No masks, please – we must talk to patients
In all the controversy over wearing face masks to restrict the spread of coronavirus, one issue, of particular importance in general practice, seems to have been ignored. If both doctor and patient wear masks (not to mention goggles), communication is drastically impaired.
I have spent the past couple of weeks in a Covid-19 “hot hub” established to assess patients with suspected infection in primary care. The aim is to make a diagnosis on the basis of clinical features (testing is not available at these hubs) and decide whether patients can be monitored in the community or need hospital admission.
Working on the assumption that patients may have Covid-19, it is necessary to conduct an assessment wearing full personal protective equipment, including apron and gloves, goggles and face mask (the patient is also issued with a mask). We have all become familiar with images of intensive care unit staff in similar attire. But ICU staff need only communicate with one another – their patients are generally unconscious. We need to talk to ours.
Last week, a mother, who was self-isolating but well, brought in her toddler who had developed a mild fever. The child took one look at me in my weird PPE and burst into tears. It took some time to persuade her that I was not in fact an alien and allow me to examine her.
Several minutes shouting across the approved two-metre separation at an elderly man who was quite deaf reminded me how many people with hearing impairments rely on lip-reading and other facial cues.
Call me old-fashioned, but I hope the growing pressure to wear masks will not extend into our surgeries, and we can return to face-to-face interaction as soon as possible.
Endangered ritual
Handshaking has been identified as a significant mode of transmission of the coronavirus, implicated in the infection of the Prime Minister and other public figures. This longestablished social practice seems destined to become another casualty of the pandemic.
I was brought up in Yorkshire by Irish parents, both cultures in which handshaking is prevalent among men, women and children. In these worlds, man-hugging and air-kissing are scorned as southern, English, affectations, for men a bit effeminate, like carrying an umbrella.
In general practice, I shake hands and introduce myself to patients I have not met before, and whoever comes into the surgery with them, being sure to catch their names, make eye contact, to engage with them. A firm handshake reflects confidence: “I’m all right – you’re all right.” A limp handshake suggests diffidence, self-deprecation. A sweaty tremulous palm indicates anxiety, fever or perhaps an endocrine disorder.
A wealth of information in a traditional ritual, now endangered!
Dubious promises
I arrived home from a session at the “hot hub” to find a leaflet, handdelivered, offering “at-home rapid PCR swab test” for the Covid-19 virus at £295 a go. The “package” on offer includes a telephone consultation with a GP.
Is it worth it? It takes 24 hours for a courier to bring the test kit and results are promised within three to five working days. If the weekend intervenes, this could take at least a week – the period of time during which self-isolation would anyway be recommended on account of symptoms.
Is the test accurate? The leaflet claims that the test “can correctly identify positive cases >98 per cent of the time”. This sounds too good to be true: similar tests used in China missed 30 per cent of positive cases. Yale medicine professor Harlan Krumholz advises that, “if you have had likely exposures and symptoms to suggest Covid-19 infection, you probably have it – even if your test is negative”. I think I’ll give it a miss.
The child took one look at me in my PPE and burst into tears. I had to persuade her I wasn’t an alien