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If you have any questions, comments, or suggestions related to pharmacists with hearing loss, please contact: Dan Sheridan at pharmacy@amphl.org.
Table of Contents
ABOUT PHARMACY
GETTING INTO PHARMACY SCHOOL
Preparing for and applying to Pharmacy School
- 1) Before we begin
- 2) "Is this really what you want to do?”
- 3) How much college do pharmacists need?
- 4) How do I apply to pharmacy school?
- 5) Can I meet the technical standards of my field of interest?
- 6) How do I maximize my verbal test scores?
- 7) Whether and how to disclose one's hearing status during the application process
- 8 ) The Interview
- 9) If I suspect discrimination, what am I to do?
PHARMACY SCHOOLS
BEFORE PHARMACY SCHOOL STARTS
- What Now? Do I need to do anything before school starts?
- Self-Introduction
THE CLASSROOM YEARS
- How do I get the information?
THE CLINICAL ROTATION YEARS
- Using the telephone or compensating for the inability to use it
- Pagers
- Interpreting services
THE FIRST JOB
- Applying for that First Job
- On the Job
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ABOUT PHARMACY
Pharmacy is a fun, but challenging profession. A pharmacy degree requires six to eight years of college. Pharmacists must also gain work experience and pass a licensure examination before being permitted to practice. The field of medicine is constantly changing, so pharmacists must be life-long learners. They must also have a strong desire to help others, and must combine good science and interpersonal skills.
Pharmacy is a clinical profession. Many hospital pharmacists have the job title “clinical pharmacist”. There are many different areas of work in pharmacy: hospital, community, industry and education/research. Many pharmacists go on to be managers. Some specialize in medical writing or work in drug information centers. Most pharmacists working in community and hospital pharmacy have direct contact with patients.
Working conditions vary from situation to situation. Even different hospitals have different situations. Pharmacists must keep abreast of the many different drug names – both brand and generic. They must be proficient in the use of computers. They must be able to communicate with others – other pharmacists, healthcare providers and patients. Interaction in large groups (for example meetings, ward rounds, attending emergencies on wards) may pose a communication challenge. Patient contact would include: handing out prescriptions, giving advice to patients about medicines – both prescribed medicines and over the counter sales; conducting medication reviews; running anti-coagulant clinics and taking part in hospital ward rounds; conducting health checks in the community pharmacy (i.e. blood pressure monitoring and blood tests for diabetics). Some pharmacists in the United Kingdom have recently qualified as pharmacist prescribers and now see patients and are allowed to prescribe certain drugs for them.
The main problems a deaf or hard of hearing pharmacist faces are taking telephone questions from patients and medical staff and the group situation on ward rounds, when it is difficult to follow conversation. Different accents and different speech patterns can cause problems in following conversations as can noise levels caused by surrounding chatter, background music, alarms etc. It is best if drug names can be written down to avoid confusion and inaccurate information.
Some pharmacists may need to use stethoscopes for blood pressure monitoring as part of a “mini physical exam”. However, most pharmacists do not use stethoscopes. (There is an excellent discussion of stethoscope options elsewhere on the AMPHL web site).
Pharmacy can be a good profession for someone who is deaf or hard of hearing. There is such a variety of work environments that it‘s relatively easy to find one that is a good fit. It’s also helpful that there is (at least in the USA) a serious shortage of pharmacists. Once licensed, a pharmacist is virtually assured of a job.
Getting into Pharmacy School
Preparing for and applying to Pharmacy School
1) Before we begin
The AMPHL pharmacy guidelines were written based on collective experiences of deaf and hard of hearing pharmacists. Everyone with deafness or a hearing loss is different. Some have more hearing than others. Some feel more comfortable setting limits for themselves, while others plow headlong into working environments that are more challenging for those who are deaf or hard of hearing. Some are very much a part of the Deaf culture, while some have been raised in a strictly oralist fashion. All of these differences affect who we are and how we approach challenges. It is important to AMPHL that we respect the feelings and viewpoints of people with different experiences. AMPHL strongly encourages others to share their experiences and to give constructive criticism regarding our pharmacist guidelines so that we may continually make improvements.
The most important thing to remember as you read these guidelines is that you can do anything you want to do. Never let anyone else tell you that you cannot do something because you are deaf or hard of hearing. You should be the one to decide what your capabilities are.
We will not mislead you. the road has not been easy for deaf and hard of hearing people working in health care fields. It took courage, perseverance, and strength. Many times we became discouraged and almost gave up. We persevered and succeeded. Because of this, we take pride in what we have accomplished. For us, things turned out to be well worth the effort. We are members of a profession that we love, and we are doing the kind of work we have always wanted to do. Now we want to help others aspiring to follow in our footsteps and encourage them to follow their hearts and their dreams. We are proof that it can be done, and we want to share our experiences with you in hopes that you can learn from the challenges we faced, the obstacles we overcame, and the mistakes we made. We hope that you will not become discouraged from reading our guidelines. We wish to describe our paths and paint a realistic picture. Rather we hope you become inspired and even more determined to pursue your goal of becoming a pharmacist. Remember that you can do anything you want to do!
2) "Is this really what you want to do?”
