COMPLICATED COMMUNICATIONS DURING THE PANDEMIC

ABSTRACT

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.