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Am Fam Physician. 1998;58(3):659

to the editor: The article1 and editorial2 on helping deaf and hard-of-hearing patients provide much useful information. I have treated deaf patients in the past and have arranged for medical interpreters. It is interesting that the author of the editorial comments that physicians “seem to have less enthusiasm for their deaf and hard-of-hearing patients than their hearing patients.”2 Unfortunately, no comment is made in either the article or the editorial regarding the unfair financial burden placed on physicians who would like to treat deaf patients.

Frequently, deaf patients have insurance that reimburses at a substantially discounted level. Medical interpreters are extremely expensive. The physician is billed from the time the interpreter leaves his or her door until the time that he or she returns—although the interpreter may spend only 15 minutes actually performing a service. Specifically, this amounts to about two hours at $50 per hour. Assuming that the patient has come to the office for a level III visit and that the reimbursement is from Medicare, the amount reimbursed is $35.41. Add to that the heavy-handed threat of a six-figure lawsuit for not providing an interpreter, and it does not take an accountant to understand why physicians may not be enthusiastic about treating these patients.

It is unfortunate that our society chooses to penalize physicians who treat deaf patients. It would be helpful for us to evaluate alternatives to placing the financial burden for medical interpreting on the individual's physician.

editor's note: This letter was sent to the authors of “Issues to Consider in Deaf and Hard-of-Hearing Patients,” who declined to reply.

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This series is coordinated by Kenny Lin, MD, MPH, deputy editor.

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