You can do anything you want, but are you sure you want to be a pharmacist? You need to have some exposure to the profession. Volunteer or find jobs at retail pharmacies, hospitals, anywhere you can get valuable hands-on experience. This will help you decide what you want to do and will show the admissions committees that you have tested the waters and are still committed.
3) How much college do pharmacists need?
In the USA, pharmacy colleges vary in the number of years that it takes to complete the program. Most colleges now require a minimum of six years of study, leading to a PharmD (Doctor of Pharmacy). There are also seven and eight year programs. For example, an eight year program may require a four year degree in another field, followed by a 4 year pharmacy degree.
In the USA, pharmacists must also comply with the licensing requirements of their state. For example, Ohio requires that applicants have 1,500 hours of work experience in a pharmacy before being permitted to take the exam for pharmacy licensure. In the United Kingdom, after gaining an M.Pharm. Degree, the graduate undertakes a pre-registration year in hospital, community, or industrial pharmacy.
4) How do I apply to pharmacy school?
Each pharmacy school has its own application process, but a common thread is the requirement to take the PCAT (Pharmacy College Admission Test). This is a test consisting of 280 multiple-choice questions and an essay. Applicants are given four and ½ hours to complete the test. The test measures skills in Verbal Ability, Biology, Reading Comprehension, Quantitative Ability, and Chemistry.
When selecting applicants, a typical college of pharmacy will consider the PCAT score, letters of recommendation, academic performance, and a personal interview.
5) Can I meet the technical standards of my field of interest?
There are often what are known as "technical standards” among pharmacy schools; these are intended to outline what a person must fulfill in order to succeed as a pharmacist. These usually involve five areas: observation, communication, motor/movement, intellectual/conceptual, and behavioral/social abilities. One can easily find examples from various pharmacy schools online by searching for “technical standards” and “college of pharmacy.”
Admissions committees use technical standards to judge qualified individuals with a disability. Some schools enforce very restrictive technical standards. Other programs are more willing to consider how a given individual can compensate for a challenge. It could be worthwhile for you to learn about the technical standards of some of the schools you are considering. Be prepared to explain to the admissions committee what accommodations and technical devises you will need for accessibility. Remember that it is the responsibility of the university to provide the accommodations; the person needs to take responsibility for asking for the accommodations they need and for meeting with the Office of Students with Disabilities, etc. but the actual accommodations are the responsibility of the university.
The most common concerns that admissions committees have are:
- How you are going to communicate with patients in person and over the phone
- What accommodations, technical devices, etc, you will need and use to ensure accuracy in prescription orders.
- How you are going to obtain the information that is presented in the classroom, in labs, and in clinical rounds
- Note: Please see our sections on the classroom and clinical years. Answers to these tough questions do exist, even for those who are deaf or profoundly hard of hearing.
6) How do I maximize my verbal test scores?
The PCAT is a part of the application process, and it includes a test of verbal reasoning skills. Some individuals are fortunate that these tests do not present a problem. However, some individuals who became deaf or hard of hearing at the early stages of language development might not have had exposure to the full range of language complexity. Speech therapy might have trained you to develop strong speaking skills, and your English coursework might have honed your writing skills; but they do not necessarily cover the types of skills being tested on standardized measures. You might need more time to process the verbal reasoning questions. In this case, taking the graduate entry examination, in part or in whole, without time limits is the solution. (The drawback to this is that it will be disclosed to the admissions committee, who may look unfavorably upon it.) For others, an explanation to the admissions committee that the verbal reasoning section does not accurately reflect your language skills would suffice. Consider asking your audiologist or counselor to write a letter on your behalf. You may wish to obtain an interpreter for the test day to assist with instructions and registration.
There is an organization called National Task Force on Equity in High Stakes Testing for deaf and hard of hearing people. Members of this committee look at the verbal, linguistic and cultural biases of testing and the low performance of deaf and hard of hearing people on these types of tests (SAT, standardized testing, professional certification and licensing examinations) http://gri.gallaudet.edu/TestEquity/index.html Health professionals are included in this.
7) Whether and how to disclose one's hearing status during the application process
Some of us may not be accustomed to open disclosure of the fact that we are hard of hearing or deaf, others openly and visibly acknowledge this. We all want to be judged on our merits. We do not want being deaf or hard of hearing to be used against us or for it to be a liability issue. By the same token, if we are not honest with the admissions committee, it could backfire. It is very difficult to hide being deaf or hard of hearing. If the admissions committee finds out from someone else that you are deaf or hard of hearing, it may be a negative reflection on you that you were not direct with them and were unwilling to address the issue. Even if they do not find out, the admissions committee may not recognize that you have to work harder than many of your hearing peers and thus fail to give you credit for your work ethic and discipline. In the end, you are your own best advocate.
For many pharmacy college applications, a personal statement or essay is required. Generally, the applicant is given free rein in how to structure the essay; it is here that applicants are given an opportunity to reveal more about their personal aspects which are often not clear in transcripts or a curriculum vitae. One’s motivation to enter the field of pharmacy is one of the generally expected topics. If you are deaf and would like to disclose it, the essay is an ideal place to do so, as you may explain in detail how you prefer to communicate and possible ideas you may have for how you will carry out your duties as a pharmacy student.
