Bare to the Elbows
One of the most obvious outward manifestations of changes wrought by COVID-19 is the change in clothing worn by health professionals. We have had to embrace PPE – aprons, gowns, masks, visors and gloves. We use vast quantities of soap and hand sanitizer. Disinfectant has become our new perfume and aftershave!
“Bare to the elbows” is our new fashion statement and wristwatches are a thing of the past.
PPE is essential in our fight against the virus protecting both patient and doctor but it also erects a physical barrier between us. We are trained to be patient centred practitioners, maintaining an open mind and being aware of our body language – striving not to create virtual or physical barriers between us.
Now we are tasked with creating a physical barrier which hides our faces and a uniform which makes it difficult for others to recognise us as individuals.
Both parties wearing masks and trying to stop our glasses fogging up does not lend itself to a relaxed interaction!
Laying on of Hands
“The laying on of hands” has always been a core part of the doctor patient interaction. It can take many forms – the most obvious being as part of a physical examination. Often the reassurance of the ritualistic placing of the stethoscope on the chest can be an important part of the therapy as the ensuing prescription.
The simple act of shaking hands or a light parting touch can provide part of the healing journey. Somehow, the laying on of the gloved hand is not the same nor is elbow bumping beloved ones. I have even seen foot tapping on occasion!
At times of great emotion, people want to touch. Not everyone reacts this way but many do, especially if they know and trust the caregiver who is with them.
It is a normal part of our day to impart good news and bad news. Most of the time it can take the form of simple reassurance; that the lump that has been presented is a simple sebaceous cyst and not the anticipated dreaded cancer.
At other times it can be much more momentous. Of late breaking the news that the problem is one that merits hospital admission has become even more difficult. You can see pictures of COVID-19 wards from TV exploding in patients minds when a simple appendix operation is proposed.
On more than one such occasion recently, I have seen patients instinctively reach for my hand only to grasp my forearm instead. The first instinctive reaction is ‘oh no PPE breech!’ but seconds later the normal human doctor patient interaction kicks in and we share a moment of empathy. Naturally when the patient leaves the vigorous 20 second hand washing may extend further up the wrist than usual!
In the new normal bare to the elbow is not such a bad idea after all – we are adaptable human beings and we find new ways to interact and move forward on our journey together.