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Bedside Manner in the Age of COVID-19

Dr. Nicholas Kulbida discusses bedside manner in the age of COVID-19.
Bedside Manner in the Age of COVID-19
Featured Speaker:
Nicholas Kulbida, MD
Dr. Nicholas Kulbida is a seasoned board-certified OB/GYN who joined OB Hospitalist Group in July of 2010. He is currently a practicing hospitalist at Ellis Medicine in Schenectady, New York where he serves as the OB/GYN department chair. Dr. Kulbida also serves his peers as an OBHG Medical Director of Operations for the Northeast region.

He received a bachelor’s degree from New York University and earned his medical degree from the Universidad Del Noreste School of Medicine in Mexico. He completed his residency in obstetrics/gynecology at the University at Buffalo Medical and Dental Consortium, SUNY.

Dr. Kulbida speaks four different languages - English, Spanish, Ukrainian, and Russian.

Dr. Mike: How has physician bedside manner changed in the age of COVID-19? This is the Obstetrics Podcast, I'm Dr. Mike. Let's talk with Dr. Nicholas Kulbida. Dr. Kulbida is a medical director of operations at Ob Hospitalist Group. Dr. Kulbida, before we jump into how COVID-19 has changed the way we communicate with our patients, maybe our bedside manner, let's go pre COVID-19, what were some of the methods you previously used to establish rapport with your patients?

Dr. Kulbida: Typically two things you're always looking to try to do. I want to be a good communicator and you want to try to have good interpersonal skills so you can establish some element of trust with the patient. When you only have a short period of time with somebody you're trying to get a lot done in a healthcare setting in terms of assessing what a person's needs are in terms of their immediate complaints, health-related complaints, trying to get a better idea of what the potential diagnosis or differential diagnoses might be. And then also trying to explain all that to somebody and involving them in the process of determining what the best method of managing their condition is. Going to be. So all of these things really require that you communicate well with somebody and also establish a good relationship so that they're involved in the process. And the more involved they are in the process, the more feeling of trust they have in the provider, the more likely they're going to adhere to whatever plan of care you devise together, and the better the outcomes are likely going to be down the road. So that's the goal.

Host: So COVID-19 has changed everything, right?

The difficulty that we get into now is that we're putting additional layers between ourselves and our patients specifically masking ourselves in order to lessen the chance for infections both for them and their healthcare providers. We're also putting on additional gowns and you're looking more like something out of a movie setting as opposed to your typical healthcare setting. And that perception that people have of that, it can be frightening, can be very anxiety provoking and it can also potentially lessen their ability to pick up on the cues that we would normally have in terms of body language and how we express ourselves. That would help them to better understand where we as healthcare providers are coming from to help them. People expect just because we're in a healthcare setting, we're helping them, but it takes more than just that. You have to be able to develop that one-on-one relationship in a very short period of time and it has to be an effective relationship in order for it to work for everybody's advantage. We're now living in stressful times that make it somewhat difficult to be able to have that open relationship.

Host: So how do you, you know, speaking of the masks, the gowns, I like the way you said it, there's kind of like a layers of separation now between you and the patient. How are you now establishing rapport? How are you making that personal connection when right now it doesn't look personal at all, right? It looks very, as you said, movie like.

Dr. Kulbida: Exactly. So the way I like to try to couch this is that the biggest layer of separation is the physical distancing. And I know a lot of people are currently using the term social distancing. I think it's more appropriate to say that we're physically distancing. Social distancing means that we're really not looking for any interaction, but that's not the case. During this time, it's probably even more so that people are looking for interaction. It's just that they can't do it at a close proximity. So physical distancing is something we should all be practicing, including in the healthcare setting. Typically it would be the same things that we would want to normally do in order to be good communicators and to try to develop an interpersonal, some sort of a basic interpersonal relationship with somebody. But we need to do it at a distance. So you have to be very mindful that now we have to concentrate on the basics.

Host: What are some of those basics? 

Dr. Kulbida: When I walk into a room and I'm talking to my patient, I like to usually sit down, try to do all my communication at eye level and to develop that eye contact that's necessary. So that somebody knows that I'm paying attention to them and I want to know exactly what's going on. So good communication skills and also good listening skills. And you do that by not looking like you're in a hurry. So taking the time to sit down usually tips people off that you're devoting some time to what I'm going to say. So that's something that's going to be positive. So you want to, again sit down if you can, you don't want to look distracted. You want to look somebody right in their eyes. And if you're doing that behind a mask, it's hard for them to see your facial cues, but they'll still see your eyes and that helps to develop that eye contact. And when you're smiling, your eyes tend to light up a little bit more. So having a smile throughout that is not a bad idea because people will respond to those little things and now they're just more muffled than they were in the past. So anything that they clue in on, it's very important to know how you're comporting yourself leaning into a conversation.

So even though I may be sitting six feet away from somebody, if I lean in towards them, that's also a sign that I'm interested in what they're saying and I'm not distracted by anything else that's going on. So these are all good communication skills that we always want to try to have. And then of course the interpersonal side is enhanced by those communication skills, but also trying to show some empathy in terms of what's going on and understanding that these are difficult times.