Another option is to include, with your application, an additional letter that describes your deafness or hearing loss and how you plan to be successful. Discuss technologies (e-mail), devices (computer, hearing aids, TTY), simple alterations, etc., that will allow you to perform effectively on the job It may be helpful to have a faculty member, dean, or advisor - someone who knows you well - call those schools and vouch for you. At the very least, talk with the dean of your school about your situation. At the end of your letter, encourage the admissions committee to contact the dean, your advisor, or you with any questions.
It's important for candidates to be able to assert what they need and be confident and not be coy about being hard of hearing or deaf. Admissions committees would prefer to see an application from someone who knows what they need to succeed and knows they can succeed, and who can confidently and comfortably help their school and faculty work with them, than someone who is coy, uncertain and not assertive or positive about their needs and capabilities. Faculty will worry they won't know what to do to assist. It is not uncharted territory, and there have been other deaf or hard of hearing pharmacists who have succeeded
The question of disclosing that one is deaf or hard of hearing remains a controversial one. The admissions committee still may wonder if you will succeed in a demanding academic environment. They may feel threatened by the effort and expense of the accommodations you may require. While federal legislation makes discrimination on such grounds illegal, it cannot overturn discriminatory attitudes. The committee may simply rank you lower on its list of candidates and rank other candidates as being more attractive.
8 ) The Interview
Many interviewers have little or no experience working with individuals who are deaf or hard of hearing. They may not feel comfortable while interviewing you and may fail to address their reservations with you. By law, a potential employer cannot discriminate against applicants based on disability, so interviewers are discouraged from raising the issue during an interview. But if their concerns are not addressed, their initial bias may lead them away from offering you a position. If your deafness or hard of hearing status requires significant accommodations, you might want to set the tone and ask if anyone has any questions related to how they will communicate and how you will perform the functions of your job. Put them at ease. Describe your hearing in a positive context. Explain how you compensate and how you plan to meet the technical requirements of the program. You want to come across as being a determined and confident person who would make an excellent addition to their program.
Decide in advance how you will communicate in the interview. Make an appointment with the university's Office of Students with Disabilities in advance of the admissions interview and find out what kinds of services they have available and how they can help with access. They should be able to help you obtain an interpreter or CART provider. For example, at Ohio State University, the Office of Students with Disabilities works to educate the faculty on all that is involved.
Consider taking the initiative and setting up the room so that your interviewers are away from the glare of windows, and perhaps in a semi-circle.
9) If I suspect discrimination, what am I to do?
Ask your interviewer or admissions committee why you were not selected and what you can do to improve your candidacy for other interviews. You may or may not receive useful information, but at least you have a starting point. Ask your dean or advisor to look into the matter. Go to the Disabilities Office on your campus. Contact professionals in your field of interest who are deaf or hard of hearing.
PHARMACY SCHOOLS
Below is a list of colleges of pharmacy which have graduated an individual with who is deaf or hard of hearing, or who have such a student currently enrolled in their program. This list is provided due to interest expressed by pre-professional students.
:. Bradford University(UK)
:. Manchester University(UK)
:. Aston University(Birmingham, UK)
:. John Moores University(Liverpool, UK)
:. McWhorter School of Pharmacy - Samford University
:. The Ohio State University College of Pharmacy
:. University of California, San Francisco
:. University of Toledo
:. Victorian College of Pharmacy at Monash University(Australia)
If you know of any other pharmacy schools not listed above, please contact the webmaster with the school name, the name of the student, and the year of graduation. AMPHL presents this list with several cautions:
• This list is by no means comprehensive.
• Some of the pharmacists who graduated from these programs, if they are not still students, may have graduated a number of years ago. The programs, faculty, staff, and services may have changed since then.
• We strongly believe that everyone's educational experience is unique. While one person may have felt a program met all their unique accommodation requests, another may have a vastly different experience. For some, a previously graduated pharmacist who is deaf or hard of hearing may help pave the road; for others, it may make no difference in their experience.
• While this list represents programs that have or have had a student who is deaf or hard of hearing, it does not represent an endorsement of the program nor a guarantee that they accommodate those who are deaf or hard of hearing.
AMPHL's recommendation
Contact schools in which you are interested based on factors such as quality of program, location, reputation, etc. Then schedule a meeting with the appropriate faculty member or the Disability Office to discuss your accommodation needs. Apply to the school that feels best to you regardless of whether they have graduated a pharmacist who is deaf or hard of hearing.
BEFORE PHARMACY SCHOOL STARTS
What Now? Do I need to do anything before school starts?
Be prepared. If you want people to be on your side, you have to reach out to them first. Meet with the school's office of student affairs, the dean of students, and the office of disability or diversity. Introduce yourself and tell them what you need. If needed, write a one-page self-introduction (see below for an example) which explains your needs; review this in person with the staff. Even if you do not want any special assistance, you should still introduce yourself and mention to your professors that you are deaf or hard of hearing. Thus, the instructors will not think you are rude for not responding if they talk to you when you are not looking at them; they know that they need to make a special effort to communicate when they call on you in class; and so on. The Disability Services department at the university may have a brochure that they give to professors in advance of the class, such as this one from The Ohio State University.
