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I'd like to first start out by asking each of the panelists
to introduce themselves.
They are, of course, here for a reason.
They are each experts in their respective fields,
and so I'd like to ask you all to introduce yourselves.
Hello. I'm Dr. Michael Stein.
I am a professor here at RIT/NTID.
As well, I am a practicing attorney.
Before I came to RIT,
I worked for the National Association of the Deaf,
the ***.
There, I was involved in a variety of different cases.
Some suits involved hospitals not providing interpreters.
Currently, I'm working with the *** and my own law firm
suing a medical school in Nebraska.
That just recently went to trial.
I've also had some experience
pursuing state boards of pharmacy,
and I'll explain more about that later.
So I've been involved in a variety of different cases
involving people who are deaf
wanting to pursue medical careers,
and I'm excited to be here.
Thank you.
Deaf and hard-of-hearing professionals' involvement
in the health care field is a relatively new concept.
It is our hope that they tackle the world's future problems.
Thank you, Michael, for all your past contributions,
and next, we have Tiffany.
Hi. My name is Tiffany Panko.
I'm currently a second-year medical student
at the University of Rochester.
Before that, I worked as a research coordinator
at the National Center on Deaf Health Research,
and before that, I was a student.
I got a degree from RIT, here, Bachelor's degree,
and I also got an MBA.
So here I am.
Hello, everyone. My name is Scott Smith.
I graduated from medical school around 16 years ago.
I'm a pediatrician by training.
I work at Rochester General Hospital.
I'll call it RGH.
I've done that for about 4 1/2 years now,
seeing patients, both hearing and deaf.
I then transferred to the University of Rochester,
where I am an assistant professor
in the Department of Public Health Sciences.
I focus mainly on research centered around improving
deaf people's health, their health literacy,
and awareness.
Well, good evening, everybody.
It really is a pleasure to be here.
My name is Rickard Doolittle, and I serve as the vice dean
and professor in the College of Health Science and Technology
here at RIT.
I graduated from the University of Rochester,
earning a dual-degree Ph.D. in anatomy and pathology,
and I came to RIT in 1986, a long time ago,
and since that time, I've been pretty actively involved
in teaching and research and have been working closely
with deaf and hard-of-hearing students
since those very early days, and it's been exciting to see
the changes that have opened up the doors
for this population, and even today teaching
and still engaged actively in research,
I've got deaf students working with me today.
So it's just been great to see that transition over time.
Good evening. My name is Bob Pollard.
I'm a clinical psychologist.
I'm a professor of psychiatry
at the University of Rochester Medical Center,
and I've been there since 1990,
and I was the first person in my department,
in the Department of Psychiatry,
who was dealing directly with deaf persons,
and, because it was part of the medical school,
I began to do teaching on a variety of levels
regarding deaf people in the field of medicine,
et cetera, and over time began to serve
as somewhat of a consultant when we had deaf
or hard-of-hearing individuals interacting
with the medical school as students
or residents or otherwise, and in addition,
I do a lot of forensic work,
and a good number of the cases I've been involved with
are Americans With Disabilities Act-related cases
pertaining to deaf people pursuing health care careers,
and so that's one of the experiences
that I've had that we'll be talking about tonight.
One thing we would like to talk about is diversity.
As you can see, we do have a diverse panel here tonight.
Diversity is important, especially in the medical field.
Now I'm wondering, are there many female physicians
in the medical field?
We do have Tiffany here,
who is an up-and-coming professional,
but can you speak to the diversity
in the medical field?
What are your experiences, and what have you seen?
That's pretty common among medical schools.
They value diversity, and most of the time
when you're applying to medical school,
they'll ask about how you can contribute
to their diversity efforts.
So absolutely, medical schools are looking
for diverse applicants and diversity.
However, at the same time, we need more diversity
as far as deaf and hard-of-hearing people
in the workforce.
So far, we have seem mostly white individuals,
a few women, yes, finally.
We are seeing more and more of them,
but the point is, we need more diversity
in all areas, including race and gender,
within the deaf and hard-of-hearing workforce,
not just within the hearing workforce.
Richard, you're responsible
for the College of Health Care Science and Technology
here at RIT.
Can you share the requirements to enter your college
and the programs your college offers,
and what are the health-care-related careers
related to the programs here at RIT?
At this current time, the college has been
in existence for two years now.
What we've done is, we've brought existing programs
under our umbrella.
So we have a physician assistant program
that's been going for 20 years.
We have a diagnostic medical sonography program,
ultrasound program, that we're expanding to echocardiography,
or ultrasound of the heart.
We have a nutrition program, and then we have--
The largest program is our biomedical science program.
