An unintended consequence of COVID universal masking

Spring 2020 has brought a disproportionate amount of grief for many of us. The losses include mortal ones, such as the death of a loved one, a colleague, or a patient. We’ve lost productivity, opportunities, and income. We’ve also lost freedoms, from the personal liberty to go where we please to our ability to spend time alone (due to quarantine in close quarters with family members). And as an anesthesiologist, another loss due to COVID-19 I’ve realized is a loss of rapport with my patients.

At my hospital and many others, a policy of universal masking is in effect. We must wear masks in the building at all times. All patients are likewise required to wear masks, either brought from home or provided to them when they arrive on site. Now, when I meet my patients in the preoperative suite to discuss their surgery and anesthetic, their face is half-covered. And so is mine.

No matter what we’re trying to say, a huge part of our communication as humans is nonverbal: body language, facial expressions, eye contact. Masks, by all definitions, significantly cover some of these elements. While eyes remain visible, the entirety of a facial expression can be lost in an interaction. Voices are muffled. The other day, a fellow doctor with perfectly good hearing said to me, “I never realized until now how much I use lip reading to understand other people.”

Imagine you’re hospitalized with COVID: febrile, short of breath, scared, and uncertain. No family members are allowed to be with you. And the only people who talk to you are doing so through a mask, or maybe a PAPR. We’ve seen and heard the stories of these patients suffering alone. Now imagine that you don’t have COVID, and you’re finally cleared to have the surgery you’ve been waiting months for. You’re lying on the cold stretcher in your hospital gown, just as scared and uncertain about how things will go. Your family isn’t allowed in the preop suite, and again the only people who talk to you are doing so through a mask. Including a health care team you’re about to trust with your life.

Despite what many might imagine, a huge part of my job as an anesthesiologist is establishing patient rapport. Yes, my interactions with patients (when not anesthetized) are much shorter than doctors of other specialties, but a trusting relationship between my patients and me is absolutely vital to their anesthetic and surgical experience. With over ten years of practice, I’ve worked hard on how I approach patients of all backgrounds getting all types of surgeries. I’ve honed my methods to relate to them in a very short period of time and explain to their satisfaction the unique plan I have in place for their anesthesia, along with their risks and benefits. At the risk of sounding glib, I feel like this is a great strength of my practice.

Until now. The masks have thrown a challenge my way. Don’t get me wrong; I recognize the importance of their use when in close contact with patients in this age of COVID. The small change I’ve incorporated to deal with this is to take advantage of the airway examination. When I ask my patients to remove their mask for my airway exam, I make sure (with appropriate distance) to first remove mine for a moment so that I can demonstrate the exam and also give them a big smile. The reciprocations warm my heart.

Have you noticed this in your own practice, regardless of specialty? How have you dealt with the communication disconnect? What else are you mourning this spring?

Dawn Baker is an anesthesiologist who blogs at Practice Balance.

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