A geriatrician reflects on the usage of mask and the impact it has on day-day practise.
A lot has been spoken about the use and the indispensability of face masks in recent times that anything to the contrary would be almost blasphemous. While the mask intends to, (and rightly so), covers the mouth and the nose, this also hides facial expressions, which are of vital importance when managing a patient. When Robert Hutchinson penned down “the patient interview”, in his manual of Clinical Methods in 1897, he may not have had to deal with the masked patient.
As a doctor who largely deals with older patients, I find it perplexing to figure out if my masked patient is smiling, anxious or downright depressed. A greeting “What brings you here this day?” is met with the same distant look in the eyes he/ she had prior to entering my chamber. The lip movements and other small facial muscles that conjure up a smile, a grimace or sadness lies concealed behind the veil. “When palpating the patient’s abdomen, look for tenderness, by observing the patient’s face”, our teachers said. Nobody said anything about uncovering the face while doing so. And if your patient was an infant or an older person with dementia, who needed to recognize the carer’s / doctor’s familiar face, then God help you.
So, when my 80 year old patient with dementia who cannot vocalize, frowns at me when I try to examine her, I am tempted to pull down my mask and yank off my visor to grasp her attention. That one second of recognition, that moment of relief may actually help her co-operate and thus help in managing her better.Regardless of all said, these desperate times call for strict vigil and the benefit of these masks cannot be understated. A soft whisper or a gentle touch may achieve the desired purpose. Until safer times, we need to mask ourselves and ‘unmask’ other non verbal modes of communication.
Dr. Steve Paul
Dr. Steve Paul is a consultant Geriatrician from Kerala. He pens down his unique experiences from his day-day practise of caring for the elderly.
Featured image courtesy: Tai captures at unsplash.