That program has got a lot of flexibility in it.
It offers a lot of science elective credits,
general elective credits, so student can kind of design
their curriculum to go in one direction or another.
We have a series of focal areas within that.
There are different entrance requirements for those programs.
I would say that the program that is attracting
the largest number of deaf and hard-of-hearing students
would be the biomedical science program,
but we do have two students in our physician assistant program.
We have had a number of students
come through our ultrasound program in the past,
same with respect to our nutrition program.
So in terms of competitiveness,
they PA program is highly competitive,
especially for transfer students,
is the most difficult to get into,
but we have students who move across these majors.
They find out after a year they want to be in a different major.
They'll change their mind, change their major.
So the doors are open to those students who are qualified,
and so we want to continue to encourage those students
of the deaf and hard-of-hearing population
to look into our programs.
As a new college, we are slated to grow.
One of the areas we hope to grow in
is in behavioral medicine and mental health areas.
So we're looking at social work.
We're looking at clinical psychology,
specifically within the forensics area,
as potential new programs,
especially at the graduate level,
that we think will also serve as an attractant
for deaf and hard-of-hearing students.
So it's a time of great potential growth for us,
and we're still defining what that strategic future
would be for our college.
My next question relates to access within medical schools.
In order to be accepted into medical school,
one must take a Medical College Admissions Test, or MCAT.
Can you please talk about what the MCAT looks like
and how students can better prepare for the exam?
Also, what is the average MCAT score and GPA requirement
in order to be accepted into medical school?
Tiffany, I know you were recently accepted
into medical school.
So can you please answer that question first?
First, let me talk about how to prepare for the MCAT.
The test usually is offered around May to August, I believe.
If you take it in May, you need to start studying well before.
I would say, start studying around November.
There's also preparatory courses that are offered.
They're very expensive, though.
I'd rather save my money so that I could pay for school.
So I instead got a book.
I set a schedule for myself, and I took some practice tests.
I would buy more practice materials
along the way, as well.
I continuously studied until I sat for the exam in May.
The average score for the MCAT is about 24.
The maximum score is 45.
That, to be honest, is really hard to achieve.
A good score is 30. 35 is quite impressive.
You should aim for 30.
The average, as I mentioned is 24.
I think schools like to see a minimum of 20
or 21 for admission.
It really depends on the school.
Now, before I applied to medical school,
I did some library research.
There was one publication-- the "MSAR," I think.
I can't remember the acronym right now,
but it was from the American Association of Medical Colleges.
Yes.
They publish this publication annually,
and they publish the average MCAT scores
and the average GPA scores for each medical college.
Some were more competitive. Some were more flexible.
At the same time, I was able to compare
public versus private schools.
There was a lot of information that I could use
from that publication, and from that research,
I then narrowed down where I wanted to apply.
Clearly, you can't afford to apply to every medical school.
As far as GPA goes, 3.0 is the minimum.
3.5 is much better, and 4.0 is great,
but a minimum of 3.0 I would recommend.
For that type of really big exam,
you have to be preparing far in advance.
You can't just start preparing last minute, obviously.
There is so much information included in these tests.
You really have to try and understand the concepts,
not just memorize information.
Memorization does have its place, yes,
but the point is to practice reading exam questions.
I would say I took over 100 practice tests,
and I think that really helped me experience
the flavor of the types of questions
and how they were phrased.
Really, the point is to understand the concepts.
Be able to explain in simple words
what the point of the question was
and why did they ask that question...
just trying to understand the underlying concept
like you were trying to explain it to your mother
or grandmother, for example.
Try to envision that, and you should be successful.
Then if you have any questions
related to that specific concept,
it may improve your chances to get the right answer,
but really, the point is practice.
You have to take a course.
Some people say that a course is beneficial,
but I didn't take a course.
I just practiced on my own,
just 10 different books to read and study
over and over until I got used to the time limit
imposed by the exam.
Can you talk about some of the challenges that you have faced
transitioning into medical school?
You need to set a rigorous schedule for yourself
and ensure that you're studying basically every day.
At the same time, it's important that you have balance.
You can't study 100% of the time.
You go a little crazy.
So you want to show your family and friends
that you still care about them and make time for them.
Balance is a huge part of it.
As far as the material goes,
the information can be overwhelming at times.
I just took a two-week intensive course.
So I'm still getting used to discerning my needs.
Sometimes I have to decide whether I want to request
interpreting services or CART services.
It really depends on the situation.
So these are some of the new experiences I've encountered.
For me, going to medical school
was almost like learning a new language.
All these different terms are being thrown at you.
