting. At the end of the visit the team checked that he understood the next step. The example does not justify sharing the full record with every staff member; information is available only to the extent each role needs.

How do you respect the patient’s privacy and autonomy?

A companion being present does not mean questions should be directed to them, or that the patient has agreed to share everything with them. The patient’s wishes and the facility’s procedures determine what can be shared, taking capacity and legal representation into account where needed. In the UAE, for example, the charter states that a patient’s health information belongs to them and may be disclosed to a third party only with their permission or where the law requires, and that the right to consent passes to the legal representative if the patient lacks capacity. ^[5]

Before any sensitive conversation, such as a new diagnosis or consent to a procedure, check four things: the support method or interpreter is confirmed, sound or video quality is adequate for remote interpreting, the room protects privacy, and the patient has said who they want present.

For team training, ask participants to review a complete communication journey: booking, arrival, explanation and post-visit instructions. Each participant identifies a point where the system assumes the patient can hear the phone, read a text or understand a particular language, then proposes a workable alternative. This is a service-design exercise, not a simulation of living with a disability.

Which references apply in the Gulf?

References differ by country and health authority, so one country’s text should not be applied to another:

• Saudi Arabia: the Ministry of Health’s general rights page states that patients are entitled to have the treating doctor explain their condition in a language and manner they understand, to an interpreter if the doctor does not speak their language, to have no unrelated person present during examination, and to know the proposed treatment measures. ^[4]
• UAE: the Patient’s Rights and Responsibilities Charter, issued by Ministerial Resolution No. 14 of 2021, requires health facilities to provide translation services for patients who cannot understand the physician’s language, to explain illness and treatment in simple, understandable language, to protect patients’ privacy and data, and to obtain informed consent. ^[5] Facilities in each emirate should also check the requirements of their local health authority.
• Other Gulf states: facilities should check their own national health authority’s rules and the language services available.

It is also important to be clear about the scope of international references. The NHS Accessible Information Standard focuses on needs linked to disability, impairment or sensory loss and states that interpreting or translation in a language other than English is outside its scope. ^[2] That is why this article combines the accessibility reference with AHRQ’s guidance on language differences, without treating them as a single requirement. ^{[1, 3]}

Conclusion

Ask rather than assume, and record the need in a form that lets the next person act on it. Use a qualified interpreter for clinical information, check understanding with the patient directly, and follow your own country’s health authority framework.