Universal lessons learned by a gastroenterologist from a deaf and mute patient: the importance of nonverbal communication and establishing patient rapport and trust.

Deaf and mute patients may require minimal extra attention to establish trust and allay anxieties before minor medical maneuvers such as rectal examination. An extreme case is reported of the consequences from failure to accomplish this. A generally cooperative deaf and mute patient struggled and suffered a rectal tear and perforation during enema insertion that required emergency colorectal surgery; his nurse had failed to establish a trusting relationship before enema insertion. Ironically, the patient's physician had earlier easily performed digital rectal examination, a similar medical maneuver, with patient cooperation after establishing patient rapport. This report demonstrates the importance of treating individuals with disabilities like everyone else in addressing anxieties before medical maneuvers. The health care worker has the same responsibility of calming the patient, whether deaf or not; the sole difference is that communication between deaf and hearing requires greater skill and patience.