Patients favor surgeons wearing clear masks during procedures
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Surgeons who wore clear masks were considered by patients to “be better communicators, have more empathy and elicit greater trust” than surgeons who wore masks that obscured a full view of their faces, researchers reported.
Based on the results, experts are debating whether clear masks should be used in other medical settings, including primary care.
‘I don’t even know what you look like’
Muneera Kapadia, MD, an associate professor of surgery in the University of North Carolina School of Medicine, explained in a press release why the study was done.
“At beginning of pandemic, I had a patient say, ‘It’s odd you’ve taken out a big part of my colon and I don’t even know what you look like’,” she said. “It made me realize we don’t have much information on how masks are effecting surgeon-patient communication and relationships.”
Kapadia and colleagues conducted a randomized clinical trial at a single academic medical center that included 200 patients — half had surgeons who wore clear masks that showed the lower half of their face and half had surgeons who wore a more traditional surgical mask that covered the lower half of their face.
Based on patient surveys, the researchers found that when surgeons wore clear masks, patients rated the surgeons higher in showing empathy (99% vs. 85%; P < .001), giving “understandable” explanations (95% vs. 78%; P < .001), and “building trust” (94% vs. 72%; P < .001). Patients favored the clear masks (P < .001), “citing improved surgeon communication and appreciation for visualization of the face.”
However, eight of the 15 participating surgeons said they were unlikely to choose wearing a clear mask over their standard covered mask.
“Surgeons voiced questions about appropriate protection,” Kapadia and colleagues wrote. “While the clear masks’ protection rating is equivalent to standard covered masks, lack of confidence in their ability to provide protection would likely be a barrier in their use.”
However, some of the surgeons expressed a willingness to use clear masks if there was a demonstrable benefit to patients, according to the researchers.
“This study does show that benefit, in that the negative consequences of surgeons wearing covered masks were significantly mitigated by the clear mask,” they wrote.
Connecting with providers
Kapadia said the study results underscore the significance of face-to-face contact with patients.
“We react to people with facial cues, which are being covered by the masks, and that’s having a big impact on communication,” she said. “We need to be cognizant that patients are having more difficulty connecting with us as providers. I think knowing that before interacting with them will help mitigate the issue by reminding us to spend more time getting to know our patients and making sure they understand what we are trying to convey.”
In a related commentary, Margaret L. Schwarze, MD, a professor of vascular surgery at the University of Wisconsin-Madison, and Elle L. Kalbfell, MD, a general surgeon resident also at the University of Wisconsin-Madison, encouraged the use of clear masks, noting that “how we speak may be more important than what we say.”
“As surgeons, we do many bold things because they improve patient care, and wearing a clear mask with new patients should be one of them,” they added.
References:
Kratzke IM, et al. JAMA Surg. 2021;doi:10.1001/jamasurg.2021.0836..
University of North Carolina Health and University of North Carolina School of Medicine. New study shows impact of mask wearing on patient trust and perception of surgeons. https://news.unchealthcare.org/2021/03/new-study-shows-impact-of-mask-wearing-on-patient-trust-and-perception-of-surgeons/. Accessed March 30, 2021.
Perspective
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Jagdish Khubchandani, MPH, MD, PhD
The findings of Kratzke and colleagues can be readily adopted for primary care and other health care provider offices and visits. Surgical encounters are more complicated and often lengthy, so if the strategy worked with surgeons, we can safely assume it will work in other specialties.
Medical and surgical care are a big part of what health care providers have to succeed at. Two additional major components of quality care — effectiveness and patient centeredness — are linked to good communication and other interrelated domains (trust, empathy, comfort, respect, etc.). This study has major implications for how health care providers can continue to add the extra cushion of good communication and patient centeredness.
As long as mask quality is not compromised, this practice should be broadly tested and adopted. In a pandemic, people have many stressors including greater health care needs, delayed care or unfulfilled needs. Good communication can ensure that health care quality remains optimum and for that to happen, it is essential that patients can see providers more clearly and with greater empathy and care. Many of our health care quality problems prior to the pandemic were due to poor communication and errors. Traditional masks may continue to add to that burden, but a transparent mask may help reduce some of those communication issues.
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Margot L. Savoy, MD, MPH
This interesting study highlights a patients’ desire to see a clinician’s face during the encounter to help with communication and trust. Typically, we think about this for patients who are hearing impaired and use lip reading to communicate; however, the value of seeing a full face in subtle communications like facial expression is not typically discussed.
I wonder if the findings would be applicable to primary care settings with established patients who already know their clinicians and have a long‐standing relationship. It doesn’t seem entirely surprising in a surgical setting where patients are often meeting the doctor for the first time for a limited problem. With no established relationship, it might be more desirable to have a way to see the person you are speaking to more easily. I know that amid COVID‐19, I have appreciated using telemedicine visits with video to see the patient for the initial visit and then following up in the office for the exam and lab work using more traditional masks.
It is interesting that the surgeons did not prefer the clear masks. I had the same questions about fogging given the challenges I have experienced with face shields and eye goggles during the pandemic. I also would want to know that there is no increased risk for infection given the lack of filtration in the clear masks. I also wondered if the seal on the clear mask would make the voice muffled or quieter, which could add a challenge for patients who are hearing impaired. Overall, it is an interesting study, and I would be interested in exploring alternative ways to ensure a better patient experience without sacrificing clinician safety.
Chair and associate professor of family and community medicine, Lewis Katz School of Medicine,Temple University, Philadelphia
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