60% of telehealth platforms used by top hospitals do not offer captioning, so hard-of-hearing patients cannot understand their doctors during video visits

Only 40% of telehealth platforms used by the top 20 U.S. News Best Hospitals routinely offered automatic captioning as of a 2022 analysis — meaning 60% of the most prestigious health systems in the country were conducting video visits on platforms where hard-of-hearing patients could not read what their doctor was saying. This is not a fringe issue: telehealth visits exploded during COVID and have remained a permanent fixture of healthcare delivery, with an estimated 37% of adults using telehealth in 2024. For the 48 million Americans with some degree of hearing loss, a telehealth visit without captioning is functionally inaccessible. This matters because telehealth was supposed to increase healthcare access, especially for elderly and rural patients — the same populations with the highest rates of hearing loss. Instead, it created a new barrier. A hard-of-hearing patient on a video call with their doctor faces compressed audio, network latency, and the loss of visual lip-reading cues (poor camera angles, small video windows, masks). Without captions, they miss medication names, dosage instructions, diagnosis explanations, and follow-up care plans. They nod along and hang up without understanding their treatment. They take the wrong dose. They miss a warning about drug interactions. They do not schedule the follow-up their doctor recommended. The patient is not non-compliant — they are uninformed because the platform denied them access to the information. The structural reason this persists is that telehealth platforms were built for the hearing majority and retrofitted for accessibility as an afterthought. Hospital IT departments select telehealth vendors based on HIPAA compliance, EHR integration, cost, and clinician workflow — not patient accessibility features. The FCC issued a rule effective September 2024 requiring video platforms to include captioning, but enforcement is nascent and many hospital-specific telehealth portals (built on white-label platforms) have not been updated. Even where captioning exists, clinicians must manually enable it — and many do not know how, or forget. The burden falls on the patient to ask, 'Can you turn on captions?' — assuming they can hear the doctor well enough to know what they are missing in the first place.