The doctor won’t see you now

How COVID culture continues to compromise patient care

Photo by Kobby Mendez on Unsplash

By Anonymed (an anonymous Canadian Doctor)

Prime Minister Stephen Harper once controversially suggested that sporting the niqab (a veil worn by some Muslim women which covers the entire face apart from the eyes) while taking the oath of Canadian citizenship was, in a sense, to contravene the ideals of that very citizenship. Reasonable people could certainly disagree about that, but refusal to show one’s face in the West is indeed considered an act of contempt. Many believed, I think with good reason, that allowing newcomers to violate this most basic precept at the outset was a bad policy. 

Shortly after pandemic mask mandates came into effect, I remember someone shrieking online that she, “[Didn’t] want to hear ever again about the dangers of the niqab/burqa in the public square.” (paraphrase) By this she presumably meant that since we were all wearing masks everywhere and the sun was still rising in the east, the arguments against fundamentalist face coverings -  they make driving more dangerous, they give thieves a clever way to disguise themselves, and so on - were moot. It’s true that I can’t recall a bank robbery where the perpetrators got away using N95s, but as with the face veil, the real problem with masks is not that they restrict vision or double as a Halloween costume. These are peripheral concerns. The problem is, they cover the face.

Whatever one thinks of the utility of masking, claiming that masks exonerated the niqab/burqa boosters among us is to misunderstand both issues in their fundament. Mask mandates actually showed, I think beyond any doubt, just how disorienting and harmful to basic human interaction covering one’s face can be. Counter the anti-social COVID hold outs, masks, much like the burqa, do constitute at least a kind of cruelty. They deprive us of essential non-verbal communication that facilitates important social reactions - trust (or distrust), humour, seriousness, empathy and contempt. They also, if I must, do real damage to the disadvantaged among us - the deaf, those with ASD, those who speak English as a second language, and all those octogenarians whose presbycusis precludes conversational engagement at the best of times. And we haven’t even addressed the kids - developmentally on track and otherwise - who were forced to forgo face-to-face interaction at a time when most developmental pediatricians agree they need it most. For my part, it also became obvious that while the eyes may be the window to the soul, the nose, mouth, cheeks and chin are the window to familiarity and friendship and flirtation. Everyone reading this will know the feeling of getting to know a new acquaintance exclusively in mask form, only for one’s perception of that person to change dramatically when the mask is (literally) lifted. Does that make us superficial? No, it makes us human. We aren’t a pair of talking eyeballs. 

Face-to-face interactions are as essential (if not moreso) in medicine as they are anywhere else where humans need to collaborate. Wearing masks around colleagues was difficult enough, but with patients it was destructive. So much of medicine involves reading people; and so much is based on trust. It turns out it’s difficult to trust someone you can’t really see. Some patients may have had the same physician for years and thus not have suffered the emotional distance that masks inflict, but, especially in today’s healthcare system, this is not the norm. And for those of us who work in acute care settings, prompt establishment of rapport with patients and (often) their families is not only important for quality of care, but also for efficiency. Try getting a nerve-racked back pain patient out the door in a timely manner without them trusting you enough to forgo imaging (it’s a pain in the…back).

It will probably take years to fully tabulate the costs of the many evidence-light pandemic policies we endured in the name of public health. But even with mandates now lifted (even in hospitals) society still has a COVID hangover. When camera-happy COVID czar Tony Fauci remarked near the beginning of the pandemic that some things, like shaking hands, may be gone forever, he didn’t know how right he was (or maybe he did). Despite a return to relative epidemiological normalcy, COVID culture persists for large swathes of the population. Many people still wear masks everywhere, even outside. They don’t shake hands with strangers. The familiar pandemic car, with a mask and a dice in the mirror, persists. Patients often come to clinic assuming they still need to wear a mask and are surprised to see that I don’t. When I advise they can remove it if they wish, most are hesitant (though some breathe a sigh of relief as if someone had been holding them under water - which, in a sense, someone had been). Stranger still are the countless businesses that have taken it upon themselves to remind patrons that while masks are no longer required, they are “strongly recommended.” Strongly recommended based on what evidence, I wonder? Are the makers of such signs as certain about equipoise as Rochelle Walensky? Or as knowledgeable about safe sex as Theresa Tam?

In medicine, the effects of COVID hysteria extend well beyond face-cover culture. It isn’t just that people want to cover their faces in each others’ presence. It's that they often don't want to interact in person at all. COVID pushed doctors and patients into virtual lalaland and a sizable portion of both seems content to stay there. When COVID began, we shut everything down short of emergency services. In many parts of the country, hospitals were empty for months. In the US, the government was forced to subsidize private hospitals to prevent insolvency, such was the dearth of medical business. When clinics reopened, we wouldn’t see anyone with so much as the sniffles, and even the sniffle-free were often relegated to a superficial phone call (what we hilariously call “virtual” care).

To this day if a patient is contacted by phone, the documentation will often contain a preamble about the in-person component being “deferred due to COVID-19.” This is untrue and has been for a longtime. To pretend we still need (as opposed to prefer) to assess patients remotely is disingenuous if not outright negligent. It’s true that some things are fine to take care of over the phone. But many patients are complicated and ought to have in-person assessments; and even simpler patients respond to face to face care and “therapeutic touch” (not a euphemism). What’s more, all patients benefit from a robust doctor-patient relationship, which, with some exceptions, is almost certainly better-developed in person. 

Medicine is fundamentally a people profession. And the vast majority of people interact best when they can see each other, not at a distance and not while wearing face coverings. Yes, I’m going to wear a mask around cancer patients if I have a cold (or stay away entirely) and yes, I know the blind can’t technically see faces. Going to the doctor with rip-roaring COVID is also a reasonable faux pas. But these are rule-proving exceptions.

In response to Freedom Convoy-types labeling masks “face diapers” (a term I dislike, mostly because I have kids and it sounds gross) and deriding their imposition as “communism” (not my take, but it does have to start somewhere), many pandemic enthusiasts sought to educate our provincial plebs about the world: “Don’t you know that in Asia people loved masks way before 2020?” they chided. “Why can’t we be responsible like that?” As with the burqa analogy, these Twitter doctors refute their own points even as they think they’re making them. Emulating cultural norms from Asia is a risky business, don’t you know? It’s true that the Japanese, for instance, put on masks at the first sign of the sniffles, which sounds responsible. But it’s also true that they don’t like themselves or each other enough to reproduce - like at all. Their society is crumbling under the weight of a birth rate of 1.26 births per woman. Do these behaviours have a common, um, progenitor? Who knows. All I can say is that Japan isn’t exactly a model for healthy human interaction and we might want to think twice before mimicking its mores.

At its heart, the West is decidedly pro-face in its moral outlook. It is for this reason that we have expressions like “face-to-face”, “nice to see you”, “show your face”, and pejoratize “faceless”, “lose face”, “about-face”, and “bald-faced.” I’m sure there are similar colloquialisms in the non-English speaking West as well. The point is, person to person interaction matters - in medicine as in life. It matters when it’s disrupted. Whether it’s the niqab, the burqa, a surgical mask, or just the distance we place between ourselves and others out of fear, it matters. If we continue down the path of practicing medicine at a distance, I believe the profession will suffer and so will our patients. We need to put this COVID mindset behind us. Put another way, if we don’t face our fears, we will eventually face the music. Our complacency in this regard is extremely worrying to me. How can you tell? Look at my face.

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Thanks for reading. For more from this author read, Enemies, frenemies and religious hegemonies

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