Young Physicians: Learning to Communicate in a Pandemic

Jessica Fujimoto, MD

The transition from resident physician to attending physician is full of challenges: fighting imposter syndrome, learning to work in a new hospital system, and finding one’s voice as a new leader. During the SARS-CoV2 pandemic, young physicians have the added task of doing all of this while donning PAPRs, P100 respirators, or N95s to protect themselves. Though interpersonal communication is a skill that physicians start to build in residency, communicating while wearing a mask is an entirely new skill. Masks cover mouths and noses, taking away our primary means of nonverbal communication. They muffle voices, particularly at higher pitches, which hinders our ability to communicate verbally. Interpersonal communication is a critical part of our job – a key component of both the physician-patient relationship and health care team dynamics; thus, poor communication is a threat to patient care and patient safety.

As with other challenges, we can begin by learning from those with different experiences than our own. Surgeons effectively communicate and lead teams in the OR while wearing a mask by keeping clear and open channels of communication. Muslim women who wear niqab are able to convey emotions by varying voice pitch and tone. People with congenital prosopagnosia use nonverbal cues such as gait and hand gestures to interpret sentiments of their communication partners. Additional review of current literature reveals the following recommendations for overcoming the challenge of communicating while wearing masks:

Acknowledge the challenge. It is important to first recognize the communication challenges that come with mask wearing. • Verbally name the communication challenges presented by mask wearing. This helps team members and patients get on the same page and adjust communication styles. • Departments or hospitals should provide education about the challenges of interpersonal communication in masks. • Consider discussing strategies with speech language therapists, who can be a helpful resource given their experience with patients rehabilitating from aphasias and facial nerve palsies.

Set the stage. Time spent preparing the environment for an exchange can pay dividends. • Reduce background noise by discussing communication goals with the team, and by minimizing the number of people and equipment in the room. • Perform a team huddle when high stress, complex patient encounters are expected (e.g. cardiac arrest). The huddle allows the leader to convey a medical management plan in addition to a communication plan. It also allows team members to familiarize themselves with each other’s roles. • When possible, reduce obstructions of visual fields in order to optimize viewing of each other’s nonverbal cues. Speak up. Optimizing verbal communication can help compensate for the impairment of nonverbal communication caused by mask wearing. • When in doubt, speak up! Masks muffle voices, particularly at higher frequency. • Always introduce yourself, including your role. It is challenging for patients and staff to distinguish each other when everyone is wearing gowns, bouffants, goggles, face shields, and masks. • Use names as much as possible when addressing others. This decreases reliance on eye contact, which is difficult to determine when wearing PPE. • Communicate nonverbal information verbally. For example, tell your patient “I’m smiling back at you” since they are unable to see your expression under your mask. • Invite questions and check for understanding to maintain open lines of communication.

Interpersonal communication is a critical part of our job – a key component of both the physician-patient relationship and health care team dynamics; thus, poor communication is a threat to patient care and patient safety.”