It was overwhelming at times.
I think the key that helped me
was having good interpreters there,
interpreters who were willing to work with me as a team.
There would be two interpreters at the same time.
There would be the off interpreter
listening to the lecture and writing down words.
If there was a term that was used
where they didn't know a sign for it
or what that word meant,
the off interpreter would write it down,
and then after class or at the end of the day,
the 3 of us would meet together and discuss what the words meant
and bring a medical dictionary to look them up in.
Oftentimes, words were divided into their root words,
their suffixes and prefixes,
and then we would make up a sign for each part of the word
and then combine them.
For example, "hyper" meant high...
and that would be one part of the word--"high,"
or "hypertension,"
"high pressure," "high blood pressure."
Any time the interpreter heard the word "hyper,"
automatically they would know, "Ah, that means high"...
or "hyperthyroidism" is another related example.
That was a big challenge, learning a new language.
Scott, you make some great points
that lead me to my next question.
I know that we have experts here on the panel
who work with deaf and hard-of-hearing people
transitioning into the medical field.
My question now relates to the legal aspects.
So, Michael, as an attorney, you have been involved
in some cases involving litigation
relating to students trying to get access to education
and get access services in medical schools.
Can you share some of the information
in the cases you participated in?
Certainly. I'll comment about a few of my cases.
Before this, I'd like to emphasize
that most people have had very positive experiences
when applying to medical school and to graduate school.
For the most part, people have positive experiences.
I'm gonna talk about some of those unfortunate experiences
where people did not get services.
So don't think this applies to all.
For example, we have Tiffany, who's been very successful
getting services in her program.
First, I'd like to comment about a suit that's occurring
in the State of Nebraska.
I happen to have a client who's deaf
who applied for medical school and was accepted,
and upon entering the school,
he requested several accommodations--
CART, an oral interpreter because he grew up
with no knowledge of sign language
but he felt he could benefit from an oral interpreter
or a cued speech translator...
and possibly an FM system my provide some assistance,
but it hasn't been successful so far for him,
and the medical school reviewed his application
and said that they would provide an FM system,
that that would suffice for his needs.
The student decided to go ahead with that accommodation,
even though it wasn't his first choice.
Now let me explain about the ADA.
The ADA does not mandate the use of a sign language interpreter.
The ADA states that you have the right
to effective communication-- again, effective communication--
not the right to a sign language interpreter,
which means, well, one of several things.
If you need an interpreter to communicate,
then you have a right to an interpreter.
However, another deaf person may do just fine one on one
in small group conversations
and not need an interpreter in those circumstances.
So they don't have that same right.
Your right depends on your communication skills,
your communication needs.
So the medical school felt
that they were complying with the ADA,
that this person didn't need the services of an interpreter
or CART at all.
They felt the FM system was sufficient enough,
and the student said, "OK.
"I'll try this for a short time,"
and so he entered medical school for the first month
with the use of this FM system.
It was a difficult struggle. He wasn't able to follow along.
He wasn't able to understand what was happening
in the educational process.
He explained that he needed something different
than the FM system, especially in the lab environment.
The medical school denied this request,
said that he didn't need the services of an interpreter.
It's analogous to if you're driving a car.
Any car that moves works for you.
You don't need a fancy car. You don't need a Cadillac.
So it's analogous to the school's response.
"You don't need CART services.
"You don't need an oral interpreter.
"We are compliant with the law."
What the student decided to do
was that he certainly needed the CART services
and the services of interpreters.
So he borrowed some money from his parents...
to purchase these services on his own.
The cost was about $50,000 to $60,000 per year.
Then a lawsuit was filed and has taken 4 years
for this case to finally go to trial.
We were victorious in the suit, but it's not over yet.
The judge now has the opportunity
to determine what is next.
The student has finished only two years of school
and is into his third year of school.
So the judge will decide what the student needs
for the third and fourth year only.
I mention this case because it gives you a sense
of what your rights can look like.
Remember again, you don't have the right
to an interpreter, per se.
You have the right to effective communication,
and what is meant by effective communication
depends on your individual circumstances.
One person may need an interpreter.
For another person, it doesn't mean that.
CART may suffice or other services.
It depends on the individual person.
First is the general issue
of what's called technical standards.
After the ADA was passed, professional schools--
in particular,
professional schools in the health care fields--
developed these policies that are referred to
as technical standards which set forth
the physical requirements that a student
or a graduate would need to be able to accomplish
in order to either be enrolled in the school
or graduate from the school, and these policies
are very, very powerful and important,
and anybody who's applying to a health care school
will be able to read in the school's policies
and documentations what their technical standards are,
and these technical standards were a way for the school
to try and determine who will or won't be capable
of doing the physical requirements necessary
for patient care, let's say, in that particular field.