Show the staff your assistive listening device, if you use one. Microphones may already be used because lecture halls are sometimes big enough to make them necessary for hearing students as well. No matter what special accommodations you use, it is a good policy to introduce that means of communication early on.
It may be a good idea to tell the faculty that if they feel something is not working or if you are not performing to their expectations, you want to know right away. You cannot afford to wait until the end of class and find out through a bad grade. People do not like to say negative things about others, so you may need to reinforce the idea that you are open to all constructive criticism. As the course or rotation progresses, the faculty may have suggestions or ideas for doing things in a better way. Be open to such advice; ask for such ideas if a challenge arises. For example, one person was in a course where two faculty members interacted in front of the audience, and she did not know how to listen to both of them. One of the faculty members helped her to set up two FM systems in a novel way so that she could pick up both of them through one receiver. Others may need to individualize their accommodation needs in this type of situation, such as requesting portable CART services or an interpreter.
Self-Introduction
To: Staff involved with (course/rotation)
From: (your name)
Regarding: Deafness (or Hearing loss)
On (date), I will start participating in (course/rotation). As you may know, I am (deaf or hard of hearing. I want to make you aware of communication skills which best enable me to interact with others.
1. In order to understand what you are saying, I must be able to see your lips since I rely heavily on speech reading. Please get my attention prior to talking with me so I may be able to fully concentrate on what you have to say.
2. During certain situations, I may utilize an assistive listening device that involves the speaker wearing a small receiver on their belt or pocket with a small attached microphone. This device decreases my need for speech reading and help in situations with large groups and background noises.
3. It is difficult for me to follow group discussions. If you are leading a discussion, rephrasing others' questions or comments is extremely helpful to me since my attention will be primarily on you. Similarly, identifying one person to lead a discussion or give an explanation (rather than several people) is beneficial to me since it takes me a few seconds to locate and reorient on a new speaker. During that lag, I may miss important information.
4. I may need to ask questions of you or my classmates in order to clarify things I have missed. I try to ask such questions at appropriate times.
5. Unfamiliar words are difficult for me to grasp and understand. I may ask you to rephrase the concept with different words or to write the word out for me. Similarly, I will often repeat important information back to you to assure myself that I heard you correctly, such as medication dosages, so that I will not make an inadvertent mistake.
6. Please feel free to approach me with questions or suggestions you may have. This rotation will be an experiment in progress. Several staff members in previous rotations have suggested solutions to problems they perceived that helped immensely and improved my performance/communication ability.
I look forward to this (course/rotation) and working with the staff!
Sincerely,
(your name)
THE CLASSROOM YEARS
How do I get the information?
At some universities, most professors put their PowerPoint slides and lecture notes on their course pages on the web. Many Universities use "Blackboard" or other technologies that allow students to obtain course information (notes, announcements, assignments, etc.), participate in on-line course discussions between classes, submit assignments, and participate in virtual office hours. So one thing students might want to consider is the state of the art of the technology available at the universities they are applying to as this can be very helpful to deaf and hard of hearing students in hearing universities.
In pharmacy school, one must absorb a tremendous volume of information. If you are deaf or hard of hearing, there is another challenge: how to listen to a lecture and write down all that information. There are a number of options for note-taking services:
• Copy your classmate's notes (you can obtain carbon-less copy paper to eliminate the hassle of making photocopies).
• The school may hire a fellow student to take notes for you.
• Your class may organize a note-taking service where they take turns taking notes for each class and get reimbursed for a small fee (everybody pays $40-$100 up-front and receives very thorough, typed notes).
• During the classroom years, many professors develop pre-printed syllabi which are sold to the students for a fee. These syllabi often contain the lecturers’ PowerPoint slides and relevant graphs or text. Such syllabi can be invaluable to any student, hearing or deaf.
What if you cannot follow what is being said in the first place? Sign or oral interpreters are an option. Oral interpreters silently enunciate what is being said with only a little lag time and may use signs to supplement their transliteration. Check with your school ‘s Office of Disability Services to see if has worked with interpreters before. Contact the Registry of Interpreters for the Deaf (RID) to inquire about interpreter referral agencies. The Alexander Graham Bell Association has a national listing of individual oral interpreters, which is not always up-to-date and does not tell you about each person's credentials.
When the lights go out for slide review, the speech readers have lost their ability to follow. The low-tech solution is to get a lamp installed on the lectern. The high-tech answer is real-time captioning (also known as Computer-Aided Real-Time Captioning or CART). A stenographer types what is being said into a stenographer machine which is hooked up to a computer; the computer software transcribes the stenographer language into English that is scrolled on the screen. You can read what is being said with only a little lag time. When you have a good real-time captioner, this can be an incredible experience. Check with your school or other students who are deaf or hard of hearing in your area to find out about local CART services. If you do not know where to start, there is a web page for CART reporters, CARTWheel, which may prove to be a valuable resource. Remote captioning is an option for those who train in areas where there are no local services. In this case, the CART reporter and user are connected through computers over a phone line in conjunction with either another phone line or an internet connection. The CART reporter listens to a lecture with a microphone that is connected to an phone line and his transliteration is transmitted over the modem or network connection to the user's computer.
