Recent research at a hospital revealed patients preferred clear masks because they allowed them to see the clinician’s face, but more than half of surgeons said they were unlikely to use a clear mask.1
The research included 200 patient perceptions of surgeon communication and trust in surgeons, plus quantitative assessments and qualitative assessments regarding patient impressions of the surgeon’s mask.
Patients completed a survey after encounters with the surgeons that included Clinician and Group Consumer Assessment of Healthcare Providers and Systems questions. The researchers also asked about the patients’ perceptions of surgeon empathy, trust, and the patients’ impression of the surgeons’ masks. “When surgeons wore a clear mask, patients rated their surgeons higher for providing understandable explanations (clear, 95 of 100 [95%] vs. covered, 78 of 100 [78%]; P < 0.001), demonstrating empathy (clear, 99 [99%] vs. covered, 85 [85%]; P < 0.001), and building trust (clear, 94 [94%] vs. covered, 72 [72%]; P < 0.001),” the authors wrote. “Patients preferred clear masks (clear, 100 [100%] vs. covered, 72 [72%]; P < 0.001), citing improved surgeon communication and appreciation for visualization of the face.”
Deaf patients also like clear masks, as reading facial expressions is an important communication cue. Still, in this study, surgeons were not as fond of the clear masks. Eight of 15 surgeons said they were unlikely to choose the clear mask over a standard mask.
The study was prompted by a surgeon’s experience in which a patient asked the surgeon to lower her mask so he could see what she looked like, explains researcher Ian M. Kratzke, MD, study co-author and a general surgery resident at the University of North Carolina at Chapel Hill. With COVID-19, clinicians are wearing masks with every patient encounter rather than just in an operating room or other treatment scenario.
“[The surgeon] had done this big operation, and [the patient] didn’t even know what she looked like. That kind of struck her as concerning that she didn’t have even that basic level of connection with her patient,” Kratzke says. “We found clear masks and did this randomized control trial to see what patients were feeling about the patient perceptions of the surgeons.”
Kratzke and colleagues expected patients to show some preference for clear masks because they allowed for better communication, but they were surprised at how much patients preferred the clear masks.
“For the surgeons wearing clear masks, about 95 of the 100 patients responded favorably on all the questions. With the covered masks, some of the responses dipped in to the 70s and 80s for favorability,” Kratzke says. “For questions about things like whether the surgeon explained things well, the covered mask may have made it difficult for patients to hear. But with questions like whether you trust your surgeon, we saw a difference there, too. That suggests an influence on how connections are formed.”
Kratzke and colleagues concluded that the increased use of masks is interfering with the relationship between clinicians and patients. The use of clear masks is a possible solution, although Kratzke and colleagues did not study the effectiveness of clear masks vs. covered or the benefits of any particular type of clear mask.
This research involved new patients with surgeons they had never met before, but Kratzke says there could be implications for other patient interactions in hospitals. With everyone in healthcare facilities wearing masks all the time, patients may feel less connection to clinicians. That could theoretically affect patient satisfaction scores, even if patients do not realize the masks are why they feel less connection to their caregivers.
Kratzke and colleagues intend to study the issue further, perhaps focusing on why patients trust the decisions of their surgeons less when their faces are covered. They will conduct interviews with patients to obtain more detailed responses than were possible with the survey. They also may study different settings for the physician and patient encounters. “The bigger picture is making sure that as providers, when we are interacting with patients, that we’re cognizant that the mask may be making it more difficult to form that relationship,” Kratzke says. “We may need to take extra time explaining things to make sure the patient understands. We have to recognize that the mask can be a barrier to our relationships. It’s on the healthcare industry to find a way to address that.”
- Kratzke IM, Rosenbaum ME, Cox C, et al. Effect of clear vs. standard covered masks on communication with patients during surgical clinic encounters: A randomized clinical trial. JAMA Surg 2021;156:372-378.
- Ian M. Kratzke, MD, UNC PGY-4 General Surgery Resident, University of North Carolina at Chapel Hill. Email: firstname.lastname@example.org.