The problem with the way the technical standards documents
are often written is,
they're written by not just hearing people,
but people who don't have experience with disabilities
more often than not, and so as they think
about how to write these policies
about what you have to be able to do physically,
they'll often think,
"Well, what would I, as, let's say,
"a hearing person who doesn't use a wheelchair
"or has not visual problems
"or any other type of disabilities,
"how would I try to accomplish the things
"that are required in our program?"
and so, unfortunately, these standards
are often written in what I refer to
as an organic way,
meaning a physically focused way.
They'll say, "You have to see this well to be in our program
"or graduate from our program, or you have to hear this well
"to be able to enroll or graduate from our program.
"You have to be able to lift this many pounds, et cetera."
In contrast to that philosophy-- this organic,
strongly physical-focused philosophy--
a very rare number of health care schools
will write these standards in a way that I agree with,
which I refer to as a functional manner,
in which case, they don't dictate
the amount of sight or hearing
or lifting ability you have to have,
but they simply say what you have to accomplish,
such as, you have to be able to detect a heart murmur
or you have to be able to detect a lung sound
or determine a broken bone in an X-ray,
the point being that they don't say how you have to do it,
whether it's through your hearing
or through your vision or through your legs
or what have you, but they say
you have to accomplish these things for your patients,
and how you accomplish those things,
whether it is through your hearing
or through a stethoscope
that many deaf health care professional use
that may show its output on a visual screen,
it doesn't matter.
You just have to accomplish these physical things.
You have to accomplish these functional things
for your patients, and in a number of the lawsuits
I've been in, it's this issue of technical standards
being written in a organic way versus a functional way,
which becomes a focus of what's wrong
with a particular school's policies.
There's a number of other things that I could mention
that come from my experience in these lawsuits.
I'll mention them briefly.
First of all would be the issue
of how a school deals with reasonable accommodations
during the didactic or classroom portion of training
compared with the portions of training
where you would begin to interact with patients.
In my experience in these cases,
a number of schools will feel comfortable
providing reasonable accommodations
for the classroom didactic portion
of a student's education,
but as soon as they start dealing with patients
or that time in their education arrives,
the faculty, the school become very frightened
about whether or not a deaf individual
will be dangerous, shall we say,
in serving patients, and that opens up
a number of other concerns that have to be addressed,
unfortunately, after the student has already been enrolled.
Another issue that's important in these cases
is that many schools who are worried about a deaf individual
taking care of patients will hypothesize
about some long-term future situation
where the deaf individual is out there,
independent practice and some strange situation
might occur where they don't hear something
and the patient is in danger, et cetera, when in reality--
and Michael will, of course, correct me
if I say anything wrong here--
where the legal issue at hand is what's happening in school.
The legal matter is what safety issues
or legal issue, et cetera,
pertain to your school education,
not some strange situation 10 years from now
when you're in independent practice
in the middle of Alaska and you can't hear something,
and in my experience, these lawsuits
will often have persons speculating
these bizarre circumstances that don't pertain
to the actual school situation itself,
and the school situation itself always involves students
being surrounded by numerous teachers and other individuals
who provide many levels of supervision and safety
that just don't make any sense in comparison
to these bizarre stories they're thinking of
5 years down the road in the middle of Alaska.
So it's important in these lawsuits
to keep the focus on if people are concerned
about patient safety, what's the real,
true patient situation, patient safety situation,
in the school environment where a student
is always gonna be surrounded by numerous colleagues
and supervisors who are watching their work
and making sure that patients are safe
and keeping the reality of that situation
in the forefront of the case.
That's helpful information.
We have a question from the audience.
The question is,
"I notice a common problem is, people will progress
"through medical school, but post medical school,
"they experience issues of them focusing
"on their inability to hear.
"So I'm wondering, what have you done
"to overcome that general discrimination
"out in the real world?"
That is not a simple question.
Discrimination is still alive and well in the world today.
Even though I've gone through medical school
and now have my MD,
it is still not always easy to convince, you could say,
naive hearing people that deaf people can do it.
It is also hard to convince them of the cost involved
because interpreting services are, unfortunately, not cheap.
A lot of hearing people are resistant to that,
and ADA does not, unfortunately, have its own funds
to pay for interpreters.
The ADA really forces me, as a deaf professional,
to negotiate with the hospitals and other companies
as far as how to accommodate what I'm looking for
like Michael was talking about-- reasonable accommodations.
It's a negotiation.
It depends on the situation, as well.
