The power of words behind the mask.

One lesson I learned in my 12 years working in the NHS was the difference a few words can make to a patient’s experience. Words can be very powerful, especially at such a vulnerable time in people’s lives. A few words can be the difference between making someone feel cared for and understood, and making someone feel helpless and afraid.

In the crisis we face today, increasingly it is the front line staff who are in a position to have these conversations and moments with patients suffering from Covid-19. With visiting restrictions, the need for connection and comfort is heightened for these patients who are without their loved ones at this difficult time. So as a doctor, how can you make the most of the moments you have to provide comfort and connection to these vulnerable patients?

Introductions 

Introductions with your patients are really important. Good introductions are key to building a connection and establishing trust. I have been in the position of a patient and know what it feels like when the doctor doesn’t make eye contact, doesn’t introduce themselves or the 6 other people around my bedside discussing me.

When making introductions:

• Make eye contact with your patient,
• Behind PPE you may think a smile can’t be seen but you can always see a smile in someone's eyes! Even if they can’t see your smile they will notice it in the tone of your voice as the act of smiling changes your tone of voice to be more warm and friendly.
• Introduce yourself and if you are happy, give them permission to use your first name.
• Remember that many people feel more comfortable being addressed by their christian name so ask them what they would like to be called. Some may also prefer a shortened version of their name or they may use their middle name so never assume the first name written down is the name to use.
• Because your face is not well visible behind PPE, consider laminating a photo of yourself smiling with your name and attaching it to your gown. This will help the patient connect with you.

Small talk 

Small talk is the beginning of nearly every social and professional relationship and is crucial for establishing trust. It helps you show your patients that you see them as people and not just problems to be solved. Life as a doctor is busy and demanding, but small talk only needs to be a few seconds of your interaction. Those seconds can ensure you establish trust with your patient making them more likely to be open and honest, and engage with your recommendations. It’s a well known stereotype that British people love talking about the weather, in fact a recent study showed that British people on average spend 4.5 months of their lives talking about the weather! This isn’t surprising as it’s a non-threatening topic and is a good way to find common ground.

When making small talk:

• Avoid personal topics or topics that could be controversial like politics or religion.
• Use topics such as the weather, sports (or the lack of during this time), or simply ask them how they slept last night.
• In my experience, items in the room can provide good topics for small talk. Is there a tray of hospital food on their table? You could ask them how they are enjoying hospital food! Do they have a book on the table or some personal photos? I always found that showing interest by commenting or asking questions about these can instantly help establish rapport, the basis of any good doctor patient relationship.

Humour 

It may seem strange to talk about humour at such a time, but humour can play an incredibly important part of your interactions. There is plenty of research to prove that humour and laughter can have a significant physiological impact on a persons stress level and ability to heal. Studies also show that humour in the health care setting can facilitate connection, reduce fear and build trust. In British culture humour is used and expected as a regular part of daily conversations. British people often use humour to defuse tense situations and lighten the mood and this can be particularly true in hospital settings. As an Occupational Therapist I conducted numerous standardised and non-standardised assessment with patients, many of which could determine whether the patient could be discharged home, whether they could drive following a stroke or whether they had the capacity to make a decision about their care. Establishing rapport and easing anxieties were essential to be able to conduct a fair assessment. Humour can be such an important tool when trying to ease anxieties. 

Consider the fear people feel when faced with a medical professional in full protective gear. A joke at the beginning of the first encounter can make an incredible difference to the patient’s experience especially in these circumstances. Consider making a joke when you meet the patient, likening your outfit to an alien from outer space, or apologising for the gear you are wearing explaining you are covering a bad shaving accident or you didn’t have time to apply make up this morning. Lightening the mood at the beginning can change the whole experience for a patient and for you as a doctor.