[Rethinking the Prescription's Comprehension: an Example of Care Centers for Deaf People]. / Repenser la compréhension de l'ordonnance : l'exemple des soins aux Sourds.

CONTEXT: Since the realization of the difficulties for Deaf people to access care, specific assisting services in french sign language (FSL) and adapted prevention campaigns have developed in France. Illiteracy, a significant problem among Deaf people, makes the comprehension of prescription uncertain. AIM: Exploring and describing the adaptations implemented by professional signers to avoid confusion related to prescription's directions. METHOD: This qualitative study in participant observation listed the different sources of confusion and the adaptations applied on prescriptions on a daily basis by eight practitioners and three intermediators who worked in six care cent ers for Deaf people. Interviews with deaf patients aimed to ascertain the encountered difficulties. These adaptations were presented, for a three-way correlation, during a national meeting attended by professional workers in care centers for Deaf people. They were subjected to a review by all attendees in order to generate a more consensual report. RESULTS: The sources of the identified misunderstandings turned out to be connected with time representation, the use of unknown words or words with double meaning, and the issuing of several documents. To reduce the risk of error, professional signers would use charts, calendars, drawings, replace durations by dates. Some of them requested that the patient would rephrase the understood information. Pros and cons, as well as the pat ient's profile were detailed for each adaptation. CONCLUSION: Even if no method can suppress all risks of confusion, this work leads us to a reflection on alterity through the risk of medicinal errors, on prescription in general, may it be directed to a patient with no particular vulnerability or to a handicapped or illiterate one.

[A dedicated ambulatory system for the primary healthcare of the deaf people]. / Un dispositif ambulatoire pour la santé des Sourds en soins primaires.

BACKGROUND: A law of 11 February 2005 recognises French Sign Language (LSF) as a language in its own right and requires the implementation of practices that facilitate access to health care of deaf patients. OBJECTIVE: This study describes an ambulatory system devoted to primary care for the deaf people. METHOD: Case study: quantitative and prospective analysis of consultation data between 2009/01/01 and 2012/12/01, qualitative analysis of the ambulatory system, of an appointments selection and of some community-based health practices. RESULTS: From an active list of 116 patients, 885 consultations were held. The number of annual consultations doubled between 2009 and 2012; the average number of consultations per patient amounts to 3,5/year. The system, stemming from private practice, consists of a general practitioner trained in LSF progressively helped by his partners from the group practice. It compensates for the lack of hospital units in the area. The clinical situations described help in the understanding of the project's significance. CONCLUSION: The benefits of the system are obvious but should not become a reason to ignore the necessity of the creation of a hospital unit that provides health care for the deaf people, including the possibility of a mobile unit taking into account multiple disabilities and isolated people.