It's not a perfect world yet, but I think we still have
a lot of work to do as far as educating the hearing world.
The ADA requires an interactive process
to be pursued.
What that means is that if, for example,
I am a doctor who's deaf and a hospital hires me...
certainly you want to be grateful for the opportunity,
but you also let the hospital know what your needs are,
but it's not automatic that you get
those services for those needs.
You sit down, and you have that discussion--
what is reasonable, what is effective,
what is not effective.
You consider the costs and other issues
during those negotiations.
So it's important that you sit down with your employer
and have that discussion about what is necessary
for effective communication.
Often, many hospitals are concerned
not just about the costs, but also about people
they've served in the past, and they have some fears
about mishaps that may result
because of providing certain services.
I was involved in a lawsuit about 5 years ago
involving the State of Alabama.
There happened to be a pharmacy that hired a deaf pharmacist...
and they were concerned about the deaf pharmacist
using video phones through the video relay service
calling doctors about orders,
concerned about misunderstandings
about the names of certain prescriptions.
They were concerned that there would be a mishap
through using video relay services.
So they did not want that to be pursued.
Also, the State Board of Pharmacy
prohibited the use of interpreters through VRS,
through the relay services, for prescription orders.
The pharmacist would have to call the physician
to collect information on a certain prescription--
the amount, the name--
and they forbid the use of video relay service
because the state board stated that only licensed pharmacists
could receive the orders for prescriptions.
Unlicensed pharmacists could not.
That was just a general rule...
and, as a result, the state board
saw the use of an interpreter through the video relay service
as not being a licensed pharmacist.
They saw that this practice was forbidden.
This decision didn't make sense. It wasn't logical.
It was just that the state board had never encountered
this request before and decided to prohibit this practice.
Many deaf medical professionals have to continually educate
and articulate how these practices
are safe and sound, how they are wise to utilize
these services that are available.
The state board hired an expert person
to test the system to see if using the video relay service
was a safe means of putting in prescription orders.
So they ran this test through the system,
and the results were 100% accurate,
and, therefore, the state board decided
this was a reasonable request and approved it for future use.
So those who are deaf in the medical fields
need to continually educate these different systems.
Sometimes they're the first person
in these particular fields,
and they have to share the strategies
that are effective for them.
It's important that they sit down and engage
in that interactive process, to have that discussion
about what works for them.
The point, really, is that hearing people
are not used to deaf people.
So if the deaf person does something
in a little bit of a different way,
hearing people are thinking, "Oh, no, no. This is no-good."
So I think the point is, we have to show hearing people
that, yes, we do things in a different way,
but we have an equal outcome.
The result is still good
and equivalent to a hearing person's.
Understand, we do it in a different way
but get the same result.
I think the key point is the outcomes.
Stop focusing on the process.
Don't get caught up on the process.
Instead, focus on the results.
I thing it's true and somewhat unfortunate
that deaf and hard-of-hearing individuals,
especially those young people who are still in training,
are gonna have a lifelong burden
of being a teacher to hearing people.
On the other hand, if you have intermediaries--
whether they're faculty who understand you, et cetera--
who could sort of play some of the educational role
on your behalf so that you don't have to add that burden
to all your studying, everything else you're doing,
that can be very useful.
I often play that role in the medical center
where, when they're anticipating that a deaf
or hard-of-hearing person is gonna become a medical student
or an employee or a resident or whatever
in a given department, I have this canned lecture
that I do where I get invited to,
in a very actually nice way, kind of a hearing person
talking to hearing people where they can let their guard down
a little bit and ask stupid questions
if they want to ask stupid questions
and not feel so defensive, and I always ask
the deaf individual who we're going to be talking about,
"Do you want to be there with me
"as we do this or do this together,
"or would you rather I do this without you present?"
and actually, more often than not,
the deaf person will say, "No.
"Actually, I'd rather you just do it without me there
"so that people can feel more comfortable
"to ask dumb questions or express their fears, et cetera,"
and I have found that-- and, I think, others
that I've worked with have found that--very effective.
So that's another possible choice
that sometimes could be made.
>> What resources are available for deaf
>> and hard-of-hearing individuals
who are out in the medical field?
Are there any professional organizations or resources
that they can take advantage of?
There is an association for medical professionals
with hearing loss.
It's called the AMPHLA.
Look at their website.
There's a lot of useful information there,
a lot of technical information, as well, including stethoscopes,
assistive devices, things that you can use
>> in conjunction with a hearing air or an implant.
It's impossible to give a good answer to that question.
It depends on the individual communication needs.
How they do one on one,
they may do just fine without an interpreter.