Host: How is empathy important?

Dr. Kulbida: If we as healthcare providers think they're difficult times and we do. It's really important to understand that for many of the patients that we take care of, many of the women especially expected moms, that we take care of that these are also very difficult times. The plan that they had in place for the birth of their trial, possibly a once in a lifetime event for them is now completely different in light of the pandemic that we're currently living in and trying to deal with. So understanding that and showing that we understand that this is not what they originally expected and basically just showing empathy for that is very important.

Host: What about the mannerisms, you know, physical mannerisms, those send a lot of cues as well. You mentioned one, for instance, leaning in, smiling, your eyes can be seen. Is there any other things you would do or not do with your arms, your hands at this time? Again, given that separation.

Dr. Kulbida: It'd be the same things that even if we're wearing a gown and mask and full protective equipment, you want to do all those things that show that you're open to the person, to the individual, but not trying to close them off. So in terms of the arms, you'd really want to try to avoid any distractions from any other part of your body. As you're communicating with somebody, it's really important for them to focus their attention on your eyes and on what you're saying, not have any other distractions if possible.

Host: Obviously you deal with postpartum depression, perinatal depression. Are you concerned that you might see an increase in this? Given the fact that we're in a pandemic?

Dr. Kulbida: It's really a major concern as far as from my perspective, and the reason for that is because prenatal depression, whether it occurs during the pregnancy or after the pregnancy, this is probably one of the most common medical complications of pregnancy that we'll typically tend to see and it affects pretty much one out of every seven women. And when you start thinking about what are the potential risk factors for depression, typically maternal anxiety, life's stresses, history of depression in the past, and lack of social support, are right up there at the top of that list. So when you think about a pandemic, I can honestly say that I've never lived through this before so I can clearly empathize with just about anybody walking through the door. We're living in some strange times right now and all my typical ways of doing things have changed. And I'm sure that's the same for every single one of my patients right now.

So it's really important for us, number one, to be able to empathize on that level because it's affecting all of us. And clearly it's a stressor because some folks are very social beings and technically all of us are some to a greater extent, some to a lesser extent, but it's clear that we are social beings and we need to be able to socialize and we're no longer doing that in the way we were used to doing that before, so now this is where the whole idea of physical distancing is not the same as social distancing. We actually want to be more socially interactive, but just to add a physical distance and separation. And that's very important, especially when we're talking about depression. We have to understand that the more we isolate people, and unfortunately if somebody is infected with SARS, Kovi 2, which is the virus that causes COVID-19, if they're infected with that or if they're suspected to be infected with that virus, then we do have to isolate them to some degree. So the challenge then is how do you isolate somebody physically but still maintain that level of social interactivity?

And that's something to be honest with you, that we're living in a time of necessity and necessity leads to innovation and invention. So I've seen different people do different things and all of us are kind of struggling to find what the best way is to do that.

Host: Can you give us an example?

Dr. Kulbida: So one example, we're now starting to utilize monitors in the labor and delivery room to try to interact with our patients, doing it at a distance, but still maintaining good communication with them. So in other words, on a TV screen or on a FaceTime tablet, you're basically able to communicate with the person in the room and not have to constantly dawn and doff the protective equipment that you need in order to be able to go into the room and do anything that requires more contact. So this is a way of increasing that social interaction without completely isolating somebody and limiting your contact to them only when you've got protective equipment on.

Host: So I know this is a tough question, I just want to get your thoughts on it. How do you think COVID-19 is going to change the way we communicate with patients? Cause we all know as physicians that it's going to happen. There's going to be another novel virus. The world is so connected today. It's things just travel so easy, transmit so easy in today's world. What do you think? Are there going to be some permanent changes from this?

Dr. Kulbida: I definitely think that how we interact with our patients is going to change in a very fundamental way going forward. I'd hate to say that it's a bad thing. Change is always usually considered to be stressful, number one. And because it's stressful, it tends to be bad, but the reality of the situation is that some changes were necessary in terms of how healthcare is provided and to improve accessibility. So I really do see information technology, different platforms for communicating different apps on your phone, having video capability, televideo capability. I mean these things are now starting to take on a new role in the provision of healthcare. Whereas in the past they were frowned upon because people felt that they distanced the provider from their patient. Whereas now when you're living in the need to have to physically distance yourself, they're actually the way of us interacting more with our patients and improving that social connection. So I think that introduction of televideo, telemedicine into the healthcare world, it's been out there already and the platform has been utilized to a limited degree in many different specialties and including obstetrics. But from here on in, I think it's just going to take on a much bigger role and we're going to need to figure out better ways, improve that socialization through this particular tool. And that's basically what it is. It's going to be a tool for us to learn how to interact better with our patients going forward.

Host: That's Dr. Nicholas Kulbida. He's a medical director of operations for Ob Hospitalist Group. If you're interested in joining Dr. Kulbida as an OB GYN physician at OB Hospitalist Group, please visit I'm Dr. Mike Smith. Thanks for listening.