Unmasking communication during COVID-19

Unmasking communication during COVID-19

As face masks become ubiquitous in our health-care practice due to the COVID-19 pandemic, communication between the patient and health-care provider has become harder than ever before. The challenges posed by COVID-19 have highlighted various areas of deficiencies in the health care industry as well as heightened anxiety among health-care providers as well as patients. Communication with patients has become particularly challenging and ever so more important than before.

Imagine the plight of a patient struggling to breathe, being greeted by someone in full PPE, struggling to understand your muffled speech through the mask amidst the background noise of oxygen hissing through a breathing mask. Earlier, your smile would have worked to ease some of the anxiety by coming across as approachable and friendly; however, your face mask has cost you a brave soldier in your battle of gaining trust. The situation is worse in the elderly, frail, and cognitively impaired patients who may rely on lip-reading and facial expressions to communicate.

Health care workers are forced to have difficult conversations of do-not-resuscitate orders, advance care planning, and break bad news while wearing a face mask and PPE, creating a barrier for effective communication with patients and their family members.

If you have previously relied on a firm handshake and a smile to lessen the anxiety of patients but are now finding it challenging to have clear communication, here are few ways to improve communication with patients.

Unmasking communication during COVID-19
Cite this article as: Neha Hudlikar, UAE, "Unmasking communication during COVID-19," in International Emergency Medicine Education Project, August 10, 2020, https://iem-student.org/2020/08/10/unmasking-communication-during-covid-19/, date accessed: September 25, 2021

Triads in Medicine – Rapid Review for Medical Students

triads in medicine

One of the most convenient ways of learning and remembering the main components of disease and identifying a medical condition on an exam are Triads, and medical students/interns/residents swear by them.

Be it a question during rounds, a multiple-choice exam question to be solved, or even in medical practice, the famous triads help physicians recall important characteristics and clinical features of a disease or treatment in an instant.

Since exam season is here, this could serve as a rapid review to recall the most common medical conditions.

While there are a vast number of triads/pentads available online, I have listed the most important (high-yy) ones that every student would be asked about at least once in the duration of their course.

1) Lethal Triad also known as The Trauma Triad of Death
Hypothermia + Coagulopathy + Metabolic Acidosis

2) Beck’s Triad of Cardiac Tamponade
Muffled heart sounds + Distended neck veins + Hypotension

3) Virchow’s Triad – Venous Thrombosis
Hypercoagulability + stasis + endothelial damage

4) Charcot’s Triad – Ascending Cholangitis
Fever with rigors + Right upper quadrant pain + Jaundice

5) Cushing’s Triad – Raised Intracranial Pressure
Bradycardia + Irregular respiration + Hypertension

6) Triad of Ruptured Abdominal Aortic Aneurysm
Severe Abdominal/Back Pain + Hypotension + Pulsatile Abdominal mass

7) Reactive Arthritis
Can’t See (Conjunctivitis) + Can’t Pee (Urethritis) + Can’t Climb a Tree (Arthritis)

8) Triad of Opioid Overdose
Pinpoint pupils + Respiratory Depression + CNS Depression

9) Hakims Triad – Normal Pressure Hydrocephalus
Gait Disturbance + Dementia + Urinary Incontinence

10) Horner’s Syndrome Triad
Ptosis + Miosis + Anydrosis

11) Mackler’s Triad – Oesophageal Perforation (Boerhaave Syndrome)
Vomiting + Lower Thoracic Pain + Subcutaneous Emphysema

12) Pheochromocytoma
Palpitations + Headache + Perspiration (Diaphoresis)

13) Leriche Syndrome
Buttock claudication + Impotence + Symmetrical Atrophy of bilateral lower extremities

14) Rigler’s Triad – Gallstone ileus
Gallstones + Pneumobilia + Small bowel obstruction

15) Whipple’s Triad – Insulinoma
Hypoglycemic attack + Low glucose + Resolving of the attack on glucose administration

16) Meniere’s Disease
Tinnitus + Vertigo + Hearing loss

17) Wernicke’s Encephalopathy- Thiamine Deficiency
Confusion + Ophthalmoplegia + Ataxia

18) Unhappy Triad – Knee Injury
Injury to Anterior Cruciate Ligament + Medial collateral ligament + Medial or Lateral Meniscus

19) Henoch Schonlein Purpura
Purpura + Abdominal pain + Joint pain

20) Meigs Syndrome
Benign ovarian tumor + pleural effusion + ascites

21) Felty’s Syndrome
Rheumatoid Arthritis + Splenomegaly + Neutropenia

22) Cauda Equina Syndrome
Low back pain + Bowel/Bladder Dysfunction + Saddle Anesthesia

23) Meningitis
Fever + Headache + Neck Stiffness

24) Wolf Parkinson White Syndrome
Delta Waves + Short PR Interval + Wide QRS Complex

25) Neurogenic Shock
Bradycardia + Hypotension + Hypothermia

Further Reading

Cite this article as: Sumaiya Hafiz, UAE, "Triads in Medicine – Rapid Review for Medical Students," in International Emergency Medicine Education Project, June 12, 2020, https://iem-student.org/2020/06/12/triads-in-medicine/, date accessed: September 25, 2021

Communication is the key!