However, if their first language is ASL
and they can't speak for themselves,
they have a difficult time lip reading,
that circumstance may require the use of an interpreter.
So it depends on the individual communication needs and skills.
If an interpreter is requested in a medical employment
and is denied--
they determine that there isn't a need for an interpreter--
and a communication mishap occurs,
then that's a different situation.
My dream would be that we could all work together
to change the ADA in order to have the government be able
to give funds to cover the costs of accommodations.
I say that because in that way,
we don't have to go through these negotiations
with hospitals, with offices, with private practices.
If I apply for a job, they can just hire me,
and they wouldn't have to worry about the extra costs.
So, to me, I feel that that would really level
the playing field for all of us,
regardless of our communication needs,
but, unfortunately, the ADA was written over 20 years ago,
and, really, there were not many deaf people involved
with the writing of the ADA.
The ADA is for more people with general disabilities.
So I think before that happens, what can we do?
Educate, educate, educate. Get the word out there.
We need to share our experiences with as many people as we can
so they understand why--
regardless of having a good, quality education;
good job performance-- it's still hard for us
to find better employment sometimes,
largely because of costs and, still, that focus
on our ability or inability to hear.
Sorry. I don't have an easy answer yet.
>> Thank you. I certainly agree that costs are a big issue
and probably the hardest to resolve,
but another subset of discrimination
is simply attitude and fearfulness and ignorance
about a hearing person thinking,
"How could possibly a deaf person
do X, Y, Z health care occupation?"
and I think that is an easier problem
to begin to address.
Certainly in my experience, talking to hearing people
who otherwise didn't know
about the Association of Medical Professionals with Hearing Loss
opens their eyes to,
"Oh, really? There's such a thing?"
or explaining about deaf medical doctors I know
and deaf nurses I know and deaf psychologists I know
that I can talk about when I'm at trials or whatever
or educating facilities.
"Oh, really? We've never heard of that,"
and so simply explaining that these things are possible
can be very helpful, and I try to sometimes compare it to,
"Can you imagine 100 years ago or even less
"when there we no female doctors or the idea, the crazy idea,
"that we could never have a female president
"because she'd have PMS or something
"and start a nuclear war?"
We have to work on changing attitudes,
and the best way to do that is to show that there are more
and more deaf people in the health care professions
and that there are organizations which support them,
and there's technologies which are constantly improving
which make hearing loss less and less of a problem
in terms of taking care of patients,
regardless of what profession you may be in.
You may feel frustrated, dejected
and sometimes, as a result, decide to give up
and pursue other careers.
I encourage you not to do that.
It is a hard and difficult journey.
You fight is well worth it not just for yourself,
but those who follow in your footsteps.
You are the pioneers.
You're opening the doors for future deaf people.
I'll give you an example.
When I attended law school, my law school asked me
what services I needed, and we talked about the use of CART,
and my lawyer asked me what I thought about that,
and I'd learned that a person prior to me
fought a battle for two years trying to get CART services,
and, as a result, the policy was set up
where I had access to CART service.
Everything was ready for me,
and I owe a great deal of gratitude to my predecessor.
So for those of you who are frustrated,
please continue.
Fight those battles for yourself
and for those who will follow in your footsteps.
Heck, I wouldn't advise you any differently
than I'd advise any other student.
I think we're at that point now,
and, certainly, this is the culture
and we've created at our college,
which is, we help students
pursue their goals and their dreams,
and I think that it comes down to what do you want to do,
and the worst news I can hear from a student is,
"Well, I really want to do this, but I'm afraid
"that they're not gonna be able to support me."
Well, we don't know that.
You've got to be able to put yourself out there
and to go forward confidently
with the skills that you've created
to pursue the career and the program
that you want to pursue, and it's not without challenges.
I was telling Michael about a student
who's applying for dental school,
and he ran into clear cases of discrimination,
but he's still working at it, and now he's got
an early interview at the University of Maryland
for dental school, and he's incredibly talented
and very driven in what he wants to do.
I think it's those kinds of people that kick the doors open.
They don't give up because they know what they want to do
with the training they've got, and they just stay after it.
I think that's a very important point.
If a student has experienced discrimination--
for example, in the process of applying for graduate school
or medical school or after they graduate from here--
what are the appropriate steps a student can take
instead of just giving up or saying,
"ADA gives me the right to accommodations"?
What do you recommend from a legal perspective,
or, Tiffany, as a current student,
is there anything you'd like to share?
Oh, I agree that costs, which we've all
been talking about, are a factor.
I face that experience where I've been wary
of the costs involved.
