Clear Masks Elicit Better Patient Perceptions Of Surgeon Communication

JAMA Surgery recently published results of a randomized clinical trial evaluating the communication-related impact of the surgeon wearing a clear versus a standard mask during patient encounters. Randomization at each visit determined if a surgeon wore a clear or covered mask for 200 new patient visits in 15 surgeons’ clinics. After the visit, patients participated in a verbal survey evaluating perceptions of the surgeon’s communication, trust in the surgeon and their impression in general of the mask.

Surgeons who wore clear masks received higher ratings regarding providing understandable explanations, demonstrating empathy, and building trust. Patients preferred their surgeon wear a clear mask, expressing that visualization of the face was important and improved communication. Interestingly, eight of the 15 surgeons in the study related they were unlikely to choose the clear mask over the standard covered mask. The authors concluded that due to increased need for masks in a wider variety of settings, actions to preserve communication among surgeons and patients is an important consideration.

Lisa Levick, DPM, FACFAS says she found, regardless of mask usage or type, the doctor-patient relationship became strained during the pandemic secondary to fear and anxiety around the virus. At the beginning of the pandemic, she notes she observed the surgeon-patient relationship appearing transactional as opposed to relational.

“Fear of COVID-19 led patients to be quick with their histories and surgeons, and doctors were even quicker with their physical examinations,” she explains. “I noticed patients would jump from their chairs at the end of the treatment plan and put on their shoes as quickly as possible. They would grab their instructions and bolt for the door with little interaction with staff. The patient-doctor relationship became less intimate.”

Jacqueline Donovan, DPM, FACFAS shares that from her perspective, until reading this article, she did not notice any change in her relationship with patients.

“I have however, felt that some patients are offended when you ask them to wear a mask,” she adds.

Dr. Levick, in practice in Des Plaines, Ill., stresses that a physician should make the patient feel comfortable whether during a pandemic or not. She cites examples of spending more time with the patient, speaking a little louder through the mask, touching the patient more, and using ones’s eyes to engage in conversation.

“Engaging with patients on a personal level makes a more comfortable environment for the patient. I make more of an effort to get to know my patients, especially their social lives, in order to obtain a meaningful relationship. Asking follow-up questions, no matter how redundant, will also help the patient perceive more empathy from you. For instance, asking, ‘do you understand the risks I just went over?’ or ‘do the follow up instructions make sense to you?’ will help the patient feel like you are spending more time with them, thus building trust.”

Dr. Donovan, in practice in Beachwood, OH, agrees that this study is helpful in obtaining insight on this issue.

“I would definitely change my current practice guidelines if evidence showed the clear mask protects against COVID-19 as much as the traditional surgical masks,” she says. 

Recent Poster Sheds Light On Fat Grafting For Chronic Wounds

By Jennifer Spector, DPM, FACFAS, Managing Editor

A poster recently presented at the Symposium for Advanced Wound Care (SAWC) Fall meeting that took place in Las Vegas, NV, examined the effects of an adipose tissue allograft on healing in recalcitrant wounds. The authors treated a series of five patients with recurrent ulcerations that failed previous wound care underwent 1.5 to three cc of adipose tissue allograft (Leneva, MTF Biologics) and subsequent primary closure. All studied patients healed in the series between two weeks and two months from initiation of treatment. Only one subject experienced a recurrent ulceration after increasing activity levels. Additionally, the authors found that time to healing did not correlate with the original size of the wound.

The authors opined that using an adipose tissue allograft as a modality could allow surgeons to resect bony prominences without as much concern about creating an empty space for bacterial growth and potentially an abcess. They relate that the case series will likely require further expansion and study to determine the potential for wound recurrence, especially when considering variability of patient adherence to treatment plans.

Anthony Tickner, DPM, FRCPS, FACCWS, FAPWCA, FAPWH, an author on the poster, sat down for an interview during the conference and stresses that a multidisciplinary approach that takes into account the contributions of the entire team is crucial in caring for this population of patients. Additionally, he relates his excitement at being back in person at a conference such as SAWC Fall.

“(Our residents) are excited to present this data on our five patients that went on to complete closure,” says Dr. Tickner, Medical Director of the wound healing center at St. Vincent Hospital/ Restorix Health in Worcester, Mass.

He goes on to share what inspired his team to work on such a study.

“We worked on this project because we deal with a lot of patients that have chronic wounds, … bony prominences, and things of that nature,” he explains. “This was a powerful modality to help us fill in some of those voids.”

Are Patients With High-Risk Puncture Wounds Receiving Proper Tetanus Prophylaxis?

By Jennifer Spector, DPM, FACFAS, Managing Editor

An article published in the Journal of the American Podiatric Medical Association took a closer look at tetanus prophylaxis practices as they relate to high-risk foot patients. Researchers included 114 patients (83 with diabetes and 31 without) in the study with foot infections secondary to punctures over an almost eight-year period. They gathered electronic medical records data on a multitude of metrics, including: demographics; the patients’ past medical history; peripheral arterial disease; peripheral neuropathy; laboratory values; clinical outcomes; and tetanus immunization history. They gathered information on that tetanus immunization history both in general and specifically upon presentation to the emergency department.

The study authors found that 46.5 percent of subjects who presented to the ED with a puncture wound did not have a record of an up-to-date tetanus immunization. Additionally, 79.2 percent of those patients without a current satisfactory tetanus immunization status received a tetanus-containing vaccine booster. Clinicians administered intramuscular tetanus immunoglobulin (TIG) in 3.8 percent of patients, and another 3.8 percent received both a booster and TIG. Lastly, 20.8 percent of those studied received no form of tetanus prophylaxis during their ED visit. Of note, they also found that a patient’s diabetes status did not show a statistically significant correlation with tetanus prophylaxis practices.

The authors concluded that not all patients studied received tetanus prophylaxis in accordance with standard guidelines. Given that patients that deal with diabetes are at higher risk for infection, including that from tetanus, the authors stress the importance of eliciting a clear and comprehensive tetanus vaccination history and vaccination if the patient’s status is unclear.