Masks and Communication Problems

a scary looking man wearing a mask

Unintended consequences! I’m sure mask use has led to a problem.

I was so wrapped up in the technical issues of using PPE (why, when, how, etc.) that I overlooked all-important human factors.

I saw a new patient a few weeks ago. She was recommended to me by her daughter, a long-time patient of mine, in the hope that I could help her mother’s troublesome chronic lumbar problem.

During the second session, I decided to release her right low lumbar spine by an HVT technique.

Naturally, I went through the usual pre-technique explanation of what I was doing, why I was doing it, and so on.

The patient gave her consent, and all seemed fine.

I didn’t ask her to book back in as she had a complex pattern and I felt it was best to see how she got on. I asked her to update me by email two to three days after the treatment.

Anyway, a week after that second session, she called me. There hadn’t been any previous email. She was quite upset, complaining that I had caused her low-back to seize up a couple of days before the phone call, and it was all because of the discomfort she had experienced during the HVT.

Leaving aside the rights and wrongs of her complaint, the main issue I had to deal with was the dilemma that faces all practitioners in this situation.

How do we make peace with an irate or upset patient while not admitting fault?

Sometimes we feel we have got something wrong, but insurance reasons dictate caution re admitting this. A lot depends on the relationship with, and attitude of, the patient.

But in this particular case, I didn’t feel that I had caused her new low back seize-up.

Anyway, I did my best. I don’t have much experience with this tricky balancing act. Racking my memory, I think this might be only the second time I have had a patient conversation like this – the other was in my first year of practice.

It took a day or so of reflecting on what had happened.

Finally, the penny dropped.

Both of us wearing masks had seriously complicated the situation. Not having seen me before and likely with apprehensions about treatment, she was treated by a faceless man in a way she didn’t like.

All she could see was my eyes.

Even worse, they were hidden behind steamed-up spectacles!

And for me? All those years of developing a sixth-sense in terms of reading patient’s facial expressions were irrelevant. I couldn’t see her face.

So we both were in a situation where we couldn’t communicate with each other in the way we wanted to and needed to.

I’m sure this was a massively complicating factor.

Now I compensate.

  • I explicitly tell all patients, not just the new ones who don’t know me, that we have a real challenge to communication caused by mask use and that we need to verbalise more.
  • I show my (smiling) face to new patients – at a safe distance – when I greet them outside the clinic and spend a minute or so chatting before masking up and bringing them in.
  • And my antennae are now raised to Def-Con 4.

Hopefully, this will be enough?

Ultimately, of course, what happened was my responsibility. I should have foreseen these issues.

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