There are challenges to consider when using interpreters or CART services. The quality of service is variable, given differences in training and accreditation. Currently, there is no national accreditation for CART reporting. The numbers of CART reporters (also known as captionists) are small as the technology is relatively new. Many are court stenographers who want to expand their businesses. Still fewer are specifically trained and certified for CART services for individuals who are deaf or hard of hearing. The interpreter or captionist may have never encountered such a sheer volume of information and complexity of medical terminology. He will have to read the class syllabus or something comparable before each class. The captionist will need to input all new words into his software dictionary so that whatever he types in steno will automatically be transcribed into English for you. In two years of medical school, one doctor reports that his captionist amassed over 25,000 words in her medical school dictionary. As you can imagine, few people have the temperament and work ethic to take on that kind of a job! You may have to try out a number of reporters before finding one who works well with you.
It is very important to have a good sense of self-awareness as you enter this challenging program. Often people need assistive devices, but don’t realize it. Other times they are not aware of what is available or how they can benefit. We strongly recommend a visit to the Disability Services Office prior to enrollment. You may be surprised by what is available and how you can benefit.
One deaf graduate student reports that she was very fortunate during her Ph.D. program to have a consistent interpreter who was also a graduate student and had already taken statistics, research, etc. She had a very good scientific mind and was highly qualified to interpret the course work. It is a good idea for you to ask around for recommendations for specific interpreters who are qualified with the necessary vocabulary, etc. It is very helpful also if you can have the same interpreter throughout a course. It's not often that you can find a well qualified interpreter that is consistently available for all your courses. You may find that your performance may fluctuate with the capabilities of your interpreters.
THE CLINICAL ROTATION YEARS
Most, if not all, pharmacy programs require that the student spend a year or more rotating through different practice sites. For example, one program assigns the student to a different site each month for a year. Sites may include large and small hospitals, retail pharmacies, home care pharmacies, nursing home pharmacies, pharmaceutical manufacturers, and warfarin dosing clinics. These rotations are valuable in helping students to learn about a variety of practice sites, and to learn of the career opportunities in each field.
During some rotations, pharmacy students may make rounds with interns, residents, and/or faculty on their team's cases. Typically, the team stands outside of each patient's room. The intern or student responsible for the patient's care will discuss how the patient is and give the latest updates on the case. Everyone has an opportunity to visit each patient. Then a plan for the day for each patient is formulated.
Rounds can be frustrating for those who are deaf or hard of hearing and it is often hard to learn from cases other than your own. The person speaking is not always going to be looking in your direction, even if you repeatedly ask the group to try to face you when they are talking. The group is usually pressed for time and cannot slow down to keep repeating things for you. There is usually a lot of background noise which makes it hard for even hearing people to follow the discussion. To make the most of your experience on rounds, you need to become more assertive. Tell people to speak up, to face you as much as possible, and to slow down when necessary. You are not always going to get what you want, but the more persistent you are, hopefully the more people will remember to do those things which will help you. Sometimes when things are happening too quickly and you are lost, a colleague, if asked, will repeat some major points for you.
An FM/microphone system may be helpful in selectively amplifying the conversation of interest over the incessant background noise. When choosing a FM system, you may want to get one that has the option of "zoom" amplification which focuses on just one or a few speaker(s). Also, in a standing group conversation (as in work rounds), you might like the option of holding the transmitter/microphone yourself instead of having different speakers pass it around. (Check the web links on various FM/microphone systems.)
Sometimes the group is just too large or the dynamics of the conversation are too much of an obstacle. Interpreting services, whether signing or oral, may prove to be the solution. Try to find interpreters who have already worked in a hospital setting. It’s very helpful to consistently have the same interpreter. The complex medical terminology and the speed of communication are tough for lay persons, let alone for you. If you cannot find someone who qualifies, you may have to do some job training of your own. Another option is to take the time to read patient's charts before and/or after rounds and ask questions about things you do not understand.
Using the telephone or compensating for the inability to use it
A hospital is a big place. The phone system has become crucial, as one needs to be able to contact others (such as physicians, nurses, and other pharmacy employees) efficiently and effectively. Unfortunately for us, the telephone is a prominent feature in the health care setting. It is frustrating to see other people do something effortlessly that is so difficult for us.
A number of hospitals have phones which are volume-controlled. If not, push for amplified phones in areas where you will be working. You may also need to request telephones compatible with assistive devices such as HATIS or cochlear implant telephone jacks. If you cannot use the telephone, request to have a telecommunication device for the deaf (TDD) placed at suitable locations. Some telephone companies may be willing to cover the cost of one TDD that you select from their regional dealers.
A TDD may be utilized in one of several ways. More traditionally, you may type messages back and forth with someone else who also has a TDD. If the other person does not have one, you need to call an operator in your state's Relay system. The operator calls the person you want to contact, transcribes what she is saying to your TDD digital screen, and if necessary, will voice your typed responses. Thirdly, you may use Voice Carry Over (VCO) where you speak for yourself into the headset but the relay operator still transcribes what the other person is saying to your TDD digital screen. If you have access to conference calling, some medical professionals utilize two-line VCO. In this situation, the operator is more of a silent partner. You can hear what the other person is saying and speak directly to the person you called. At the same time, the relay operator is transcribing what the other person says into your TDD digital screen. If you miss hearing a word, you can then glance down and fill in the blank.
