Practice Management Alert

Do some prep now to facilitate smoother interactions for people who depend on nonverbal cues.

As more traditional means of healthcare begin to reopen, practice managers are grappling with how to keep their offices safe for patients and staff. Keeping a stock of personal protective equipment (PPE) on hand and making sure everyone knows how to correctly don and doff all the elements are major aspects of reopening.

However, connecting with patients in a meaningful way is also a crucial part of providing high-quality care. With the stay-at-home orders still varying across the country, there is a good chance the patients you’ll be seeing haven’t had much in-person interaction in the past few months. Knowing how to connect with patients regardless of PPE usage may be key.

Insist on Mask Usage

The Centers for Disease Control and Prevention (CDC) has included mask usage as a part of its official guidance for nonemergent care facilities reopening.

All staff, as well as patients, should wear masks in the office, the CDC and the Centers for Medicare & Medicaid Services (CMS) say. All healthcare personnel should wear surgical masks, and patients should wear cloth face masks if they cannot obtain surgical masks. You or a staff member can use the appointment reminder calls to tell patients that all practice visitors must wear masks.

Leading industry stakeholders are fighting for more resources and assistance for practices, too. “We are hearing significant and growing concern from our member physicians that they cannot secure needed supplies to safely reopen and that they are unsure where to turn for further guidance and assistance,” said James L. Madara, MD, CEO and executive vice president of the American Medical Association (AMA) in a June letter to U.S. Vice President Mike Pence.

Don’t Think of Masks As Barrier to Patient Satisfaction

For physicians or staff worried about how patients will react to the change in face-to-face encounters, the evidence generally suggests that patients aren’t less satisfied with healthcare personnel who use masks. Most of the available studies are from countries in Asia and places where face mask usage became routine before the COVID-19 pandemic.

“In this large randomized controlled trial, we found that the wearing of face masks by doctors had little effect on patient enablement and satisfaction but had a significant and negative effect on patients’ perceptions of the doctors’ empathy,” say Carmen Ka Man Wong and Benjamin Hon Kei Yip, et. al., in their 2013 article “Effect of face masks on empathy and relational continuity: a randomized controlled trial in primary care,” published in BMC Family Practice Volume 14.

Be Sensitive to Communication Styles

Face masks can also be an obstacle for patients who rely on facial or vocal cues to take part in conversations, especially for the deaf community or people who experience hearing loss. Nonverbal communication is a significant aspect of many face-to-face encounters, both in healthcare and in society at large.

“Many facial expressions are the same across cultures, like happiness, sadness, anger, and fear, and our faces can express emotions without saying a word. Given widespread masking, this nonverbal communication has become increasingly difficult,” say Mathias Schlögl, MD, MPH, of University Hospital Zurich in Zurich, Switzerland, and Christopher A. Jones, MD, MBA, of University of Pennsylvania in Philadelphia, in a letter to the editor in The Journal of American Geriatrics, Volume 68.

Schlögl and Jones recommend keeping these behaviors in mind when attending patients while wearing PPE: Attend mindfully, behave calmly, communicate clearly. Though their guidance is especially crucial for patients who are cognitively impaired, such as people with dementia, the advice is useful for all healthcare practitioners who want to be mindful of how masks can complicate interactions. Specifically, using short, simple sentences and accompanying your words with gestures can be helpful, as can pausing after statements or questions.

Encourage your staff to become familiar with the resource guide put together by the Hearing Loss Association of America (HLAA), which includes suggestions from contributors who recommend various apps and other strategies. Patients who experience hearing loss may come to your practice utilizing some of these recommendations, so becoming familiar with speech-to-text apps and making your Wi-Fi accessible for such app usage can be a huge boon to smoothing potentially stressful interactions.

Resource: See the HLAA recommendations here: www.hearingloss.org/communication-access-recommendations-hospitals-covid-19.