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PT and the Greater Good

Cultural Competency or Patient Safety?

Published September 24, 2013 4:55 PM by Dean Metz

An interesting discussion has arisen here in the UK regarding healthcare providers and the niqab (the full face veil some Muslim women wear) Prime Minister David Cameron stated that it should not be up to the government to decide what people can or cannot wear in a free society. Deftly dodged, David. He did support organizations, such as schools and others, having a dress code though.

There is no current national guidance on this issue and the debate goes on about it in the NHS. The doctor interviewed for the BBC article stated that she removes her niqab when treating patients, as it is "essential" to their care. Given how much we are taught about the impact of non-verbal communication, I think I agree with her. What about patients who read lips due to hearing impairment? What about security issues? How do I know if someone is really my doctor or nurse if I'm unable to view/recognize her face? I can't verify the face with the badge.

We have dress codes in all areas of healthcare. For example in the trust I worked in, we had to be "bare below the elbows," meaning no watches, jewelry or long sleeves. Even wedding rings with stones in them were prohibited. Plain wedding bands were the only exception allowed. This was to minimize risk of infection. We all had uniforms so that we could be easily identified in our role. We had to give up some personal identity in order to assure patient safety. In this light, I feel the niqab is inappropriate while working in a patient care environment.

What do you think?

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3 comments

It was very well disscussed article I strongly agree that medical proffesional should lift their veil to show their face while treating the patient for safety issue

                                        Iwas enlightened by article

preeti shah October 3, 2013 8:29 PM
temple TX

Karen, good points all. I think the hospitals hadn't addressed it earlier because it wasn't an issue earlier. The UK, like the USA, has had a greater influx of immigrants who are muslim in recent years.

There are no guards at clinics here. I don't know that I'm entirely comfortable with that idea, but thats another discussion.

Nuns' habits leave the face visible so one can see their facial expressions. The veil covers all but the eyes. I wasn't thinking only about those who are deaf, but those who are older or may have incomplete hearing loss. A fair number of those patients learn to perform a combination of lip reading to supplement what they can hear. They also use facial expression to that end as well.

Excellent points about the need for precautions such as a hepa mask. The doctor in the video does indeed remove her veil for patient contact and does not support wearing the veil in patient care interactions. There is a young nurse in the article who is quoted as saying, "If all I'm doing is giving medications and they can hear me, why do I need to remove the veil?" I found her rationale lacking.

As for "offensive" tattoos below the elbow, no, they cannot be covered by anything. This harkens back to a post Janey Goude made a while back and her own reflections about tattoos. Also, "offensive" over here could mean having a Sunderland Football Club tattoo  while in Newcastle or vice-versa. How does one determine what is offensive?

I appreciate your input.

Dean Metz September 27, 2013 5:33 AM

Since there is no policy in place the veil will be worn.  Why didn't the hospitals address this issue years ago? Is a veil any different than a nun's habit or cornette that covers the head?  

Most facilities should have an interpreter who can "sign" to the deaf patients what the doctor or nurse is saying.  Writing it down works too. Not everybody can lip read.  If clinics have guards at the door they can verify she is the doctor.   Patients don't have to use that particular doctor either, they should request a change if they do not feel comfortable.  When this happens enough the doctor who wears a veil will find there are no patients who want to be seen by her.

Are the veils taken off when they go into a room with precautions where they must gown up?  A hepa mask will not properly fit over the veil.  And if they do unveil themselves in that instance why couldn't they do it in other instances.  

If a person has "offensive" tattoos below the elbow do they need to be covered?

Karen September 26, 2013 10:36 PM

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    Dean Metz
    Occupation: Staff Development Specialist
    Setting: New York, NY – Newcastle Upon Tyne, Great Britain
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