What does COVID mean for clinician-patient communication? Dr. Beverly Zavaleta talks to us from the front lines about the significant communication challenges presented by COVID, how she and her team are dealing with them, and what’s she’s learned about making words matter.
Communication from clinicians to their patients, and those patients’ families, is always a complex endeavor. But COVID-19 has made communication more complicated, in multiple ways. Physician Beverly Zavaleta comes back to the show to check in, and tell us how she’s handling this staggering communication challenge. And she offers some insight and support.
This is 10 Minutes to Better Patient Communication from Health Communication Partners. I’m Dr. Anne-Marie Liebel live via Skype with Dr Beverly Zavaleta who’s talking to us from Brownsville Texas. Doctor Zavaleta welcome back to the show
Thank you so much Anne Marie it is a pleasure to be here again.
We did an interview together just before COVID broke in the US. I’m so glad you’re back here so we can check in. Can you tell us what you’ve been doing the last few weeks in Texas?
Sure so i’ve been splitting my time between taking care of patients as part of the hospitalist group, both in the COVID unit and on the regular floor, as well as participating in our covid-19 response team which is responsible for preparing and managing the hospital response to covid-19 pandemic and getting and keeping us ready for that
Wow so patient care, in and beyond the COVID unit, and administrative work. Wow
Correct. That’s right.
Well the lot of communication going on. Can you talk about some of the problems with communication specifically with the patients and their families now in the COVID era?
Communication has been a little bit trickier now that we don’t have visitors allowed in the hospital, most of the time, with rare exception. One problem that comes up is that the family communication is is mostly done on the phone. And so that means a fair amount of phone tag just trying to get people on the phone. And then doing all the explanations of the treatments, and tests, and results, and diagnosis makes it difficult over the phone. And just trying to really help them understand what’s going on with their loved one
And when they don’t have like your facial expressions and body language to deal with I can see how that’s a problem on both sides of the line. Not being able to see each other’s body language and facial expressions
The same goes for even in person with the patients as well, because everybody’s wearing masks now.
That’s true, so you’re losing facial expressions!
Right we’re covered up whether the patient is on the Cobra unit or not we’re wearing regular masks everywhere in the hospital all the PPE that personal protective equipment in the COVID unit. So we can’t, they can’t read our lips, they can’t see our face, and it’s really difficult to communicate information to the patient. And even even on the healthcare team, because of the layers of PPE that we’re wearing.
And I can see how for people who have any hearing difficulties or your patience for whom English is an additional language being able to read lips is pretty important
Yes so for the patients who are hard of hearing, what we find for example the COVID unit, is ironically we’ll be leaning in close–almost yelling, which is an infection risk, though we are protected with the face shield. And then even between the nurses and I, we’re practically shouting at each other because of the layers of double masking and face shield. And I mean year, it’s a challenge, communicating, communicating the information is is tough
And you’re trying to do more than just communicate information too. Like this is a stressful situation this is an unknown situation there’s a lot of confusion
Yeah. So “stressful” would be the understatement. I think most patients, especially on the COVID unit are terrified. And I find that trying to reassure a patient, when all they can see is a sliver of my eyes, is really challenging. I mean, if I’m smiling behind the mask and trying to ease Their Fear, they can’t see that. So I’m smiling with my eyebrows and and you know I’m hoping that it helps so it’s it’s difficult.
That’s what I’m wondering now: how are you feeling in all of this emotional intensity?
I’m, sometimes I feel inadequate because they are so scared and I mean I’ve I’ve been scared too as patients started to surge in our hospital, it’s, it’s scary. I am very happy for our protocols procedures and the PPE that we have. I feel I’m surrounded by their loneliness. The patients are lonely, the families are lonely and scared. I’m sad that I can’t change a lot of this, I don’t have control over it. It it’s such a hard situation. I, I’ve got people sobbing on the phone, I’ve got a daughter sobbing on the phone that she doesn’t want her mother to die alone in the hospital. So I, I’m sitting in their grief with them, and I feel helpless about it. It’s harder for me to give people peace than it is when they’re there in person
How, gosh I’m trying to think about that, giving people peace, as a part of your job. Because they can’t see what you’re seeing, they can’t see it with their own eyes, they’re not, they’re not there. How are you handling these just unbelievable communication problems?