Communication is slower with relay, as you are going through a third party who is unfamiliar with medical terminology. Many people often mistake relay for a telemarketer and hang up. Despite this, most people are very understanding about going through relay and do not have a problem with it. Explain the relay system to hospital staff and patients/clients ahead of time if you know that you will be giving them a call. You may want to take into consideration that using a TDD may take longer than having someone else make a fast call for you or making a quick dash down the hall.
Other relay services are available online, including text relay and video relay. Online text relay services can be accessed with a web browser; the process is identical to TTY relay services except that a computer takes the place of the TTY. Those who prefer sign language might prefer video relay services, which require a computer and webcam. By accessing the proper sites with a browser and turning on the webcam, a video relay interpreter can interpret a call for you. Many video relay services now have VCO capabilities as well. (See our relay links for more information.)
Another option now available in the USA is the CapTel telephone. This is similar to the Voice Carry Over option described above, but the calling assistant speaks to a voice recognition program, which then displays captions on a screen for you.
Another way to deal with hospital communication is a text pager. Hospital staff will be able to leave messages with an operator, who will transcribe them into a digital read-out on your pager. Your coworkers can also sometimes send messages directly to your pager from the paging company’s web site. If your pager is a two-way pager, you also can type short email messages on its built-in miniature keyboard. Please see the next section on pagers for more information.
Interpreters may be able to help you with phone calls too. They may listen for you and interpret what is being said; you may respond directly into the phone headset if you communicate orally or sign to them and allow them to translate to spoken English.
Pagers
Most hospitals use overhead paging systems. Obviously this may not work for the student who is deaf or hard of hearing. A possible solution is to use a vibrating pager and have people page you directly. Set up a code beforehand and explain it to the front desk, hospital staff, and your team members. For example, "1" may be "call this number" (followed by the number for you to call); "2" may be "go to the front desk;" and "3" may be "go to ___." Another idea is to set up a code based on the level of urgency, where "1" is urgent and "3" is less pressing.
Current paging technology has evolved to the point where there are numerous options for communication. Some of the latest text pagers on the market (Sidekick II by T-Mobile, Ogo by AT and T, RIM 950 by Deaf Wireless, to name a few) allow you to utilize e-mail, instant messaging, text messaging (cell phone to cell phone messaging) and in some cases, internet-based relay services (essentially the same as using the relay on a TTY) for your communication needs. More advanced devices such as the Blackberry line of PDA’s and the Treo line of “smart phones” combine similar capabilities with the addition of PDA features. Many large hospitals, universities, and organizations contract with companies such as Sprint or Verizon, so you may want to contact the department responsible for coordinating such services and find out which devices are offered through the existing plan before purchasing a pager.
Deaf Wireless offers its clients a voice message service that allows hearing people to call the pager user and leave a message (transcribed to text by the service) on their pager. Communication Service for the Deaf, Inc. (www.C-S-D.org) provides a similar service for virtually any text pager.
Interpreting services
Interpreting services can be very helpful and even necessary for many of us. We have already discussed contacting the appropriate officials ahead of time. If you encounter resistance when requesting such services, be diplomatic. Explain how interpreting services help you to learn and work effectively, as well as make things easier on those with whom you work. Point out that interpreters are covered under "reasonable accommodations" as stipulated by the American with Disabilities Act (ADA). You can work with the program in several ways:
Help the program determine the criteria by which your interpreters are selected, if possible. When you can, interview interpreter candidates ahead of time. Traits such as willingness to work long hours, ability to master large amounts of vocabulary, and ability to deal with stressful situations and rapid group conversations can be invaluable in the long run. Consider the overall ability of individual interpreters rather than just looking for the highest credentials. Someone who is enthusiastic and willing to work hard may be easier to train and work with than someone who is set in their ways. Look for interpreters who have a science background or have worked in medical settings before. For those who are interested in oral interpreting services, keep in mind that some nationally-certified oral interpreters offer two- or three-day training programs for relatively new interpreters. Be assertive if an interpreter is not working out; a bad interpreter can be a major liability when you are making decisions that affect patient's lives.
Contact faculty and staff members ahead of time to let them know there will be interpreters present and what their role will be. Ask for copies of syllabi, hand-outs, course packets, and any useful texts for the interpreters so that they know what is going on during a given day and can look for unfamiliar vocabulary ahead of time (or even during a free moment when the medical team stops talking for a few minutes). Buy them a medical dictionary or vocabulary book. Set up a schedule to go over unfamiliar medical terms with the interpreters on a regular basis. This will allow you to come up with abbreviations/signs for those rapid-fire lectures and discussions where finger spelling every other word becomes logistically impossible, as well as provide a time where you can fine-tune things such as professional expectations (interpreter code of ethics, etc), positioning during rounds and surgery, how to handle radiology readings, etc.
If you are lucky enough to attend a program where interpreters have been used before, ask around and find out if the student(s) or interpreters have any suggestions.