I was encouraged to request interpreters only for the time
that I needed them, maybe for an hour
or less than that, where an hour seemed reasonable,
but then I started thinking about why they were forcing me
to limit myself and how many hours I had interpreters for.
That was my experience last year,
and I felt really conflicted about it,
but now I know who I can talk to and who I can trust
and who I can ask for advice.
Luckily, I spoke with the right person in my case,
and they knew who to talk to, in turn, for me,
and I'm fortunate that the University of Rochester
has a great team of interpreters already.
Maybe, Bob, you were involved in that.
I'm not sure.
You really don't have to worry. Talk to the school.
Educate them about what they can do.
Make sure that the school does not limit you
in whatever you need interpreterwise,
and, clearly, for classes, you need interpreters--
that's pretty black-and-white--
but also outside of class at informal gatherings,
interpreters are important, too,
and they really do need to learn about that.
So it's important that you talk to the right people
and not just have a visceral response and get upset.
Think about it more rationally
and think about who you can talk to about it.
We need to identify who these individuals are,
people that we can trust,
like these two gentlemen on stage.
There are two of our hearing allies.
They support us as a deaf community,
and we know their hearts are in the right place,
which means that if a problem or a conflict arises,
we are able to talk with them and receive advisement.
It may not always be a perfect solution,
but at least it's progress.
Really, I want to reinforce my point
that it's not just an individual or two.
That number can't do it.
It takes many more to come forward,
and that's part of the reason we are all here
at this panel discussion not to talk negatively, no,
but to think of a more positive future.
With more of you involved, it means we have a stronger case
and hearing people can't just say no any longer.
Also, self-advocacy is so important--
how you share the information,
how you educate those individuals,
how you're able to articulate
what you communication needs are.
Talk about what has been effective before,
what accommodations you have a proven history of.
That will help you a great deal...
as well, being able to explain the ADA,
your right to effective communication.
You should check out the website.
There's a lot of information there
where you can print and share links
to medical schools and to law schools
who want to learn more about the ADA.
So the *** is a great resource.
Another great resource is the U.S. Department of Justice,
the DOJ.
They have a lot of information on their website, as well,
that you can share with the graduate programs...
and I want to emphasize the importance, again,
of sitting down, engaging that interactive process,
having that discussion about what your needs are
and what their concerns may be
and to come to some sort of compromise
on a good solution.
It's important that you have open communication,
clear communication,
and also tap into the allies that are available to you
at the same time.
The first is that,
as far as knowing the right people to go to,
that's very important, as Tiffany pointed out,
in particular because sometimes lower-level people--
let's say, somebody at a department level
or a department chair, et cetera,
of an admissions committee member--
simple doesn't know about the ADA sufficiently
to answer questions correctly.
I can recall a situation some time back
where a deaf person was applying
to the clinical psychology program
at the University of Rochester,
and I received a call from this person
because he or she said that when she was telephoning
somebody in the clinical psychology program,
that individual said,
"Oh, our clinical psychology program couldn't afford to pay
"for the amount of interpreter services you would need.
"Therefore, you can't apply," and that reflects ignorance
of the nature of the ADA, where what we call the undue cost,
the undue burden, let's say, of fiscal costs
is not judged at a department level
or a program level or even at--quote, unquote--
"the medical school level."
It would be judged at the level of the entire budget
of the entire University of Rochester.
So that individual, by saying no to the applicant,
put the University of Rochester at legal risk
because they would've definitely lost a lawsuit
because the undue burden is not based at a department level.
It's based at the entire university level.
So making sure you are talking to people
who really know their stuff, as Tiffany pointed out,
is important.
The second comment I wanted to make
has to do with another comment Tiffany made
about what we refer to as the informal curriculum.
Yes, of course, most people will understand
that interpreter services or CART, et cetera,
will be needed at a classroom didactic situation,
but so much of learning-- especially at graduate levels,
and the health care professional levels--
happens outside the classroom in social environments,
in other what you would think of a somewhat informal meetings,
but there's a whole literature on--quote, unquote--
the informal curriculum, and it's very, very important
that the informal curriculum-- social meetings, et cetera--
where you talk about work is accessible to you, as well.
So I would strongly encourage you
and the persons you work with to advocate
for interpreter services or whatever you might need
in those informal, yet important,
learning situations.
The third comment I wanted to make
was that, again, considering the difference
between classroom didactic communication needs
and the transition to communication needs,
let's say, in clinic settings
where you're dealing with patients
implies that you know what your communications
are even gonna be like in those service settings,
and that's, in my experience, what many deaf persons,
understandably, wouldn't know.
