"Doctor if I See You Again I Won't Even Recognize You!"
The Doctor- Patient consultation is a sacred covenant, full of meaningful interactions where the patient unburdens herself to the physician who listens, watches, and interacts with the patient. It is one of the most intimate interpersonal communications- akin to a confessional in a way.
The current Pandemic has changed the consultation process in unimaginable ways.
Let me highlight the protocols being followed all over to ensure that the patient and the medical facility both remain safe -
- Only one patient is seen in the chamber- Attendants are actively discouraged from entering unless the patient is a minor child or cannot communicate effectively with the doctor for some reason. Patients in India are famous for bringing many attendants - sometimes the whole family turns up to show one person. This has stopped.
- Only one to two patients are permitted in waiting areas to maintain physical distancing and to minimize chances of cross infection. So the hustle and bustle of a busy clinic is missing.
- Patient is masked at all times, except for the brief period when the Nose or Throat are being examined.
- Contact time in the clinic is minimal - it is generally accepted that the less the time you spend in a medical facility the safer you are.
- All soft furnishings, curtains, sofa sets etc. have been removed. So the clinic has a bare bones appearance- like a mini post apocalyptic scenario.
- The attending doctor and staff wear full PPE - completely covered from head to toe, along with gloves and eye glasses and face shield - so apart from a narrow slit of the eyes nothing else is visible.
How has this affected the traditional patient-doctor interaction?
Effective human communication depends upon speech, gestures and facial expressions.
In the current situation all three are affected to a lesser or greater degree.
The full face mask prevents effective speech - quite often we have to ask the other person to repeat since the voice comes out muffled. Being an ENT Clinic many of my patients are hard of hearing and they depend upon lip reading to enhance the understanding of the spoken word. This skill of theirs cannot be put to any use now.
The wearing of masks and gloves as well as the full PPE by the doctor prevents easy gesticulation thus hampering communication.
More importantly it is the loss of visualizing facial expressions that throws the biggest damper on effective communication. The face is amazingly expressive- it can produce thousands of expressive outlines to highlight our inner emotions. The dull monotone of the mask covered face robs the consultation of a deep human and emotional connect. If I crack a joke to lighten the mood of a somber moment, I cannot even see if my patient is smiling!
For many conditions the patient has to physically visit the clinic- for a deeper examination, to carry out diagnostic procedures, for pain alleviation- as in wax impaction in the ears causing severe pain which needs to be removed, to remove a piece of play dough stuck in a child's ear, for further evaluation - as in performing an accurate Audiogram for hearing loss and for many other such indications.
Interestingly, I was taken aback after one such consultation when a patient told me jokingly - 'Doctor if I see you again, I won't even recognize you!'
Ever since then we have a large photograph of my face hung up on the wall to let the patient know what I look like!!