THE FIRST JOB
Applying for that First Job
We already discussed at length the question of whether or not to disclose the fact that you are deaf or hard of hearing during the application process. The AMPHL directors understand that there is no one approach to this question. If you have an obvious deafness or hearing loss, or one that necessitates significant accommodations, you will have to come to a decision on when to disclose this information. Some individuals feel the need to be upfront from the beginning; others will want to avoid negative stereotypes and misconceptions from being formed prematurely. You are screening potential employers as much as they are screening their applicants. If one does not want to work with you, why work with that person?
During the interview, check out the work environment. Can you comfortably hear in the hallways and in the clinic rooms? Is there technology in place that would make it easier for you to institute your accommodations? How many people will you work with at any given time? Request some time to meet staff with whom you will work. How open minded do they appear?
When you have selected a final group of potential employers, become more specific regarding the working details of your job. What will you need to deal with telephone conversations? If you cannot use the phone, can you work out an arrangement that is satisfactory to both you and your potential employer? How will you deal with coverage from home? Can you utilize a text pager? Address as many of the details as possible before you take a job. This makes for better job security later on.
Decide in advance how you will communicate in the interview. Keep in mind that US employers need to comply with the Americans with Disabilities Act. A good summary of the obligations of employers under this act can be found on the National Association of the Deaf web site.
Consider taking the initiative and setting up the room so that your interviewers are away from the glare of windows, and perhaps in a semi-circle.
On the Job
There are some very nice articles on the SHHH web site, at http://www.shhh.org/html/workplace_issues.html with great advice about the working world for people who are deaf or hard of hearing. These are not specific to pharmacy, but should be useful in any profession.
More specific to pharmacy, the following is a collection of tips presented at an AMPHL meeting. This list contains twenty strategies that have helped one pharmacist to succeed, in spite of being profoundly hard of hearing. The pharmacist who presented these tips is a hospital pharmacist who used to be the pharmacy manager, before moving into a position as the hospital’s medication safety pharmacist.
1) Type of Employer: Some deaf or hard of hearing pharmacists find that it’s easier to work in a hospital instead of a retail pharmacy. There are two reasons for this. First, pharmacists in a retail pharmacy may have to deal with several thousand patients who don’t know them. By working in a hospital, they instead deal with several hundred doctors, nurses, and other employees, most of whom know them. The telephone may also be less of a problem in a hospital, as will be seen in the next item. (Keep in mind that some deaf or hard of hearing pharmacists do find that they enjoy retail pharmacy more, and that many other career options are available, including teaching and research.)
2) Don’t work alone: It’s helpful for a deaf or hard of hearing pharmacist to work in a setting where they don't have to work alone, so they don't have to use the telephone. Unless the pharmacy is very small, it may be possible to always have a pharmacy technician or student working with the pharmacist. Technicians have on-the-job training or perhaps a one or two year college degree in pharmacy. Pharmacies hire them and train them to do certain things. When working with a pharmacist who is deaf or hard of hearing, the technicians can answer the telephone and write notes about what the person needs. If the pharmacist has to explain something complicated, he may take the telephone, explain it, and hand it back and let the coworker listen.
Hospital pharmacists may spend much of their time working on nursing units. They will probably be the only pharmacy employee there, but will generally know the nurses very well. The nurses will thus likely be very patient with the pharmacist, usually writing notes if needed.
3) The Goldilocks theory: Remember the story of Goldilocks and the three bears? Goldilocks went into the house, and after she ate the porridge, she lay down to take a nap. The first bed was too big and too hard. The second was too small and too soft, but the third bed was just right. A deaf or hard of hearing pharmacist may find that the same thing is true in terms of the size of the hospital where they work. A very small hospital may not be as challenging, and the staffing might be small enough that the pharmacist may have to work alone. A very big hospital might mean dealing with many unfamiliar coworkers who would not know that the pharmacist is deaf or hard of hearing. Some deaf or hard of hearing pharmacists find that the perfect size hospital is about 100 to 250 beds.
4) Be Assertive: If you don't hear something, you can ask people to write it. Try to create an environment that works well for you. For example, if the pharmacy is being remodeled, it may be a good chance to ask for some features that work well for you. A carpeted floor may offer better acoustics then a tile floor, and sound-absorbing ceiling tiles may also help to cut the background noise.
5) Be Upfront: When dealing with patients, try to be very upfront that you are deaf or hard of hearing. Try to set up an environment that works well for you. For example, when you walk into a patient's room, try to make sure that the light is not behind the patient. Try to sit close to the patient, so you are not looking down at them. Consider taking written teaching materials with you, so if they don't understand you well, they'll have something else to refer to.
6) Use e-mail: Many times you can eliminate the need for a telephone call by using e-mail. Try to make a habit of answering the e-mail quickly so that people know they can rely on you to get right back to them.
7) Ask for a fax: In pharmacy, it's always a good idea to have medication orders in writing instead of just a verbal order. Verbal orders, even if you hear well, are error-prone. Encourage nurses to fax you notes instead of calling you. This also creates a better work flow in the pharmacy.