I mean, they know what a classroom is like--
you've been in classrooms all your life--
but how are you gonna know what it's like
to work on this floor as a nursing student
or that situation as a medical student,
and so I've been in a number of situations
where the school is expecting the student to advise them
on what their communications are going to--
excuse me--their communication needs are going to be
in these clinical situations
they've never experienced before,
and so students such as that can't predict those very well
unless they have visited those situations
or talked with faculty who can explain,
"Well, here's what it's like to be in the emergency room.
"Here's what its like to be on this or that floor."
So be careful of that dilemma or that trap
that you can't necessarily advise a program
of what your communication needs are going to be
in a situation that you've never been in before,
and that implies that you're going to need to find out
about that clinical setting, et cetera,
before you'll have any idea
what your communication needs are going to be.
If you are qualified for that, if you have good grades,
then maybe you will be helped,
but you will still have to educate more people
because you are in a medical school
and a research school.
So I don't know, but if you're qualified,
then I think it could improve your chances.
My advice would be, go ahead and apply.
Don't be afraid.
Don't think, "Well, I'm deaf. I can't get in."
Follow your heart.
I've had limited experience thus far.
I've had some experience in family medicine on Tuesdays.
I don't really notice a change.
Actually, I feel like everything goes very smoothly,
very streamlined.
So I've had a good experience... so far, mind you.
For me, my biggest challenge was dictation.
For hearing doctors, the way they increase their productivity
is by dictation.
They see patients fast, and they dictate fast,
but does that mean they provide good care?
Who's to say?
In terms of insurance versus good care,
I think it's a balance.
For me, dictation is a big challenge
because I can't use that method.
I had to figure out a different way.
Sometimes I typed out my own reports,
which had to take 4 to 5 hours in the evenings
after I had been working all day,
or I'd have an interpreter there voicing what I sign,
but then I would have to pay the interpreter, too.
So there are still some production issues
that will affect deaf and hard-of-hearing professionals.
There is always a way around it. We just do it differently.
I think the key is that you have to find
the right hearing people who are willing to work with you
in that capacity.
>> The world of medicine has changed a lot
in the past 20 or 30 years.
In the past, we had fee for service,
which meant the patient would pay the doctor
for each visit, very straightforward.
Now that insurance got involved, there is a certain dollar amount
that is applied maybe for a 15-minute chunk of time
and that if you take longer that 15 minutes, as a doctor,
you are told, "Too bad."
They won't add any more funds for reimbursement.
Even if the result is better care for the patient,
the insurance company, unfortunately,
has their own system...
their own way that they judge value for service,
and that's really based on hearing people's ideas
who are very productive, very individualistic,
and based on speed, seeing a lot of patients.
Insurance companies are following that business model.
They are trying to maximize profits, of course,
being the business they are in.
So we will always have issues with that model.
What are some of the technological advancements
that you have seen thus far?
For example, Dr. Chris spoke
about the electronic medical records system.
So what are some advancements you have seen,
or even see down the pipeline, that could help support
deaf professionals and practitioners
working in the medical field?
I remember in the past, doctors would have to wear masks
that would make lip reading difficult,
but now we have see-through masks.
Advancements like these not only benefit deaf individuals,
but also, in turn, benefit hearing individuals, as well.
What other advancements have you seen in the last few years?
I use a stethoscope that connects directly to my implant,
but there are other options, as well,
where you can have a visual display.
I haven't used that.
I don't know if you'd like to talk about that, Scott.
Yes. I did. I can speak to that.
I have used a visual display that connects to a stethoscope,
and it's a real-time wave
that represents the sound of a heart.
There are two normal heart sounds
that we can expect to hear, and I can see those visually
on the display.
If there is a murmur, there will be an extra wave
that shows up, visually displaying the murmur.
I think it will be important in the future,
to have a device to display lung sounds.
We don't have something perfected yet
to identify lung sounds, but I have heard someone mention
a tactile device that is placed on the patient
which increases the sensation felt.
I'm lucky as a pediatrician
because children have thinner skin
and so it's easier for me to palpate
and feel what it might sound like.
This is true for some, but not all children.
It depends.
Some children are a little bit bigger, too.
Some might have asthma. They're suffering from a wheeze.
You can't always capture that.
The point is, in the future, hopefully,
we will have more technology like that.
It'll make jobs easier for deaf and hard-of-hearing people,
regardless of the medical field they are in.
>> I'd like to thank the panelists for their wisdom
they've shared tonight.
I hope you've all found this information helpful.
I'd like to thank you all for joining us this evening.
We do plan on having future panel discussions
on various topics throughout the year.
Hopefully, you can plan on attending,
>> and I'd like to once again thank our panelists.