COMPLICATED COMMUNICATIONS DURING THE PANDEMIC

CASE: The Pandemic has been one of the greatest challenges in health care. Communication is the most vital part of the patient visit. The pandemic hindered the doctor-patient communiciation in unimaginable ways. Besides using Televisits with its new set of challenges, I present these clinic visits with complicated communication. Case 1-Deaf mute patient 45 year male deaf mute with chronic kidney disease stage 3a with hypertension and med "non compliance." The interpreter used Americal sign language along with lip reading. Lip reading is hindered by the standard mask. This interpreter used a special type of lip tranparent mask. We discovered that the patient was confused regarding the BP medications attributing to his non compliance. Repeat BP check at 1 and 3 months was at goal after he understood the instructions. Other patients also found the lip transparent mask to be useful when they had hearing deficit or English accent problem and relied on lip reading for communication. Case 2-Grieving 42 year old Spanish only speaking lady just lost her husband to COVID. She herself was recovering from COVID and was grieving. Computer based interpreter was used along with social distancing and shield and mask. This made comforting the patient challenging. Case 3-Computer based interpreters A 28 year female patient speaking only Amharric had breast pain. I used computer based interpreter with audio only option and kept the video off, especially during the physical examination. 89 year Vietnamese only speaking male had multi organ failure. I had to use the computer based interpreter to explain the situation to him and family and offer them hospice. Hospice concept was totally new to them. They were committed to caring for him at home and felt that hospice was an intrusion that God did not want and was not culturally acceptable. Today they are happy with home hospice care. Case 4-Intellectually challenged patients-Cerebral palsy 40 year aphasic male with cerebral palsy came with his host caregiver. Patient had open sores on his neck that he had been scratching. He was cooperative but was pulling at his mask and was unable to understand my simple instructions through my mask and shield. IMPACT/DISCUSSION: Clear communication is a key to a good clinic visit and patient and provider satisfaction. Low English proficiency (LEP) is a road block that we try to overcome by using interpreters. This vignette is an excellent demonstration of challenges to communication that we encountered during the pandemic. Publication here will give an opportunity to identify with our struggles, exchange ideas and help our trainees. CONCLUSION: Wearing mask and social distancing saved countless lives during the COVID pandemic.It presented unprecendented challenges to doctor-patient communication. It is important to anticipate, understand and educate our learners about these challenges and continue to provide culturally competant care.

THE EFFECTS OF FACE MASK USE DURING COVID-19 ON SPEECH COMPREHENSION IN GERIATRIC PATIENTS WITH HEARING LOSS WHO USE LIP-READING FOR COMMUNICATION: A PROSPECTIVE CROSS-SECTIONAL STUDY

Objective: Communication difficulties are considered the most significant consequence of hearing loss. This study aimed to determine whether surgical face masks, which have been mandatory throughout the COVID-19 pandemic, have an effect on speech comprehension scores in geriatric lip-reading patients with hearing loss and to raise awareness of the need for solutions to this problem. Materials and Method: Patients with moderate and higher sensorineural or mixed bilateral symmetrical hearing loss who stated that they lip-read to better understand during communication were included in the study. The patients’ speech comprehension scores were gathered while the audiologist wore a surgical mask and then a transparent mask, respectively. Results: Twelve (33,3%) of the patients were female, and 24 (66.7%) were male. The mean age of the patients was 66.64±1.53 years. The mean speech comprehension scores of the patients when the audiologist was wearing a surgical mask (38.25±14.33) and a transparent mask (67.81 ± 14.30), respectively, were compared. The surgical mask significantly affected speech comprehension scores, and the Cohen d value of the effect size was 2.06. As such, the surgical face mask had a great effect on these patients’ speech comprehension scores. Conclusions: In elderly lip-reading patients who suffer from hearing loss, seeing the lip movements of the speaker, especially in hospital applications, promotes more effective communication. Transparent face masks can be considered a solution.

How facial masks against Covid-19 spread affect the speech spectrum

Introduction: At the aim of counteracting the spread of the infection, the European Center for Disease Prevention and Control has provided indications on the suitability of the use of face masks when the social distancing cannot be implemented. Facial masks can alter verbal communication, causing potential safety problems. Methods: Eight types of masks (medical, PPE and cloth), one face-shield and four combinations of the same devices were tested, mounted on Head and Torso Simulator with an artificial mouth. For each configuration, tests were carried out in an anechoic chamber with an appropriate measurement chain for signal acquisition and processing. Results: The results show that medical devices exhibit lower attenuation at high frequencies, even compared to cloth. FFP2 and FFP3 have attenuations greater than 5 dB in the octave bands of 4 and 8 kHz, with negligible influence on acoustic performance due to the presence of valves. Face shield distorts the vocal spectrum, behaving like a low-pass filter with a cut-off frequency around 1 kHz, with a steep slope (with attenuation > 10 dB at 4 and 8 kHz) and an accentuated resonance at 1 kHz (about 6-8 dB), due to the thin PET screen. Clear mask shows low attenuation up to 4 kHz and adds the benefit of lip reading, especially useful for workers with hearing difficulties. Conclusions: These results show that the devices examined can alter the quality of speech. Further insights will concern the assessment of speech intelligibility in order to provide a contribution to an ergonomic design also linked to the acoustic comfort of these devices, which would be desirable in a post-p

The implications of hearing loss on a medical student: A personal view and learning points for medical educators.

Due to the widening access to medicine scheme, students with disabilities are entering medicine. Hearing-impaired students are an important subcategory of medical students, whose specific learning challenges with respect to medicine are poorly explored in the literature. We feel that this topic is particularly important and relevant given the current covid-19 pandemic, which has led to the widespread use of surgical masks, thereby posing a barrier to hearing, communication and education for hearing-impaired medical students. Therefore, the medical education of these students is of even more paramount importance as the pandemic continues. This personal view details the experiences of a current hearing-impaired medical student in the United Kingdom, with key learning points for medical educators who may require insight into hearing loss and how to tailor their teaching techniques accordingly.