I, I have been really trying hard to reassure them by choosing my words very specifically. Such as, I was saying to a patient’s family member, “I can’t replace you, we can’t replace you here at at your dad’s bedside. But I’ve got your eye on him, and we’re going to take care of him.” I admitted a young man to the ICU couple of weeks ago and he was tearful and I I said, “I know you wish your family were here but we’re doing our best, and you are not alone.” I also use a lot of touch, which you know from time to time I take someone’s hand or touch their arm, but I find I’m doing it more. And I think it’s my compensation, that they can’t see me smile. They don’t see my whole face, they just see my eyes, and so I’m reaching for their hands and emphasizing my words with a touch.
How about your team? How is your team doing with communication?
The team is great. The nurses and staff are making an effort to make sure that the patients can call their their family members. Some of the patients are not able to. They have physical impairments or mental impairments. They’re confused and they can’t use their phone. And so the nurses are using their hospital phones to dial the family, and they hold the phone up to the patients ear so that they can hear the voice of their family member
That makes sense. I love the image of a nurse holding the phone up to a patient’s ear, too. That’s really that’s really remarkable. So I know all of this is still going on you’re very much in the thick of it right now. Do you feel like you’re learning anything so far from how you’re handling things?
I do. I feel that words matter more than ever. It seems to really help if I use these very explicit, strong words of connection like what I mentioned above such as ‘we are here with you’ or ‘you are not alone’ I think that the patient’s anxiety improves, and the families seem soothed after I clearly state our team’s intentions that we are going to be there with them. And I think it requires a bit of extra bravery to say these very clear phrases of extreme connection. It’s like an extra touch of love from the team, from me, from the nurse. It’s it’s a little bit more risky and vulnerable because it’s really acknowledge in how much distress their patients are in emotionally, and how much the families are suffering right now, and walking right into it and saying “I’m going to be there with you, I’m going to do this with you.”
And I just that that image to of your walking with, with patients as much as you can. I’m thinking about the emotional energy it might take to do that. And that makes me think about clinician well-being, which is always a serious topic, but it’s certainly an issue now. Does this kind of doing more and making emotional stretches, does that potentially run you into burnout territory?
So burnout is really important. It’s something that can be a big problem. But I, I think that fatigue and burnout are different. And burnout happens when a physician or clinician knows what they can provide and something systemic prevents them from doing it. Whereas going the extra mile, digging deeper, and just being exposed to sadness or tragedy is difficult–but it does not have to be a highway to burnout. In this case when we’re feeling these emotions and being there for people we are providing what they need. And this can be tiring, but fulfilling. And and this is a paradox. But this is not going to create burnout. This is in fact using these tools and our abilities to the fullest and this is why we’re here.
So on that note, is there anything you would like to say to any of the health care workers in the audience about this?
I, I would encourage clinicians to, to be brave and extend compassionate connection to their patients and to the patients families. I think that in order to get through this pandemic–which is turning out to be a marathon–the way to make our work meaningful for us is to have this compassionate connection. Which means, you know, saying these words of explicit Connection and love. And that’s also the way that we are really going to impact the health of our patients and help them heal that would be my hope and that’s what I would encourage clinicians to do.
Thank you, thank you Dr. Zaveleta for being on the show, thank you for those words.
Thank you Anne Marie.
Thanks for the work you’re doing too. This has been 10 Minutes to Better Patient Communication from Health Communication Partners. I’m Dr. Anne Marie Liebel with Dr. Beverly Zavaleta.