8 ) Borrow some ears: The most challenging time for a deaf or hard of hearing hospital pharmacist, in terms of communication, may be attending a code, when a patient’s heart or breathing has stopped. Codes are stressful in themselves, because a life is always on the line. To keep up with these critical situations, consider asking a pharmacy technician or student to go along with you. You may find that not all of your co-workers are comfortable attending codes, but it helps to explain that all they have to do is write down what the doctor asks for. Consider taking with you a piece of paper that has all of the common code drugs on it. With this paper, your coworkers can simply point to the drug that's needed. Also, it’s always a good practice to repeat the drug name and dose when handing the drug to the nurse. Also, try to know enough about the protocols that you can anticipate what drug will be needed next, so it's not a complete surprise.
9) Educate yourself! Try to be more educated than your peers. This will make you a valuable resource for your coworkers. Pharmacists have to do a certain amount of continuing education every year, and you may wish to do twice the required amount, just to stay ahead of the curve.
10) Beep-Beep: Consider carrying an alphanumeric pager, which displays text on it. Even a one-way pager may work well. Use basic codes, and your coworkers may be able to just pick up the phone, dial the phone number, punch in some numbers, hit the pound key and the numbers will display on your beeper. For example, 111 may mean “please come to the pharmacy”, 911 “get back here fast, please”, 444 “Do you want Chinese food for lunch?” The pager can vibrate, so you don’t have to worry about not hearing the beeps.
Pager companies often have web site with a “Send a Message” feature. The hospital staff can go to that web site and very easily send you a text message. Your spouse and friends can also use it to keep in touch.
For something more sophisticated, consider a two-way pager, such as the Blackberry, T-Mobile Sidekick, or Wyndtell.
11) Have a strategy for coping with meetings: One method is to take along a secretary with a laptop computer. The secretary types the gist of what people say. It’s also helpful to arrive at the meeting early and arrange the seating in the room the way that you like it. For example, if there's a meeting with eight people in it, you can put two tables together and arrange the chairs around them so that we are all facing each other. You can go to the room 15 minutes before the meeting, set up the chairs the way you want them, then go back to work until it’s time for the meeting to start.
It’s helpful to be the one who prepares the meeting agendas. That lets you focus the discussion. For example, instead of just listing the name of a drug, you can write “Should we add (drug name) to the formulary?” If it’s a critical issue that you really want to go a certain way, you can meet with the key people individually in advance of the meeting.
12) CART: When you go to a seminar, ask the person putting on the meeting for the accommodations that you need, such as CART (Computer Assisted Real-time Transcription) services or interpreters. The meeting organizers usually don’t know who can provide this service in their area, so it may help to do some research on the internet and find a local CART provider or interpreting agency, and include that information when you ask the organizers for the service. It may help to contact the local chapter of SHHH (Self-Help for Hard of Hearing People) and ask them to recommend a CART reporter, since many SHHH meetings are captioned.
13) Do more than your share: Try to do more than your share of other jobs, so your co-workers don't feel bad about answering the telephone for you. For example, if you are relying on someone else to answer the phone all the time, and their usual job is to run things to the nursing unit, volunteer to do some running for them. Try to be thoughtful to your co-workers to take the burden off of them.
14) Make yourself valuable: Try to be the resident expert at your place of employment on certain things. For example, one hard of hearing pharmacist specializes in working to prevent medication errors. He chairs the hospital’s medication safety team, and also serves as a volunteer advisor for a national medication error prevention organization. He also tries try to be an expert on the pharmacy computer system.
15) Get to know the other employees: Your work life will be much easier if as many employees as possible know you in the hospital. One way to accomplish this is to volunteer to teach orientation sessions for new nurses. It also helps to be friendly and helpful. In a hospital, if you work on a nursing unit, you will develop a nice rapport with the nurses and physicians who work in the unit.
16) Video Relay: Don't forget about the availability of video phones today (with web cams) Check out the AT&T web site for video relay interpreting and Sorenson video relay (Sorenson VRS). The CapTel phone is also wonderful, if it is offered in your state.
17) Teach your co-workers what works: One pharmacist reports “My coworkers in the pharmacy usually just try speaking clearly to me. Several of them know how to fingerspell, and they may do that if there is a word or two that I just cannot understand. They’ll write me notes to relay questions from a nurse or physician. Some people prefer to just keep a word processor open and type notes to me. I try to be assertive about letting people know what they need to do to communicate with me. “
18 ) Do the hiring: Obviously this section only applies if you are in a management position, but it can be very helpful to do the hiring for the pharmacy. While you must hire people who are well qualified for the job, it’s also an opportunity to hire people who are easy for you to understand. If you hire people who speak slowly, are patient and friendly, and are willing to work to communicate, they will likely be wonderful employees.
19) Stress coping: It's very important to have a plan to cope with stress, because working and being deaf or hard of hearing can be stressful. For some, it helps to have family time and vacations. One hard of hearing pharmacist loves to get on his bicycle and go for a long ride. Others may enjoy relaxing with friends, going for quiet walks, swimming, or yoga.
20) Don’t sweat the small stuff! A lot of stuff happens in the working world that you can worry about and obsess over, but it’s really not worth it. Enjoy the good in life, and let go of the small stuff.
Best wishes in your endeavors!
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