Reflections by Vijay Nagpal and Bret A. Nicks

While many believe the environment of care is the greatest limiting factor as opposed to quality communication, literature would suggest otherwise. Establishing a positive patient-provider relationship is essential for patient care. One must recognize that while you may not be able to solve the patient’s condition or chronic illness, using effective communication skills and providing a positive patient experience will assuage many patient fears (Mole, 2016). Keep in mind, in general, patients remember less than 10% of the content (what was actually said), 38% of how you say it (verbal liking), and 55% of how you look saying it (body language) (Helman, 2015).

Patients remember

What you say
Web Designer 10%
How you say it
38%
How you look saying it
55%

Effective provider communicators routinely employ these 5 Steps

1

Be Genuine

We know it. People can sense the disingenuous person – whether it is a gut feeling or through other senses. Try to see the situation from the patient’s perspective, and it will ensure that you are acting in his best interest and with integrity.

2

Be Present

As emergency providers, we are interrupted more than perhaps any other specialty. However, for the few moments that we are engaged with the patient or his family, be all in. If there is a planned interruption upcoming, make it known prior to starting a discussion. Be focused on them and the conversation; value what they have to share. At the end of your encounter, briefly summarizing what the patient has told you can help to reassure the patient that you were listening and also give them the chance to clarify discrepancies.

3

Ask Questions

To effectively communicate, one must listen more than he talks. After introducing yourself, inquire about the patient’s medical concern; give them 60 seconds of uninterrupted time. Most patients are amazed and provide unique insights that would otherwise not be obtained. Once the patient has provided you with his concerns, begin asking the specific questions needed to further differentiate the care needed. By asking questions and allowing for answers, you make it about them and give them an avenue to share with you what they are most concerned about, enabling you to address those concerns.

4

Build Trust

Given the nature of the patient-provider relationship in emergency medicine, building trust is essential but often difficult. Building trust is like building a fire; it starts with the initial contact and builds with each interaction. Trust is also built on engaging in culturally acceptable interactions (Chan, 2012) such as a handshake, affirming node, hand-on-shoulder, or engaging posture.

5

Communicate Directly

Ensure that at the end of your initial encounter you have established a clear plan of care, what the patient can expect, how long it may take, and when you will return to reassess or provide additional information. Doing this also allows the patient to be more involved in his care and ask further questions regarding his workup and treatment plan. Additionally, helping the patient to understand what to expect while in the department can help to alleviate fear associated with unannounced tests or imaging studies, especially when these tests may require him or her to be temporarily taken out of the department (e.g., a trip to the CT scanner).

Many of these concepts have been identified in patient satisfaction and operational metrics. In one study, wait times were not associated with the perception of quality of care, but empathy by the provider with the initial interaction was clearly associated (Helman, 2015). In addition, patient dissatisfaction with delays to care is less linked to the actual time spent in the ED and more with a to set time expectations about the care process, a perceived lack of personal attention, and a perceived lack of staff communication and concern for the patient’s comfort.

To learn more about it

References

  • Nagpal V, Nicks BA. Communication and Interpersonal Interactions. In: Cevik AA, Quek LS, Noureldin A, Cakal ED (eds) iEmergency Medicine for Medical Students and Interns – 2018. Retrieved February 15, 2019, from https://iem-student.org/communication-and-interpersonal-interactions/
  • Mole TB, Begum H, Cooper-Moss N, et al. Limits of ‘patient-centeredness’: valuing contextually specific communication patterns. Med Educ. 2016 Mar; 50(3):359-69.
  • Helman A. Effective Patient Communication. Available at: http://emergencymedicinecases.com/episode-49-patient-centered-care/ Accessed December 18, 2015.
  • Chan EM, Wallner C, Swoboda TK, et al. Assessing Interpersonal and Communication Skills in Emergency Medicine. Acad Emerg Med 2012; 19:1390-1402.

ED-based Patient Handoff Tool (I-CAN)

Effective Communication in the ED

From Experts to Our Students! – Communication Skills in the ED

Bret A. Nicks - Communication Skills

Communication and Interpersonal Interactions chapter written by Vijay Nagpal and Bret A. Nicks from USA is just uploaded to the Website!