Can a deaf person specialize in emergency medicine? Part 1 (Note: I recommend this topic for everyone interested in increasing intelligence and creativity.)
Q: I just found your site and am totally hooked by it. I happened to jump into the emergency medicine world. I became obsessed with it. One problem is that I am deaf, and I don't speak nor hear at all. Obviously, I am fluent in American Sign Language. There is a stethographics device that you don't need to hear, but just reading the results on the machine. You can have a pager that gives you different vibrations for "on call", different colors for "CODE", etc. You have to be with an interpreter who is knowledgeable about medical terminology. There are approximately 40 deaf doctors in the USA. I really want to be a physician. I am a good college student myself, but I have been strongly discouraged to become an ER physician because of my deafness; they suggest working in other specialties in which I don't need to "TALK" with many patients everyday. I strongly want to study emergency medicine which surprises many patients who come to the hospital and approach a deaf physician. Please be honest with me, do you think I can be a physician with my deafness? Can I be a successful physician in the ER? I would really appreciate your reply. I am really helpless with the ignorant medical world.
Answer by Kevin Pezzi, MD: I admire your resolve, but I think that being deaf imposes insurmountable obstacles that contraindicate a career in emergency medicine. Here's why:
- In the ER, seconds can make the difference between life and death. The need to communicate through an interpreter will impose a bottleneck that inevitably hinders how fast you can send or receive information.
- One skill that emergency physicians must possess is the ability to quickly establish rapport with a wide range of patients, from screaming drunks to corporate CEOs, and frightened youngsters to irascible septuagenarians. Rapport is a relationship of mutual trust or emotional affinity; hence, it is a two-way street. Even if you could quickly bond to your patients, I think that many of them will have more difficulty forming an instant connection that is so vital in the ER.
- More than a few patients will undoubtedly object to having another person—the interpreter—made privy to their secrets.
- Having an interpreter interface with others on your behalf poses a number of medicolegal pitfalls for you, your employer, the hospital you work in, your insurer, and your interpreter—who would almost undoubtedly be dragged into every lawsuit you face. Who would pay for the interpreter's malpractice insurance? Would an ER interpreter be able to obtain insurance?
- Even if your interpreter knows medical terminology, that person could not possibly communicate everything of importance to you unless he or she was also trained as an emergency physician. The cacophony of sounds in an emergency department is an important clue that helps the ER doctor keep his finger on the pulse of the ER, so to speak. Without that auditory link, you could not possibly keep abreast with what is happening in other parts of the ER. There are so many sounds from so many sources that your interpreter couldn't communicate all of them to you even if that was all he or she did. Furthermore, sound is an important diagnostic clue. Stethographics can help you interpret heart and lung sounds, but it won't tell you that the cry of the baby just brought into a room down the hall sounds too shrill to be normal; perhaps that child has meningitis and needs a spinal tap now, not two hours from now when you might otherwise get around to seeing that patient.
I could list other reasons, but the ones above are sufficient justification for choosing another specialty. Ultimately, the deciding factor hinges not on what is best for you, but what is best for your future patients.
However, before I say "NO" unequivocally, let me acknowledge that every doctor is a person with his or her own strengths and weaknesses. A physician's overall ability depends on the balance between the two. Therefore, while your deafness will handicap some aspects of your performance, perhaps you possess other abilities that more than make up for that problem. For example, perhaps you are a gifted emergency diagnostician—so talented that the net result of having you treat patients would be positive. If that were known in advance, then I would be less pessimistic about you specializing in emergency medicine. However, such a skill usually isn't evident until one becomes an ER doctor. Sans a crystal ball, I think that you or, more to the point, the people who decide which residents to accept, would therefore have a difficult time justifying why a career in emergency medicine was the best choice for you and the 100,000-plus patients you would treat in your career.
Q: I accepted the fact that it is about PATIENTS, not ME.
A: I am glad to see that you are bright enough and mature enough to realize that patient needs must always take precedence over the desires of healthcare practitioners. Aside from the obvious ethical considerations, this 1 practitioner to 100,000 patient ratio strongly favors doing what is best for patients. I mentioned this subject in my other ER site in a discussion of why I think that PAs (Physician Assistants) and NPs (Nurse Practitioners) have very shaky justification for abbreviating their educations. What they're doing is legally permissible, but not ethically permissible, for the reasons I presented (the PA discussion begins with the third topic down from the top of that page).
Q: I know that my deafness would pose problems if I worked in emergency medicine, as you mentioned. Can I leisurely read emergency medicine?
A: Definitely! The only thing better than a thirst for knowledge is satisfying it. I am a fervent proponent of lifelong learning about a variety of subjects.
Q: I am a college sophomore, majoring in French. Can you tell me the other specialties that I might consider? I am thinking about radiology or cardiovascular surgery.
A: I don't think that any surgical specialty is a viable option because surgeons must verbally communicate with other members of the operative team throughout surgical procedures. It would not be practical for you to put down whatever instruments are in your hands, communicate via sign language, and then pick up the instruments again to resume surgery. Just as in the ER, seconds count during surgery. Radiology and pathology would be much better choices.
Q: Please help me! I refuse to give up on studying medicine. It is my world! On other hand, can I meet you in person? I really admire you. You are my only hope to decide whether I should attend medical school. My parents are deaf themselves, and they do not want me to attend medical school at all. They don't want me to face discrimination like they did in high school.
A: Avoiding medical school won't shield you from discrimination. Humans seem to have little difficulty thinking of 1001 reasons to discriminate against others. If someone looks different, speaks different, doesn't drive the "right" car or live in the "right" neighborhood or house, that alone can make others shun him or her. Ultimately, I think this stems from xenophobic tribalism. Such tribalism engenders isolation, which begets more tribalism. The only way I know to break this vicious circle is to cross the invisible boundaries that people and groups put up around themselves to distance themselves from ones who are "different." If you acquiesce to that distancing, it will only reinforce and perpetuate the bias that fuels their xenophobia. Therefore, while you will always face discrimination, it can be mitigated to some extent if you break through the divisive barriers that isolate people. Ergo, I support and applaud your determination to attend medical school.
If we were to meet, then you would discover one of my weaknesses, which is writing. I am a slow and inept typist, which may be difficult to believe given the number of books and web sites I produced, but it is true. I imagine that learning sign language takes months, correct? Incidentally, that reminds me of a deaf contestant I recently saw on American Inventor. His brothers refused to learn sign language, so he was isolated from them. If I had a deaf brother, sister, or friend, I would make the effort to learn sign language because I wouldn't want to be isolated from that person. For a brother to essentially write off another brother just because he is deaf is a sad reflection on how lazy and self-centered the brothers with hearing are.